Self-efficacy, self-care and outcomes in persons with diabetes.

Abstract

PURPOSE This dissertation aims to explore the relationship between self-reported self-efficacy, self-care and outcomes in adults with type 2 Diabetes Mellitus in Malta. RESEARCH DESIGN AND METHODS Using a cross-sectional research design, a questionnaire was distributed to 396 persons attending the diabetes clinics of a local public hospital and three health centres. Apart from collecting demographic information and details about disease characteristics, the levels of self-efficacy and diabetes self-care were measured using the Diabetes Empowerment Scale - Short Form (DES-SF) and the Summary of Diabetes Self-Care Activities scale (SDSCA) respectively. Outcomes were assessed by ascertaining the presence or absence of complications, and HbAlc values were used as a marker for glycaemic control. Variables which were found to be significantly associated with self-efficacy, self-care and outcomes in univariate analyses were used as predictors in multivariate regression models which identified the most significant predictors of self-care and outcomes, together with their odds ratios. RESULTS A response rate of 89.4% (N = 354) was achieved. Persons with higher levels of self-efficacy were found to have higher scores in the dietary and foot care areas of self-care. Furthermore, they were less likely to have uncontrolled diabetes and complications. Levels of self-efficacy were high in the study sample, confirming the results of other studies carried out locally. Self-efficacy was also found to vary independently of the demographic and disease characteristic variables collected, suggesting an absence of sub-groups of persons who are at-risk of having low self-efficacy. The study also gave insight on the levels of self-care amongst different population sub-groups. Respondents scored best in the dietary areas of self-care, and worst in 'Exercise' and 'Blood sugar testing'. Persons on insulin were found to have higher and lower scores in the 'Blood sugar testing' and 'Exercise' areas of self-care respectively when compared to persons who are not dependent on insulin. They were also more likely to report the presence of one or more complications. CONCLUSIONS This dissertation confirms that the concept of self-efficacy is also applicable locally since it is similarly associated with self-care and outcomes as reported in studies carried out abroad. The only exception is 'Exercise' self-care which was found to be very low, even in persons with high self-efficacy, suggesting the presence of additional barriers which were not studied in this dissertation. Further research to identify these barriers would assist policymakers and practitioners to devise measures to mitigate the effects of these barriers. The study identifies particular groups of persons who have low levels of self-care and this information could be used by practitioners to more easily identify these persons and offer additional advice to them during consultation. Public health policies which are aimed at improving outcomes of persons with diabetes would do well to consider the effect that self-efficacy-enhancing lifestyle interventions might have on improving outcomes. More research should be conducted in this field to assess whether these could provide a cost-effective alternative to expensive medications. The use of a screening tool might be advisable to identify those persons with low levels of self-efficacy who would stand to benefit most from these interventions since this study found no particular at-risk groups that could be targeted.