The role of adherence in the relationship between self-efficacy and self-management in diabetic patients undergoing CABG in Taiwan

Heng-Hsin Tung, Ru-Yu Lien, Jeng Wei, Daniel L Clinciu, Jyun-Yi Lee, Hui-Chuan Huang, Heng-Hsin Tung, Ru-Yu Lien, Jeng Wei, Daniel L Clinciu, Jyun-Yi Lee, Hui-Chuan Huang

Abstract

Objectives: To determine the role of adherence and its significance in the relationship between self-efficacy and self-management of diabetic patients undergoing coronary artery bypass graft (CABG) in Taiwan.

Design: Descriptive and correlational survey design.

Setting: Three outpatient clinics in Taiwan.

Participants: Patients diagnosed with diabetes undergoing CABG at least 6 months before the study, 18 years of age or older, able to communicate verbally without any psychiatric problems, and with a life expectancy longer than 1 year.

Main outcome measures: Self-management assessment (self-efficacy for managing disease and adherence to guidelines and medication measured on a scale of 0-8), the higher aspects of self-management (keeping appointments, taking medication properly and keeping follow-up appointments) and the lower aspects of self-management (inability to share decisions with primary physician, inability to take correct actions when symptoms worsen and inability to adapt habits to improve health).

Results: The mean score obtained for self-management among the 166 participants was 6.48, with 57 (34.3%) of them showing non-adherent behaviour. Self-efficacy accounts for 38% (R(2)=0.380, F(1,103)=63.124, p < 0.001), and 54% of good self-management was explained by self-efficacy and adherence in managing disease (R(2)=0.540, F(2,102)=56.937, p<0.001). Adherence accounts for 16% of better self-management, age and education combined account for 4.9% (R(2)=0.589, F(6.98)=23.399, p<0.001), and lifestyle items account for 5.2% (R(2)=0.641, F(14,90)=11.457, p<0.001). Disease-related variables contribute 3.4% (R(2)=0.674, F(17,87)=10.599, p<0.001). Thus self-efficacy, adherence, age, education, primary care provider and systolic pressure are considered significant predictors of self-management. With the exception of adherence, none of the variables had a statistically significant mediating effect.

Conclusions: The results confirm strong relationships between self-efficacy, adherence and self-management, with adherence having a significant mediating effect in post-CABG patients with diabetes in Taiwan.

Keywords: ALLIED SPECIALITIES.

Figures

Figure 1
Figure 1
Mediating role of adherence in relationship between self-efficacy and self-management. M, mediation effects (%); R2, explanatory power.

References

    1. World Health Organization. WHO statistical information system (WHOSIS). 2009. (accessed 1 Jul 2010).
    1. Department of Health, Executive Yuan. 2010 National health insurance annual mortality report. Retrieved 16 July 2011.
    1. Department of Health, Executive Yuan. 2010 National health insurance annual medical utilization report: Major surgeries of outpatients and inpatients Retrieved 16 July 2011.
    1. Hurst RT, Lee RW. Increased incidence of coronary atherosclerosis in type 2 diabetes mellitus: mechanisms and management. Ann Intern Med 2003;139:824–34.
    1. DAI Study Group. The prevalence of coronary heart disease in type 2 diabetic patients in Italy: the DAI study. Diabet Med 2004;21:738–45.
    1. Button E, Keaton P. Glycemic control after coronary bypass graft: using intravenous insulin regulated by a computerized system. Crit Care Nurs Clin North Am 2006;18:257–65.
    1. Brandt M, Harder K, Walluscheck KP, et al. Coronary artery bypass surgery in diabetic patients. J Cardiovasc Surg 2004;19:36–40.
    1. Flaherty JD, Davidson CJ. Diabetes and coronary revascularization. JAMA 2009;23:1501–8.
    1. Pell JP, Pell CH, Jeffery RR, et al. Comparison of survival following coronary artery bypass grafting vs. percutanous coronary intervention in diabetic and non-diabetic patients: retrospective cohort study of 6320 procedures. Diabet Med 2004;21:790–2.
    1. Woods S, Eppley C, Engel A. The influence of diabetes mellitus in patients undergoing coronary artery bypass grafting surgery: a prospective cohort study. Am Surg 2008;74:839–44.
    1. Woods S, Smith M, Sohail S, et al. The influence of diabetes mellitus in patients undergoing coronary artery bypass grafting surgery: an 8-year prospective cohort study. Chest 2004;126:1789–95.
    1. Cramer JA, Benedict A, Muszbek N, et al. The significance of compliance and persistence in the treatment of diabetes, hypertension and dyslipidaemia: a review. Int J Clin Pract 2008;62:76–87.
    1. Yamagishi SL, Nalamura K, Matsui T, et al. Role of postprandial hyperglycemia in cardiovascular disease in diabetes. Int J Clin Pract 2006;61:83–7.
    1. Merz CN, Buse JB, Tuncer D, et al. Physician attitudes and practices and patient awareness of the cardiovascular complications of diabetes. JACC 2002;40:1877–81.
    1. Costantini L. Compliance, adherence, and self-management: is a paradigm shift possible for chronic kidney disease clients? CANNT J 2006;16:22–6.
    1. Berg J, Evangelista LS, Carruthers D, Dunbar-Jacob JM, et al. , eds. Chronic illness: impact and interventions. Sudbury, MA: Jones and Bartlett Publishers, 2006:221–52.
    1. Chen MM. The barriers to take medications as prescribed of elderly patients with multiple chronic disease. Tainan: National Cheng Kung University, 2008.
    1. Patel RP, Taylor SD. Factors affecting medication adherence in hypertensive patients. Ann Pharmacother 2002;36:40–5.
    1. Tai TY, Chuang LM, Tsai ST, et al. The Diabetic Mellitus (Taiwan) Study Group. Treatment of type 2 diabetic mellitus in primary care setting in Taiwan: comparison with secondary and tertiary care. J Formos Med Assoc 2006;105:105–12.
    1. Creer T, Christian W. Chronic diseases and handicapped children. Champaign, IL: Research Press, 1976.
    1. Lorig KR, Holman H. Self-management education: history, definition outcomes, and mechanisms. Ann Behav Med 2003;26:1–7.
    1. Brownson CA, Hoerger TJ, Fisher EB, et al. Cost effectiveness of diabetics’ self-management programs in community primary care settings. Diabetes Educ 2009;35:761–9.
    1. Lorig K, Ritter P, Stewart AL, et al. Chronic disease self-management program: 2-year health status and health care utilization. Med Care 2001;39:1217–23.
    1. Gallagher R, Donoghue J, Chenoweth L, et al. Self-management in older patients with chronic illness. Int J Nurs Pract 2008;14:373–82.
    1. Wade V, Jackson D, Daly J. Coronary heart disease in aboriginal communities: towards a model for self-management. Contemp Nurse 2003;15:300–9.
    1. Bandura A. Self-efficacy: insights. Harvard mental health letter. Soc Behav Personal 1997;13:4–8.
    1. Edwatds R, Rclfair J, Cecil H, et al. Reliability and validity of a self-efficacy instrument specific to sickle cell disease. Behav Res Ther 2000;38:951–63.
    1. Bandura A. Self-efficacy in changing societies. New York: Cambridge University Press, 1995.
    1. Zhong X, Tanasugarn C, Fisher EB, et al. Awareness and practices of self-management and influence factors among individuals with type 2 diabetes in urban community settings in anhui province, china. Southeast Asian J Trop Med Public Health 2011;42:185–6, 184, 187–96.
    1. Atak N, Gurkan T, Kose K. The effect of education on knowledge, self-management behaviors and self-efficacy of patients with type 2 diabetes. AJAN 2007;26:66–74.
    1. Sousa VD, Zauszniewski JA . Toward a theory of diabetes self-care management. JTCT 2005;9:61–7.
    1. Orem DE. Nursing: concepts of practice. 5th edn St Louis, MO: Mosby, 1995.
    1. Battersby M, Ask A, Reece M, et al. The partners in health scale: development and psychometric properties of a generic assessment scale for chronic condition self-management. AJPH 2003;9:41–52.
    1. Battersby M, Harvey P, Mills PD, et al. SA health plus: a controlled trial of a statewide application of a generic model of chronic illness care. Milbank Q 2007;85:37–97.
    1. Petkov J, Harvey P, Battersby M. The internal consistency and construct validity of the partners in health scale: validation of a patient rated chronic condition self-management measure. Qual Life Res 2010;19:1079–85.
    1. Lorig K, Holman H, Sobel D, et al. Living a healthy life with chronic conditions: self-management of heart disease, diabetes, asthma, bronchitis, emphysema and others. Boulder, CO: Bull publishing company, 2000.
    1. Pang MY, Eng JJ, Lin KH, et al. Association of depression and pain interference with disease-management self-efficacy in community-dwelling individuals with spinal cord injury. J Rehabil Med 2009;41:1068–73.
    1. Jiang CI. The effect of the family support on the compliance of patients with chronic illness. Taipei Medical University, 2003.
    1. Tsai CL. The impact of patients’ adherence outcome and utilization under the shared care disease management program for the diabetes—an example from a regional teaching hospital. Asia University, 2005.
    1. Chang WC. Effect of compliant behaviors on blood glucose control and quality of life in diabetic patients. Chiayi: Meiho University, 2007.
    1. Topinkova E, Fialova D, Carpenter GI, et al. [Cross-national comparison of drug compliance and non-compliance associated factors in the elderly with polypharmacotherapy]. Cas Lek Cesk 2006;145:726–32.

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