Objective: Identifying moderators of the effects of self-efficacy-enhancing interventions could improve their efficiency. We examined the effects of a home-based variant of the Chronic Disease Self-Management Program on self-efficacy, and explored the moderating effects of perceived control over self-management (PCSM).
Methods: In a randomized controlled trial, patients (N= 415) aged>40 years with various chronic conditions plus basic activity impairment and/or significant depressive symptoms were randomized to one of three groups: intervention provided in homes or by telephone, v. usual care control. We used mixed effects linear models for repeated measures to examine effects on self-management self-efficacy at 6-month follow-up and explore moderation by PCSM.
Results: Only the home intervention had a significant self-efficacy-enhancing effect (Wald test, χ 2 = 13.8, p = 0.008; effect size = 0.3). The effect was moderated by PCSM, considered as a continuous [effective in subjects with lower PCSM (Wald test, χ2 = 13.4, p = 0.009)] or categorical (effective only for subjects in the lowest tercile) variable.
Conclusions: People with lower PCSM appear more likely to experience enhanced self-efficacy from chronic illness self-management training than those with higher PCSM. These findings, although preliminary, suggest that office-based measurement of PCSM might identify those chronically ill patients likely to benefit most from self-management training.
Bandura A.Self-efficacy: the exercise of control, New York: Freeman, 1997.
2.
Kraemer HC , Wilson GT , Fairburn CG , Agras WSMediators and moderators of treatment effects in randomized clinical trials . Arch Gen Psychiatry2002; 59: 877-83.
3.
Barnason S. , Zimmerman L. , Nieveen J. , Schmaderer M. , Carranza B. , Reilly S.Impact of a home communication intervention for coronary artery bypass graft patients with ischemic heart failure on self-efficacy, coronary disease risk factor modification, and functioning . Heart Lung2003; 32: 147-58.
4.
Brody BL , Roch-Levecq AC , Gamst AC , Maclean K. , Kaplan RM , Brown SISelf-management of age-related macular degeneration and quality of life: a randomized controlled trial . Arch Ophthalmol2002; 120: 1477-83.
5.
Dallow CB , Anderson J.Using self-efficacy and a transtheoretical model to develop a physical activity intervention for obese women . Am J Health Promotion2003; 17: 373-81.
6.
Goeppinger J. , Arthur MW , Baglioni AJ , Brunk SE , Brunner CMA reexamination of the effectiveness of self-care education for persons with arthritis . Arthritis Rheum1989; 32: 706-16.
7.
Kukafka R. , Lussier YA , Eng P. , Patel VL , Cimino JJWeb-based tailoring and its effect on self-efficacy: results from the MI-HEART randomized controlled trial . Proc AMIA Symp2002; 410-14.
8.
Lorig KR , Ritter P. , Stewart AL , et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes . Med Care2001; 39: 1217-23.
9.
Lorig KR , Sobel DS , Stewart AL , et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial . Med Care1999; 37: 5-14.
10.
Tsay SL , Dallow CB , Anderson J. , et al. Self-efficacy training for patients with end-stage renal disease . J Adv Nurs2003; 43: 370-5.
11.
Warnecke RB , Morera O. , Turner L. , et al. Changes in self-efficacy and readiness for smoking cessation among women with high school or less education . J Health Soc Behav2001; 42: 97-110.
12.
Griffiths C. , Motlib J. , Azad A. , et al. Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease . Br J Gen Pract2005; 55: 831-7.
13.
Kennedy A. , Reeves D. , Bower P. , et al. The effectiveness and cost effectiveness of a national lay-led self-care support programme for patients with long-term conditions: a pragmatic randomised controlled trial . J Epidemiol Community Health2007; 61: 254-61.
Issel LMProcess evaluation. Measuring inputs and outputs. Health program planning and evaluation: a practical, systematic approach for community health, Sudbury , MA: Jones and Bartlett , 2004.
16.
Bandura A. , Wood R.Effect of controllability and performance standards on self-regulation of complex decision making . J Pers Soc Psychol1989; 56: 805-14.
17.
Jerant AF , von Friederichs-Fitzwater MM , Moore M.Patients' perceived barriers to active self-management of chronic conditions . Patient Educ Couns2005; 57: 300-7.
18.
Fries JF , Spitz P. , Kraines RG , Holman HRMeasurement of patient outcome in arthritis . Arthritis Rheum1980; 23: 137-45.
19.
Irwin M. , Artin KH , Oxman MNScreening for depression in the older adult: criterion validity of the 10-item Center for Epidemiologic Studies Depression Scale (CES-D) . Arch Intern Med1999; 159: 1701-4.
20.
Lorig KR , Holman H.Self-management education: history, definition, outcomes, and mechanisms . Ann Behav Med2003; 26: 1-7.
21.
Lorig K. , Stewart A. , Ritter P. , Gonzalez V. , Laurent D. , Lynch J.Outcome measures for health education and other health care interventions , Thousand Oaks, CA: Sage, 1996.
22.
Armitage CJ , Conner M.Distinguishing perceptions of control from self-efficacy: predicting consumption of a low-fat diet using the theory of planned behavior . J Appl Soc Psychol1999; 29: 72-90.
23.
Burton P. , Gurrin L. , Sly P.Extending the simple linear regression model to account for correlated responses: an introduction to generalized estimating equations and multi-level mixed modeling . Stat Med1998; 17: 1261-91.
24.
Kent DM , Hayward RALimitations of applying summary results of clinical trials to individual patients. The need for risk stratification . JAMA2007 ; 298: 1209-12.
25.
Tolma EL , Reininger BM , Evans A. , Ureda J.Examining the theory of planned behavior and the construct of self-efficacy to predict mammography intention . Health Educ Behav2006; 33: 233-51.
26.
Myers LB , Horswill MSSocial cognitive predictors of sun protection intention and behavior . Behav Med2006; 32: 57-63.
27.
Litt MDSelf-efficacy and perceived control: cognitive mediators of pain tolerance . J Pers Soc Psychol1988; 54: 149-60.
