Abstract
Singapore is facing a rapidly aging population with a concurrent rise in the prevalence of chronic diseases. 1 Hypertension, hyperlipidemia and type 2 diabetes mellitus are now amongst the top medical conditions being managed at the local public primary care clinics (polyclinics). 2 However, these medical conditions are reviewed by the healthcare professionals only periodically, even at the best healthcare institutions. In between consultations, patients have to manage these life-long diseases on their own.
The management of these diseases is not merely about pharmacotherapy. Patients have to adopt and maintain lifestyle changes. Discipline in adhering to a healthy diet, participating in regular physical activities, and regular monitoring of their weight is needed. At the same time, patients need to curb habits associated with an unhealthy lifestyle such as smoking and excessive alcohol intake. They need to take their prescribed medication(s) accordingly and adhere to their appointments for medical reviews, laboratory investigations and related screening programs. Accomplishing these myriad tasks on a daily basis is challenging. The capability and willingness to perform these tasks vary between patients. The ability to do so reflects their self-efficacy, in turn providing healthcare providers an objective and convenient approach to assess the patients’ self-management potential.
Self-efficacy is an individual’s belief in his/her capabilities to achieve certain goals. 3 Patients with a stronger self-efficacy are more likely to initiate and maintain recommended health behaviors. 3 It has also been shown to be associated with enhanced self-management in dealing with chronic disease.4,5 Self-management support is a pillar in the Chronic Care Model developed by Wagner et al., 6 which has been widely adopted by local healthcare institutions in the re-design of the healthcare delivery system to tackle the silver tsunami. Assessing the self-efficacy of patients is expected to gain momentum and may become a component in their chronic disease management.
Current instruments for measuring self-efficacy have largely been developed abroad and need to be validated for their application in the local multi-ethnic Asian population. Selecting the most appropriate self-efficacy assessment instrument for validation study requires a systematic approach to determine the relevance and context of its content, precision and other qualities objectively. In this issue of Proceedings, a group of medical students from a local medical school undertook a review of instruments to assess self-efficacy for patients with hypertension. Their endeavor, as part of their research internship at a primary care institution, also provides an insight into the rationale and processes used in carrying out the review. The medical students subsequently completed the validation study of a selected instrument, which has been published in another medical journal. 7
For these future doctors, the invaluable experience gained and an appreciation of the complexities of chronic disease management in Singapore is more important than the successful outcome of their internship. They have recognized that this is a small step in the vast realm of chronic disease management. Future research areas worthy of study include the selection and validation of self-efficacy assessment instruments for other chronic diseases and those with multiple morbidities, the integration of such assessments in routine clinical practice within crowded polyclinics, the acceptance of these instruments by patients, the training of staff to perform these assessments, and the leveraging on Information Technology-enabled systems for do-it-yourself assessments.