Role of self-efficacy outcome expectancy perceived health competence in coping and self-management of diabetes patients

Abstract

Diabetes is a chronic disease associated with high rates of morbidity and mortality, as well as increased health care costs that require multitude of daily self-management decisions and self-care activities. Management of diabetes encompasses maintaining normal blood glucose level and thus prevent the likelihood of long term complications. This includes self management activities like oral medications, insulin injections, blood glucose monitoring, following prescribed diet and exercise regime. Patients understand that these self-management activities are essential elements for improvement of their health status as a result of which they use different coping strategies to deal with these activities. In addition to coping, different psychological factors such as self-efficacy, outcome expectancy and perceived health competence also have significant influence on self-management of illness. Taking all the above factors into consideration the study used a mixed methods sequential explanatory design to assess the following objectives: (i) to examine the difference in the level of self-efficacy, outcome expectancy, perceived health competence among three groups of Type II diabetes patients categorized on the basis of duration of disease (ii) to examine the relationship between self-efficacy, outcome expectancy, perceived health competence, coping and self-management of illness of type 2 diabetes patients (iii) to understand the role of self-efficacy, outcome expectancy, perceived health competence in coping of illness of Type 2 diabetes patients (iv) to understand the role of self-efficacy, outcome expectancy, perceived health competence and coping in self-management of illness of Type 2 diabetes patients (v) to explore the lived experiences of Type 2 diabetes patients regarding their coping strategies to diabetes. The study included two phases: in phase I, a total of 295 (147 men and 148 women) patients age range from 30-73 years from the state of Mizoram participated and completed the measures namely, Multidimensional Diabetes Questionnaire, Perceived Health Competence, Diabetes Coping Measure and Diabetes Self-management Questionnaire. Inphase II, Interpretative Phenomenological Analysis was employed to explore the coping strategies of 11 patients with type 2 diabetes (34-67 years) who were randomly selected from phase I. The data collected in phase 1 were analyzed using descriptive (frequencies and percentages) and inferential statistics (ANOVA, Pearson Correlation and Hierarchical Multiple Regression). The results of the study showed that the three groups categorized on the basis of duration of disease differed in the level of self-efficacy, coping and self-management. After ascertaining that the significant relationships between the variables under study, subsequent analyses were conducted to assess the role of predictor variables on criterion variables. Self-efficacy, outcome expectancy, perceived health competence and demographic variables explained significant proportion of variance in overall diabetes coping. In addition to the above predictors, coping was added, which explained significant proportion of variance in overall diabetes self-management. Using thematic analysis, results of phase 2 identified five (5) coping strategies along with eight (8) themes and sixteen (16) sub-themes. The identified coping strategies were - planful problem solving, seeking social support, shifting burden to supernatural power, distancing and escape -avoidance. The limitations and implications of the study are also discussed.