Predictors of Self-Efficacy in Individuals Aging with a Disability

AIMS

To examine the association of self-efficacy (SE) related to management of chronic disease with demographic and clinical indicators in individuals aging with physical disability. Self-efficacy is a critical mediator of human behavior and an important target for interventions to improve health outcomes. Changes in SE have been reported to be the best predictors of response to rehabilitation treatments. Understanding the role of SE in people’s ability to successfully self-manage and live effectively with physical limitations is important for designing treatments that can lead to better quality of life (QOL).

METHODS

The University of Washington Self-Efficacy Scale (UW-SES) that conceptualizes SE as perceived confidence in managing challenges related to living with a physical disability was used to measure SE. PROMIS© short forms (version 1) were used to measure pain interference, physical function, fatigue and social soles satisfaction. In addition to demographics we measured social support (the Multi-dimensional Scale of Perceived Social Support), depression (PHQ9), resilience (the Connor-Davidson Resiliency scale), interference with participation, and falls. A multivariate regression model was used to examine associations between SE and demographics, and symptoms or QOL indicators.

RESULTS

858 older people (aged 45+) with muscular dystrophy (MD: 18%), multiple sclerosis (MS: 32%), spinal cord injury (SCI: 26%), or post-polio syndrome (PPS: 24%) who participated in a study of aging with a disability responded to a mail survey. Of the 2,041 people invited 1,862 completed it (91% return rate). About a half of the participants were asked to respond to UWSES. The final multivariate model explained 68% of the variance in self-efficacy and included the following statistically significant independent variables: satisfaction with social roles, resilience, pain interference, interference with participation, social support, fatigue, and employment. Age, gender, marital status, education, income, physical function, depression, falls, and overall mobility were not found to be statistically significantly related to SE.

CONCLUSIONS

There is a strong link between SE, social variables and other clinical indicators including resilience, and symptoms of fatigue and pain. Interventions aimed at increasing SE in older adults living with physical disability should include strategies for improving social participation, increasing resiliency, and management of fatigue and pain.