Published online Dec 12, 2019. doi: 10.5494/wjh.v9.i3.30
Peer-review started: July 16, 2019
First decision: August 7, 2019
Revised: September 4, 2019
Accepted: November 26, 2019
Article in press: November 26, 2019
Published online: December 12, 2019
Consistent symptom management and treatment adherence are necessary for managing chronic conditions. Self-efficacy has been an influential predictor and mediator of adherence to treatment behaviors for patients with chronic conditions, such as hypertension. Patients with hypertension often manage multiple comorbid conditions since hypertension is often associated with numerous other medical conditions (e.g., cerebrovascular disease, cardiovascular diseases). However, self-efficacy for managing hypertension and comorbid conditions has not been thoroughly examined.
Effectively improving self-efficacy for managing hypertension and comorbid conditions is critical for self-management of hypertension. Investigating self-efficacy for managing hypertension and comorbid conditions and its relationships to other health-related outcomes will allow clinicians and researchers to design therapeutic interventions tailored to patients with hypertension. Further, differences in self-efficacy domains and items may help develop targeted interventions to improve self-efficacy in this patient population.
Objectives of this study are to examine self-efficacy for managing chronic conditions in patients with hypertension and compare it to patients with other chronic conditions. We identified the structural model explaining the relationship of self-efficacy for managing hypertension with other health-related outcomes at the domain level.
A total of 1087 individuals with chronic conditions were selected in this study. Individuals with chronic conditions were grouped into hypertension and non-hypertension group. Differences in self-efficacy for managing chronic conditions between the two groups were examined at domain-and item-level using five domains of patient-reported outcomes measurement information system self-efficacy for managing chronic conditions measures (PROMIS-SE). Also, the associations between five domains of PROMIS-SE and other health-related outcomes such as global physical health, global mental health, and general quality of life were investigated using structural equation modeling for the hypertension group.
A total of 437 reported having hypertension (617: non-hypertension and 33: missing). Statistical differences in self-efficacy for managing chronic conditions between hypertension and non-hypertension groups were identified in the self-efficacy for managing daily activities domain. Also, for hypertension patients, self-efficacy for managing daily activities and emotions were significant predictors of global physical health. For global mental health, only one domain, self-efficacy for managing emotions was a significant predictor. Overall, both global physical and mental health statistically significantly predicted hypertension patients’ general quality of life.
The hypertension group had lower self-efficacy for managing daily activities as compared to the non-hypertension group. For individuals with hypertension, self-efficacy for managing daily activities and emotions were indirect predictors for their general quality of life, mediated by global physical and mental health.
Future studies are encouraged to examine specific roles of these two domains of self-efficacy for managing hypertension and comorbid conditions on global physical and mental health, and general quality of life in order to provide domain specific interventions that effectively enhance those outcomes.