Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy?
Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy?
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DOI：
10.2337/diacare.29.04.06.dc05-1615
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发表时间：
2006-04-01
期刊：
影响因子：
16.2
通讯作者：
Schillinger, D
中科院分区：
文献类型：
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作者：
Sarkar, U;Fisher, L;Schillinger, D
目的 - 尽管先前的研究表明，提高糖尿病自我效能可以改善自我管理行为，但人们对这项研究在不同种族/民族和健康素养水平上的适用性知之甚少。我们在健康素养有限的城市、多元化、低收入人群中研究了糖尿病自我效能和自我管理行为之间的关系。 研究设计和方法 - 我们对公立医院两家初级保健诊所的 2 型糖尿病患者进行了西班牙语和英语口头问卷调查。我们使用现有工具测量自我效能、健康素养和自我管理行为。我们进行了多变量回归，以探索自我效能和自我管理之间的关联，并根据临床和人口统计因素进行调整。我们测试了自我效能、种族/族裔和健康素养之间在自我管理方面的相互作用。 结果 - 研究参与者来自不同种族（18% 亚裔/太平洋岛民、25% 非裔美国人、42% 拉丁裔/a 和 15% 白人），52% 的健康素养有限（成人功能健康素养测试的简版得分 < 23）。糖尿病自我效能与五个自我管理领域中的四个相关（P < 0.01）。调整后，自我效能得分每增加 1.0%，患者更有可能报告最佳饮食（每周增加 0.14 天）、运动（每周增加 0.09 天）、血糖自我监测（比值比 1.16）和战利品护理（1.22），但并非如此。药物依从性（1.10，P = 0.40）。自我效能与自我管理之间的关联在不同种族/民族和健康素养水平之间是一致的。结论——自我效能与这一弱势群体的自我管理行为相关，无论种族/民族还是健康素养水平。然而，这些关联的规模表明，在不同人群中，有必要进一步研究自我管理的决定因素和障碍。政策工作应侧重于扩大自我管理干预措施的范围，将健康素养范围内的不同种族人群纳入其中。
OBJECTIVE - Although prior research demonstrated that improving diabetes self-efficacy can improve self-management behavior, little is known about the applicability of this research across race/ethnicity and health literacy levels. We examined the relationship between diabetes self-efficacy and self-management behavior in an urban, diverse, low-income population with a high prevalence of limited health literacy.RESEARCH DESIGN AND METHODS - We administered an oral questionnaire in Spanish and English to patients With type 2 diabetes at two primary care clinics at a public hospital. We measured self-efficacy, health literacy, and self-management behaviors using established instruments. We performed multivariate regressions to explore the associations between self-efficacy and self-management, adjusting for clinical and demographic factors. We tested for interactions between self-efficacy, race/ethnicity, and health literacy on self-management.RESULTS - The Study participants were ethnically diverse (18% Asian/Pacific Islander, 25% African American, 42% Latino/a, and 15% white), and 52% had limited health literacy (short version of the Test of Functional Health Literacy in Adults score < 23). Diabetes self-efficacy was associated with four of the five self-management domains (P < 0.01). After adjustment, with each 1.0% increase in self-efficacy score, patients were more likely to report optimal diet (0.14 day more per week), exercise (0.09 day more per week), self-monitoring of blood glucose (odds ratio 1.16), and loot care (1.22), but not. medication adherence (1.10, P = 0.40). The associations between self-efficacy and self-management were consistent across race/ethnicity and health literacy levels.CONCLUSIONS - Self-efficacy was associated with self-management behaviors in this vulnerable population, across both race/ethnicity and health literacy levels. However, the magnitude of the associations Suggests that, among diverse populations, further study of the determinants of and barriers to self-management is warranted. Policy efforts should be focused on expanding the reach of self-management interventions to include ethnically diverse populations across the Spectrum of health literacy.