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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

3006 — Does Self-Efficacy Mediate the Influence of Chronic Pain on Patients’ Self-Care Adherence?

Author List:
Krein SL (Center for Practice Management and Outcomes Research)
Heisler M (Center for Practice Management and Outcomes Research)
Piette JD (Center for Practice Management and Outcomes Research)
Butchart A (Center for Practice Management and Outcomes Research)
Kerr EA (Center for Practice Management and Outcomes Research)

Patients with multiple chronic conditions are increasingly common. Patient self-management is a key component of chronic disease management. However, the extent to which multimorbidity affects self-management and effective strategies for optimizing self-care adherence are not fully understood. Because many patients with common chronic conditions, such as diabetes, also experience chronic pain, we examined the impact of comorbid chronic pain and the potential mediating effect of self-efficacy (the level of confidence in one’s own ability to perform a specific task) on patients’ adherence.

Cross-sectional study based on survey data collected from 529 patients with chronic health conditions who were receiving care through the VA healthcare system. Patients with chronic pain were identified as those reporting pain present most of the time for six months or more during the past year. Adherence was measured using a scale derived from patients’ assessment of their level of difficulty in performing three specified self-care activities as suggested by their doctor. Data were analyzed using multivariable regression techniques.

Over 60% of survey respondents reported chronic pain. Among those with chronic pain, 40% had a self-care adherence score indicating poor adherence compared to 22% of those without chronic pain. Regression analyses showed that chronic pain was negatively associated with both self-efficacy (P<.001) and self-care adherence (P=.001). However, chronic pain was no longer independently associated with adherence after adjusting for self-efficacy, which had a significant positive association with adherence (P<.001).

Chronic pain negatively affects self-care adherence for patients with other chronic diseases. However, this effect appears to be mediated by self-efficacy.

Identifying and employing more effective strategies to promote self-care adherence and self-management are increasingly important for decreasing preventable morbidity, decreasing healthcare costs, and ensuring a better quality of life for individuals with chronic health conditions. Patient non-adherence is often attributed to a lack of knowledge or lack of motivation but may actually be in part due to other health conditions, such as chronic pain. The use of strategies that focus on enhancing self-efficacy may be especially effective in promoting adherence and self-care among the growing number of individuals with multiple chronic conditions.

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