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Perceived control moderated the self-efficacy-enhancing effects of a chronic illness self-management intervention

Department of Family and Community Medicine, University of California Davis School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA 95817, USA, afjerant{at}ucdavis.edu

Monique Moore

Department of Family and Community Medicine, University of California Davis School of Medicine, 3700 Business Drive, Suite 130, Sacramento, CA 95817, USA

Kate Lorig

Department of Medicine, Patient Education Research Center, Stanford University School of Medicine, 1000 Welch Road, Suite 204, Palo Alto, CA 94304, USA

Peter Franks

Center for Healthcare Policy and Research, Department of Family and Community Medicine, University of California Davis School of Medicine, 4860 Street, Suite 2300, Sacramento, CA 95817, USA

Objective: Identifying moderators of the effects of self-efficacy-enhancing interventions could improve their efficiency. We examined the effects of a home-based variant of the Chronic Disease Self-Management Program on self-efficacy, and explored the moderating effects of perceived control over self-management (PCSM).

Methods: In a randomized controlled trial, patients (N= 415) aged>40 years with various chronic conditions plus basic activity impairment and/or significant depressive symptoms were randomized to one of three groups: intervention provided in homes or by telephone, v. usual care control. We used mixed effects linear models for repeated measures to examine effects on self-management self-efficacy at 6-month follow-up and explore moderation by PCSM.

Results: Only the home intervention had a significant self-efficacy-enhancing effect (Wald test, ² = 13.8, p = 0.008; effect size = 0.3). The effect was moderated by PCSM, considered as a continuous [effective in subjects with lower PCSM (Wald test, ² = 13.4, p = 0.009)] or categorical (effective only for subjects in the lowest tercile) variable.

Conclusions: People with lower PCSM appear more likely to experience enhanced self-efficacy from chronic illness self-management training than those with higher PCSM. These findings, although preliminary, suggest that office-based measurement of PCSM might identify those chronically ill patients likely to benefit most from self-management training.

Key Words: Chronic disease • Perceived control • Self-care • Self-efficacy • Telephone

Chronic Illness, Vol. 4, No. 3, 173-182 (2008)
DOI: 10.1177/1742395308089057


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