The relationship of co-morbidities and self-efficacy in regimen management

Translation of interventions may be influenced by individual or populations characteristics.  In our program project grant we are examining factors which will impact the translation of behavioral interventions.  One factor is the complexity of care the patient is managing reflected in the number of co-morbidities the patient has.  This presentation examines the relationship of co-morbidities and self-efficacy across four populations and the potential mediating relationship of quality of life, depression, and number of medications prescribed.  The sample consisted of 462 persons participating in one of four studies examining behavioral interventions to improve adherence or management of medications.  The populations consisted of caregivers of adults with cognitive decline (3M), adults with diabetes, hypertension, and hyperlipidemia (HABIT), adults with diabetes and depression (CONCORDANCE), and adults with obesity (SELF).  The sample was 70.3% white, 69.2% female, with an average age of 59 years and an average of 15 years of formal education.  Data across the studies suggested there was a low but significant negative relationship between the number of co-morbidities and self-efficacy (r=-0.224, p<.001).  For the two diabetes studies, quality of life mediated the relationship, (HABIT physical function SF36, EST=-0.076, p<.001 and CONCORDANCE mental health SF36, EST=0.191, p<.010).  Depression (BDI) mediated the relationship in HABIT (EST -0.052, p<.019) and number of medications mediated the relationship in CONCORDANCE (EST=-0.100, p<.009).  No other mediational effects were found.  Efforts to boost self-efficacy are an integral component of many behavioral interventions.  Our data suggest that persons with greater numbers of co-morbidities are likely to have lower self-efficacy.  The question arises as to whether different self-efficacy enhancing strategies would be more effective for persons with few or many co-morbidities.  The finding that quality of life, reflected in SF36 component scores, impacts this relationship among diabetes patients but not among caregivers or otherwise healthy obese needs further investigation.