Factors Associated with Patients' Perceived Ability to Manage Multiple Chronic Illnesses

Management of chronic illnesses requires the individual to engage in various self-care behaviors.  Self-efficacy refers to the individual’s sense of personal control and belief that he/she can accomplish behaviors required to manage the illness.  Self-efficacy has been positively associated with adherence to medication, engagement in self-care behaviors, lower depressive symptoms, and improved health outcomes in numerous chronic illnesses (e.g., depression, hypertension, arthritis, asthma, diabetes).  This study examined potential mediators of self-efficacy in a sample of patients being treated for depression and diabetes or hypertension.

Baseline descriptive and correlational data and regression models are presented for 74 adult patients being treated for depression and diabetes or hypertension. Relationships between depression, self-reported physical and psychosocial quality of life (QOL), number of prescribed medications, number of co-morbid conditions and self-efficacy are examined.

The sample was:  72% female; 66% White; 40% married; mean age 56; 36% employed;  mean (SD) number co-morbid conditions 9(3.3); mean (SD) Beck depression score 19(10). Regression analyses examined 4 potential mediators of the relationship between number of co-morbid conditions and self-efficacy: physical and mental QOL, depressive symptoms, and number of prescribed medications. Analyses revealed that the number of prescribed medications mediated the relationship between number of chronic conditions and self-efficacy (P<.009); and mental health QOL mediated the relationship between number of chronic medical conditions and self-efficacy (P<.01).

Individual’s perceived ability to manage their illness regimen is an important determinant of adherence and health outcomes.  These findings suggest that when teaching patients (with co-morbid conditions) how to manage a specific illness, it is important for practitioners to consider the number of currently prescribed medications, because this will influence the overall complexity of the patient’s medication taking behavior. Current mental health functioning will determine the patient’s level of motivation, energy, ability to remember, concentration and ability to make decisions about health behaviors.