Academic journal article Research and Theory for Nursing Practice

Relationships among Self-Care Agency, Self-Efficacy, Self-Care, and Glycemic Control

Academic journal article Research and Theory for Nursing Practice

Relationships among Self-Care Agency, Self-Efficacy, Self-Care, and Glycemic Control

Article excerpt

Costly complications of diabetes often arise from poor glycemic control. Appropriate diabetes self-care management may improve control. This study examined whether self-care management affects glycemic control and mediates relationships between self-efficacy and self-care agency with glycemic control. In a cross-sectional correlational design, data from a prior study of 141 insulin-requiring adults with type 1 or type 2 diabetes were examined using descriptive statistics, Pearson's correlation, and multiple hierarchical regression. Findings indicated that greater self-care agency and self-efficacy lead to greater self-care management, in turn leading to better glycemic control. Self-care management did not mediate between self-efficacy or self-care agency and glycemic control. Thus, beliefs or capabilities for self-care are insufficient to improve glycemic control; doing so requires self-care management.

Keywords: self-care agency; self-efficacy; self-care; glycemic control

According to the Centers for Disease Control (CDC), diabetes mellitus affects approximately 17 million people in the United States (CDC, 2002). It is the sixth leading cause of death and a major cause of complications of the cardiovascular, renal, ocular, and nervous systems (Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, 2000). The annual economic cost of managing these disease-related complications was $132 billion in 2002 (CDC, 2002).

Diabetes-related complications are classified as microvascular and macrovascular. Microvascular complications include retinopathies (12,000 to 24,000 new cases of blindness each year), nephropathies (43% of new cases of end-stage renal disease), and neuropathies (present in 60% to 70% of people with diabetes and a major cause of lower extremity amputations). Macrovascular complications include coronary artery disease (the leading cause of diabetes-related death with a risk two to four times higher in people with diabetes), cerebral vascular disease (the risk of stroke is two to four times higher in people with diabetes), and peripheral vascular disease, leading to ulceration and limb amputation (50% of lower limb amputations in the United States occur among people with diabetes) (CDC, 2002).

Many of these complications are related to inadequate glycemic control (Ohkubo et al., 1995; Susman & Helseth, 1997; The Diabetes Control and Complications Trials Research [DCCT], 1993; The United Kingdom Prospective Diabetes Study Group [UKPDS], 1998). These diabetes-related complications can be prevented or delayed with adequate glycemic control. This control can be achieved with self-care management, which includes appropriate diet, exercise, blood glucose monitoring, and medication (oral hypoglycemic and/or insulin) (Agurs-Collins, Kumanyika, Have, & Adams-Campbell, 1997; Jones et al., 2003; Parchman, Pugh, Hitchcock, & Larme, 2002; Senécal, Nouwen, & White, 2000).

To successfully perform diabetes self-care, the individual needs self-care agency, the ability to perform specific behaviors (Paterson, Thorne, & Dewis, 1998; Sousa, Zauszniewski, Musil, McDonald, & Milligan, 2004; Wagner, Schnoll, & Gipson, 1998), and must believe in his or her capability or self-efficacy to perform the behaviors necessary for maintaining health and well-being (Kavanagh, Gooley, & Wilson, 1993; Ludlow & Gein, 1995; Senécal et al., 2000; Skelly, Marshall, Haughey, Davis, & Dunford, 1995; Sousa et al., 2004). Individuals who perceive themselves as highly efficacious and/or rate themselves as being capable to manage their diabetes perform more diabetes self-care activities and have better diabetes control (Aljasem, Peyrot, Wissow, & Rubin, 2001; Heisler, Smith, Hayward, Krein, & Kerr, 2003b; Johnston-Brooks, Lewis, & Garg, 2002; Jones et al., 2003). Self-efficacy also is associated with better glycemic control (Ikeda, Aoki, Saito, Muramatsu, & Suzuki, 2003; Ludlow & Gein, 1995). …

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