Understanding the Relationship

Between Self-Efficacy, Locus of

Control, and Self-Management

Behaviors in Adult Patients with

Ehlers-Danlos Syndrome

Sabrina M. Neeley, PhD, MPHAssistant Professor

Dept. of Community Health

Objectives

By the end of this session, the learner will be able to:• Explain the meaning of self-management as

it relates to chronic health conditions• Explain self-efficacy and its role in the self-

management of chronic health conditions• Explain locus of control and how it affects

self-management of chronic health conditions• Explain the relationships between self-

efficacy, locus of control, and self-management in a sample of adults with EDS

Self-Management

Activities people undertake to create order and control as they incorporate a chronic health condition into their daily lives and seek the best possible quality of life• Put together healthcare team• Problem solving• Communicating with healthcare providers• Setting goals• Diet, exercise, preventive care, stress reduction,

rest• Mental health

Self-Efficacy

The degree to which an individual has confidence in her or his ability to do what needs to be done in order to achieve desired outcomes.• Decreasing and managing pain• Keeping pain from interfering with life• Regulating activity• Keeping fatigue from interfering with

life• Helping self feel better• Dealing with frustration

Locus of Control

To who/what individuals attribute the status of their condition (positive & negative)• Internal• Chance• Doctors• Others

This Study

• Survey of adult EDS patient attendees at 2010 EDNF conference, plus online survey

• n=151

• Scientifically recognized, validated, condition-modified scales for self-efficacy (Lorig, et al.) and locus of control (MHLC – Wallston, et al.)

• Self-management behaviors derived from discussions with physicians and Stanford University Chronic Disease Self-Management program

Self-Efficacy

• 8-questions, 10-pt scale (Certainty)

• High score = high self-efficacy

• Mean=38; Median=38.5; Mode=40; sd=13.7

• ½ of questions had mean scores < 5, none > 6• Keep EDS pain from interfering with sleep• Regulate activity to avoid aggravating EDS• Keep EDS pain from interfering with activities**• Keep fatigue from interfering with activities**

Locus of Control

• 18 questions, 6-pt scale (Agreement)

• 4 subscales

• High score = high locus of control

• Internal locus of control highest

• All scores at approximate scale midpoint

Self-Management

• 19 questions, 5-pt scale (Likelihood)

• High score = high self-management

• Mean=80.35; Median=83; Mode=85; sd=10.6

• Generally, very high scores

Relationships (SE-SM)

• SE regulate activity to avoid aggravating EDS• SM develop/implement exercise plan• SM take care of myself mentally & physically• SM accept responsibility to manage problems• SM speak up for myself about treatment/care

• SE keep fatigue from interfering with activities• SM develop/implement exercise plan• SM take care of myself mentally & physically

Relationships (SE-SM)

• SE keep pain from interfering/decrease pain• SM develop/implement exercise plan• SM take care of myself mentally & physically• SM accept responsibility to manage problems• SM find ways to reduce stress

• SE help self feel better/deal with frustrations• SM develop/implement exercise plan• SM take care of myself mentally & physically• SM develop/maintain support systems• SM search/gather information about EDS• SM accept responsibility to manage problems

Conclusions

• Self-efficacy generally low• Pain• Fatigue• Interfering with sleep and life

• Self-management key behaviors• Exercise plan• Physical & mental care• Accept responsibility for problem-solving

Self-efficacy enhanced with successful goal setting and

achievement

ReferencesBandura A (1997). Self-efficacy: The Exercise of Control. New York, NY: Freeman.

Bodenheimer T, Lorig K, Holman H, Grumbach K (2002). Patient self-management of chronic disease in primary care. JAMA 288: 2469-2475.

Farrell K, Wicks MN, Martin JC (2004). Chronic disease self-management improved with enhanced self-efficacy. Clinical Nursing Research 13: 289-308.

Kralik D, Koch T, Price K, Howard N (2004). Chronic disease self-management: Taking action to create order. Journal of Clinical Nursing 13; 259-267.

Lorig K, Holman H, Sobel D, Laurent D, Gonzalez V, Minor M (2000). Living a Healthy Life with Chronic Conditions. Palo Alto, CA: Bull Publications.

Norman P, Bennett P, Smith C, Murphy S (1998). Health locus of control and health behavior. Journal of Health Psychology 3: 171-180.

Wallston KA, Stein MJ, Smith KA (1994). Form C of the MHLC scales: A condition-specific measure of locus of control. Journal of Personality Assessment 63; 534-553.