Skip to main content
Top
Published in: Health and Quality of Life Outcomes 1/2019

Open Access 01-12-2019 | Care | Research

Self-efficacy and health-related quality of life: a cross-sectional study of primary care patients with multi-morbidity

Authors: Michele Peters, Caroline M. Potter, Laura Kelly, Ray Fitzpatrick

Published in: Health and Quality of Life Outcomes | Issue 1/2019

Login to get access

Abstract

Background

Multi-morbidity in chronic long-term conditions is a major concern for health services. Self-management in concert with clinical care forms part of the effective management of multi-morbidity. Self-efficacy is a mechanism through which self-management can be achieved. Quality of life is adversely impacted by multi-morbidity but could be improved by effective self-management. This study examines the relationship between self-efficacy and quality of life in primary care patients with multi-morbidity.

Methods

A cross-sectional survey was conducted with primary care patients in England. Potential participants were mailed a questionnaire containing quality of life measures (the EQ-5D-5L and the Long-Term Conditions Questionnaire (LTCQ)), the Disease Burden Impact Scale (DBIS) and the Self-efficacy for Managing Chronic Disease Scale. Descriptive statistics, analysis of variance and linear regression analyses were conducted to examine the relationship between quality of life (dependent variable), self-efficacy, and demographic and disease-related variables.

Results

The 848 participants living with multi-morbidity reported a mean of 6.46 (SD 3.49) chronic long-term conditions, with the mean number of physical conditions 5.99 (SD 3.34) and mental health conditions 0.47 (SD 0.66). The mean scores were 15.45 (SD 12.00) for disease burden, 0.69 (SD 0.28) for the EQ-5D-5L, 65.44 (SD 23.66) for the EQ-VAS, and 69.31 (SD 21.77) for the LTCQ. The mean self-efficacy score was 6.69 (SD 2.53). The regression models were all significant at p < 0.001 (adjusted R2 > 0.70). Significant factors in all models were self-efficacy, disease burden and being permanently sick or disabled. Other factors varied between models, with the most notable being the presence of a mental health condition in the LTCQ model.

Conclusions

Multi-morbid primary care patients with lower self-efficacy and higher disease burden have lower quality of life. Awareness of self-efficacy levels among patients with multi-morbidity may help health professionals identify patients who are in need of enhanced self-management support. Providing self-management support for chronic disease has been hailed as a hallmark of good care. Higher self-efficacy may lead to enhanced quality of life in multi-morbidity.
Appendix
Available only for authorised users
Literature
1.
go back to reference Navickas R, Petric VK, Feigl AB, Seychell M. Multimorbidity: what do we know? What should we do? J Comorbidity. 2016;6:4–11.CrossRef Navickas R, Petric VK, Feigl AB, Seychell M. Multimorbidity: what do we know? What should we do? J Comorbidity. 2016;6:4–11.CrossRef
2.
go back to reference Prakeh AK, Goodman RA, Gordon C, Koh HK. Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Rep. 2011;126:460–71.CrossRef Prakeh AK, Goodman RA, Gordon C, Koh HK. Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Rep. 2011;126:460–71.CrossRef
3.
go back to reference The Academy of Medical Sciences. Multimorbidity: a priority for global health research. London: Sciences TAoM ed; 2018. p. 1–142. The Academy of Medical Sciences. Multimorbidity: a priority for global health research. London: Sciences TAoM ed; 2018. p. 1–142.
4.
go back to reference National Institute for Health and Care Excellence (NICE): Multimorbidity: clinical assessment and management. London; 2016. National Institute for Health and Care Excellence (NICE): Multimorbidity: clinical assessment and management. London; 2016.
5.
go back to reference Van den Akker M, Buntinx F, Knottnerus J. Comorbidity or multimorbidity: what’s in a name? A review of the literature. Eur J Gen Pract. 1996;2:65–70.CrossRef Van den Akker M, Buntinx F, Knottnerus J. Comorbidity or multimorbidity: what’s in a name? A review of the literature. Eur J Gen Pract. 1996;2:65–70.CrossRef
6.
go back to reference Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition--multimorbidity. JAMA. 2012;307:2493–4.PubMedPubMedCentral Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition--multimorbidity. JAMA. 2012;307:2493–4.PubMedPubMedCentral
7.
go back to reference Li J, Green M, Kearns B, Holding E, Smith C, Haywood A, Cooper C, Strong M, Relton C. Patterns of multimorbidity and their association with health outcomes within Yorkshire, England: baseline results from the Yorkshire health study. BMC Public Health. 2016;16:649.CrossRef Li J, Green M, Kearns B, Holding E, Smith C, Haywood A, Cooper C, Strong M, Relton C. Patterns of multimorbidity and their association with health outcomes within Yorkshire, England: baseline results from the Yorkshire health study. BMC Public Health. 2016;16:649.CrossRef
8.
go back to reference Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ. 2015;350:h176.CrossRef Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ. 2015;350:h176.CrossRef
9.
go back to reference Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu A, Maltais D. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004;2:51.CrossRef Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu A, Maltais D. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004;2:51.CrossRef
10.
go back to reference Sullivan PW, Ghushchyan VH, Bayliss EA. The impact of co-morbidity burden on preference-based health-related quality of life in the United States. Pharmacoeconomics. 2012;30:431–42.CrossRef Sullivan PW, Ghushchyan VH, Bayliss EA. The impact of co-morbidity burden on preference-based health-related quality of life in the United States. Pharmacoeconomics. 2012;30:431–42.CrossRef
11.
go back to reference Wang L, Palmer AJ, Cocker F, Sanderson K. Multimorbidity and health-related quality of life (HRQoL) in a nationally representative population sample: implications of count versus cluster method for defining multimorbidity on HRQoL. Health Qual Life Outcomes. 2017;15:7.CrossRef Wang L, Palmer AJ, Cocker F, Sanderson K. Multimorbidity and health-related quality of life (HRQoL) in a nationally representative population sample: implications of count versus cluster method for defining multimorbidity on HRQoL. Health Qual Life Outcomes. 2017;15:7.CrossRef
12.
go back to reference Bayliss EA, Ellis JL, Steiner JF. Seniors' self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. J Clin Epidemiol. 2009;62:550–7 e551.CrossRef Bayliss EA, Ellis JL, Steiner JF. Seniors' self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. J Clin Epidemiol. 2009;62:550–7 e551.CrossRef
13.
go back to reference Boyd CM, Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Rev. 2010;32:451-74. Boyd CM, Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Rev. 2010;32:451-74.
15.
go back to reference Rijken M, Struckmann V, van der Heide I, Barbabell F, van Ginneken E, Schellevis F. Consortium oboIE: how to improve care for people with multimorbidity in Europe? In: Health Systems and Policy Analysis, vol. policy brief 23. Utrecht: NIVEL and TU Berlin; 2017. p. 1–31. Rijken M, Struckmann V, van der Heide I, Barbabell F, van Ginneken E, Schellevis F. Consortium oboIE: how to improve care for people with multimorbidity in Europe? In: Health Systems and Policy Analysis, vol. policy brief 23. Utrecht: NIVEL and TU Berlin; 2017. p. 1–31.
16.
go back to reference Elissen A, Nolte E, Knai C, Brunn M, Chevreul K, Conklin A, Durand-Zaleski I, Erler A, Flamm M, Frolich A, et al. Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches. BMC Health Serv Res. 2013;13:117.CrossRef Elissen A, Nolte E, Knai C, Brunn M, Chevreul K, Conklin A, Durand-Zaleski I, Erler A, Flamm M, Frolich A, et al. Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches. BMC Health Serv Res. 2013;13:117.CrossRef
17.
go back to reference Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26:1–7.CrossRef Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26:1–7.CrossRef
18.
go back to reference Holman H, Lorig K. Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep. 2004;119:239–43.CrossRef Holman H, Lorig K. Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep. 2004;119:239–43.CrossRef
19.
go back to reference Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.CrossRef Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.CrossRef
20.
go back to reference Tan N. Self-efficacy assessment: a step towards personalized management of chronic disease. Proc Singapore Healthcare. 2016;25:71.CrossRef Tan N. Self-efficacy assessment: a step towards personalized management of chronic disease. Proc Singapore Healthcare. 2016;25:71.CrossRef
21.
go back to reference Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract. 2005;6:148–56.CrossRef Marks R, Allegrante JP, Lorig K. A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implications for health education practice (part II). Health Promot Pract. 2005;6:148–56.CrossRef
22.
go back to reference Panagioti M, Richardson G, Small N, Murray E, Rogers A, Kennedy A, Newman S, Bower P. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis. BMC Health Serv Res. 2014;14:356.CrossRef Panagioti M, Richardson G, Small N, Murray E, Rogers A, Kennedy A, Newman S, Bower P. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis. BMC Health Serv Res. 2014;14:356.CrossRef
23.
go back to reference Bratzke LC, Muehrer RJ, Kehl KA, Lee KS, Ward EC, Kwekkeboom KL. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature. Int J Nurs Stud. 2015;52:744–55.CrossRef Bratzke LC, Muehrer RJ, Kehl KA, Lee KS, Ward EC, Kwekkeboom KL. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature. Int J Nurs Stud. 2015;52:744–55.CrossRef
24.
go back to reference Ludman EJ, Peterson D, Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Young B, Gensichen J. Improving confidence for self care in patients with depression and chronic illnesses. Behav Med. 2013;39:1–6.CrossRef Ludman EJ, Peterson D, Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Young B, Gensichen J. Improving confidence for self care in patients with depression and chronic illnesses. Behav Med. 2013;39:1–6.CrossRef
25.
go back to reference Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW Jr, Bandura A, Gonzalez VM, Laurent DD, Holman HR. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001;39:1217–23.CrossRef Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW Jr, Bandura A, Gonzalez VM, Laurent DD, Holman HR. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001;39:1217–23.CrossRef
26.
go back to reference Smith SM, Wallace E, Salisbury C, Sasseville M, Bayliss E, Fortin M. A Core outcome set for multimorbidity research (COSmm). Ann Fam Med. 2018;16:132–8.CrossRef Smith SM, Wallace E, Salisbury C, Sasseville M, Bayliss E, Fortin M. A Core outcome set for multimorbidity research (COSmm). Ann Fam Med. 2018;16:132–8.CrossRef
27.
go back to reference Potter CM, Batchelder L, A'Court C, Geneen L, Kelly L, Fox D, Baker M, Bostock J, Coulter A, Fitzpatrick R, et al. Validation of the long-term conditions questionnaire (LTCQ) in a diverse sample of health and social care users in England. BMJ Open. 2017;7:1–13. Potter CM, Batchelder L, A'Court C, Geneen L, Kelly L, Fox D, Baker M, Bostock J, Coulter A, Fitzpatrick R, et al. Validation of the long-term conditions questionnaire (LTCQ) in a diverse sample of health and social care users in England. BMJ Open. 2017;7:1–13.
28.
go back to reference NHS Digital: Quality and outcomes framework. 2016. NHS Digital: Quality and outcomes framework. 2016.
29.
go back to reference Peters M, Potter CM, Kelly L, Hunter C, Gibbons E, Jenkinson C, Coulter A, Forder J, Towers AM, A'Court C, Fitzpatrick R. The long-term conditions questionnaire: conceptual framework and item development. Patient Relat Outcome Meas. 2016;7:109–25.CrossRef Peters M, Potter CM, Kelly L, Hunter C, Gibbons E, Jenkinson C, Coulter A, Forder J, Towers AM, A'Court C, Fitzpatrick R. The long-term conditions questionnaire: conceptual framework and item development. Patient Relat Outcome Meas. 2016;7:109–25.CrossRef
30.
go back to reference Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43.CrossRef Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380:37–43.CrossRef
31.
go back to reference Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001;4:256–62.PubMed Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract. 2001;4:256–62.PubMed
32.
go back to reference Ritter PL, Lorig K. The English and Spanish self-efficacy to manage chronic disease scale measures were validated using multiple studies. J Clin Epidemiol. 2014;67:1265–73.CrossRef Ritter PL, Lorig K. The English and Spanish self-efficacy to manage chronic disease scale measures were validated using multiple studies. J Clin Epidemiol. 2014;67:1265–73.CrossRef
33.
go back to reference Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36.CrossRef Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36.CrossRef
34.
go back to reference Rabin R, Oemar M, Oppe M, Janssen B, Herdman M. In: Group TE, editor. EQ-5D-5L user guide. Basic information on how to use the EQ-5D-5L instrument. Rotterdam: EuroQol Research Foundation; 2011. Rabin R, Oemar M, Oppe M, Janssen B, Herdman M. In: Group TE, editor. EQ-5D-5L user guide. Basic information on how to use the EQ-5D-5L instrument. Rotterdam: EuroQol Research Foundation; 2011.
35.
go back to reference Bayliss EA, Ellis JL, Steiner JF. Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health Qual Life Outcomes. 2005;3:51.CrossRef Bayliss EA, Ellis JL, Steiner JF. Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health Qual Life Outcomes. 2005;3:51.CrossRef
36.
go back to reference Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ. 2018;27:7–22.CrossRef Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ. 2018;27:7–22.CrossRef
37.
go back to reference Ramond-Roquin A, Haggerty J, Lambert M, Almirall J, Fortin M. Different multimorbidity measures result in varying estimated levels of physical quality of life in individuals with multimorbidity: a cross-sectional study in the general population. Biomed Res Int. 2016;2016:7845438.CrossRef Ramond-Roquin A, Haggerty J, Lambert M, Almirall J, Fortin M. Different multimorbidity measures result in varying estimated levels of physical quality of life in individuals with multimorbidity: a cross-sectional study in the general population. Biomed Res Int. 2016;2016:7845438.CrossRef
38.
go back to reference Finney Rutten LJ, Hesse BW, St Sauver JL, Wilson P, Chawla N, Hartigan DB, Moser RP, Taplin S, Glasgow R, Arora NK. Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Adv Ther. 2016;33:1440–51.CrossRef Finney Rutten LJ, Hesse BW, St Sauver JL, Wilson P, Chawla N, Hartigan DB, Moser RP, Taplin S, Glasgow R, Arora NK. Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Adv Ther. 2016;33:1440–51.CrossRef
39.
go back to reference Freund T, Gensichen J, Goetz K, Szecsenyi J, Mahler C. Evaluating self-efficacy for managing chronic disease: psychometric properties of the six-item self-efficacy scale in Germany. J Eval Clin Pract. 2013;19:39–43.CrossRef Freund T, Gensichen J, Goetz K, Szecsenyi J, Mahler C. Evaluating self-efficacy for managing chronic disease: psychometric properties of the six-item self-efficacy scale in Germany. J Eval Clin Pract. 2013;19:39–43.CrossRef
40.
go back to reference Fors A, Taft C, Ulin K, Ekman I. Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. Eur J Cardiovasc Nurs. 2016;15:186–94.CrossRef Fors A, Taft C, Ulin K, Ekman I. Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. Eur J Cardiovasc Nurs. 2016;15:186–94.CrossRef
41.
go back to reference Jones F. Strategies to enhance chronic disease self-management: how can we apply this to stroke? Disabil Rehabil. 2006;28:841–7.CrossRef Jones F. Strategies to enhance chronic disease self-management: how can we apply this to stroke? Disabil Rehabil. 2006;28:841–7.CrossRef
42.
go back to reference Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, Gardner C, Gately C, Rogers A. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. J Epidemiol Community Health. 2007;61:254–61.CrossRef Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, Gardner C, Gately C, Rogers A. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. J Epidemiol Community Health. 2007;61:254–61.CrossRef
43.
go back to reference Bonsaksen T, Lerdal A, Fagermoen MS. Factors associated with self-efficacy in persons with chronic illness. Scand J Psychol. 2012;53:333–9.CrossRef Bonsaksen T, Lerdal A, Fagermoen MS. Factors associated with self-efficacy in persons with chronic illness. Scand J Psychol. 2012;53:333–9.CrossRef
45.
go back to reference Mujica-Mota RE, Roberts M, Abel G, Elliott M, Lyratzopoulos G, Roland M, Campbell J. Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey. Qual Life Res. 2014;24:1–10. Mujica-Mota RE, Roberts M, Abel G, Elliott M, Lyratzopoulos G, Roland M, Campbell J. Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey. Qual Life Res. 2014;24:1–10.
46.
go back to reference Deruaz-Luyet A, N'Goran AA, Senn N, Bodenmann P, Pasquier J, Widmer D, Tandjung R, Rosemann T, Frey P, Streit S, et al. Multimorbidity and patterns of chronic conditions in a primary care population in Switzerland: a cross-sectional study. BMJ Open. 2017;7:e013664.CrossRef Deruaz-Luyet A, N'Goran AA, Senn N, Bodenmann P, Pasquier J, Widmer D, Tandjung R, Rosemann T, Frey P, Streit S, et al. Multimorbidity and patterns of chronic conditions in a primary care population in Switzerland: a cross-sectional study. BMJ Open. 2017;7:e013664.CrossRef
47.
go back to reference Schafer I, von Leitner E, Schon G, Koller D, Hansen H, Kolonko T, Kaduszkiewicz H, Wegscheider K, Glaeske G, van den Bussche H. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010;5:e15941.CrossRef Schafer I, von Leitner E, Schon G, Koller D, Hansen H, Kolonko T, Kaduszkiewicz H, Wegscheider K, Glaeske G, van den Bussche H. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010;5:e15941.CrossRef
48.
go back to reference Taylor S, Pinnock H, Epiphaniou E, Pearce G, Parke H, Schwappach A, Purushotham N, Jacob S, Griffiths C, Greenhalgh T, Sheikh A. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – practical systematic RevIew of self-management support for long-term conditions. Health Serv Deliv Res. 2014;2. Taylor S, Pinnock H, Epiphaniou E, Pearce G, Parke H, Schwappach A, Purushotham N, Jacob S, Griffiths C, Greenhalgh T, Sheikh A. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – practical systematic RevIew of self-management support for long-term conditions. Health Serv Deliv Res. 2014;2.
Metadata
Title
Self-efficacy and health-related quality of life: a cross-sectional study of primary care patients with multi-morbidity
Authors
Michele Peters
Caroline M. Potter
Laura Kelly
Ray Fitzpatrick
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
Health and Quality of Life Outcomes / Issue 1/2019
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-019-1103-3

Other articles of this Issue 1/2019

Health and Quality of Life Outcomes 1/2019 Go to the issue