Is self-efficacy associated with diabetes self-management across race/ethnicity and health literacy?
OBJECTIVE
Although prior research demonstrated that improving diabetes self-efficacy can improve self-management behavior, little is known about the applicability of this research across race/ethnicity and health literacy levels. We examined the relationship between diabetes self-efficacy and self-management behavior in an urban, diverse, low-income population with a high prevalence of limited health literacy.


METHODS
We administered an oral questionnaire in Spanish and English to patients with type 2 diabetes at two primary care clinics at a public hospital. We measured self-efficacy, health literacy, and self-management behaviors using established instruments. We performed multivariate regressions to explore the associations between self-efficacy and self-management, adjusting for clinical and demographic factors. We tested for interactions between self-efficacy, race/ethnicity, and health literacy on self-management.


RESULTS
The study participants were ethnically diverse (18% Asian/Pacific Islander, 25% African American, 42% Latino/a, and 15% white), and 52% had limited health literacy (short version of the Test of Functional Health Literacy in Adults score <23). Diabetes self-efficacy was associated with four of the five self-management domains (P < 0.01). After adjustment, with each 10% increase in self-efficacy score, patients were more likely to report optimal diet (0.14 day more per week), exercise (0.09 day more per week), self-monitoring of blood glucose (odds ratio 1.16), and foot care (1.22), but not medication adherence (1.10, P = 0.40). The associations between self-efficacy and self-management were consistent across race/ethnicity and health literacy levels.


CONCLUSIONS
Self-efficacy was associated with self-management behaviors in this vulnerable population, across both race/ethnicity and health literacy levels. However, the magnitude of the associations suggests that, among diverse populations, further study of the determinants of and barriers to self-management is warranted. Policy efforts should be focused on expanding the reach of self-management interventions to include ethnically diverse populations across the spectrum of health literacy.
Division of General Internal Medicine, University of California, San Francisco, CA 94143, USA. usarkar@medicine.ucsf.edu
Urmimala
U
Sarkar
Lawrence
L
Fisher
Dean
D
Schillinger
D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000628:therapy; D004522:Educational Status; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D044469:Racial Groups; D012044:Regression Analysis; D012495:San Francisco; D012648:Self Care; D020377:Self Efficacy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population