Abstract
BackgroundMulti-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.MethodsA 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.ResultsThe 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.ConclusionsMulti-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.
Highlights
Multi-morbidity in chronic long-term conditions is a major concern for health services
This paper examines the relationship between self-efficacy and quality of life in primary care patients with multi-morbidity
Recruitment Potential participants were invited through 15 primary care practices, with the target population being adults (i.e. 18 years of age or above) who had received a diagnosis at least 12 months ago of one of 11 specified chronic conditions: cancer within the last 5 years, chronic back pain, chronic obstructive pulmonary disease (COPD), diabetes, depression, irritable bowel syndrome (IBS), ischaemic heart disease (IHD), multiple sclerosis (MS), osteoarthritis (OA), severe mental health, and stroke
Summary
Multi-morbidity in chronic long-term conditions is a major concern for health services. Quality of life is adversely impacted by multimorbidity but could be improved by effective self-management. Multi-morbidity is a major concern for health services, health research and health policy [1,2,3]. Higher use of health services and polypharmacy are more common in people with multi-morbidity than those without [1, 7], making its management complex [8]. Multi-morbidity adversely affects patient outcomes such as quality of life and disease burden [7, 9,10,11,12]; and impacts on carers, health services and the economy [3]. Self-management is based on the central premise that individuals need to self-care in a range of health care practices on a day to day basis between medical appointments [17, 18]
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