the impact of mobility, self-efficacy, family factors, and perceived competence on self-management...
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The Impact of Mobility, Self-Efficacy, Family Factors, and Perceived Competence on Self-Management Behaviors in Young
Adults with Spina BifidaKathleen J. Sawin, PhD, CPNP-PC, FAAN
Professor and Research Chair in the Nursing of Children
University of Wisconsin-Milwaukee and Children's Hospital of Wisconsin
Center Scientist, Self-Management Science Center, UWM
Presented at:
The 2012 National State of the Science Congress on Nursing Research
Washington DC, September 15, 2012
Co-Authors
Kim Whitmore, MSN, RN, CPNWilliam Waring, MDR. Cory O’Conner, MDMerle Orr, MDKaren Rauen, MSN, RN, BCIAC, PMDBTera Bartelt, MS, PCNS-BCHeidi Miranda, MS, CCLS
Conflict of Interest
• No Conflicts of Interest to Report
• Funding: Joint Research Chair in the Nursing of
Children
• College of Nursing, University of Wisconsin-Milwaukee
• Children’s Hospital of Wisconsin
Purpose
As contextual and process factors may play an important role in transition outcomes, the purpose of this study was:
• To explore contextual and process factors related to reported self-management in young adults with spina bifida (YASB) who do not have an intellectual disability.
• To discuss implications for research and practice.
Background
• A Spina Bifida Transition Program in a Midwestern US city was developed with a partnership between pediatric and adult providers.
• A parallel research project was conducted to evaluate the experiences of young adults with spina bifida (YASB) during the transition.
Individual and Family Self-Management Theory© Ryan & Sawin, 2008 Self-management Science Center (1P20NR0010674-01)
OutcomesDistal
Health StatusQuality of Life or Well Being
Cost of Health
ContextRisk & ProtectiveFactors
Condition SpecificComplexity of condition Complexity of treatmentTrajectory
Physical & SocialEnvironmentAccess to care, Setting and provider transitions, TransportationCulture, Social Capital
Individual & FamilyDevelopmental stagesPerspectives, Literacy, Information processing, Capabilities
Processof Self-management
Knowledge & BeliefsSelf-efficacyOutcome expectancyGoal congruence
Self-RegulationSkills & AbilitiesGoal Setting, Self-monitoringand reflective thinking, Decisionmaking, Planning and Action,Self-evaluation, Emotional Control
Social FacilitationInfluenceSupportCollaboration
OutcomesProximal
Self-management BehaviorsCondition Specific
Cost of Health Care Services
C
Mobility/ Bladder Management
C
Self – Efficacy/ Perceived Comp
C
Family Factors
Research Question
Is there a relationship between YASB’s
Context Variables • Mobility, bladder management• Family status (satisfaction/conflict)
Process Variables • Self-efficacy, • Perceived health competence
AND Self-management behaviors?
Methods
Design
• Descriptive, longitudinal study• Data were collected for one year from time
of transition to adult health care• This analysis uses baseline data from 30
YASB without intellectual disabilities
IRB approval obtained
Context Variables• Mobility and Bladder Management
• Functional Independence Measure (FIM™)• Family Factors
• Family Satisfaction (Family APGAR)• Family Conflict (FES Subscale)
Process Variables • Self-Efficacy
• Communication and Problem Solving Self-Efficacy Scale (CPSSES)
• Health Competence • Perceived Health Competence Scale (PHCS)
Proximal Outcome • Self-Management Behaviors
• Adolescent/Young Adult Self-Management Scale (AMIS II)
Instruments
Mobility and Bladder Management
Functional Independence Measure (FIM™)
• Two items • Scored 1 7 • Independence in climbing a flight of stairs • Frequency of urinary incontinence
Family Satisfaction (Family APGAR)• 5 total items • 5 point Likert-type scale (Never Always)• Cronbach’s alpha=0.89
Family Conflict (FES Subscale)• 9 conflict items True/False• Cronbach’s alpha=0.55 omitted from
further analysis
Omitted from further analysis
Family Factors
Self-Efficacy
Communication and Problem Solving Self- Efficacy Scale (CPSSES)
• 10 total items • Not confident at all (0)Very confident (100)• Cronbach’s Alpha=0.90
Perceived Health Competence
Perceived Health Competence Scale (PHCS)
• 8 total items• 5 point Likert-type scale • Strongly Disagree Strongly Agree• Cronbach’s Alpha=0.79
Adolescent/Young Adult Self-Management and Independence Scale (AMIS II)
• 17 total items, interview format• 2 Subscales: Condition/Independent Living • 7 point detailed scoring protocol (totally independent=7; totally dependent=1)• Cronbach’s alpha=0.94; subscales=0.88-0.90
Self-Management
Data Analysis
• Frequencies were used to describe the sample.
• Correlations were used to evaluate preliminary relationships to outcome and relationships between variables.
• IFSMT guided the hierarchical regression analysis exploring factors associated with self-management
Results
Characteristics of the Sample• Caucasian 90% • Gender 45% Female; 55% Male • Age Mean=22 (sd=4.0) range 18-35• Employed 62% with most in training, child care,
secretary, Wal-Mart greeter, or part time • In School 45% have attended some sort of school in
the last 6 months
• Highest Ed 52% had high school of less; 48% some college/trade school
• Marital Status Only 2 had been married; one separatedcurrently
• Friends 51% had 4 or more friends and 63% see them
5 times a month or more
Frequencies
Context Bladder incontinence M=4.79 (sd=2.0) range 1-7 Mobility M=4.48 (sd=2.4) range 1-7 Family satisfaction M=3.95 (sd=.80) range 2.4-
5.0
Process Self-efficacy M=65.9 (sd=16.5) range 39-100 Perceived HC M=3.60 (sd=0.49) range 3-5
Outcomes AMIS II M=4.90 (sd=1.4) range
2.59-7.0
CorrelationsPreliminary Correlation Analysis Revealed:
• No significant relationship between• demographic variables and self-management. • bladder management or family factor
(satisfaction) and self-management. Thus they were omitted from the regression
analysis.
• Moderate to large relationship (r=0.60) between self-efficacy and perceived competence which led to 2 blocks in regression for process variables.
Total AMIS II Score Block 1: Context Variables Beta t Sig Mobility 0.58 3.7 0.01 R2=.31 (p=0.001)
Block 2: Process Variable #1 Beta t SigMobility 0.43 2.7 0.01 Self-Efficacy 0.34 2.4 0.03 R2=.41 (p=0.026)
Block 3: Process Variable #2 Beta t Sig
Perceived Competence 0.19 0.98 0.34 R2=.41 (p=0.335/NS)
Results-Hierarchical Regression Analysis
Block 1: Context Variables Beta t Sig Mobility 0.51 3.1 0.010 R2=.23 (p=0.005)
Block 2: Process Variable #1 Beta t SigMobility 0.31 2.0 0.058 Self-Efficacy 0.49 3.1 0.004 R2=.42 (p=0.004)
Block 3: Process Variable #2 Beta t SigMobility 0.25 1.5 0.140Self-Efficacy 0.37 2.0 0.050Perceived Competence 0.25 1.3 0.193 R2=.44 (p=0.193/NS)
Results-Condition Subscale
Sobel Statistic for Mediation
• Self –efficacy mediates the impact of mobility on Self-Management-Condition.
• Sobel Statistic =2.026 p=0.043
Block 1: Context Variables Beta t Sig Mobility 0.60 3.8 0.001 R2=.33 (p=0.001)
Block 2: Process Variable #1 Beta t SigMobility 0.48 2.9 0.007 Self-Efficacy 0.28 2.7 0.097 R2=.38 (p=0.097)
Block 3: Process Variable #2 Beta t SigMobility 0.44 2.56 0.017 Self-Efficacy 0.21 1.09 0.286Perceived Competence 0.19 0.98 0.461 R2=.36 (p=0.46/NS)
Results-Independent Living Subscale
Conclusion
• Transition to adult health care is a global issue for youth with a chronic health condition.
• Communication and problem-solving self-efficacy substantially expanded the amount of the variance in overall self-management and mediates the impact of mobility on SM-Condition.
• Health care providers that transition YASB to adult health care need to reinforce the importance of increasing self-efficacy in order to positively influence self-management.
• Mobility is a major risk factor for low self-management in this population. Providers need to provide particular support and intervention to enhance self-efficacy to those with mobility impairment.
A special thanks to the young adults with spina bifida that participated in this study.
Questions?
UW-Milwaukee
www.nursing.uwm.edu
College of Nursing
Children’s Hospital of Wisconsin