An exploration of self-efficacy among older adult participants in a disease self-management program
Graham, Kathleen Cahill
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Introduction Both age and chronic disease have been linked to falls, injury due to falls, and decreased functional status. Stanford’s Chronic Disease Self-Management Program (CDSMP) is an evidence-based program that uses self-efficacy (SE) as a key program component to improve self-management of chronic disease. CDSMP shares similar course structure, content (including a 10-minute segment on fall prevention), and focus on self-efficacy (SE) with fall prevention programs (FPP). Despite these program commonalities, researchers had not yet investigated Fall-related SE in relation to CDSMP participation. This dissertation investigated possible relationships between SE to manage disease (SEMCD) and Fall-related SE, whether Fall-related SE changed following participation in CDSMP, and older adult perception and understanding regarding (SEMCD) and Fall-related SE. Methodology A sequential mixed methods design explored older adult perceptions regarding self-efficacy and CDSMP. Phase 1 SE scale collection: Researchers gathered and analyzed baseline and post-intervention self-efficacy scale data from 36 participants enrolled in a six-week CDSMP. The six-question Self-Efficacy to Manage Chronic Disease scale (SEMCD Scale) and the five-question Fall-related Self-Efficacy scale (FallE Scale) measured relationships between types of SE as well as post-intervention changes in SE. Phase 2 interviews: 15 older adults (65 or older) completed semi-structured interviews following CDSMP participation to explore meanings and perceptions made by older adults regarding SE and self-management of health. Results Phase 1: SE scales were reliable (consistent with previous studies), distinctly different, and yet related measures of SE. Only the Fall-related SE significantly improved in proportion of participants and magnitude of change following CDSMP. Phase 2: The conceptual category, Believing I can do emerged as an overarching concept. Impact of CDSMP on SE was perceived as a general type of efficacy, SE to manage health, represented by overlapping or general aspects of self-management. The metacategories Giving Me More and Reinforcing what I know represented the perceived impact of CDSMP on SE from a general rather than specific perspective. Conclusions Although, SEMCD and Fall-related SE were distinct types of SE, correlations and mixed analysis indicated that Fall-related SE may share a common connection to SEMCD through the broader aspects of managing health provided during CDSMP workshops.