Does self-efficacy mediate the cross-sectional relationship between perceived quality of health care and self-management of diabetes? Results from Diabetes MILES – Australia

Abstract

Objective: Quality of health care (QoC) and self-efficacy may affect self-management of diabetes, but such effects are not well understood. We examined the indirect role of diabetes-specific self-efficacy (DSE) and generalised self-efficacy (GSE) in mediating the cross-sectional relationship between self-reported QoC and diabetes self-management.

Design: Diabetes MILES–Australia was a national survey of 3,338 adults with diabetes. We analysed data from 1,624 respondents (age: M = 52.1, SD = 13.9) with type 1 (T1D; n = 680) or type 2 diabetes (T2D; n = 944), who responded to a version of the survey containing key measures.

Main Outcome Measures: self-reported healthy eating, physical activity, self-monitoring of blood glucose frequency, HbA_1c, medication/insulin adherence.

Results: We used Preacher and Hayes’ bootstrapping method, controlling for age, gender and diabetes duration, to test mediation of DSE and GSE on the relationship of QoC with each self-management variable. We found statistically significant but trivial mediation effects of DSE and of GSE on most, but not all, variables (all effect sizes < .06).

Conclusion: Support for mediation was weak, suggesting that relationships amongst these variables are small and that future research might explore other aspects of self-management in diabetes.

Keywords:

• Australia
• diabetes
• population
• quality of care
• self-efficacy
• self-management

Acknowledgement

We thank Dr Christel Hendrieckx and Ms Elizabeth Holmes-Truscott (both from The Australian Centre for Behavioural Research in Diabetes and Deakin University) for their contributions to the Diabetes MILES – Australia study, from which the participant sample used in this paper was drawn. We also thank all participants of this study for volunteering their time to take part, and all organisations (most notably Diabetes Victoria) that assisted with participant recruitment. The Diabetes MILES–Australia 2011 Survey was funded by a National Diabetes Services Scheme (NDSS) Strategic Development Grant. The NDSS is an initiative of the Australian Government administered by Diabetes Australia. In addition, Diabetes MILES–Australia received an unrestricted educational grant from Sanofi to support the development of the study website www.diabetesMILES.org and miscellaneous activities. JLB and JS are supported by core funding to The Australian Centre for Behavioural Research in Diabetes from Diabetes Victoria and Deakin University.

Disclosure statement

Authors Tregea, Lee, Browne, Pouwer and Speight have no financial interest or benefit arising from the direct applications of this research.