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Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?

¹ Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
² Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
³ Primary Care Research Center, University of California, San Francisco, San Francisco General Hospital, San Francisco, California

Address correspondence and reprint requests to Urmimala Sarkar, Division of General Internal Medicine, Box 1211, University of California, San Francisco, San Francisco, CA. 94143. E-mail: usarkar{at}medicine.ucsf.edu

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.

RESEARCH DESIGN AND 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.

Abbreviations: SMBG, self-monitoring of blood glucose • s-TOFHLA, short version of the Test of Functional Health Literacy in Adults

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