The role of adherence in the relationship between self-efficacy and self-management in diabetic patients undergoing CABG in Taiwan

Objectives To determine the role of adherence and its significance in the relationship between self-efficacy and self-management of diabetic patients undergoing coronary artery bypass graft (CABG) in Taiwan.

Design Descriptive and correlational survey design.

Setting Three outpatient clinics in Taiwan.

Participants Patients diagnosed with diabetes undergoing CABG at least 6 months before the study, 18 years of age or older, able to communicate verbally without any psychiatric problems, and with a life expectancy longer than 1 year.

Main outcome measures Self-management assessment (self-efficacy for managing disease and adherence to guidelines and medication measured on a scale of 0-8), the higher aspects of self-management (keeping appointments, taking medication properly and keeping follow-up appointments) and the lower aspects of self-management (inability to share decisions with primary physician, inability to take correct actions when symptoms worsen and inability to adapt habits to improve health).

Results The mean score obtained for self-management among the 166 participants was 6.48, with 57 (34.3%) of them showing non-adherent behaviour. Self-efficacy accounts for 38% (R²=0.380, F(1,103)=63.124, p<0.001), and 54% of good self-management was explained by self-efficacy and adherence in managing disease (R²=0.540, F(2,102)=56.937, p<0.001). Adherence accounts for 16% of better self-management, age and education combined account for 4.9% (R²=0.589, F(6.98)=23.399, p<0.001), and lifestyle items account for 5.2% (R²=0.641, F(14,90)=11.457, p<0.001). Disease-related variables contribute 3.4% (R²=0.674, F(17,87)=10.599, p<0.001). Thus selfefficacy, adherence, age, education, primary care provider and systolic pressure are considered significant predictors of self-management. With the exception of adherence, none of the variables had a statistically significant mediating effect.

Conclusions The results confirm strong relationships between self-efficacy, adherence and self-management, with adherence having a significant mediating effect in post-CABG patients with diabetes in Taiwan.