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From Denver Veterans Affairs Medical Center (C.H.J-B.), Denver, CO; University of North Carolina at Chapel Hill (M.A.L.), Chapel Hill, NC; and University of Colorado Health Sciences Center (S.G.), Denver, CO.
Address reprint requests to: Catharine H. Johnston-Brooks, PhD, Routing #116 B, Denver VAMC, 1055 Clermont St., Denver, CO 80220. Email: catharine.johnston-brooks{at}med.va.gov
OBJECTIVE: The present study examined self-efficacy and self-esteem as basic aspects of the self that influence self-care and physiological outcomes among young adults with Type I diabetes. The two aims of this study were 1) to examine the cross-sectional and longitudinal role of the self-variables as they predict self-care and HbA1c and 2) to test whether self-care mediates the association between the self variables and HbA1c using cross-sectional and longitudinal data.
METHODS: One hundred ten participants were recruited from a regional diabetes outpatient clinic. Inclusion criteria were age (18–35 years) and duration of diabetes (>1 year before recruitment). Participants were 61% female and 88% white. In addition, the sample had an average annual income between $24,999 and $34,999, and 85% had completed some or all of college. The average duration of diabetes was 15 years.
RESULTS: Using multiple regression analyses we found that, compared with self-esteem, self-efficacy was a better predictor of all aspects of self-care and HbA1c in cross-sectional analyses, in addition to diet and exercise self-care, and a better predictor of HbA1c in longitudinal analyses. The data also supported the cross-sectional and longitudinal mediational model in which better self-care helped account for the association between greater self-efficacy and better HbA1c.
CONCLUSIONS: Self-efficacy is an important factor for management of self-care practices and physiological outcomes among young adults with Type I diabetes, and self-care may be an important mechanism by which self-efficacy influences HbA1c levels.
Key Words: diabetes, • self-efficacy, • self-esteem, • HbA1c, • self-care, • mediation.
Abbreviations: DCCT = Diabetes Control and Complications Trial;; HbA1c = glucose control/glycosylated hemoglobin;; IDDM = insulin-dependent diabetes mellitus;; NIDDM = non–insulin-dependent diabetes mellitus.
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