Health literacy

Epidemiology/Health Services/Psychosocial Research
O R I G I N A L A R T I C L E

Is Self-Efficacy Associated With Diabetes Self-Management Across Race/Ethnicity and Health Literacy?
URMIMALA SARKAR, MD, MPH1 LAWRENCE FISHER, PHD2 DEAN SCHILLINGER, MD3 to help avoid diabetes-related morbidity and mortality. Self-management is a cornerstone of diabetes care, and it is believed that improving patient self-efficacy is a critical pathway to improved selfmanagement. The concept of self-efficacy is based on social cognitive theory, which describes the interaction between behavioral, personal, and environmental factors in health and chronic disease. The theory of self-efficacy proposes that patients’ confidence in their ability to perform health behaviors influences which behaviors they will engage in (4 – 6). Because diabetes self-management incorporates behavioral, personal, and environmental factors into daily performance of recommended activities, the concept of selfefficacy is relevant for improving selfmanagement. Among highly selected patients, self-efficacy has been shown to be important for appropriate selfmanagement for many chronic health conditions (7–10), and, in diabetes, the research demonstrates mixed results for interventions that attempt to improve self-management behavior through improved self-efficacy (11–17). Although a few recent studies have addressed selected racial/ethnic minority populations (18,19), little is known about the applicability of self-efficacy research to ethnically diverse and low-income patients with diabetes. In these populations, access barriers (20), costs of treatment (21), and cultural beliefs (22) may be key determinants of self-management behavior. To the extent that these factors contribute to high rates of failed attempts and/or lack of modeling of successful behaviors, they may also contribute to lower self-efficacy. Within this patient population, individuals with limited health literacy may be especially vulnerable to these