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% (R(2)=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 (R(2)=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% (R(2)=0.589, F(6.98)=23.399, p<0.001), and lifestyle items account for 5.2% (R(2)=0.641, F(14,90)=11.457, p<0.001). Disease-related variables contribute 3.4% (R(2)=0.674, F(17,87)=10.599, p<0.001). Thus self-efficacy, 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.