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The Impact of Mobility, Self-Efficacy, Family Factors, and Perceived Competence on Self-Management Behaviors in Young
Adults with Spina BifidaKathleen J. Sawin, PhD, CPNP-PC, FAAN
Professor and Research Chair in the Nursing of Children
University of Wisconsin-Milwaukee and Children's Hospital of Wisconsin
Center Scientist, Self-Management Science Center, UWM
Presented at:
The 2012 National State of the Science Congress on Nursing Research
Washington DC, September 15, 2012
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Co-Authors
Kim Whitmore, MSN, RN, CPNWilliam Waring, MDR. Cory O’Conner, MDMerle Orr, MDKaren Rauen, MSN, RN, BCIAC, PMDBTera Bartelt, MS, PCNS-BCHeidi Miranda, MS, CCLS
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Conflict of Interest
• No Conflicts of Interest to Report
• Funding: Joint Research Chair in the Nursing of
Children
• College of Nursing, University of Wisconsin-Milwaukee
• Children’s Hospital of Wisconsin
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Purpose
As contextual and process factors may play an important role in transition outcomes, the purpose of this study was:
• To explore contextual and process factors related to reported self-management in young adults with spina bifida (YASB) who do not have an intellectual disability.
• To discuss implications for research and practice.
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Background
• A Spina Bifida Transition Program in a Midwestern US city was developed with a partnership between pediatric and adult providers.
• A parallel research project was conducted to evaluate the experiences of young adults with spina bifida (YASB) during the transition.
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Individual and Family Self-Management Theory© Ryan & Sawin, 2008 Self-management Science Center (1P20NR0010674-01)
OutcomesDistal
Health StatusQuality of Life or Well Being
Cost of Health
ContextRisk & ProtectiveFactors
Condition SpecificComplexity of condition Complexity of treatmentTrajectory
Physical & SocialEnvironmentAccess to care, Setting and provider transitions, TransportationCulture, Social Capital
Individual & FamilyDevelopmental stagesPerspectives, Literacy, Information processing, Capabilities
Processof Self-management
Knowledge & BeliefsSelf-efficacyOutcome expectancyGoal congruence
Self-RegulationSkills & AbilitiesGoal Setting, Self-monitoringand reflective thinking, Decisionmaking, Planning and Action,Self-evaluation, Emotional Control
Social FacilitationInfluenceSupportCollaboration
OutcomesProximal
Self-management BehaviorsCondition Specific
Cost of Health Care Services
C
Mobility/ Bladder Management
C
Self – Efficacy/ Perceived Comp
C
Family Factors
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Research Question
Is there a relationship between YASB’s
Context Variables • Mobility, bladder management• Family status (satisfaction/conflict)
Process Variables • Self-efficacy, • Perceived health competence
AND Self-management behaviors?
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Methods
Design
• Descriptive, longitudinal study• Data were collected for one year from time
of transition to adult health care• This analysis uses baseline data from 30
YASB without intellectual disabilities
IRB approval obtained
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Context Variables• Mobility and Bladder Management
• Functional Independence Measure (FIM™)• Family Factors
• Family Satisfaction (Family APGAR)• Family Conflict (FES Subscale)
Process Variables • Self-Efficacy
• Communication and Problem Solving Self-Efficacy Scale (CPSSES)
• Health Competence • Perceived Health Competence Scale (PHCS)
Proximal Outcome • Self-Management Behaviors
• Adolescent/Young Adult Self-Management Scale (AMIS II)
Instruments
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Mobility and Bladder Management
Functional Independence Measure (FIM™)
• Two items • Scored 1 7 • Independence in climbing a flight of stairs • Frequency of urinary incontinence
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Family Satisfaction (Family APGAR)• 5 total items • 5 point Likert-type scale (Never Always)• Cronbach’s alpha=0.89
Family Conflict (FES Subscale)• 9 conflict items True/False• Cronbach’s alpha=0.55 omitted from
further analysis
Omitted from further analysis
Family Factors
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Self-Efficacy
Communication and Problem Solving Self- Efficacy Scale (CPSSES)
• 10 total items • Not confident at all (0)Very confident (100)• Cronbach’s Alpha=0.90
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Perceived Health Competence
Perceived Health Competence Scale (PHCS)
• 8 total items• 5 point Likert-type scale • Strongly Disagree Strongly Agree• Cronbach’s Alpha=0.79
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Adolescent/Young Adult Self-Management and Independence Scale (AMIS II)
• 17 total items, interview format• 2 Subscales: Condition/Independent Living • 7 point detailed scoring protocol (totally independent=7; totally dependent=1)• Cronbach’s alpha=0.94; subscales=0.88-0.90
Self-Management
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Data Analysis
• Frequencies were used to describe the sample.
• Correlations were used to evaluate preliminary relationships to outcome and relationships between variables.
• IFSMT guided the hierarchical regression analysis exploring factors associated with self-management
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Results
Characteristics of the Sample• Caucasian 90% • Gender 45% Female; 55% Male • Age Mean=22 (sd=4.0) range 18-35• Employed 62% with most in training, child care,
secretary, Wal-Mart greeter, or part time • In School 45% have attended some sort of school in
the last 6 months
• Highest Ed 52% had high school of less; 48% some college/trade school
• Marital Status Only 2 had been married; one separatedcurrently
• Friends 51% had 4 or more friends and 63% see them
5 times a month or more
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Frequencies
Context Bladder incontinence M=4.79 (sd=2.0) range 1-7 Mobility M=4.48 (sd=2.4) range 1-7 Family satisfaction M=3.95 (sd=.80) range 2.4-
5.0
Process Self-efficacy M=65.9 (sd=16.5) range 39-100 Perceived HC M=3.60 (sd=0.49) range 3-5
Outcomes AMIS II M=4.90 (sd=1.4) range
2.59-7.0
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CorrelationsPreliminary Correlation Analysis Revealed:
• No significant relationship between• demographic variables and self-management. • bladder management or family factor
(satisfaction) and self-management. Thus they were omitted from the regression
analysis.
• Moderate to large relationship (r=0.60) between self-efficacy and perceived competence which led to 2 blocks in regression for process variables.
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Total AMIS II Score Block 1: Context Variables Beta t Sig Mobility 0.58 3.7 0.01 R2=.31 (p=0.001)
Block 2: Process Variable #1 Beta t SigMobility 0.43 2.7 0.01 Self-Efficacy 0.34 2.4 0.03 R2=.41 (p=0.026)
Block 3: Process Variable #2 Beta t Sig
Perceived Competence 0.19 0.98 0.34 R2=.41 (p=0.335/NS)
Results-Hierarchical Regression Analysis
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Block 1: Context Variables Beta t Sig Mobility 0.51 3.1 0.010 R2=.23 (p=0.005)
Block 2: Process Variable #1 Beta t SigMobility 0.31 2.0 0.058 Self-Efficacy 0.49 3.1 0.004 R2=.42 (p=0.004)
Block 3: Process Variable #2 Beta t SigMobility 0.25 1.5 0.140Self-Efficacy 0.37 2.0 0.050Perceived Competence 0.25 1.3 0.193 R2=.44 (p=0.193/NS)
Results-Condition Subscale
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Sobel Statistic for Mediation
• Self –efficacy mediates the impact of mobility on Self-Management-Condition.
• Sobel Statistic =2.026 p=0.043
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Block 1: Context Variables Beta t Sig Mobility 0.60 3.8 0.001 R2=.33 (p=0.001)
Block 2: Process Variable #1 Beta t SigMobility 0.48 2.9 0.007 Self-Efficacy 0.28 2.7 0.097 R2=.38 (p=0.097)
Block 3: Process Variable #2 Beta t SigMobility 0.44 2.56 0.017 Self-Efficacy 0.21 1.09 0.286Perceived Competence 0.19 0.98 0.461 R2=.36 (p=0.46/NS)
Results-Independent Living Subscale
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Conclusion
• Transition to adult health care is a global issue for youth with a chronic health condition.
• Communication and problem-solving self-efficacy substantially expanded the amount of the variance in overall self-management and mediates the impact of mobility on SM-Condition.
• Health care providers that transition YASB to adult health care need to reinforce the importance of increasing self-efficacy in order to positively influence self-management.
• Mobility is a major risk factor for low self-management in this population. Providers need to provide particular support and intervention to enhance self-efficacy to those with mobility impairment.
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A special thanks to the young adults with spina bifida that participated in this study.
Questions?
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UW-Milwaukee
www.nursing.uwm.edu
College of Nursing
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Children’s Hospital of Wisconsin