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

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

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

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.

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.

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

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?

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

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

Mobility and Bladder Management

Functional Independence Measure (FIM™)

• Two items • Scored 1 7 • Independence in climbing a flight of stairs • Frequency of urinary incontinence

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

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

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

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

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

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

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

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.

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

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

Sobel Statistic for Mediation

• Self –efficacy mediates the impact of mobility on Self-Management-Condition.

• Sobel Statistic =2.026 p=0.043

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

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.

A special thanks to the young adults with spina bifida that participated in this study.

Questions?

UW-Milwaukee

www.nursing.uwm.edu

College of Nursing

Children’s Hospital of Wisconsin