Sansing, Veronica Vera
(2011)
The Role of Self-Efficacy in Patients with Comorbid Type 2 Diabetes and Coronary Artery Disease in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
OBJECTIVES: Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are highly comorbid conditions that are affected by psychological factors, such as self-efficacy. Psychological factors can either hinder or promote medical interventions. Self-efficacy, the belief that one is able to make changes necessary for self-management, is associated with glycemic control and cardiac symptom burden, as well as behaviors that affect CAD prevention and outcomes.METHODS: Using data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, we assessed the relationship between self-efficacy and the treatment, risk factor control, and cardiac outcomes of patients with T2DM and CAD.RESULTS: The first paper (N=889) showed no significant relationships between self-efficacy and randomized treatment for CAD (revascularization vs. medical therapy β=0.06, p=0.66) and T2DM (insulin sensitizers vs. insulin providers β=0.06, p=0.65) in patients with baseline self-efficacy scores ≤8. The second paper (N=1,562) verified a negative association between baseline self-efficacy and follow-up HbA1c (β=-0.03, p<.001) and a positive association with self-efficacy and physical functioning in which time negatively modified the association(interaction p=0.02). A lagged association (feedback loop) was shown between self-efficacy and HbA1c, physical functioning, and BMI over time. The feedback loops were stronger in White non-Hispanic patients compared to minority patients. In the third paper (N=1,817), poor baseline self-efficacy was associated with an increased risk of a composite endpoint of death/myocardial infarction/stroke (hazard ratio [HR] =1.34, p=0.01), subsequent revascularizations (HR=1.30, p=0.004), subsequent PCIs (HR=1.43, p<.001), and angina (odds ratio [OR] =1.11, p<.001) compared to Fair-Excellent self-efficacy, but not after adjusting for baseline covariates. A decrease in self-efficacy from baseline to Year 1 was positively associated with all-cause mortality (adjusted HR=2.32, p<.001) and death/MI/stroke (adjusted HR=1.79, p<.001).CONCLUSIONS: In summary, self-efficacy was associated with clinical risk factors and cardiac outcomes in patients with CAD and T2DM. This is of public health significance because it stresses the importance of improving a patient's confidence in managing their conditions outside of the medical setting.
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| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
31 January 2011 |
| Date Type: |
Completion |
| Defense Date: |
11 October 2010 |
| Approval Date: |
31 January 2011 |
| Submission Date: |
29 November 2010 |
| Access Restriction: |
5 year -- Restrict access to University of Pittsburgh for a period of 5 years. |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
coronary artery disease; diabetes; self-efficacy |
| Other ID: |
http://etd.library.pitt.edu/ETD/available/etd-11292010-224630/, etd-11292010-224630 |
| Date Deposited: |
10 Nov 2011 20:06 |
| Last Modified: |
19 Dec 2016 14:37 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/9866 |
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