Over the past decade results from a series of research studies have contributed to the
development and evaluation of the Arthritis Self-Management Program (ASMP), a volunteer-led
patient education program for persons with arthritis. To date, these studies have primarily
focussed on program effectiveness, process, implementation, and dissemination. In these studies
self-efficacy was identified as an important construct contributing to the program's effectiveness,
however, the exact relationship between self-efficacy and health outcomes has not been
determined. In this dissertation research I investigate the evidence of a causal relationship
between self-efficacy and three program outcomes (a decrease in depression, less pain, and a
higher self-rating of overall health status), and attempt to determine the nature of that
relationship.
The research methodology involved the use of structural equation modeling (SEM) with
two longitudinal samples, one (n=122) of 1991 ASMP participants in British Columbia, the other
(n=189) of 1992 ASMP participants in Ontario. In the analysis self-efficacy was paired
separately with depression, pain and perceived health status.
The results of the SEM failed to confirm a dominant causal relationship from self-efficacy
to depression, or to pain. This may indicate that these variables have a reciprocal or
"spiral" relationship or that both sets of variables may be caused by factors not considered in the analysis. The results of the SEM between self-efficacy and perceived health status did, however,
show that higher self-rated health status leads to higher self-efficacy at a later time. The data did
not show statistical significance for other causal patterns among these variables.
The findings suggest that self-efficacy may play a moderator role in the complex
relationship involving individuals with arthritis, their behaviors, and health outcomes. As well,
the findings have implications for health promotion planning and research in that they reinforce
the complex interplay of psychological and behavioral variables (probably influenced by social
variables) in programs which attempt to give individuals greater control over their health. The
efficacy and effectiveness of the ASMP has been established in previous studies. This study in no
way calls these into question. It does, however, suggest that the mechanism by which these
effective outcomes are achieved warrants further investigation.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:BVAU.2429/6112 |
| Date | 11 1900 |
| Creators | McGowan, Patrick Thomas |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Relation | UBC Retrospective Theses Digitization Project [http://www.library.ubc.ca/archives/retro_theses/] |
Page generated in 0.0065 seconds