JKAN Journal of Korean Academy of Nursing J Korean Acad Nurs 2005-3673 2093-758X Korean Society of Nursing Science 10.4040/jkan.2019.49.3.298 jkan-49-298 Original Article Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors LeeBo Gyeong1 LeeTae Sook2 KimSoo Hyun2 College of Nursing, The Research Institute of Nursing Science, Daegu Catholic University, Daegu Department of Nursing, Inha University, Incheon, Korea Address reprint requests to : Kim, Soo Hyun Department of Nursing, Inha University, 100 Inha-ro, Michuhol-gu, Incheon 22212, Korea Tel: +82-32-860-8213 Fax: +82-32-874-5880 E-mail: soohyun@inha.ac.kr 012019 15012019 493 298306 080120190204201908042019 Copyright © 2019 Korean Society of Nursing Science 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium. Abstract Purpose

This study aimed to examine the levels of perceived self-management support, self-efficacy for self-management, and health-related quality of life (HRQoL) in cancer survivors, and to identify the mediating effect of self-efficacy in the relationship between perceived self-management support and HRQoL.

 Methods

This study used a descriptive correlational design. Two hundred and four cancer survivors who had completed treatment participated in the study. Measurements included the Patient Assessment of Chronic Illness Care Scale, the Korean version of the Cancer Survivors’ Self-Efficacy Scale, and the Medical Outcomes Study Short Form-36. Data were analyzed using descriptive statistics, Pearson's correlation coefficient analysis, and multiple regression analysis using Baron and Kenny's method for mediation.

 Results

The mean score for perceived self-management support was 3.35 out of 5 points, self-efficacy was 7.26 out of 10 points, and HRQoL was 65.90 out of 100 points. Perceived self-management support was significantly positively correlated with self-efficacy (r=.29, p<.001) and HRQoL (r=.27, p<.001). Self-efficacy was also significantly correlated with HRQoL (r=.59, p<.001). Furthermore, self-efficacy (β=.55, p<.001) had a complete mediating effect on the relationship between perceived self-management support and HRQoL (Z=3.88, p<.001).

 Conclusion

The impact of perceived self-management support on HRQoL in cancer survivors was mediated by self-efficacy for self-management. This suggests that strategies for enhancing self-efficacy in cancer survivors should be considered when developing self-management interventions for improving their HRQoL.

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Mediating effect of self-efficacy in relationship between perceived self-management support and health-related quality of life.

General Characteristics of Participants (N=204)

Characteristics Categories M±SD or n (%) Min-Max
Age (yr) 54.2±11.1 23~83
Gender Male 25 (12.3)
Female 179 (87.7)
Marital status Married 151 (74.0)
Widowed 20 (9.8)
Divorced or separated 15 (7.4)
Single 18 (8.8)
Education level <High school 53 (26.0)
High school graduation 98 (48.0)
≥College 53 (26.0)
Employment status Employed 76 (37.3)
Unemployed 128 (62.7)
Cancer type† Breast 155 (76.0)
Thyroid 26 (12.8)
Gastrointestinal 22 (11.8)
Gynecological 7 (3.4)
Hematological 5 (2.5)
Other†† 12 (5.9)
Treatment received† Surgery 197 (96.6)
Radiation therapy 136 (66.7)
Chemotherapy 143 (70.1)
Other 21 (10.3)
Months since completion of treatment (months) 43.9±42.0 1~165
Comorbid condition† (n=100) Hypertension 41 (20.1)
Musculoskeletal disease 41 (20.1)
Gastrointestinal disease 25 (12.3)
Diabetes 14 (6.9)
Pulmonary disease 5 (2.5)
Heart disease 3 (1.5)
Other 16 (7.8)

M=Mean; SD=Standard Deviation.

Duplicate response was permitted;

Other cancer type included kidney cancer, gall bladder cancer, lung cancer, liver cancer, neuroblastoma, skin cancer, larynx cancer, plasmacytoma.

Descriptive Statistics of Perceived Self-Management Support, Self-Efficacy, and Health-Related Quality of Life (N=204)

Subscales Number of items M±SD Possible range
SMS Patient activation 3 3.82±1.04 1~5
Goal setting/Tailoring 5 3.03±1.08 1~5
Problem-solving/Contextual counseling 4 3.29±1.07 1~5
Total 12 3.35±0.94 1~5
Self-efficacy Manage fatigue 1 6.90±2.20 1~10
Manage physical discomfort or pain 1 6.84±2.20 1~10
Manage emotional distress 1 7.13±2.21 1~10
Manage other symptoms or health problems 1 7.03±2.22 1~10
Do different tasks and activities 1 7.18±2.04 1~10
Access information 1 6.97±2.31 1~10
Access people to help and support 1 7.52±2.47 1~10
Deal with problems by yourself 1 7.03±2.40 1~10
Contact doctor 1 7.89±2.20 1~10
Get support with problems 1 8.14±2.10 1~10
Total 10 7.26±1.70 1~10
HRQoL Physical functioning 10 74.61±21.15 0~100
Role functioning/physical 4 55.15±39.83 0~100
Bodily pain 2 74.62±21.51 0~100
General health 5 56.05±20.22 0~100
Vitality 4 56.47±22.33 0~100
Social functioning 2 78.31±21.59 0~100
Role functioning/emotional 3 61.11±19.29 0~100
Mental health 5 68.92±19.29 0~100
Total 35 65.90±18.58 0~100

HRQoL=Health-Related Quality of Life; M=Mean; SD=Standard Deviation; SMS=Self-Management Support.

Correlations among Self-Management Support, Self-Efficacy, and Health-Related Quality of Life (N=204)

SMS
 Self-efficacy
r (p) r (p)
Self-efficacy .29 (<.001)
HRQoL .27 (<.001) .59 (<.001)

HRQoL=Health-Related Quality of Life; SMS=Self-Management Support.

Mediating Effect of Self-Efficacy in Relationship between Perceived Self-Management Support and Health-Related Quality of Life (N=204)

B SE β t p Adj.R2 F p
Step 1. SMS → Self-efficacy 0.52 0.12 .29 4.26 <.001 0.08 18.12 <.001
Step 2. SMS → HRQoL 5.30 1.33 .27 3.98 <.001 0.07 15.87 <.001
Step 3. SMS, Self-efficacy → HRQoL 0.35 55.13 <.001
  1) SMS → HRQoL 2.18 1.16 .11 1.88 .062
  2) Self-efficacy → HRQoL 5.99 0.64 .55 9.36 <.001
Sobel test: B=5.99, Z=3.88 (p<.001)

Adj.R2=Adjusted R-squared; HRQoL=Health-Related Quality of Life; SE=Standard Error; SMS=Self-Management Support.