Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors

Bo Gyeong Lee; Tae Sook Lee; Soo Hyun Kim

doi:10.4040/jkan.2019.49.3.298

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Lee, Lee, and Kim: Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors

Original Article

J Korean Acad Nurs 2019;49(3):298-306.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.3.298

Mediation Effect of Self-Efficacy on the Relationship between Perceived Self-Management Support and Health-Related Quality of Life among Cancer Survivors

Bo Gyeong Lee¹, Tae Sook Lee², Soo Hyun Kim^2,

¹College of Nursing, The Research Institute of Nursing Science, Daegu Catholic University, Daegu

²Department 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

Received 8 January 2019 Revised 2 April 2019 Accepted 8 April 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.

Keywords: Cancer Survivors, Self-Management, Quality of Life, Self Efficacy

References

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Figure 1.

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

Table 1.

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.

Table 2.

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.

Table 3.

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.

Table 4.

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.

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