Better Self-Efficacy Linked to Better Health-Related Quality of Life in Patients With SLE

A better health-related quality of life (HRQoL) was observed in patients with systemic lupus erythematosus (SLE) who reported better self-efficacy, even after adjusting for confounders, according to a study published in Lupus Science & Medicine.¹

“HRQoL is affected in patients with SLE, and it is influenced by the patient’s age, poverty, educational level, behavioral issues, some clinical manifestations and comorbidities,” Manuel Francisco Ugarte-Gil, MD, MSc, a researcher in rheumatology at the Hospital Nacional Guillermo Almenara Irigoyen, Peru, and colleagues, stated. “However, the association between HRQoL and disease activity or damage has not been consistently reported, suggesting that factors related to the patient could be more relevant than those related to the disease itself. One of these factors is self-efficacy, as it measures the patients’ ability to perform specific tasks. In older adults, self-efficacy has been shown to be a mediator between frailty and HRQoL, suggesting that improvements on one will result in improvements on the other.”

Patients with SLE included in the Almenara Lupus Cohort were evaluated. Self-efficacy for patients with chronic conditions was described as a person’s confidence in his or her ability to perform behaviors or tasks related to their health in various situations.² Among the inclusion criteria, patients were required to have at least 2 clinical visits between October 2018 and February 2020.

Self-efficacy was determined using the 5 domains from the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for chronic condition management and the PROMIS general self-efficacy. While the average score for this patient population is 50, a higher score is associated with greater self-efficacy.

HRQoL was evaluated using both physical and mental component summary (PCS and MCS, respectively) measures of the Short-Form 36 (SF-36). Estimating equations were conducted, using the self-efficacy from the previous visit and PCS or MCS in the subsequent visit.

Multivariable models were adjusted for potential confounders, which were measured during the visit that evaluated self-efficacy. Confounders included gender, disease duration at baseline, age at diagnosis, socioeconomic status, certain drugs, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and previous PCS and MCS.

Ultimately, 209 patients, with a total of 564 visits, were included in the analysis. Most patients (92.8%, n = 194) were female, the mean age at diagnosis was 36.4 years, and the mean disease duration at baseline was 6.0 years.

According to multivariable models, better self-efficacy for managing symptoms, medications and treatments, social interactions, and general self-efficacy predicted a better PCS. Further, A better self-efficacy for managing daily activities, symptoms, medications and treatments, and social interactions predicted a better MCS. In alternative models, bodily pain, mental health, and role emotional were predicted by the 6 PROMIS domains.

Investigators noted that the PROMIS domains analyzed different aspects of self-efficacy, which may explain their different impacts on HRQoL. Domains related to physical activities, for example, were more affected by self-efficacy domains linked to activities, rather than emotions or treatment.

The impact of disease before baseline could not be excluded, as this was a primarily mestizo prevalent cohort. Additionally, investigators were unable to exclude the impact of other factors that could affect self-efficacy, such as personal beliefs and social or family support. However, this was the largest study evaluating the association between self-efficacy and HRQoL in this patient population to date.

“These results should encourage clinicians to develop strategies to improve self-efficacy in patients with SLE,” investigators concluded.

References

1. ^{Ugarte-Gil MF, Gamboa-Cardenas RV, Reátegui-Sokolova C, et al. A better self-efficacy is predictive of better health-related quality of life (HRQoL) in patients with systemic lupus erythematosus: data from the Almenara Lupus Cohort. Lupus Sci Med. 2023;10(1):e000874. doi:10.1136/lupus-2022-000874}
2. ^{Sood P, Romero S, Velozo C, et al. Defining self-efficacy for managing chronic conditions and identifying priority sub-domains: a web-based delphi technique. Arch Phys Med Rehabil 2015;96:e43. doi:10.1016/j.apmr.2015.08.140}