Social Determinants of Self-Efficacy for individuals with Multiple Sclerosis

Intro: Research has shown that self-efficacy may be a modifiable factor that can be targeted in self-management interventions for people with multiple sclerosis (MS). Most research on self-efficacy has examined individual factors, although social factors may also play a role. Social determinants of self-efficacy such as income, education, family structure, service availability, sanitation, social support, and racial discrimination, have not been examined in MS. The purpose of this study was to examine the social determinants of self-efficacy in MS to inform self-management interventions. Methods: A cross-section of data from a longitudinal survey of community-dwelling individuals with MS (N = 617). The outcome measure of self efficacy was measured using the 20-item Disability Management Self Efficacy Scale (DMSES). Predictors considered included age, gender, marital status, education level, household income, employment status, Medicaid health insurance, and social support (MSPSS). Contributing factors included severity of disease (EDSS), duration of disease, and presence of secondary symptoms (pain, fatigue, depression). A forward regression prediction model was fitted using STATA v11.0. Results: The prediction model fit for self efficacy included gender, fatigue, severity of disease (EDSS), social support (MSPSS), and duration of disease (R2 = 0.51, F (5, 394) = 99.13, p < 0.001). Conclusion: Of the social determinant predictors considered, gender and social support were included in the final model. Individuals with MS who have lesser social support are more likely to have lower self-efficacy compared to those with high social support controlling for gender, fatigue, and severity and duration of MS.