Gender differences in chronic disease management self-efficacy in adults with type 2 diabetes and heart disease

Background: Disease specific self-efficacy, the confidence an individual has to control and manage chronic disease, has been shown to be a predictor of management behavior, medication adherence, and quality of life. Objective: The objective of this study is to investigate the social determinants of self-efficacy, particularly by gender, and to determine if this relationship is influenced by receipt of management plans in a population-based sample of adults with Type 2 diabetes and heart disease. Methods: We analyzed data from 8,907 adults (weighted n = 3,472,196) with self-reported type 2 diabetes and heart disease from the 2009 California Health Interview Survey. Self-efficacy was measured using the disease specific questions ‘How confident are you in your ability to control and manage your [diabetes, heart disease]?' Staged multivariable logistic regression models were used to examine if the relationship between gender and asthma self-efficacy was retained controlling for disease severity, health care access (health insurance type, usual source of care), health care utilization (delayed or foregone medical or prescription care), and health care delivery (receipt of written disease management plan). Results: In the fully adjusted models, women with type 2 diabetes were less likely to have high diabetes self-efficacy than men with heart disease (OR 0.6, 95% CI 0.5-0.8). Women with heart disease were also less likely to have high heart disease self-efficacy than men with heart disease (OR 0.7, 95% CI 0.5-0.9). Conclusion: There appear to be meaningful differences in self-efficacy by gender that exists across chronic conditions.