The Role of Self-Efficacy in Self-Management of Atopic Dermatitis
As atopic dermatitis (AD) is increasing in prevalence, so is the suffering that accompanies it.1-3 AD affects up to 13% of children in the United States and up to 20% worldwide.4,5 Due to its impact on sleep and social and intellectual development, AD can diminish the quality of life in children and families. AD is a multibillion-dollar problem to society, with an estimated direct cost of $314 million per year in the United States.2,6-8 Combating the burden of this disease requires a multipronged approach, but complex treatment plans often compromise adherence to treatment.
Much research has been done to better understand the pathophysiology of AD and to develop better treatments. Research on the factors that affect patients’ adherence to treatment has the potential to vastly improve patients’ outcomes and to do so quickly and at low cost. Models that describe the factors that affect patients’ adherence are being developed. A key factor in these models is self-management, a promising strategy that combines patient education and psychological support to actively engage patients in their health care.
Self-management is a patient’s ability to manage symptoms, treatments, and physical and psychological consequences associated with a chronic condition. Since patients, not providers, are responsible for day-to-day disease management, patients must be more actively involved in their care through self-management. Evidence suggests that self-management interventions effectively increase patient knowledge, symptom management, and health status.9 Self-management may help bridge the gap between patients’ needs and the ability of health care to meet those needs.
There is increasing interest in developing self-management interventions for patients with AD.10-12 Since AD can be disabling to patients and families, educational and psychological support of the patient and caregiver are essential components of disease management. Educational interventions teach parents to better understand the need for medical interventions and effective disease management. The content of educational interventions may include disease information, treatment instructions, management, and prevention strategies. Approaches include pamphlets, workshops, programs, online video education, and Web-based interventions.13-16 However, interventions solely based on education are unlikely to bring about health behavior change.16
Successful educational interventions improve participant’s motivation, familial shared decision-making, development of problem-solving skills, goal setting, action plans, and self-efficacy. Self-efficacy is the extent to which a person is able to successfully initiate and complete actions needed to achieve a specific outcome.17 Self-efficacy influences how individuals approach goals, tasks, and challenges. Individuals with high self-efficacy tend to be more confident in confronting challenging tasks, while individuals with low self-efficacy tend to avoid challenges altogether.17 Interventions that strengthen a patient’s self-efficacy result in positive changes in health behaviors and improved health outcomes.11,18,19 There are 4 key sources of self-efficacy: mastery, vicarious experience, verbal persuasion, and emotional regulation.
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