Helping physicians understand the need for self-efficacy to be assessed so that it can be improved will impact other patient outcomes as well.

Although rheumatologists observe that HRQOL is impaired in patients with SLE, the impact of HRQOL on disease activity or damage is not thoroughly understood, explains Manuel Francisco Ugarte-Gil, MD, MSc. “If we help patients improve their self-efficacy, improvement in their HRQOL will follow,” he says. “Self-efficacy is the belief that one can perform a task necessary to reach a goal. Self-management programs that improve self-efficacy and fatigue, while diminishing limitations on various activities, reinforce the notion that HRQOL could also be modified in the same manner.”

This suggests that factors related to the patient might carry more weight on HRQOL than those related to the disease itself, according to Dr. Ugarte-Gil. “Self-efficacy is one of these factors, as it assesses a patients’ ability to perform tasks.”

However, the correlation between HRQOL and disease activity or damage is little to none, Dr. Ugarte-Gil points out. “In patients with neurological disorders, for instance, it’s been observed that self-efficacy for managing chronic conditions is a better predictor of improved mental health, lower disability rates, and global health than either diagnosis or disease severity,” he says. “But, in patients with SLE, the impact of self-efficacy on HRQOL has been scarcely evaluated.”

‘Strategies That Improve Self-Efficacy Need to Be Developed’

For a study published in Lupus Science & Medicine, Dr. Ugarte-Gil and colleagues aimed to define the possible predictive value of self-efficacy on HRQOL in patients with SLE, selecting patients from the Almenara Lupus Cohort. The study team evaluated data based on 564 visits from 209 patients, examining the impact of the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for managing chronic conditions. Most patients (92.8%) were women; mean age at diagnosis was 36.4 (14.0).

A PROMIS score of 50 is average for patients with a chronic condition; a higher score indicates greater self-efficacy. The researchers assessed HRQOL with the physical and mental component summary (PCS and MCS) measures of the Short-Form 36 (SF-36). They conducted generalized estimating equations using the self-efficacy domain during the first visit and PCS or MCS in the subsequent visit. For possible confounders, multivariable models were adjusted.

“Our study team observed that a better self-efficacy predicts better physical and mental components of HRQOL, even after adjusting for possible confounders,” Dr. Ugarte-Gil says. “As self-efficacy is a modifiable factor, strategies that improve self-efficacy need to be developed. We need to evaluate it and establish strategies to improve it, which will, in some cases, improve our patients’ capabilities, but also make their activities less complicated. For example, self-efficacy for managing medications and treatments could be influenced by the number of drugs used as well as by a less cumbersome schedule for taking them.” (Table)

‘Self-Management Programs Will Continue to Improve’

Dr. Ugarte-Gil and colleagues would like to see this study reinforce the relevance of existing programs aimed at improving self-management, particularly for people more affected by social determinants of health.

“Helping physicians understand that self-efficacy needs to be assessed so that it can be improved will impact other outcomes as well,” Dr. Ugarte-Gil notes. “Self-efficacy could also predict fatigue, adherence to treatment, and anxiety and depression. Additionally, self-management programs will continue to improve over the next few years and will be more readily available around the world. Therefore, we need to find possible interventions that could improve HRQOL.”