604-P: Self-Efficacy: Relationships with Diabetes Self-Care, Medication Adherence, and Diabetes Distress among Diverse Adults with Suboptimally Controlled Type 2 Diabetes (T2D)

Background: Self-efficacy has been inconsistently operationalized in diabetes, with measures often failing to focus on confidence in one’s capacity to perform self-care. Measures that focus on confidence have been shown to be closely associated with self-care behaviors, but received limited psychometric evaluation and have not been examined in relation to diabetes distress.

Methods: We examined the reliability and factor structure of a previously published 8-item scale evaluating self-efficacy for diabetes self-care activities adapted by Sarkar and colleagues in 2006. We assessed cross-sectional relationships in baseline data with overall diabetes self-care, medication adherence, and diabetes distress among 812 predominantly Latino adults with T2D. They participated in a self-management support trial (Female = 56.9%; Latino = 86.5%) ; Mean (SD) Age and A1C = 59.2 (10.8) , 9.3 (1.8) , respectively.

Results: The scale demonstrated good internal reliability in the overall sample (α = .80) and among English (n = 179, α = .77) and Spanish (n = 633, α = .80) speakers. Exploratory factor analysis yielded a single factor, explaining 42% of the variance in self-efficacy scores. After adjusting for covariates, higher self-efficacy was independently associated with better diabetes self-care (β = .56, p < .001) , better medication adherence (β = .30, p < .001) , and lower diabetes distress (β = -.42, p < .001) . Moderation analyses suggested consistency in these relationships across age, gender, SES, language, health literacy and numeracy.

Conclusions: To our knowledge, the factor structure of this diabetes self-efficacy scale has not been previously evaluated. Findings suggest self-efficacy is a robust correlate of T2D self-care, medication adherence, and distress. The scale is appropriate for predominantly disadvantaged English and Spanish speakers with varying health literacy and numeracy levels.