To Örebro University

Background: Self-efficacy (SE) is fundamental to chronic disease management, emerging as a complex interplay of disease parameters, psychological resilience, social support, comorbidity burden, and financial resources [1]. This demonstrates the need for comprehensive assessment and intervention strategies that address these interconnected domains of wellness. This study investigates SE amongst individuals with idiopathic inflammatory myopathies (IIMs), examining its relationship with disease parameters and health behaviours using data from the Collating the Voice of People in Autoimmune Diseases (COVAD)- 3 study.

Objectives: To determine SE levels in IIMs compared with other rheumatic diseases (RMDs) and healthy controls (HC), identify its key predictors, assess associated health outcomes, and evaluate health behaviours linked to higher SE.

Methods: We analysed data from the COVAD-3 study cohort, including patient-reported outcomes and the Self-Efficacy in Managing Chronic Disease (SEMCD) scale [2]. Participants were stratified into high (>67th percentile, SEMCD 6.1) and low SE (<33rd percentile, SEMCD 3.6, Figure 1A) groups. Statistical analyses included descriptive statistics, correlation analyses, and multivariate logistic regression to identify SE predictors. Comparative analyses between groups utilised appropriate parametric and non-parametric tests. Based on identified predictors and outcomes, we propose a structured intervention model incorporating peer support, targeted education, and behavioural modification strategies. Thematic analysis was performed to provide qualitative insights into patient experiences and the factors influencing SE (Figure 1B).

Results: This analysis of 3,374 participants (439 IIMs, 2,135 RMDs, 800 HCs) from the COVAD-3 registry revealed lower SE scores amongst IIM patients (median SEMCD 5.33) compared to RMDs (5.66) [range 1-10]. IIM patients were characterised by older age at diagnosis, Caucasian predominance, and residence in high HDI regions. They demonstrated shorter disease duration, greater immunosuppressant use, increased autoimmune multimorbidity, and higher functional comorbidity scores compared to RMDs and HCs, while reporting smaller household sizes. Based on SEMCD scores, IIM patients were stratified: 84 showed low SE scores (SEMCD < 3.6) and 164 showed high SE in managing IIMs (SEMCD > 6.1) [Figure 1C, Table 1]. IIM patients with high SE reported significantly better outcomes, including greater satisfaction with life, better physical function (PROMIS Physical SF4a), improved mental health (PROMIS Mental), and better overall physical health (PROMIS Physical). They also had lower fatigue (VAS fatigue), less pain (VAS pain), lower disease activity, and reduced disease damage perception (all p values <.001). Patient trust in health insurance (p = 0.022) and global damage assessment (p = 0.022) were also positively correlated with SE. No significant difference in education level was found with SE in IIMs [Figure 1D]. The logistic regression analysis, adjusted for age, age at diagnosis, gender, and ethnicity identified predictors of high SE using the best-fit model. Factors such as resilience (BRS, OR: 2.582, 95% CI: 0.310–1.588, p = 0.004), regular exercise (OR: 3.563, 95% CI: 0.214–2.327, p = 0.018), and polytherapy (OR: 3.674, 95% CI: 0.184–2.419, p = 0.022) were the positive predictors of high SE. Individuals engaging in regular exercise were more likely to exhibit high SE. Alternatively, the need for increased doses of medication (OR: 0.242, 95% CI: -2.467– -0.369, p = 0.008), and increased levels of loneliness (OR: 0.501, 95% CI: -0.995 – -0.385, p < 0.001) were identified as barriers to high SE, thereby reducing the probability of achieving the confidence in managing IIMs effectively. The predictive model demonstrated robust performance (accuracy 84.2%, sensitivity 91.8%, specificity 70.6%) [Figure 1E]. Thematic analysis identified resilience, exercise, and social support as key enhancers of SE, while loneliness and medication burden emerged as significant barriers in IIM management.

Conclusion: Self-efficacy emerges as a crucial determinant of physical and mental well-being in individuals living with IIMs. Our findings illuminate a complex interplay of factors: while resilience, regular exercise, and comprehensive medical management foster confidence in self-management, social isolation and treatment burden pose significant challenges. These insights underscore the importance of holistic care approaches that extend beyond traditional medical management. Tailored interventions integrating physical activity, psychological resilience building, and social support networks could meaningfully enhance self-management capabilities and overall wellness in this challenging chronic condition.