The impact of primary care patients' pain and emotional problems on their confidence with self-management

J Ambul Care Manage. 2008 Apr-Jun;31(2):120-7. doi: 10.1097/01.JAC.0000314702.57665.a0.


There is a paucity of information about confidence with self-management in primary care practice. This study examines changes over time in patient-reported confidence with self-management on the basis of 1047 patients aged 50-69 who had common chronic diseases, bothersome pain, or emotional problems. We examined the relationship between patients' self-reported confidence, their experiences of medical care, and health outcomes after adjustment for baseline characteristics. We observed that, over a 2-year period, about a third of the patients remained confident and a third remained not confident. Change in pain or emotional problems was strongly associated with whether a patient was confident or not at the end of the follow-up period (P < .001). Persistently good confidence or improved confidence was strongly associated with measures of high-quality medical care. For patients with diabetes, persistent confidence was more often associated with control of blood glucose (P = .004) compared with the control in patients who were not as confident. Confident patients were likely to be fully engaged in everyday work and activities (P < .001). The results suggest that for the majority of patients in primary care practices, the status of their self-reported confidence with self-management persists over time. Their confidence is impacted by their pain or emotional state and strongly associated with their medical care experiences and some outcomes of care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Affective Symptoms* / therapy
  • Aged
  • Chronic Disease
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Middle Aged
  • New England
  • Pain Management
  • Pain*
  • Patients / psychology*
  • Primary Health Care*
  • Self Care*
  • Self Efficacy*