Faculty Bibliography

Background: Self-efficacy to manage chronic conditions affects patients' health-related behaviors and interactions with the healthcare system and therefore influences health outcomes. Few studies have explored the complex relationships between mental health, self-efficacy, and management of chronic disease. A greater understanding of these interactions could inform successful community programming for marginalized populations such as public housing residents. Harlem Health Advocacy Partners is a community health worker (CHW) program designed to close health and social outcomes gaps in residents living in New York City Housing Authority (NYCHA). This study uses survey data collected for this initiative to explore the relationship between mental health and self-efficacy to manage chronic conditions among NYCHA residents with asthma, diabetes, and/or hypertension, and assess whether key variables such as connectedness to health care, social isolation and general health influence this relationship.
Method(s): Five NYCHA housing developments were selected for the CHW intervention with five matched developments for comparison. Four-hundred adult residents with a chronic disease were recruited. Baseline intake interviews were conducted in person. Self-efficacy for managing chronic disease was measured with a 6-question scale. Depression was assessed using PHQ9 scores, a screen for the presence and severity of depression. Difficulty with mental health was assessed with questions on how difficult mental health problems made it to do work, take care of things at home, or get along with others. Bivariate analyses were conducted to assess the relationship between mental health and self-efficacy. A hierarchical linear regression model was run with mental health and other relevant variables (selected based on availability in the dataset and theoretical significance) as independent variables and self-efficacy as the outcome variable.
Result(s): Self-rated general health predicted the greatest amount of variance in self-efficacy (15.7%, p < 0.001). Mental health also contributed significantly; difficulty with mental health contributed 4.0% (p< 0.001) and depressive symptoms contributed 1.1% (p=0.03) to the variance in self-efficacy. Other variables, including demographics, type of insurance, connectedness to a primary care provider, and social isolation, were not associated with self-efficacy. Overall, the full model explained 22.5% of the variance in self-efficacy to manage chronic conditions.
Conclusion(s): NYCHA residents with mental health difficulty or depression represent a uniquely marginalized subpopulation of public housing residents, and were found to have lower self-efficacy than other residents, which may mean decreased ability to self-manage chronic medical conditions. Future research should explore relationships among mental health, self-management, and health care outcomes with the goal of augmenting targeted CHW interventions