The major concern in the self-management of chronic illness is not in teaching skills to patients, but in being certain that they perform what they have been taught to control their disorder. The issue becomes more acute in considering how to be sure these patients continue to maintain the performance of these skills for as long as they need. Most of the current research centers on the construct of self-efficacy, the belief a patient has that he or she can perform self-management skills over time and across different situations. Other investigators, however, have looked at other constructs with respect to applying self-management or self-care. Yi and colleagues in an investigation of the role of resilience reported an example of such research in worsening HbA(1c) and self-care behaviors in the face of rising diabetes-related distress. A total of 111 patients with diabetes completed surveys and had their hemoglobin (HbA(1c)) assessed at baseline and at 1-year follow-up. Resilience, in turn, was defined by a factor score of self-esteem, self-efficacy, self-mastery, and optimism. Diabetes-related distress and self-care behaviors were also assessed. Results showed that baseline resilience, diabetes-related distress, and their interaction predicted physical health at 1 year. Patients with low, moderate, and high resilience were identified. Those with low or moderate resilience levels showed a strong association between rising distress and worsening HbA(1c) across time. However, those with high resilience scores did not show the same associations. Low resilience was also associated with fewer self-care behaviors when faced with increasing distress. These correlation coefficients remained significant after controlling for starting-points.

COMMENTS: The authors concluded that in patients with diabetes, resilience predicted future HbA(1c) and buffered worsening HbA(1c) and self-care behaviors in the face of rising distress levels. It likely did. Combining the factors of self-esteem, self-efficacy, self-mastery, and optimism into one measure, however, may have been unwieldy: measuring self-efficacy only would have likely produced similar findings. Resilience, in other words, may be too general a construct to use in practical clinical settings where health care personnel want to determine the factors leading to consistent and sustained performance of self-management. Still, this is an interesting study.

J.P. Yi et al. The role of resilience on psychological adjustment and physical health in patients with diabetes. British Journal of Health Psychology, Mar 1, 2007 (online).