The influence of patient engagement and self-efficacy on self-care in myeloproliferative neoplasms: A mediation analysis

Purpose To identify predictors of self-care in patients with myeloproliferative neoplasms (MPN) and test the role of self-efficacy in mediating the relationship between patient health engagement and self-care. Methods A cross-sectional study was carried out in 9 haematology centres across Italy. A sample of adult patients with essential thrombocythemia (ET), polycythaemia vera (PV), and myelofibrosis (MF) was recruited from outpatient settings. Participants completed a paper-based questionnaire assessing self-care (Self-Care in MyeloProliferative Neoplasms Inventory, SC-MPNI), self-efficacy (Self-Care Self-Efficacy Scale, SCSES), patient health engagement (Patient Health Engagement Scale, PHE-Scale), and socio-demographic and clinical characteristics. Regression analysis and structural equation modelling (SEM) were used. Results Participants were 282 patients with a diagnosis of PV (n = 78, 28.1 %), ET (n = 82, 29.5 %), and MF (n = 118, 42.4 %) (M = 60 years, SD = 13.5). Several predictors of self-care were identified, including level of education, working full-time, time since diagnosis, spirituality, and the haematologist's clarity on advising patients on what to do in daily life. The SEM showed that patient health engagement had a positive effect on self-efficacy (β = 0.40), which in turn had a positive impact on self-care maintenance (β = 0.32), self-care monitoring (β = 0.47), and self-care management (β = 0.51). Self-efficacy fully mediated the relationship between engagement and self-care. Conclusions Higher patient health engagement can enhance self-care behaviours in people with MPNs by increasing their self-efficacy.