health psychology report · volume 6(2), 8 Danuta Rode

original article 1 · A,B,C,D,E,F

Magdalena Marta Rode
2 · A,B,C,D,E,F

The relationship between self-esteem, sense

of self-efficacy and level of illness acceptance,
and healthful behaviours in patients with long-term
illnesses (type II diabetes, Hashimoto’s disease)

background results
Hashimoto thyroiditis and type II diabetes are chronic dis- The results show that for the group of type II diabetes
eases which have adverse consequences impacting emo- patients self-efficacy constitutes a statistically significant
tional and cognitive functioning. Healthful behaviours fo- moderate positive predictor of psychological attitude and
cused on improvement of one’s health or on combating the appropriate eating habits, and is a positive weak predictor
illness play a key role in psychosocial functioning of a per- of general healthful behaviour and prophylaxis at the ten-
son, particularly one suffering from a long-term illness. The dency level. For Hashimoto’s sufferers the sense of self-ef-
aim of the research was the measurement and analysis of ficacy is a  statistically significant moderate predictor of
healthful behaviours and the distinction of variables de- healthful behaviours.
termining healthful behaviours. We attempted to examine
the connection between adhering to healthful behaviours, conclusions
and the level of illness acceptance, self-efficacy and self-es- The study investigated significant relations between the lev-
teem, in terms of exhibiting healthful behaviours in the el of illness acceptance, the sense of self-efficacy and self-es-
above-mentioned groups of patients. teem, and engagement in healthful behaviour. The sense of
self-efficacy determines higher healthful practices in both
participants and procedure research groups. The study allowed for a comparison of two
The study group consisted of 140 persons (70 persons with groups of long-term illnesses sufferers – type II diabetes,
type II diabetes, 70 persons with Hashimoto’s disease). The and Hashimoto’s disease – in terms of adhering to healthful
following measurement techniques were used: the Health behaviours, and dependencies between selected psycholog-
Behaviour Inventory by Z. Juczyński, the General Self-Ef- ical variables and patients’ preferred healthful behaviours.
ficacy Scale by R. Schwarzer and M. Jerusalem adapted for
Polish by Z. Juczyński, the Acceptance of Illness Scale by key words
B. J. Felton, T. A. Revenson and G. A. Hinrichsen, and the health behaviour; self-efficacy; Hashimoto thyroiditis;
Self-Esteem Scale by M. Rosenberg. type II diabetes; long-term illness

organization – 1: University of Social Sciences and Humanities, Warsaw, Poland · 2: Institute of Psychology, University
of Silesia in Katowice, Katowice, Poland
authors’ contributions – A: Study design · B: Data collection · C: Statistical analysis · D: Data interpretation ·
E: Manuscript preparation · F: Literature search · G: Funds collection
corresponding author – Magdalena Marta Rode, Ph.D., Institute of Psychology, University of Silesia in Katowice,
Katowice, Poland, e-mail: [email protected]
to cite this article – Rode, D., & Rode, M. M. (2018). The relationship between self-esteem, sense of self-efficacy
and level of illness acceptance, and healthful behaviours in patients with long-term illnesses (type II diabetes,
Hashimoto’s disease). Health Psychology Report, 6(2), 158–170. doi: https://doi.org/10.5114/hpr.2018.71635
received 10.02.2017 · reviewed 04.05.2017 · accepted 16.06.2017 · published 07.12.2017
 Background and behavioural contribution. It is also moderated by
socio-economic status (Carlson et al., 2014), peer and
Long-term illnesses have adverse consequences af- societal influence (Salvy, de la Haye, Bowker, & Her-
fecting many areas of human functioning, impact- mans, 2012), structural barriers and factors relating
ing primarily its emotional and cognitive elements to access (Riis, Grason, Strobino, Ahmed, & Minkov-
(Ogińska-Bulik, 2014). One starts to lose certain per- itz, 2012), knowledge, motivations and beliefs (Hag-
sonal resources such as the sense of self-worth and ger & Chatzisarantis, 2009; Plotnikoff, Costigan, Ka­
self-efficacy, as well as interpersonal relationships, runamuni, &  Lubans, 2013). Another factor which
leading to a  potential deterioration of the way one indirectly, by means of affective states, determines
deals with the illness itself (Heszen-Niejodek, 2003). introducing pro-health performance in order to
Occurrence of chronic disease implies general achieve well-being is self-compassion (Zessin, Dick- The relationship
health condition deterioration and subsequently sec- häuser, &  Garbade, 2015; Sirois, Kitner, &  Hirsch, between
ondary health problems (Dixon-Ibarra & Horner-John- 2015). Taking pro-health actions in chronic diseases self-esteem, sense
son, 2014; Maddigan et al., 2003). Healthful behav- also depends on the mental state of the person – in of self-efficacy
particular the occurrence of mental disorders (Xiang, and level of illness
iours focused on improvement of one’s health or on
2016), motivational constructs (e.g. motivational acceptance
combating the illness play a key role in psychosocial
functioning of a  person, particularly one suffering self-efficacy, risk perception, outcome expectan-
from a  long-term illness. So far, research into this cies, goal setting), and volitional constructs (action
and coping planning, social support, action control,
subject has strongly focused on lifestyle and psy-
maintenance and recovery self-efficacy) (Schwarzer,
chology of the ill, as well as on offering assistance in
Lippke, & Luszczynska, 2011). The self-regulation ap-
coming to terms with becoming ill (Morris, Shake-
proach in health management is currently the most
speare-Finch, &  Scott, 2007; Linley &  Joseph, 2008;
prevalent in explaining the mechanisms of health be-
Linley, Joseph, Harrington, &  Wood 2006; Tedeschi
haviour’s actions (Lansing &  Berg, 2014; Mann, de
& Calhoun, 2007; Ogińska-Bulik, 2013). It is therefore
Ridder, &  Fujita, 2013). It should be noted that the
relevant to analyse the connection between psycho-
factors responsible for health-promoting activities
logical variables and the behaviour of persons suffer-
are different due to clinical groups.
ing from long-term illnesses. One of the key elements
The aim of the present research was the measure-
guiding one’s motivation to improve one’s health and
ment and analysis of healthful behaviours of persons
to fight the illness is the image one has of oneself,
suffering from type II diabetes and Hashimoto’s dis-
one’s likes, desires, values, and goals – self-esteem,
ease, and the distinction of variables determining
often referred to as a motivational image of oneself their healthful behaviours. We attempted to exam-
(Brunstein, 2003; Nolen-Hoeksema &  Davis, 2004; ine the connection between adhering to health-
Rheinberg, 2006). Persons suffering from a long-term ful behaviours, and the level of illness acceptance,
illness, who at the same time have a high, stable and self-efficacy and self-esteem, in terms of exhibiting
mature sense of self-worth, can effectively cope with healthful behaviours in the above-mentioned groups
accepting and adjusting to it (Wojciszke, 2003). Un- of patients. According to ICD-10, type II diabetes is
dervaluation of oneself reduces motivation and pos- described as insulin-independent diabetes (caused
itive emotional dynamics, thus decreasing the effec- by hormone secretion disorder of the pancreas), its
tiveness of actions taken to combat long-term illness development caused by lifestyle (obesity, station-
(Nowak & Tomiak, 2004; Szpitalak & Polczyk, 2015). ary lifestyle) and genetic factors (Otto-Buczkowska,
The sense of self-efficacy is motivationally sig- 2003). Hashimoto’s disease, a  prolonged inflamma-
nificant, constituting one of the fundamental mech- tion of the thyroid (ICD-10 classification: E06 – Thy-
anisms of self-regulation of human behaviour. The roiditis), belongs to a group of autoimmune defects of
generalized sense of self-efficacy is perceived as internal secretion glands.
the ability to change one’s behaviour, and is tied The course of both these diseases is gradual, oc-
to such healthful behaviours as exercising regular- curring in increments which often remain impercep-
ly, controlling food related attention and behaviour, tible. The damage caused by Hashimoto’s disease and
preventing and abandoning smoking and other type II diabetes is severe and irreversible. Symptoms
addictions (Schwarzer &  Fuchs, 1996; Juczyński, of Hashimoto’s disease appear gradually, along with
2000). Research results also indicate that pro-health the deterioration of the thyroid and a  decrease in
behaviours are highly dependent on the patient’s hormone production, leading to heart disease, infer-
beliefs considering the causal conditions of the ill- tility, and even coma. Diabetes leads to the develop-
ness. Perceiving the illness root in genetic factors ment of severe complications: circulatory disorders,
diminishes self-efficiency in introducing pro-health diabetic kidney and eye diseases. The treatment of
lifestyle (Condit et al., 2009); however, research by both Hashimoto’s disease and type II diabetes is com-
Nguyen, Oh, Moser and Patrick (2015) showed no dif- plex and requires the application of several treatment
ferences in pro-health behaviours in terms of genetic methods. Among these are non-pharmacological

volume 6(2), 8 159

 methods such as diet and exercise, as well as phar- Ethics
macological approaches
For persons in the aforementioned groups regu- This research project was reviewed and approved by
lar ingestion of medicine is a necessary condition for the Scientific Research Ethics Commission of the In-
maintaining one’s wellbeing, and for maintaining the stitute of Psychology of the University of Silesia.
body in relative homeostasis. Hashimoto’s and type II
diabetes sufferers are to a large extent dependent on
ingestible drugs. Dysfunctions of endocrinal secre- Research procedure
tions require constant monitoring of health through
periodic visits to endocrinology/diabetic clinics and Research was conducted in Voivodship Endocrinolo-
performing regular tests. Treating type II diabetes gy Clinics (Voivodship Specialist Clinic Workgroup)
Danuta Rode,
Magdalena Marta and Diabetes Clinics, upon receiving the expressed
requires one to adhere to doctor’s orders, such as
Rode consent of the directors of said clinics. Participa-
weight loss, maintaining a diabetic diet, and increas-
tion was voluntary and anonymous. Patients were
ing physical activity. Hashimoto’s disease treatment
informed of the aim and method of research. Most
requires regular ingestion of thyroid hormones, and
of the time there were two meetings with each pa-
monitoring of hormone levels and the psychological
tient. Part of the research was conducted by Dawid
state of the patient. Hypoactive thyroid and blood
Newski in the course of preparation of his Masters
sugar disorders are long-term illnesses and require
dissertation entitled “The relationship between select
the application of practices aimed at preventing their
personality traits and the level of illness acceptance,
adverse consequences and complications. and healthful behaviours in patients suffering from
long-term illnesses”.
Participants and procedure
Research tools
Research questions
1. Health Behaviour Inventory (Inwentarz Zach-
The following research questions were formulated: owań Zdrowotnych) by Z. Juczyński
1. Which group of long-term illness sufferers type The Inventory consists of 24 statements describing
II diabetics or Hashimoto’s diseases sufferers will various health-related behaviours. The general level
show more healthful behaviours? of healthful behaviours is determined on the basis of
2. Are there differences in illness acceptance levels the frequency of each behaviour as stated by the sub-
between Hashimoto’s disease and type II diabetes ject. The Inventory specifies 4 categories of healthful
sufferers? behaviours: appropriate eating habits, prophylaxis,
3. Do illness acceptance, self-efficacy and self-esteem healthful practices, and positive psychological atti-
levels determine the level of healthful behaviours? tude. The subject rates each behaviour based on the
last 12 months. The answers provided allow for the
determination of the general indicator of healthful
Participants behaviour tendency. Individual results are also relat-
ed to specific sub-scales of the questionnaire. Inter-
One hundred fifty-six persons took part in the study. nal consistency of the Health Behaviour Inventory
Results of 140 individuals were included in the study, was determined based on Cronbach’s α, which is .85
including 70 persons with medically diagnosed type for the entire Inventory, and between .60 and .65 for
II diabetes, and 70 persons with medically diagnosed each of the four sub-scales.
Hashimoto’s disease. Persons who suffered from both 2. General Self-Efficacy Scale (GSES) R. Schwarzer, M.
type II diabetes and hypoactive thyroid were exclud- Jerusalem adapted for Polish by Z. Juczyński
ed from the study. Participants were from Śląskie, The Scale was created by Schwarzer and Jerusa-
Małopolskie and Opolskie voivodships in Poland. lem, translated into Polish and adapted for Polish by
There were 35 male and 35 female subjects suf- Juczyński (2009). It refers to the concept of expecta-
fering from type II diabetes. The age range for this tions and the sense of self-efficacy formulated by Ban-
group was 31–68 years (M = 52.10, SD = 11.40). There dura (1977). Efficacy is defined as a sense of control
were 54 female and 16 male subjects suffering from exerted over actions being taken. The sense of self-ef-
hypothyroidism (Hashimoto). The gender inequali- ficacy can be determined with regards to a specific ac-
ty stems from the fact that thyroid disorders affect tivity, i.e. coping with a long-term illness. The results
mostly women (Ponichtera &  Borowiak, 2008). The are given by summation over all answers, resulting in
age range for this group was 23–62 years (M = 48.20, a general sense of self-efficacy indicator. Cronbach’s
SD = 12.80). The time since the patient’s illness diag- α coefficient is .85. The scale reliability, assessed by
nosis ranged from 5 to 10 years (M = 7.44, SD = 3.64). the test-retest method (5-week interval), is .78, and

160 health psychology report

the discriminatory power coefficient is .85. The tool ferences in healthful behaviours and self-esteem were
was validated before it was used for this study. evaluated using two-factor ANOVA variance analysis
3. The Acceptance of Illness Scale (AIS) B. J. Felton, with gender differentiation. Individual variables as
T. A. Revenson and G. A. Hinrichsen adapted for determinants of adherence to healthful behaviours
Polish by Z. Juczyński were assessed by means of forced entry and stepwise
The scale was designed by Felton and Revenson regression analysis. The tool was translated into Pol-
(1984) and contains statements describing negative ish and validated before it was used for the study.
consequences of poor health. Increased level of illness
acceptance causes better adjustment and diminished
sense of psychological discomfort. The results are Results
given by summation over all answers, resulting in The relationship
a general illness acceptance indicator. Cronbach’s α Adherence to healthful behaviours between
coefficient is .85. The scale reliability, assessed by the in patients treated for type II diabetes, self-esteem, sense
test-retest method (4-week interval), is .64. The meas- and Hashimoto’s disease sufferers of self-efficacy
urement tool was translated into Polish and validated and level of illness
by Z. Juczyński. A  two-factor ANOVA variance analysis was em- acceptance
4. Self-Esteem Scale (SES) M. Rosenberg ployed to determine whether there are significant dif-
The SES questionnaire by Morris Rosenberg al- ferences between Hashimoto’s disease sufferers and
lows one to obtain the global self-esteem indicator. persons treated for type II diabetes in terms of ad-
Self-esteem is defined as a  positive or a  negative herence to healthful behaviours. The factors were the
approach to the self, understood as a form of global illness (type II diabetes vs. Hashimoto’s), and gender
evaluation of oneself which remains fairly stable in (female vs. male). General healthful behaviours and
adults (Dzwonkowska, Łachowicz-Tabaczek, & Łagu- four dimensions (appropriate eating habits, prophy-
na, 2008, p. 7). The reliability of the Polish version, laxis, positive psychological attitude, healthful practic-
determined by Cronbach’s α coefficient, falls be- es) were dependent variables.
tween .81 and .83. There are distinct norms for men A statistically significant main effect of the illness
and women, for three different age groups: adoles- type was observed only for two dimensions: appro-
cents, young adults, and adults. priate eating habits, and positive psychological atti-
Normal distribution for variables being measured tude (Table 1). Type II diabetics scored higher on ap-
was assessed; the skewness and kurtosis for the ma- propriate eating habits, while Hashimoto’s sufferers
jority of variables being measured were within the showed higher positive psychological attitude. There
range < –1 : 1 >. This confirmed the normal distri- was also a  statistically significant effect of type of
bution of variables. Illness acceptance and the sense illness and gender interaction on appropriate eating
of self-efficacy were notable exceptions, both being habits (Table 2). For men, diabetics scored higher for
characterized by leftward leptokurtic distribution. appropriate eating habits than patients with thyroid
The Mann-Whitney U test was used to analyse the dif- deficiency – Hashimoto illness (p < 0.050). There was
ferences in variables in both groups. Intergroup dif- no such difference in the female group.

Table 1
Summary of F statistics for effect of main illness type on healthful behaviours
Type II diabetes Hashimoto F(1, 112) p η2
M SD M SD
Healthful
89.56 15.07 88.83 13.27 1.64 .240 .016
behaviours
Appropriate
22.36 4.41 21.92 4.55 6.32 .050 .056
eating habits
Prophylaxis 23.01 4.07 22.97 4.25 0.25 .680 .004
Positive
psychological 22.32 4.01 20.02 3.46 0.45 .030 .025
attitude
Healthful
21.78 5.02 20.97 4.01 0.19 .590 .001
practices
Note. M – mean, SD – standard deviation, F – ANOVA analysis statistic, p – significance, η2 – eta.

volume 6(2), 8 161

 Table 2
Summary of F statistics for effect of illness and gender interaction on healthful behaviours

Type II diabetes Hashimoto F(1, 112) p η2

Gender M SD M SD
Healthful M 87.34 15.82 81.83 12.53
0.12 .790 .004
behaviours F 91.89 12.36 91.02 12.39
Appropriate M 22.03 4.79 17.76 2.80
5.33 .040 .051
eating habits F 22.02 4.01 21.86 4.53
Danuta Rode,
Magdalena Marta M 21.98 4.43 21.81 4.62
Rode Prophylaxis 0.06 .790 .011
F 23.96 3.46 23.71 4.21
Positive M 22.79 3.78 21.98 3.73
psychological 0.09 .850 .003
attitude F 23.40 4.02 23.10 3.32

Healthful M 20.58 5.61 21.63 4.65

2.54 .210 .027
practices F 22.80 4.37 21.01 3.92
Note. M – mean, SD – standard deviation, F – ANOVA analysis statistic, p – significance, η2 – eta, M – male, F – female.

Next the authors assessed whether there were lar for type II diabetes patients and for Hashimoto’s
differences in levels of illness acceptance between disease sufferers.
persons with type II diabetes and Hashimoto’s dis- The next step of the analysis was establishing the
ease sufferers. The Mann-Whitney U  test was used, determining factors of healthful behaviours for pa-
with illness type as an independent variable (diabe- tients with type II diabetes and Hashimoto’s disease
tes vs. thyroid) and the level of illness acceptance as sufferers. To do this we employed a series of regres-
a dependent variable. There were statistically signif- sion analyses with healthful behaviours as the de-
icant intergroup differences for participants overall, pendent variables, and other variables as independ-
as well as for females and males (Table 3). Type II ent variables (i.e. illness acceptance, self-efficacy,
diabetes patients exhibited lower levels of illness ac- self-esteem). We assessed whether illness acceptance
ceptance than ones with a thyroid disorder. is a  predictor of adhering to healthful behaviours.
Next we assessed whether there were differences The results show that for both type II diabetics and
in the sense of self-efficacy between type II diabetes Hashimoto’s sufferers illness acceptance is not a de-
and Hashimoto’s diseases sufferers. The Mann-Whit- terminant of healthful behaviour (Tables 5 and 6).
ney U  test was employed with illness type (type II It was assumed that the sense of self-efficacy
diabetes vs. Hashimoto’s) as an independent variable, would be a determinant of adhering to healthful be-
and the sense of self-efficacy as a dependent variable. haviours in the groups being studied (Tables 7 and 8).
The calculations were performed for the population The results of regression analysis using the
as a whole, and with gender differentiation. “forced entry” method show that for the group of
There was no statistically significant intergroup type II diabetes patients self-efficacy constitutes
difference for the population, or for female and male a  statistically significant moderate positive predic-
groups (Table 4). The sense of self-efficacy was simi- tor of psychological attitude and appropriate eating

Table 3
Summary of U statistic for the effect of illness type on illness acceptance

Gender Type II diabetes Hashimoto U p

M SD M SD
O 27.51 6.22 35.01 5.71 710.00 .001
Illness acceptance M 26.52 6.17 34.60 3.45 65.59 .010
F 26.91 6.05 34.23 6.15 289.00 .001
Note. M – mean, SD – standard deviation, U – Mann-Whitney’s U test statistic, p – significance, O – overall, M – male, F – female.

162 health psychology report

Table 4
Summary of U statistic for the effect of the illness type on the sense of self-efficacy

Gender Type II diabetes Hashimoto U p

M SD M SD
O 32.01 3.31 31.10 3.97 1462.11 .480

Sense of self-efficacy M 31.82 3.74 31.68 3.41 169.01 .940

F 32.03 3.57 31.82 4.17 567.00 .490

The relationship
Note. M – mean, SD – standard deviation, U – Mann-Whitney’s U test statistic, p – significance, O – overall, M – male, F – female. between
self-esteem, sense
Table 5 of self-efficacy
and level of illness
Summary of regression coefficients for “forced entry” method for the relationship between illness acceptance acceptance
and healthful behaviours of patients with type II diabetes

Explained variable Non-standardized Standardized F(1, 53) R2 p

coefficients coefficients
B Standard β
error
Healthful (const.) 75.81 9.32
behaviour .26 2.41 .06 .170
(general) Illness acceptance 0.51 0.34

Appropriate (const.) 20.02 2.92

.24 2.54 .12 .150
eating habits Illness acceptance 0.17 0.13
(const.) 20.80 2.76
Prophylaxis .15 0.80 .05 .400
Illness acceptance 0.13 0.10
Positive (const.) 21.00 2.56
psychological .20 1.82 .05 .210
attitude Illness acceptance 0.22 0.12

Healthful (const.) 18.01 3.32

.21 1.65 .07 .260
practices Illness acceptance 0.16 0.14

habits, and is a  positive weak predictor of general In the group of type II diabetes patients self-esteem
healthful behaviour and prophylaxis at the tendency is a statistically significant moderate predictor of gener-
level. For Hashimoto’s sufferers the sense of self-ef- al healthful behaviours, positive psychological attitude,
ficacy is a statistically significant moderate predictor and appropriate eating habits. In the Hashimoto’s group,
of healthful behaviours. It might be suggested that self-esteem is a statistically significant moderate deter-
a higher sense of self-efficacy results in higher scores minant of positive psychological attitude, and, similarly
for overall healthful behaviours and appropriate eat- to diabetics, is a weak predictor of prophylaxis.
ing habits for this group, while also being related to
prophylaxis and the maintenance of a positive psy-
chological attitude during illness. Discussion
Self-esteem was considered to be an important
determinant of healthful behaviours in ill persons, The study was designed to, on the one hand, estab-
particularly ones suffering from long-term illnesses. lish the level of healthful behaviours in long-term
Accounting for different functions played by self-es- sufferers of type II diabetes and Hashimoto’s disease
teem – protection from fear (Greenberg, Pyszczynski, and, on the other hand, to determine whether there
& Solomon, 1986), stress and misfortune (Baumeister are significant dependencies between the sense of
et al. 2003) or maintaining alertness (Roese & Olson, self-efficacy, the level of illness acceptance, self-es-
2007) – this variable was included in the study. The teem, and healthful behaviours of diabetics and pa-
results are given in Tables 9 and 10. tients with hypoactive thyroid.

volume 6(2), 8 163

 Table 6
Summary of regression coefficients for “forced entry” method for the relationship between illness acceptance
and healthful behaviours of Hashimoto’s disease sufferers

Explained Non-standardized Standardized F(1, 53) R2 p

variable coefficients coefficients
B Standard β
error
Healthful (const.) 84.02 10.71
behaviour .05 0.15 .02 .710
Danuta Rode, Illness acceptance 0.15 0.38
(general)
Magdalena Marta
Rode Appropriate (const.) 21.62 3.79
–.04 0.05 .01 .910
eating habits Illness acceptance –0.08 0.15
(const.) 23.16 3.61
Prophylaxis .03 0.01 .02 1.000
Illness acceptance 0.07 0.12
Positive (const.) 19.43 2.75
psychological .19 1.56 .06 .250
attitude Illness acceptance 0.12 0.11

Healthful (const.) 21.01 3.42

.08 0.19 .02 .710
practices Illness acceptance 0.09 0.13

Table 7
Summary of regression coefficients for “forced entry” method for the relationship between the sense of self-effi-
cacy and healthful behaviours of patients with type II diabetes

Explained Non-standardized Standardized F(1, 56) R2 p

variable coefficients coefficients
B Standard β
error
Healthful (const.) 61.62 17.10
behaviour Sense of self- .23 2.81 .06 .100
(general) 0.91 0.60
efficacy
(const.) 14.03 4.32
Appropriate
.15 2.66 .02 .010
eating habits Sense of self- 0.17 0.12
efficacy
(const.) 14.51 4.80
Prophylaxis Sense of self- 026 3.33 .05 .090
0.28 0.16
efficacy
Positive (const.) 11.21 4.42
psychological Sense of self- .37 7.51 .15 .010
attitude 0.42 0.16
efficacy
(const.) 20.98 5.97
Healthful
Sense of self- .04 0.02 .04 .940
practices 0.06 0.21
efficacy

164 health psychology report

Table 8
Summary of regression coefficients for “forced entry” method for the relationship between the sense of self-effi-
cacy and healthful behaviours of Hashimoto’s disease sufferers

Explained Non-standardized Standardized F(1, 56) R2 p

variable coefficients coefficients
B Standard β
error
Healthful (const.) 4.91 12.67
behaviour Sense of self- .39 10.04 .15 .001 The relationship
(general) 1.35 0.43
efficacy between
self-esteem, sense
(const.) 10.61 4.57
Appropriate of self-efficacy
.37 5.01 .06 .020
eating habits Sense of self- 0.32 0.13
and level of illness
efficacy acceptance

(const.) 8.87 4.20

Prophylaxis Sense of self- .40 11.94 .17 .010
0.51 0.12
efficacy
Positive (const.) 13.30 4.21
psychological Sense of self- 0.34 7.90 .15 .030
attitude 0.29 0.10
efficacy
(const.) 14.98 4.35
Healthful
Sense of self- 0.16 1.57 .05 .160
practices 0.23 0.13
efficacy

Table 9
Summary of regression coefficients for “forced entry” method for the relationship between self-evaluation and
healthful behaviours of patients with type II diabetes

Explained Non-standardized Standardized F(1, 56) R2 p

variable coefficients coefficients
B Standard β
error
Healthful (const.) 56.65 11.97
behaviour .39 7.60 .13 .001
(general) Self-evaluation 1.10 0.45

(const.) 13.01 3.82

Appropriate
.33 6.01 .14 .040
eating habits
Self-evaluation 0.27 0.14

(const.) 15.89 3.76

Prophylaxis .30 3.90 .17 .100
Self-evaluation 0.20 0.13

Positive (const.) 12.84 3.21

psychological .34 10.92 .15 .001
attitude Self-evaluation 0.29 0.10
Healthful
(const.) 14.90 4.35 .24 2.61 .05 .150
practices

volume 6(2), 8 165

 Table 10
Summary of regression coefficients for “forced entry” method for the relationship between self-evaluation and
healthful behaviours of Hashimoto’s disease sufferers

Explained variable Non-standardized Standardized F(1, 56) R2 p

coefficients coefficients
B Standard β
error
Healthful (const.) 71.89 12.97
behaviour .18 1.40 .08 .230
Danuta Rode, Self-evaluation 0.49 0.48
(general)
Magdalena Marta
Rode Appropriate (const.) 21.49 4.90
–.04 0.04 .03 .870
eating habits Self-evaluation –0.04 0.15
(const.) 14.97 4.61
Prophylaxis .22 3.30 .05 .040
Self-evaluation 0.22 0.13
Positive (const.) 12.30 3.24
psychological .40 9.39 .15 .010
attitude Self-evaluation 0.29 0.12

Healthful (const.) 14.90 4.35

.24 2.61 .05 .150
practices Self-evaluation 0.21 0.13

Analysis of healthful behaviours practised by pa- miliarise themselves with their disease (Brakebusch
tients with type II diabetes and Hashimoto’s disease & Heufelder, 2015).
sufferers allowed us to establish differences in prac- The effect of type interaction between illness and
tice of appropriate eating habits, and positive psy- gender on appropriate eating habits was present only
chological attitude. Diabetics exhibited appropriate in the male group, while it was not observed for the
eating habits more frequently than Hashimoto’s female group. The lack of differences for both female
sufferers. One may assume this to be a result of sev- groups may be medical or psychological in nature.
eral factors: a more rigorous medication regime al- Both illnesses require weight control and a  signif-
lowing for a reduction of the number of life-threat- icant level of appropriate eating habits. Hypoactive
ening blood sugar drops (Zanuso, Jimenez, Pugliese, thyroid, much like diabetes, requires one to follow an
Coriglano, &  Balducci, 2010; Redekop et al. 2002; appropriate dietary regime. Due to social pressures
Sieradzki & Kokoszka, 2004), maintaining an appro- – wanting to have a  slim and attractive figure, and
priate body mass to avoid the problem of obesity the wish to be desired – women may have a predis-
(Bradley &  Speight, 2000; Kurowska &  Szomszor, position to appropriate eating habits even without
2011), and serious consequences of not adhering to doctor’s intervention. Based on our results, it may be
appropriate eating habits faced by diabetics – much stated that the differences resulting from healthful be-
more serious than for patients suffering from hypo- haviours for men suffering from type II diabetes, and
active thyroid. Patients receiving treatment for type Hashimoto’s, are to a large extent a result of medical
II diabetes experience direct consequences of failing advice, which is more restrictive for type II diabetes
to medicate (i.e. hypoglycaemia, hyperglycaemia), (i.e. the necessity of minimizing the threat to health
which is not the case for Hashimoto’s sufferers. and life of the patient), and not due to social attrac-
For Hashimoto’s disease sufferers the key element tiveness conditions, as may be the case for women.
of stabilizing their health is stress avoidance and Research results show that patients with type II
coping with stress. This is supported by research diabetes exhibit a  lower level of illness acceptance
results – an increase in healthful behaviours in the than persons suffering from hypoactive thyroid, re-
form of a  positive psychological attitude indicates gardless of gender. Lower illness acceptance is asso-
that patients try to avoid stress, strong emotions, ciated with decreased long-term illness adaptation,
and difficult and depressing situations. Accounting and thus with less efficient coping mechanisms. It is
for the fact that the triggering factor for Hashimo- assumed that today diabetes is one of the most psy-
to’s disease (as for every autoimmune disease) may chologically taxing long-term illnesses (Tatoń, 1992;
be stress or psychological disorders, sufferers con- Coffey, Brandle, Zhou, & Marriott, 2002; Bonenberg,
sciously avoid strong emotional stimuli as they fa- 2012). This is a result of, among other factors, the dai-

166 health psychology report

ly monitoring of blood sugar levels and controlling emotions, and suggesting that it may influence goal
other physiological parameters, requiring significant achievement and life satisfaction. High self-esteem
self-control and self-discipline from diabetics. These and belief in self-efficacy translates into an increased
requirements are far greater than those faced by pa- engagement with particular activity, i.e. maintain-
tients with hypoactive thyroid, which, while requir- ing a diet, and physical and psychological activity of
ing daily hormone ingestion, entails less frequent patients. The results obtained in this study confirm
check-ups. Greater involvement and self-control, studies by Baumeister et al. (2003), pointing to high
together with diabetes-related complications, makes self-esteem as a predictor of longevity and physical
diabetes much more difficult to accept. health due to active utilization of resources helpful in
The study investigated significant relations be- overcoming obstacles.
tween the level of illness acceptance, the sense of The study allowed for a comparison of two groups The relationship
self-efficacy and self-esteem, and engagement in of long-term illnesses sufferers – type II diabetes between
healthful behaviour. The sense of self-efficacy – the and Hashimoto’s disease – in terms of adhering to self-esteem, sense
belief that one is able to cope with the challenges of healthful behaviours, and dependencies between se- of self-efficacy
the illness – determines higher healthful practices in lected psychological variables and patients’ preferred and level of illness
both research groups. For the type II diabetes group healthful behaviours. While the study does not allow acceptance
the sense of self-efficacy is a  predictor of positive for the generalization of results to the population
psychological attitude and appropriate eating habits, of diabetics and endocrinological disorder sufferers,
as well as a predictor for general healthful practices they nevertheless allow for a  better understanding
and prophylaxis at the tendency level. Positive psy- of the relationship between the sense of self-efficacy,
chological attitude – avoidance of strong emotions self-esteem and illness acceptance, and healthful be-
and depressing situations – is conditional on an in- havioural practices.
ternal sense of being able to achieve one’s goals, and The obtained results allow for at least a  partial
on greater engagement in the chosen course of ac- consideration of introducing psychological care into
tion, even in the face of increasing health problems the therapy of Hashimoto’s and type II diabetes suf-
(Rodgers, Conner, &  Murray, 2008). Research con- ferers. The problems faced by patients, as well as
ducted on an extended health beliefs model showed their capabilities, necessitate the application of var-
that strong belief in one’s ability to control diabetes ious forms of such care. A prolonged somatic illness
and self-efficacy in taking illness-prevention actions often hinders or even prohibits the full realization
resulted in an awareness of the beneficial nature of of an individual’s developmental tasks, leading to
actions taken, while reducing perceived barriers re- psychological crises, and obstructing the progress of
lated to a  particular form of treatment (Starowicz, therapy. Both type II diabetics and thyroid disorders
2009; Woodcock, 2007). Appropriate eating habits, in sufferers would benefit from psychological consulta-
turn, affect the course of diabetes, limiting the ad- tions directed at developing new skills and activities
verse consequences and complications of this illness. in the patient and her immediate family (support
In Hashimoto’s disease sufferers the sense of self-ef- group). Psychological support should aim at develop-
ficacy effectively improves general healthful behav- ing healthy behaviours in the patient, and reducing
iours, appropriate eating habits, prophylaxis, and unhealthy tendencies (i.e. inappropriate diet, unhy-
positive psychological attitude. High sense of self-ef- gienic lifestyle). This course of therapy is particularly
ficacy may favour behaviours related to self-control relevant for diabetics, whereas Hashimoto’s sufferers
of physiological parameters, and to shaping an ob- ought to focus on coping with emotional stress (anx-
jective image of the illness, as well as serving as mo- iety, helplessness, anger, regret). It is necessary that
tivation for healthful actions in terms of prevention both groups work towards strengthening their mo-
and eating habits. tivation and hopefulness with regards to the treat-
Self-esteem is a  factor influencing the likelihood ment by, among other means, health education – the
of adopting healthful behaviours. The results show acquisition of an adequate view of one’s illness and
that higher self-esteem is associated with more one’s capabilities. These actions may be undertaken
healthful behaviours in patients being treated for as part of individual or group therapy.
type II diabetes (general healthful behaviours, ap-
propriate eating habits, prophylaxis, positive psy-
chological attitude). The fact that self-esteem is Limitations of the study
a  predictor for some healthful behaviours points to
its relevance, as well as to the consistency of the re- Finally we need to mention the limitations of this
search hypothesis with other studies (Dzwonkowska study and resultant future lines of inquiry. While the
et al. 2008; Diener & Diener, 1995; Furnham & Cheng, correlation analysis yielded a  lot of information, it
2000; Fila-Janowska 2009; Szpitalak & Polczyk, 2015) would be advisable to conduct qualitative studies in-
accepting that self-esteem predisposes one towards volving patients with type II diabetes and Hashimo-
positive affect and avoidance of strong negative to’s disease sufferers. Individual interviews would

volume 6(2), 8 167

 extend our biographical knowledge of these illness- Condit, C. M., Gronnvoll, M., Landau, J., Shen, L.,
es, and psychological functioning of those afflicted, Wright, L., &  Harris, T. M. (2009). Believing in
for different illness stages. The study did not consider both genetic determinism and behavioral action:
the significance of the length of the illness, its stag- A materialist framework and implications. Public
es, the symptoms being experienced, adverse conse- Understanding of Science, 18, 730–746.
quences, illness dynamics or social support – factors Diener, E., & Diener, M. (1995). Cross-cultural corre-
that probably influence psychological variables and lates of life satisfaction and self-esteem. Journal
patients’ coping with an illness. Another significant of Personality and Social Psychology, 68, 653–663.
factor worth researching is the positioning of the Dixon-Ibarra, A., & Horner-Johnson, W. (2014). Disa-
health locus of control in research groups, allowing bility Status as an Antecedent to Chronic Condi-
assessment of the overall sense of influence subjects tions: National Helath Survey, 2006–2012. Preven-
Danuta Rode,
Magdalena Marta feel they have over their own health (Cheng et al. ting Chronic Disease, 11, 30.
Rode 2016). Dzwonkowska, I., Lachowicz-Tabaczek, K., &  Łagu-
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long-term illness sufferers should be extended to ptacja skali SES M. Rosenberga [Self-esteem and
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