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Self-efficacy as a mediator between physical and psychological factors in the disease management of patients with occupational respiratory diseases: a structural equation model

Katrin Mueller, Christina Niermann, Nicola Kotschy-Lang, Petra Wagner


Objectives: Sustaining physical capacity and reducing psychological symptoms are important, person-centered aims in the disease management of patients with occupational lung diseases. Self-efficacy is an individual resource that appears crucial in disease management. The objective of this study is to explore the association between the severity of disease, psychological risk, self-efficacy and physical capacity.

Methods: In a cross-sectional study, 197 patients (age: M = 69.9 years) with occupational lung diseases were included at the beginning of inpatient rehabilitation. The parameters were objectively (FEV1%pred, FVC%pred) and subjectively measured severity of disease (mMRC), psychological risk (HADS-D, CRQ Emotion), self-efficacy (CSES-D) and physical capacity (6MWD).

Results: Illness-specific self-efficacy is significantly correlated with FEV1%pred, FVC%pred, perceived dyspnoea, depression, anxiety and physical capacity. Structural equation models revealed a negative effect of psychological risk on physical capacity mediated by self-efficacy with a good model fit.

Conclusions: The results emphasize the relevance of patients’ self-efficacy in the disease management of occupational lung diseases. Self-efficacy directly affects physical capacity and mediates the effect of psychological health on physical capacity. Psychological risk factors such as depressive symptoms are negatively related to self-efficacy in managing lung disease in difficult situations. However, self-efficacy is a psychological resource which is positively related to physical capacity. Therefore, our results suggest that promoting self-efficacy during rehabilitation could improve disease management in patients with occupational lung diseases.


Cognitive behavioural therapy, disease management, interpersonal psychotherapy, occupational respiratory diseases, person-centered healthcare, physical capacity, psychological risk, self-efficacy, severity of diseases, structural equation model

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