Association Between Self-efficacy and Participation in Community-Dwelling Manual Wheelchair Users Aged 50 Years or Older

Background. Self-efficacy with using a wheelchair is an emerging construct in the wheelchair-use literature that may have implications for the participation frequency in social and personal roles of wheelchair users. Objectives. The aim of this study was to investigate the direct and mediated effects of self-efficacy on participation frequency in community-dwelling manual wheelchair users aged 50 years or older. Design. A cross-sectional study was conducted. Methods. Participants were community-dwelling wheelchair users (N=124), 50 years of age or older (mean=59.7 years), with at least 6 months of experience with wheelchair use. The Late-Life Disability Instrument, the Wheelchair Use Confidence Scale, the Life-Space Assessment, and the Wheelchair Skills Test-Questionnaire Version measured participation frequency, self-efficacy, life-space mobility, and wheelchair skills, respectively. Multiple regression analyses with bootstrapping were used to investigate the direct and mediated effects. The International Classification of Functioning, Disability and Health was used to guide the analyses. Results. Self-efficacy was a statistically significant determinant of participation frequency and accounted for 17.2% of the participation variance after controlling for age, number of comorbidities, and social, support. The total mediating effect by life-space mobility, wheelchair skills, and perceived participation limitations was statistically significant (point estimate=0.14; bootstrapped 95% confidence interval=0.04, 0.24); however, the specific indirect effect by the wheelchair skills variable did not contribute to the total effect above and beyond the other 2 mediators. The mediated model accounted for 55.0% of the participation variance. Limitations. Causality cannot be established due to the cross-sectional nature of the data, and the self-report nature of our data from a volunteer sample may be influenced by measurement bias or social desirability, or both. Conclusion. Self-efficacy directly and indirectly influences the participation frequency in community-dwelling manual wheelchair users aged 50 years or older. Development of interventions to address low self-efficacy is warranted.