There has been little research on ways to help patients deal with systemic lupus erythematosus (SLE). A previous study conducted by our center found that patient self-efficacy (self-confidence) to manage SLE and social support were strongly associated with health status, even controlling for medical variables. This study aims to evaluate a theory-based educational intervention to improve patient self-efficacy and partner support to manage SLE in a randomized, controlled trial. Our intervention combines efficacy-enhancement, social support, and problem solving in a novel, and potentially powerful manner. Patient and partner will each identify areas of low self-efficacy for patient management of lupus, and be guided by a nurse educator through a problem-solving approach to one to two self-identified key problems, with 6 months of telephone follow-up. Partners will help with problem-solving, as well as learn how to provide more effective support. Control patients and partners will receive an attention placebo. One-hundred-ten patients (plus partners) will be enrolled in each group. Measures of physical and mental health status, disease activity, medical history and treatment, psychosocial measures, and health care utilization will be collected at baseline, six, and twelve months. The effect of the intervention on physical and mental health and disease activity will be analyzed with general linear models with repeated measures. We will use structural equation modeling to examine the extent to which the intervention impacts health via changes in self-efficacy, social support, problem-solving, compliance, and medical management. Better understanding of the pathways by which the intervention works will improve refinement of theory allow construction of more efficient programs to manage SLE. We will also perform a cost-effectiveness analysis of the intervention.
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