Self-Efficacy as a Predictor of Clinical and Psychosocial Outcomes in Non-Communicable Disease Management: Evidence from Malawi

Abstract

Background:
Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, with disproportionate effects in low- and middle-income countries. In Malawi, fragile health systems face challenges in managing NCDs, yet psychological determinants such as self-efficacy remain underexplored. Self-efficacy, defined as confidence in one’s ability to execute health behaviors, has been shown to predict adherence, quality of life, and engagement in Western contexts, but evidence from Sub-Saharan Africa is limited.
Methods:
A mixed-methods design was employed at Kamuzu Central Hospital, combining quantitative surveys (n = 150) with qualitative interviews (n = 30). Self-efficacy was measured using the General Self-Efficacy Scale; medication adherence using the Morisky Medication Adherence Scale (MMAS-8); quality of life using the WHOQOL-BREF; and treatment engagement using a structured questionnaire. Regression analyses tested predictive relationships, controlling for demographic covariates, while thematic analysis explored lived experiences of adherence and engagement.
Results:
Self-efficacy significantly predicted medication adherence (β = .42, p < .01), quality of life (β = .38, p < .01), and treatment engagement (β = .45, p < .01). R² values indicated substantial variance explained (.38 for adherence, .32 for QoL, .41 for engagement). Qualitative findings reinforced these results, showing that patients with higher self-efficacy employed proactive coping strategies and relied on social support networks, while those with lower self-efficacy reported ambivalence and poor treatment participation.
Conclusion:
Self-efficacy is a robust predictor of both clinical and psychosocial outcomes in NCD management in Malawi. Integrating self-efficacy training into routine care, enhancing peer support programs, and designing gender-sensitive interventions can improve patient outcomes in resource-limited settings. These findings highlight empowerment as a central mechanism for transforming health systems and advancing culturally responsive chronic disease care in Sub-Saharan Africa.