The relationship between the self-confidence in clean urinary intermittent catheterisation and self-efficacy of home care patients

Abstract

Background:

Home care patients experience great difficulty in fulfilling their daily activities. One of these difficulties is related to urinary excretion. It is necessary for individuals to possess self-efficacy as well as self-confidence in order to be able to perform self-administered clean intermittent catheterisation (CIC).

Aims:

The present study aims to determine the relationship between the self-confidence and self-efficacy of home care patients in CIC.

Method:

The data were collected from patients receiving home care services from a hospital in eastern Turkey between November 2022 and February 2023. The study data were collected online via google forms. No sample selection was made and the entire population was included in the study (372). The study was completed with 240 patients.

Results:

A significant positive correlation was found between the scores obtained from the self-confidence and self-efficacy inventories for CIC. It was found that the self-efficacy total score had an effect size of 66% on self-confidence inventories for CIC. In addition, age, education level and working status also affect self-efficacy.

Conclusions:

In the present study, it was concluded that the level of self-confidence affects the level of self-efficacy in self-catheterisation. The success rate of catheterisation increases in parallel with self-confidence.

Keywords

home care self-catheterisation self-confidence self-efficacy

Introduction

Home care is a type of health service that meets the needs and demands of patients in a domestic environment. The demand for home care services is increasing day by day as they reduce the number of hospital admissions and hospitalisations, reduce costs, alleviate potential hospital complications and shorten the hospitalisation period even if the patient is hospitalised (Andrade et al., 2017). With the increase in life expectancy at birth and the decrease in fertility rates, today’s society is increasingly aging. Turkey is among the countries where a rapid aging process is expected. By the year 2040, an increase of 201% is expected in the older person population of Turkey (Mandıracıoğlu, 2010). This increase in the older person population has brought various health service models to the agenda. There has been a global transition from ‘clinic-centered’ to ‘patient-centered’ health services (Palm, 2012). In this context, home care services have emerged as a product of the evolving sense of health care and a requirement of the changing characteristics of society.

In order to improve individuals’ quality of life, it is necessary to focus on basic daily life activities such as bathing, nutrition, excretion, respiration and mobility (Birol, 2020; Camp et al., 2021). Home care patients in particular experience great difficulty in fulfilling their daily activities (Taşdelen and Ateş, 2012). One of these difficulties is related to urinary excretion. Home care patients who experience urinary excretion problems self-administer CIC to control their bladder, manage incomplete bladder discharge and improve their quality of life (Zachariou et al., 2020). CIC is an effective and reliable technique recommended for bladder drainage of patients suffering from urinary retention due to neurogenic or non-neurogenic causes (Çulha and Acaroğlu, 2020; Saadat et al., 2019). In addition, it is a method that increases individuals’ level of independence, reduces the risk of infection, enables the kidneys and bladder to perform their function and prevents kidney damage, reduces potential trauma to the urethra and bladder stones, does not restrict the sexual activities of patients, reduces urinary incontinence and increases self-esteem and self-confidence (Biaziolo et al., 2017). Self-confidence is a very significant concept that encourages individuals to receive better health care, to become aware of their own capabilities and to be able to self-apply CIC (Biaziolo et al., 2017; Çulha and Acaroğlu, 2020). Self-confidence alleviates feelings such as fear and shame in relation to an individual’s ability to perform an action, while boosting their sense of enthusiasm and faith, ensuring that the action is successful (Çulha and Acaroğlu, 2020). It is necessary for individuals to possess self-efficacy as well as self-confidence in order to be able to perform self-administered CIC. Keeping patients away from the hospital is an important goal of home care services. In line with this goal, home care patients should be able to perform self-catheterisation independently. It is of great importance to possess high levels of self-confidence and self-efficacy in order to achieve self-catheterisation. Therefore, the present study aims to determine the relationship between the self-confidence and self-efficacy of home care patients in CIC and to contribute to the related literature.

Study question

Is there a relationship between the level of self-confidence in CIC and self-efficacy of patients receiving home care?

Material and methods

Type of study: The study was planned in a descriptive cross-sectional design.

Place and time of study: Study data were collected from patients receiving home care services from a hospital in eastern Turkey between November 2022 and February 2023.

Study sample: The population of the study consisted of 372 patients who were followed in the home care services of a hospital in eastern Turkey between the study dates. No sample selection was made and the entire population was included in the study. The study was completed with 240 patients.

Variables: Sociodemographic features of home care patients and self-confidence in CIC constituted the independent variable of the study, whereas self-efficacy served as the dependent variable.

Inclusion criteria:

– To reside in the region where the study is carried out

– Patients without any impairment in motor functions

– Receiving home care services

– Performing CIC

– Patients who can answer study questions via Google forms

– Agreeing to participate in the study

Data collection

The surveys were delivered to the patients via Google forms, and the data were collected between November 2022 and February 2023. Home care patients who applied CIC were contacted by the researcher through the contact numbers in the system, they were informed about the study and their consent was obtained.

Data collection tools: In collecting data, a seven-question personal introduction form created by the researchers was used to ask participants about information such as gender, age, marital status, level of education, working status, assistance during CIC and problems with the urinary catheter (Taşdelen and Ateş, 2012). Additionally, the Self-Confidence Scale for Clean Intermittent Self-Catheterisation and the General Self-Efficacy Scale were used, with permission to use the scales.

The self-confidence scale for clean urinary intermittent self-catheterisation (SCSCISC): The scale was developed by Biaziolo et al. (2017). It was adapted into Turkish by Çulha and Acaroğlu (2020). Each item is scored on a 5-point Likert-type scale consisting of catheterisation application steps and short sentences describing the individual’s belief that they can perform the application. The total score that can be obtained from the scale consisting of 16 items ranges from 0 to 64. High scores indicate high levels of self-confidence. The scale does not include sub-dimensions. The Cronbach’s alpha coefficient of the original scale was calculated as 0.94 (Çulha and Acaroğlu, 2020). In the present study, the Cronbach’s alpha coefficient was found to be 0.99.

The general self-efficacy scale (GSE): The scale was developed by Schwarzer and Jarusalem (1979). It was initially prepared to include 20 items, which were then reduced to 10 items with revisions in 1981 and finalised in 1995 (Schwarzer and Jeruselam, 1995). The scale was adapted into Turkish by Aypay (2010). It tests various segments’ belief in the ability to cope with new and difficult tasks. The scale consisting of 10 items, all of which are positive, was prepared in the form of a 4-point Likert-type scale bounded by points of completely false and completely true. The internal consistency of the scale was calculated as α = 0.86 in a study conducted across all countries. High scores indicate high levels of general self-efficacy (Aypay, 2010). In this study, the Cronbach’s alpha coefficient was found to be 0.99.

Ethical statement

An Bingöl University Health Sciences Scientific Research and Publication Ethics Committee Approval (2022-E.85067) was obtained to carry out the study. Health Sciences Scientific Research and Publication Ethics Committee Approval (15.11.2022-E.85067) was obtained from a state university to carry out the study. Researchers followed the rules stated in the Declaration of Helsinki throughout the research. Participants were informed about the research by the researcher and their consent was obtained.

Data analysis

The data obtained from the study were analysed using SPSS 22 (IBM Corp, 2019). A frequency test was performed in the statistical analysis of the data, the independent samples t-test was performed in paired groups within parametric distributions, the ANOVA test was performed in comparisons of three or more groups within parametric distributions, and a correlation analysis was carried out between the total mean scores of the scales. The presence of relationships between the predicted variable (self-confidence in CIC) and the predictor variables (self-efficacy) was examined through Multiple Regression analysis and, afterwards, the Pearson Correlation Coefficients between the variables examined were calculated.

Results

It was found that 57.9% of the participants were male, the majority of the participants were older than 65 years and had a low level of education, and 84.2% of them were married. Additionally, 27% of the participants were actively employed, 53.9% of them sought help from others while inserting the urinary catheter, and 24.9% of them did not experience any problems related to the urinary catheter (Table 1).

Table 1.

Frequency analysis of demographic data.

Variable	Group	n	Percent
Gender	Male	101	42.1
Gender	Female	139	57.9
Age	45–50	10	4.1
	51–55	10	4.1
	56–60	27	11
	61–65	48	19.6
	66 and above	145	59.2
Marital status	Single	38	15.8
Marital status	Married	202	84.2
Level of education	Illiterate	30	12.2
	Literate	79	32.2
	Primary school	125	51.0
	Middle school	5	2.0
	Licence	1	0.4
Working status	Yes	27	11.0
	No	120	49.0
	Retired	93	38.0
Assistance during CIC	Yes	132	53.9
Assistance during CIC	No	108	44.1
Problem with urinary catheter	Urinary system infection	29	11.8
	Catheter leakage	45	18.4
	Catheter has fallen out	45	18.4
	Haematuria	23	9.4
	Feeling pain during catheterisation application	32	13.1
	Catheter obstruction	5	2.0
	No problem	61	24.9
Total		240	100.0

CIC: clean intermittent catheterisation.

In the comparison between the sociodemographic features of the home care patients and the mean SCSCISC scores, a statistically significant difference was found between the mean scores of the participants aged 56–60 years (75.70 ± 7.58), the participants with a bachelor’s degree (78.0±6.34), and the participants who were actively employed (64.62 ± 17.88) (Table 2, p < 0.05).

Table 2.

Comparison of home care patients’ sociodemographic characteristics and their SCSCISC and GSE total scores.

Introductory features	Scales
Introductory features	SCSCISC (X ± SD)	F/t-p	GSE (X ± SD)	F/t-p
Gender
Female	39.29 ± 18.9	0.53–0.59	31.7 ± 9.2	0.14–0.8
Male	37.92 ± 20.5		31.9 ± 10.0	0.14–0.8
Age
45–50	58.50 ± 7.13	37.5–0.00**	37.80 ± 4.15	14.3–0.00**
51–55	58.20 ± 7.82		38.90 ± 3.14
56–60	59.70 ± 7.58		38.40 ± 3.69
61–65	47.04 ±15.15		35.54 ± 7.81
66 and above	29.34 ± 17.18		28.48 ± 9.90
Marital status
Single	36.84 ± 19.78	0.64–0.52	32.10 ± 9.52	1.01–0.31
Married	39.06 ± 19.55		30.39 ± 9.81	1.01–0.31
Level of education
İlliterate	21.60 ± 19.62	16.1–0.00**	25.50 ± 11.32	8.8–0.00**
Literate	32.81 ± 18.24		29.34 ± 10.0
Primary school	45.66 ± 16.66		34.72 ± 7.72
Middle school	56.40 ± 8.04		36.0 ± 5.47
Licence	62 ± 6.34		38.0 ± 2.46
Working status
Yes	48.62 ± 17.88	4.1–0.01*	35.44 ± 8.50	2.1–0.1
No	37.97 ± 18.82		31.44 ± 9.53
Retired	36.79 ± 20.31		31.30 ± 9.77
Assistance during CIC
Yes	39.54 ± 19.29	0.7–0.46	32.27 ± 9.17	0.3–0.43
No	37.70 ± 19.94		31.30 ± 10.05	0.3–0.43
Problem with urinary catheter
Urinary system infection	41.31 ± 18.11	0.6–0.71	33.55 ± 9.42	0.37–0.89
Catheter leakage	39.40 ± 22.08		31.04 ± 10.90
Catheter has fallen out	35.11 ± 18.75		30.80 ± 9.43
Haematuria	38.26 ± 18.39		31.73 ± 8.86
Feeling pain during catheterisation application	42.90 ± 21.15		32.75 ± 10.19
Catheter obstruction	38.20 ± 23.64		30.0 ± 14.14
No problem	37.65 ± 18.43		32.08 ± 8.47

SCSCISC: self-confidence scale for clean urinary intermittent self-catheterisation; GSE, general self-efficacy scale; CIC: clean intermittent catheterisation.

p < 0.05. **p < 0.01.

In the comparison between the sociodemographic features of the home care patients and the mean GSE scores, A statistically significant difference was found between the mean scores of the individuals aged 51–55 (38.90 ± 3.14) and the participants with a bachelor’s degree (38.0 ± 2.46) (Table 2, p < 0.05).

Table 3 shows a significant positive correlation between the scores obtained from the SCSCISC inventory and those from the GSE inventory (r = 0.815, p < 0.01). In other words, self-efficacy levels increase in parallel with self-confidence in CIC (Table 3).

Table 3.

Correlation analysis between SCCSCISC and GSE inventory.

Scales	n	M	SD	1	2
1. SCSCISC	240	54.71	19.56	–	0.001**
2. GSE	240	31.83	9.57		–

p < 0.05. **p < 0.01.

SCSCISC: self-confidence scale for clean urinary intermittent self-catheterisation; GSE, general self-efficacy scale.

The factors affecting home care patients’ level of the self-confidence CIC were tested through regression analysis. Self-confidence in CIC was taken as the dependent variable. GSE, age, gender, education level and employment status were taken as independent variables. Table 4 shows the results of the analysis.

Table 4.

Predictors of SCSCISC according to regression analysis.

Scales	B	Beta	t	p	R	R ²	F	p
Constant	1.69	–	0.66	0.50	0.815^a	0.664	23.94	0.000^a
GSE	1.66	0.815	21.67	0.000
Constant	82.78	–	19.58	0.000	0.572^b	0.327	115.64	0.000^b
Age	10.28	−0.572	10.75	0.000
Constant	40.66	–	10.55	0.000	0.035^c	0.001	.288	.592^c
Gender	1.37	−0.035	−0.53	0.592
Constant	9.24	–	2.41	0.016	0.463^d	0.214	64.82	0.000^d
Education status	12.02	0.463	8.05	0.000
Constant	48.68	–	10.70	0.000	0.146^e	0.021	5.19	0.024^e
Working status	4.38	−0.146	2.28	0.024

SCSCISC: self-confidence scale for clean urinary intermittent self-catheterisation; GSE, general self-efficacy scale.

Predictors: (Constant), GSE.

Predictors: (Constant), Age.

Predictors: (Constant), Gender.

Predictors: (Constant), Education status.

Predictors: (Constant), Working status.

Discussion

The literature review performed as part of the present study shows that although the number of home care patients is growing day by day, the number of studies demonstrating the current status, quality, qualification and success rate of home care in Turkey is very limited. One of the main reasons behind this is that the law on the provision of home care services was enacted in 2010. Therefore, it is thought that the present study will contribute to the theoretical framework of home care services.

While no significant difference was observed between the mean SCSCISC scores and the gender variable, a significant difference was found between SCSCISC and age (Table 2). The mean SCSCISC scores of the participants aged 56–60 were found to be higher compared to those aged 66 and over. Certain previous studies reported that there was no statistically significant difference between the mean scores of self-confidence and age groups (Akpınar and Yağan, 2019; Bostancı et al., 2018; Karagün, 2014). In another study, Henriksen et al. (2018) found a significant relationship between age and self-confidence groups (Henriksen et al., 2018). Although the SCSCISC levels of parents aged 56–60 were found to be high, individuals over the age of 65 constituted the majority of the participants. Individuals over 65 years of age were found to have low SCSCISC levels. It is thought that their self-confidence is low due to reasons such as decline in cognitive, affective and psychomotor functions due to advancing age and dizziness.

Although no significant difference was observed between SCSCISC mean scores and marital status, a significant difference was found based on education level (Table 2). The mean SCSCISC score of the participants with a bachelor’s degree was found to be higher than that of the non-literate participants. The literature suggests that individuals with higher levels of education have higher levels of self-confidence (Escolar and De Guzman, 2014; Kılıç et al., 2016). However, only one of the participants in the present study had a bachelor’s degree. The majority of the participants had an education level of primary school and below. The self-confidence levels of the individuals with a primary school education level were found to be moderate.

Although there was no significant difference in the mean SCSCISC scores based on the status of receiving assistance in urinary catheter insertion, a significant difference was observed in the mean SCSCISC scores based on the status of being actively employed (Table 2). The mean SCSCISC scores of the participants who were actively employed were found to be higher compared to those who were retired or not actively employed. However, the majority of the participants were either retired or not actively working. The SCSCISC levels of the individuals who were retired or not working in any capacity were found to be low. Actively employed individuals have certain responsibilities to fulfil. It is thought that they have high self-confidence as they fulfil their responsibilities.

Although no significant difference was found in the mean GSE scores based on gender, a significant difference was found based on age (Table 2). The mean GSE scores of the individuals aged 51–55 were found to be higher compared to the individuals aged 66 and over. Individuals’ level of self-efficacy decreases with increasing age, particularly for those over the age of 65. Previous studies report that self-efficacy levels increase in parallel with age (Dikmen et al., 2021; Saraçlar et al., 2022). However, in the present study, the self-efficacy levels of the participants over the age of 65 were found to be low. Numerous physiological changes occur in the body with aging (increase in chronic diseases, loss of vision and hearing, slowed reflexes, etc.). It is thought that the level of self-efficacy decreases in relation to these changes.

Although there was no significant difference in the mean GSE scores based on marital status, a significant difference was observed based on education level (Table 2). In the relevant literature, there are studies reporting significant differences between education level and self-efficacy and those reporting no significant differences (Çulha and Acaroğlu, 2022; Karahan and Balat, 2011; Khorasani et al., 2017; Wu et al., 2018). The mean GSE scores of the participants with an undergraduate education level were found to be higher than those of the non-literate individuals. However, only one of the participants in the present study had a bachelor’s degree. The majority of the participants had an education level of primary school and below. The self-efficacy levels of the individuals with a primary school education level were found to be moderate.

A significant positive correlation was found between the mean SCSCISC scores and GSE scores (Table 3). This suggests that as self-confidence in CIC increases, the level of self-efficacy also increases. When the related literature is examined, there are studies showing that self-confidence positively affects self-efficacy, whereas others report that self-confidence has no effect on self-efficacy differences (Dervişoğlu and Acarlı, 2018; Taytaş and Kardaş, 2022).

It was found that the self-efficacy total score had an effect size of 66%, age had an effect size of 32%, education level had an effect size of 21% and working status had an effect size of 2% on SCSCISC. It was found that gender had not have an effect on SCCSCISC (Table 4). These results show that there is a relationship between the level of self-confidence in CIC and the self-efficacy of patients receiving home care.

Conclusions

In the present study, it was found that the level of self-confidence affects the level of self-efficacy in self-catheterisation. The success rate of catheterisation increases in parallel with self-confidence. Furthermore, it was determined that there were significant differences and correlations between the level of self-confidence and self-efficacy in self-catheterisation. This relationship can be investigated more conclusively in future studies with different samples and methods.

Limitations

The limitations of the study are that the study was conducted in only one district, 240 patients could be contacted despite a study population of 372 individuals, the patient group’s advanced age, lack of technology literacy and the majority of the participants had a low level of education.

Key points for policy, practice and/or research

Confidence is essential to success in self-administered clean intermittent catheterisation (CIC). Therefore, approaches that will increase the self-confidence of the patient should be adopted while planning home care.

Since individuals aged 65 and over have low self-confidence levels in CIC, their self-confidence can be increased by creating an individualised care plan.

Individuals with higher education levels have higher self-confidence. Accordingly, their self-efficacy is also higher. Therefore, training on CIC may help increase self-efficacy.

Footnotes

Acknowledgements

We would like to thank Çelikhan home care services personnel who helped us collect the data.

Consent to participate

Informed consent was obtained from all the individual participants included in the study.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

Bingöl University Health Sciences Scientific Research and Publication Ethics Committee Approval (2022-E.85067) was obtained to carry out the study. Researchers followed the rules stated in the Declaration of Helsinki throughout the research.

ORCID iD

Mehmet Kaplan

Statistics

The statistics were checked prior to submission by an expert statistician, Behice ERCİ, behice.erci@inonu.edu.tr

Mehmet Kaplan specialised in Public Health Nursing after completing his nursing training. In 2019, he joined Bingöl University and is currently working as an Assistant Professor.

Hanife Çelik, after completing her nursing education, continues her PhD education in the field of Nursing Principles. In 2022, she joined Bingöl University and is working as a lecturer.

Feride Kaplan, after completing her nursing education, continues her PhD education in the field of Nursing Principles. She is working as a lecturer at Sütçü İmam University.

References

Andrade

Silva

Seixas

, et al. (2017) Nursing practice in home care: An integrative literature review. Revista brasileira de enfermagem 70: 210–219.

Akpınar

Yağan

(2019) Scrutiny on self-confidence levels of the ındividuals attending fitness center. The Journal of International Social Research 12: 1133–1139.

Aypay

(2010) The adaptation study of General Self-Efficacy (GSE) Scale to Turkish. Inonu University Journal of the Faculty of Education 11: 113–131.

Biaziolo

CFB

Mazzo

Martins

JCA

, et al. (2017) Validation of self-confidence scale for clean urinary intermittent self-catheterization for patients and health-caregivers. International Brazilian Journal of Urology 43: 505–511.

Birol

(2020) Hemşirelik Süreci, 1st edn. Akademisyen Kitabevi, Ankara, pp. 279–401.

Bostancı

Karaduman

Şebin

(2018) Dağcıların özgüven seviyelerinin çeşitli değişkenler açısından incelenmesi (Investıgatıon of self-confıdence level of mountaıneers ın terms of some varıables). Beden Eğitimi ve Spor Bilimleri Dergisi 20: 145–154.

Camp

Lewis

Hunter

, et al.(2021) Technology used to recognize activities of daily living in community-dwelling older adults. International Journal of Environmental Research and Public Health 18: 163.

Çulha

Acaroğlu

(2020) Temiz aralıklı kendi kendine kateterizasyonda özgüven ölçeği Türkçe karşılaman geçerlik ve güvenirliği (Validity and reliability of Turkish version of Self Confidence Scale in Clean Intermittent Self Catheterization). Çukurova Tıp Dergisi 45: 1690–1697.

Çulha

Acaroğlu

(2022) The effect of video-assisted clean ıntermittent catheterization training on patients’ practical skills and self-confidence. International Neurourology Journal 26: 331–341. DOI: 10.5213/inj.2244166.083.

10.

Dervişoğlu

Acarlı

(2018) Biyoloji öğretmen adaylarının bilimsel süreç becerileri ve biyoloji laboratuvarına yönelik tutumları, özyeterlikleri, özgüvenleri (The pre-service biology teachers’ scientific process skills and their attitudes, self-efficacy, self-confidence towards biology laboratory). Bilim Eğitim Sanat ve Teknoloji Dergisi 2: 85–92.

11.

Dikmen

Akyıl

Akçay

(2021) Sınıf öğretmenlerinin bilgisayar ve internet kullanımı öz yeterlik algılarının incelenmesi (Examination of primary school teachers’ perceptions of computer and internet use self-efficacy). Uluslararası Liderlik Eğitimi Dergisi 1: 16–25.

12.

Escolar

CRL

De Guzman

(2014) Effects of third age learning programs on the life satisfaction, self-esteem, and depression level among a select group of community dwelling Filipino elderly. Educational Gerontology 40: 77–90.

13.

Henriksen

MJV

Wienecke

Thagesen

, et al.(2018) Optimizing residents’ performance of lumbar puncture: An RCT comparing the effect of preparatory ınterventions on performance and self-confidence. Journal of General Internal Medicine 33: 148–154. DOI: 10.1007/s11606-017-4207-7.

14.

IBM Corp (2019) IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.

15.

Karahan

Balat

(2011) Özel eğitim okullarında çalışan eğitimcilerin öz-yeterlik algılarının ve tükenmişlik düzeylerinin incelenmesi (The analysis of self-efficacy perception and burnout level of special education school educators). Pamukkale Üniversitesi Eğitim Fakültesi Dergisi 29: 1–14.

16.

Karagün

(2014) Self-confidence level in professional athletes; an examination of exposure to violence, branch and socio-demographic aspects. Journal of Human Sciences 11: 744–753.

17.

Khorasani

Peyman

Esmaily

(2017) Relations between breastfeeding self-efficacy and maternal health literacy among pregnant women. Evidence Based Care Journal 6: 18–25.

18.

Kılıç

Türkoğlu

Adıbelli

, et al.(2016) Geriatrik yaş grubundaki kişilerin yaşam doyumu ve yaşam tutum profilleri arasındaki ilişki. Cumhuriyet Hemşirelik Derg 5: 1–8.

19.

Mandıracıoğlu

(2010) Dünyada ve Türkiye’de yaşlıların demografik özellikleri (Demographic characteristics of the elderly in the world and in Turkey). Ege Tıp Dergisi 49: 39–45.

20.

Palm

(2012) Declaration of healthy dependence: The case of home care. Health Care Analysis 22: 385–404. DOI: 10.1007/s10728-012-0228-x

21.

Saadat

Shepherd

Van Asseldonk

, et al. (2019) Clean intermittent catheterization: single use vs. reuse. Canadian Urological Association Journal 13: 64.

22.

Saraçlar

Ada

Gönenç

(2022) Öğretmenlerin yaşam doyumları ile özyeterlik inançları arası ilişki (Examining the relationship betweentheteachers life satisfaction and theirself-efficien). Iğdır Üniversitesi Sosyal Bilimler Dergisi 31: 267–289.

23.

Schwarzer

Jerusalem

(1995) Generalized self-efficacy scale. In Weinman

Wright

Johnston

(Eds.), Measures in Health Psychology: A User’s Portfolio. Causal and Control Beliefs (pp. 35–37). Windsor, UK: NFER-Nelson.

24.

Taşdelen

Ateş

(2012) Evde bakım gerektiren hastaların bakım gereksinimleri ile bakım verenlerin yükünün değerlendirilmesi (Evaluation of the care needs of patients requiring home care and the burden of caregivers). Hemşirelikte Eğitim ve Araştırma Dergisi 9: 22–29.

25.

Taytaş

Kardaş

(2022) Ergenlerde azim, umut ve öz-yeterliğin depresyon ile ilişkisi (The relationship of perseverance, hope and self-effıcacy with depression on adolescents). Okul Psikolojik Danışmanlığı Dergisi 5: 73–106.

26.

Han

, et al. (2018) The ınfluence of breastfeeding self-efficacy and breastfeeding ıntention on breastfeeding behavior in postpartum women. Hu Li Za Zhi 65: 42–50. DOI: 10.6224/JN.201802_65(1).07.

27.

Zachariou

Kaltsas

, et al.(2022) Translation and validation of the ıntermittent catheterization difficulty questionnaire (ICDQ) into Greek. Journal of Multidisciplinary Healthcare 15: 2571–2577.