Mediating Effects of Self-efficacy on the relation between Ethical Commitment and Quality of Services of Home-Visiting Caregivers
Nan Young Lee1, Hee Kyung Kim2*
1 Assistant Professor, Dept. of Nursing, Gimcheon University, Gimcheon, Gyungbuk, 39528, South Korea
2Professor, Dept. of Nursing, Kongju National University, Gongju, Chungnam, 32588, South Korea
* Corresponding Author Name: Hee Kyung Kim Email: [email protected] Contact: +82-10-8193-3938
Fax: +82-41-850-0315
Abstract
This study aims to provide the basic data for the development of intervention programs that could improve the service quality of caregivers, by understanding the relation between ethical commitment and service quality of home-visiting caregivers, and also verifying the mediating effects of self-efficacy on their relation. As a descriptive research, this study collected data from total 81 caregivers by visiting three home-visit care centers for the elderly in D metropolitan city.
Using the SPSS Win 25.0 program, the collected data was analyzed through the frequency, percentage, mean, standard deviation, Pearson correlational coefficients, multiple linear regression, and Sobel test. In the results of verifying the mediating effects of self-efficacy of caregivers, in step1, the ethical commitment had significant effects on self-efficacy(β=.59). In step2, the ethical commitment had significant effects on quality of services (β=.26). In step3, the self-efficacy had positive effects on quality of services (β=.27), which showed 11.6% explanatory power. The self-efficacy showed the complete mediating effects on the relation between ethical commitment and quality of services (Z=2.11, p=.035). To improve the quality of services of home-visiting caregivers, it would be necessary to develop a nursing intervention program that could improve their ethical commitment, by considering the self-efficacy.
Keywords: Caregiver; Ethical commitment; Quality of services; Self-efficacy; Mediating effects
Introduction
In Korea, the elderly population in 65 or up takes up 15.7% (N=8,125,000) of the whole population in 2020, which will be increasing to 20.3% (N=10million) in 2025. The aging phenomenon is assumed to be accelerating in the future (Statistics Korea, 2020). With the increase of elderly population, the number of caregivers would be more increasing. According to the aged statistics in 2018, in the social interests for later years of the elderly in their 65 or up in 2017, the medical & care service was 38.6%, which was more increasing when the age was higher. Regarding the main reason why the elderly in their 65 or up were living together with their children, the reason “Impossible to live independently” was 37.5%. And the medical expenses per person were increasing every year. Also, in 2017, there were 76,371 welfare facilities for the elderly, which was increasing every year, and the nursing facilities for the elderly and day & night care service show the tendency to continuously increase every year (Statistics Korea, 2018).
The elderly experience the decline of physical functions and physiological aging process, so the prevalence of chronic diseases is increasing. Due to the declined activities of daily living, it is highly possible for them to be exposed to diseases, which causes the loss of social roles and weakening of interpersonal relationships. The increase of medical expenses and long-term care costs could be led to the issue of social burden (Chung, K. H., 2017). Because of the aging population, the care and support for the elderly are not only a personal issue, but a social issue.
As the professional manpower in charge of care and support for the elderly (Lee, Y. S. et al., 2010), and the manpower providing the care service, the caregivers are performing their roles in caring the elderly and people with mobility difficulties by going through the state qualifications examination after the enforcement of the long-term care insurance system for the elderly in 2008 (Lim, S. A., 2019). As a direct service provider that provides the body & daily life services to the elderly who cannot independently perform daily life on behalf of their families (Kim, S. H. et al., 2012), they lessen the family‟s burden over the elderly care and also provide the best service to the elderly who receive the care service, so they are performing such important roles in the qualitative improvement of welfare service for the elderly (Shin, T. H. et al., 2016).
According to the Korean National Survey on the Elderly in 2017, more than half of the elderly wanted to get the home-visiting care services in their own houses even when they couldn‟t move well. Thus, contrary to the method of performing their job in a nursing hospital, the caregivers also perform their duties of providing services by visiting each home. If the caregivers could repetitively perform their given works by showing the high-level of competence under various conditions, the provided job and attitude (Lee, Y. S. et al., 2010) could become a chance to improve the contents and quality of services. Therefore, developing the intervention by analyzing the relevant factors to increase the service quality provided by caregivers would become a chance to increase their professionalism.
Even though the caregivers are playing important roles in charge of health and care of care recipients, they might be in the middle of process for taking off to the profession in the aspect of showing their techniques through intellectual activities and training, and also having the practical purpose and altruistic motivation (Lim, S. A., 2019). Lee (Lee, Y. S. et al., 2010) said that the service providers should first be equipped with knowledge, techniques, and qualifications for their profession, and also have the value and ethics required for performing the job in the relevant area. The care for the elderly is safely provided suitable for each individual‟s life habits. As they have to perform tough job when lacking in sufficient training or experience in role specialty, they need to have great occupational commitment or professional consciousness (Kim, Y. H. et al., 2011).
Meanwhile, as the general attitude and perceived quality of service provided by caregivers (Parasuraman, A. et al., 1988), the service quality means five categories such as reliability, professionalism, tangibles, empathy, and responsiveness. For the qualitative management according to the quantitative increase of caregivers, the level of service quality should be maintained by understanding the influence factors for maintaining the stable relationship with recipients (Lee, Y. J. et al., 2012). The roles, qualifications, value, belief, and abilities of caregivers are directly related to the quality of care service (Kim, S. J., 2012). Regarding the service quality of caregivers, the high-quality techniques should be continuously maintained on the basis of recipients‟ requests, and the recipients‟ satisfaction with service could be different depending on the service quality of caregivers (Lee, S. M., 2015). Also, the self-efficacy is the concrete confidence and ability to successfully perform acts to obtain the results of purpose and plan(Bandura, A., 1977). Regarding the perception of professionalism and satisfaction as
affective response to the overall occupation they work for, when the self-efficacy is high, the service quality could be improved(Park, H. S., 2017). The high self-efficacy means the high job satisfaction, which also has positive effects on service quality (Suh, C. J. et al., 2010). The self- efficacy and job satisfaction of caregivers had significant effects on service quality (Nam, G. M.
et al., 2012).
Reviewing the preceding researches related to the factors affecting the service quality, the research by Lee (Lee, H. J., 2011) showed the positive effects of professional attitude on service quality of caregivers. The research by Kim (Kim, Y. Y., 2012) said the professionalism of caregivers would become an important factor on the satisfaction and life quality of recipients.
Also, the research by Ko (Ko, H. K., 2012) reported that the service quality could be decided by the expertise, techniques, professional consciousness, and the degree of reflecting recipients‟
needs of caregivers. Also, checking if the caregivers perceive themselves as professionals could be important for evaluating the service quality. And when it is positively evaluated, the high- quality care service could be provided (Lee, Y. S. et al., 2010), so the caregivers‟ perception of professionalism would be related to the service quality.
Meanwhile, the profession means an occupation with specialty or a group of people who work for the occupation, so it has the characteristics distinguished from general occupations (Cho, C.
Y., 2007). The utilization of profession, belief in public service, belief in self-regulation, vocation, and belief in autonomy presented by Hall (Hall, R. H., 1968) are the elements of perception of professionalism for caregivers(Shin, T. H. et al., 2016). The professionalism is an workers‟
professional attitude besides knowledge and techniques required for profession (Hall, R. H., 1968), as an element for providing the high-quality care service, so the care service recipients could enjoy energetic daily life. Thus, this study prescribed the belief in self-regulation and vocation among the characteristics of the perception of professionalism by Hall (Hall, R. H., 1968) as the ethical commitment of caregivers. When the caregivers perform their occupational duties, they need to devote themselves to the care recipients by following their vocation and vocational ethics, and also to make efforts for the maintenance, enhancement, and rehabilitation of recipients‟ health based on their belief. This ethical commitment could draw the pride and fruitfulness of their occupation, eventually, raise the service quality, and also improve the health of recipients.
The self-efficacy has been revealed as a factor affecting the service quality of caregivers (Park, H. S., 2017;Suh, C. J. et al., 2010). However, it is very rare to find a research on the effects of ethical commitment on service quality of caregivers. Thus, the researcher aims to provide the basic data for the development of intervention programs for solidifying the status as professional care manpower, and also eventually improving the health and life quality of the elderly and recipients with mobility disabilities, by verifying the mediating effects of self-efficacy on the relation between ethical commitment and service quality of home-visiting caregivers.
Methods
Subjects & Data collection
The subjects of this research were total 86 home-visiting caregivers belonging to three home-visit care centers for the elderly in D metropolitan city. The researcher explained the research purpose and method to the subjects, and then conducted a survey targeting the adult male and female caregivers who worked for six months or more, who voluntarily agreed on the written consent to participate in this study. Regarding the number of subjects, in the results of analysis by applying
the significance level (.05), effect size (.15), test power (85%), and two predictive factors for the regression analysis by using the G*Power 3.1.9.4 program, the number of samples were 76, and the survey was conducted targeting total 86 subjects by considering the dropout rate. After excluding the inappropriate questionnaires from the collected data, total 81 questionnaires were used for the analysis.
Instruments Ethical commitment
To measure the ethical commitment, this study used Kim (Kim, K. S., 2017)‟s instrument for caregivers, which was the professionalism perception evaluation scale modified/complemented suitable for the conditions of Korea by Park (Park, J, W., 1994), based on the scales developed by Hall (Hall, R. H., 1968) (Profession Inventory), Snizek (Snizek, W. E., 1972), and Anderson (Anderson, W. A., 1982). After excluding three items with low reliability from total ten items including five items for belief in self-regulation and another five items for vocation in the professionalism perception instrument, total seven items were used. The items were on the basis of 5-point scale “from 1point to 5points”. The higher score means the higher degree of ethical commitment. In the research by Park (Park, J. W., 1994), the reliability coefficient was shown as Cronbach's α=0.83. In this study, it was .63.
Self-efficacy
To measure the self-efficacy, this study used Kim (Kim, M. S., 2018)‟s instrument for caregivers, based on the instrument developed by Bandura (Bandura, A, 1977). This instrument is composed of subareas of social efficacy, self-acceptance, and self-achievement. Total 12 items are based on the 5-point Likert scale like 1point for „Not at all‟ and 5 points for „Very much likely‟. The higher score means the higher self-efficacy. When the instrument was developed, the reliability coefficient was shown as Cronbach‟s ⍺=.92. In this study, it was .89.
Quality of services
To measure the quality of services, this study used Jung (Jung, H. M., 2016)‟s instrument for caregivers, based on the SERVQUAL Scale developed by Parasuraman (Parasuraman, A. et al., 1998). This instrument is composed of total 20 items such as four items for reliability, four items for responsiveness, four items for assurance, four items for empathy, and four items for tangibles.
Each item is based on the 5-point Likert scale like 1point for „Not at all‟ and 5points for „Very much likely‟. The higher score means the higher service quality. In the research by Jung (Jung, H. M., 2016), the reliability coefficient was shown as Cronbach's ⍺=.97. And in this study, it was 0.93.
Data collection
The researchers collected data by using questionnaires. Before data collection, for the accuracy of data, they had a meeting to share the data collection method and research purpose, and also to discuss the anticipated questions and responses. For data collection, the structured questionnaire was used. The data was collected from May 1st 2021 to May 30th 2021. It took about 10-20 minutes to fill out the questionnaire. After distributing and collecting total 86 questionnaires, total 81 questionnaires were used for the final analysis by excluding five questionnaires with insufficient responses.
Ethical consideration
Before data collection, this study received the approval of deliberation exemption (KNU_IRB- 2021_28) from the Institutional Review Board of K University. The guidelines for ethical research were obeyed during the research period. First, after getting permission from each participating institution, the research purpose, method, and process were explained to the research subjects who agreed to participate in this study. After explaining that they could stop participating in this study if they desire, they were asked to sign the written consent. They were explained that they could stop participating in this study anytime they want even after agreeing on the participation following their voluntary will, and there would be no disadvantages. They were also told that the collected data would not be used for other than the research purpose, and it would be kept in a place with locking system for three years, and then discarded in the method of shredding afterwards.
Data analysis
The collected data was analyzed by using the SPSS/WIN 25.0 program. The general characteristics were calculated through real number and percentage. The ethical commitment, self-efficacy, and service quality of subjects were calculated through mean and standard deviation. The correlations of ethical commitment, self-efficacy, and service quality of subjects were calculated through Pearson's correlation coefficients. For the mediating effects of self- efficacy on the relation between ethical commitment and service quality of subjects, the multiple regression analysis was performed. The significance test was analyzed by using the Sobel test.
Results
General characteristics of subjects
The mean age of 81 subjects was 58.68±7.43, including the subjects in their 60 or up (49.4%, n=40) and subjects in 50-59(38.3%, n=31) in order. Most of the subjects were women (96.3%, n=78) in sex, and graduates of high school or lower (91.4%, n=74) in education. The average service period of caregivers was 34.47±20.41 months, and over the majority (76.5%, n=62) had the career experiences for 1-5 years. The subjects only with the caregiver license were 91.4%
(n=74). And the subjects who did not receive any continuing education or job training for last one year were 69.1%(n=56), which was over the majority. In the type of work, most (98.8%, n=80) of them were in charge of home-visiting care. The subjects who were satisfied with their job were 87.7% (n=71) [Table 1].
Table1. General Characteristics in Subjects (N=81)
Variables Categories N(%) M±SD
Age(year) 49 or lower 10(12.3) 58.68±7.43
50~59 31(38.3)
60 or up 40(49.4)
Sex Women 78(96.3)
Men 3(3.7)
Education Graduation from high school or
lower 74(91.4)
Graduation from university or
higher 7(8.6)
Service period (month) Less than 12 8(9.9) 34.47±20.41
12-60 62(76.5)
60 or more 11(13.6)
Matter of having licenses other than
the caregiver license No 74(91.4)
Yes 7(8.6)
Matter of receiving the continuing
education or job training (time) 0 56(69.1)
1 or more 25(30.9)
Type of work Home-visiting care 80(98.8)
Others 1(1.2)
Job satisfaction Satisfied 71(87.7)
Dissatisfied 10(12.3) Degree of ethical commitment, self-efficacy, and service quality of subjects
The subjects showed the degree of ethical commitment as 3.86±0.32 of 5points, the degree of self-efficacy as 3.97±0.42 of 5 points, and the degree of quality of services as 4.47±0.37 of 5 points. In other words, the ethical commitment and self-efficacy of subjects were moderate while the quality of services was high[Table 2].
Table2. Degree of Ethical Commitment, Self-efficacy, and Quality of Servicesof Subjects
(N=81)
Variables M±SD Range
Ethical commitment 3.86±.32 1~5
Self-efficacy 3.97±.42 1~5
Quality of services 4.47±.37 1~5
Differences in the quality of servicesaccording to the general characteristics of subjects In differences in the quality of services according to the general characteristics of subjects, there were differences according to education(t=-9.85, p<.001). The subjects who graduated from university or higher showed the higher degree of service quality than the subjects who graduated from high school or lower. And according to age, sex, service period, matter of having other licenses, matter of receiving education, type of work, and job satisfaction, there were no differences[Table 3].
Table3. Differences in the Quality of Servicesaccording to the General Characteristics of Subjects
(N=81)
Variables Categories M±SD t/F(p)
Age (year) 49 or lower 4.66±0.41 1.40(.254)
50~59 4.44±0.40
60 or up 4.45±0.34
Sex Women 4.45±0.37 -1.49(.142)
Men 4.78±0.23
Education Graduation from high school
or lower 4.43±0.36 -9.85(<.001)
Graduation from university
or higher 4.93±0.08
Service period (month) Less than 12 4.37±0.39 1.14(.327)
12-60 4.46±0.36
60 or more 4.61±0.44
Matter of having licenses other than
the caregiver license No 4.47±0.36 0.19(.858)
Yes 4.51±0.54
Matter of receiving the continuing
education or job training (time) 0 4.53±0.32 1.86(.072)
1 or more 4.34±0.45
Type of work Home-visiting care 4.48±0.37 1.00(.320)
Others 4.10±0.39
Job satisfaction Satisfied 4.45±0.37 0.29(.775)
Dissatisfied 4.38±0.25
Correlations of ethical commitment, self-efficacy, and quality of services of subjects
The ethical commitment and quality of services (r=.26, p=.018), and the self-efficacy and service quality(r=.33, p=.003) of subjects showed positive correlations in the statistically significant level. In other words, when the degree of ethical commitment and self-efficacy is higher, the service quality also gets higher. Also, the ethical commitment and self-efficacy(r=.59, p<.001) of subjects showed a positive correlation in the statistically significant level. In other words, when the ethical commitment is higher, the degree of self-efficacy is also high[Table 4].
Table 4. Correlations of ethical commitment, self-efficacy, and service quality of subjects (N=81)
Variables Ethical commitment
r(p)
Self-efficacy r(p)
Service quality r(p) Ethical commitment 1
Self-efficacy .59(<.001) 1
Quality of services .26(.018) .33(.003) 1
Mediating effects of self-efficacy on the relation between ethical commitment and quality of services of subjects
In the results of reviewing the autocorrelation of dependent variable and multicollinearity between independent variables before verifying the mediating effects of self-efficacy on the relation between ethical commitment and service quality of subjects, the Durbin-Watson index of autocorrelation was 1.419, close to 2, which was shown as independent. In the multicollinearitybetween independent variables, the VIF(Variance Inflation Factor) index was 1.537, less than 10, which was verified as no multicollinearity.
To verify the mediating effects of self-efficacy on the relation between ethical commitment and service quality of caregivers, the 3-step verification by Baron & Kenny was performed. In the results of testing the mediating effects of self-efficacy, in Step1, the ethical commitment as an independent variable had significant effects on self-efficacy as a mediating variable(β=.59), and the explanatory power to explain the self-efficacy was 34.9%. In Step2, the ethical commitment had significant effects on service quality(β=.26), and the explanatory power to explain the service quality was 6.9%. In Step3, in the results of verifying the effects of self-efficacy on service quality by taking the ethical commitment and self-efficacy as predictive factors, and the service quality as a dependent variable, the ethical commitment(β=.11) and self-efficacy(β=.27) were the significant predictive factors on the service quality.
In the results of comparing the β values, the self-efficacy had mediating effects as much as 0.16. The β value(.11) of Step3 was lower than the β value(.26) of Step2. The effects of ethical commitment were decreased by self-efficacy as a mediating variable, which was not statistically significant. Thus, the complete mediating effects of self-efficacy were verified. In the results of testing the significance of mediating effects, it was statistically significant(Z=2.11, p=.035)[Table 5].
Table 5. Mediating Effects of Self-efficacy on the relation between Ethical Commitment and Quality of Services of Subjects
Variables B β t p R2 Adj. R2 F p
Step1: Ethical commitment
→Self-efficacy .78 .59 6.51 <.001 .349 .341 42.43 <.001
Step2: Ethical commitment
→Quality of services .31 .26 2.43 .018 .069 .057 5.88 .018
Step3: Ethical commitment, Self-
efficacy→ Quality of services .116 .093 5.13 .008
1)Ethical commitment→ Quality of
services .12 .11 .80 .431
2)Self-efficacy→ Quality of
services .24 .27 2.03 .045
Sobel test: Z=2.11, p=.035
Discussion
This study aimed to understand the degree of ethical commitment, service quality, and self- efficacy, and the relation between ethical commitment and quality of services of home-visiting
caregivers, and also to verify the mediating effects of self-efficacy on their relation. Based on such results, this study aims to discuss as follows.
The subjects showed the degree of ethical commitment as 3.86 of 5 points, the degree of self-efficacy as 3.97 of 5 points, and the degree of service quality as 4.47 of 5 points. The score of ethical commitment of research subjects was 3.86 points. Even though it was limited to directly compare because of insufficient preceding researches, the research by Shin(Shin, T.H. et al., 2016) targeting the caregivers showed the perception of professionalism as 3.03 of 5 points, belief in self-regulation as 3.26, and vocation as 3.66. According to the research by Lee(Lee, Y.S.
et al., 2010), it was shown as 3.83 of 5 points, belief in self-regulation as 4.10, and vocation as 3.76, so the belief in self-regulation was relatively high. Considering that the measurement instrument used for this study is in 1-5 points, the ethical commitment is regarded as moderate. It would be necessary to put efforts for increasing the ethical commitment through continuous education and workshop in the future.
The self-efficacy of caregivers was 3.97 of 5 points, which was similar to 3.41 of 5 points in the research by Kang(Kang, S. Y. et al., 2018) targeting the caregivers of nursing facilities, 3.53 of 5 points in the research by Kim(Kim J.O. et al., 2018), 3.60 of 5 points in the research by Jang(Jang, S.A., et al., 2021) targeting the caregivers of nursing facilities for the elderly, 3.81 of 5 points targeting the caregivers of long-term care facilities, and 3.46 of 5 points in the research by Lee(Lee, S.K. et al., 2014) targeting the home-visiting caregivers. Even though the self- efficacy is moderate or higher, it is possible to have higher self-efficacy. It would be necessary to apply the self-efficacy improvement program suitable for each caregiver for the improvement of quality of services.
The degree of service quality of caregivers was 4.47 of 5 points, which was higher than the results of preceding researches such as 3.82 of 5 points in the research by Shin(Shin, T.H. et al., 2016) targeting the caregivers, 3.97 of 5 points in the research by Lee(Lee, Y.S. et al., 2010), 3.55 in the research by Kim(Kim, J. H. et al., 2020) targeting the caregivers of long-term care facilities for the elderly, and 3.93 of 5 points in the research by Kang(Kang, S. Y. et al., 2018) targeting the caregivers of nursing facilities. In this study, such a high score was calculated in the results only targeting the caregivers in charge of home-visiting care because the severity of service was lower compared to the inpatients of nursing hospitals; the average service period was also about two years; and about 76.5% of caregivers had the career experiences for 1~5 years.
In the results of examining the correlations of ethical commitment, self-efficacy, and quality of services of subjects, when the ethical commitment and self-efficacy were higher, the degree of quality of services was high. In the results of analyzing the mediating effects of self-efficacy, the ethical commitment had significant effects on self-efficacy as a mediating variable(β=.59, p<.001). Thus, the results of this study show the mediating effects of self-efficacy on the relation between ethical commitment and service quality. The ethical commitment had significant effects on self-efficacy as a mediating variable(β=.40, p<.001), and the explanatory power to explain the self-efficacy was 34.9%. The ethical commitment had significant effects on service quality as a dependent variable(β=.26, p=.018), and the explanatory power to explain the service quality was 6.9%. In the results of analyzing the effects of self-efficacy as a mediating variable on service quality as a dependent variable by taking the ethical commitment and self-efficacy as predictive variables, and the service quality as a dependent variable, the ethical commitment(β=.11) and self-efficacy(β=.27) were the significant predictive factors on the quality of services.
The research by Shin(Shin, T.H. et al., 2016) targeting the caregivers working for nursing facilities for the elderly showed the effects of the perception of professionalism on service
quality, and the results of analyzing the effects on each subarea, the variable affecting the subareas of service quality such as assurance, empathy, and tangibles was the vocation of the perception of professionalism. Also, the research by Lee(Lee, Y.S. et al., 2010) targeting the caregivers of nursing institutions for the elderly reported that the variable of the perception of professionalism having significant effects on service quality was the vocation, which is supporting the results of this study. Therefore, the ethical consciousness and commitment which are the ethical commitment would have effects on service quality.And the research by Jang(Jang, S.A., et al., 2021) targeting the caregivers of nursing facilities for the elderly showed the positive effects of self-efficacy on job satisfaction. Also, the research by Lee(Lee, E. H., 2014) targeting the social workers showed the positive effects of general self-efficacy and social efficacy on service quality, and the positive effects of job satisfaction on service quality. Thus, in those researches, the self-efficacy had effects on job satisfaction. In other words, the higher self- efficacy has positive effects on service quality, which is supporting the results of this study. Also, the research by Seong(Seong, J. A., 2020) targeting the caregivers working for long-term care facilities showed the significantly positive effects of self-efficacy on service quality. Thus, in case of high self-efficacy, the service quality of caregivers was increased, which is supporting the results of this study.
Also, the research by Kang(Kang, S. Y. et al., 2018) showed the direct effects of self-efficacy on service quality, and the professionalism and self-efficacy were the factors affecting the quality of care service. In the results of analyzing the interaction between professionalism and self- efficacy, they have significant effects on service quality. And according to the research by Lee(Lee, J. Y., 2017), the self-efficacy of caregivers had effects on the quality of care service, and in case when the self-efficacy was high, the work situations were positively perceived and effectively coped with, which was led to the successful performance of high-quality service. Such results of those preceding researches verified that the higher self-efficacy of caregivers increased the service quality as well, so it would be necessary to raise the self-efficacy of caregivers.
Therefore, the measures for increasing the self-efficacy would be also important. There should be the measures for improving the self-efficacy, confidence, and ability of caregivers by continuously providing the education and required professional information to them.
Conclusion
This study aimed to verify the mediating effects of self-efficacy on the relation between ethical commitment and quality of services of caregivers. The ethical commitment and self-efficacy showed positive correlations with quality of services of caregivers, and the self-efficacy showed the complete mediating effects on the relation between ethical commitment and service quality, so it would be necessary to establish the practical measures related to this. Also, the degree of ethical commitment perceived by caregivers could have effects on service quality, so it would be needed to provide the opportunities of education and training for improving the ethical commitment in which the caregivers obey the rules following the vocational ethics, and perform the care works. Such education and training would bring about the results of more deeply understanding the service recipients and providing the high-quality care service to the elderly and people with chronic diseases who receive the care service.Through the results of this study, it would be possible to improve the quality of successful care service by providing various practical measures for increasing the self-efficacy and also developing the educational programs for strengthening the ethical commitment and self-efficacy of caregivers. And the institutions that
educate the home-visiting caregivers working in various environments should provide the programs and administrative/financial supports by considering the ethical commitment and self- efficacy.
Ethical clearance: Not required Source of Funding: Self
Conflict of Interest: Nil
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