Effects of perceived self-efficacy and functional status on depression in patients with chronic heart failure

The purpose of this study was to test the relationships between perceived self-efficacy, functional status and depression in a group of chronic heart failure patients. The conceptual model for this study was primarily derived from Bandura's social learning theory. The study is based on an exploratory, correlational design. A sample of 100 chronic heart failure patients who met the inclusion criteria were recruited from four cardiovascular clinics of major hospitals in northern Taiwan. The instruments used in this study included Jenkins' Self-Efficacy Expectation Scales, Seattle Angina Inventory, and Geriatric Depression Scale. Results demonstrate a significant inverse relationship between perceived self-efficacy and depressive symptoms (r = -.61, p < .001), a significant positive relationship between perceived self-efficacy and functional status (r = .55, p < .001), and a significant negative relationship between functional status and depressive symptoms (r = -.33, p < .001). The findings of the path analysis support the hypothesis that after controlling for disease severity, perceived self-efficacy has a direct and negative effect on depressive symptoms. An indirect effect of perceived self-efficacy on depression through functional status in heart failure patients was also revealed in the finding. All paths in the model were significant (p < .05). Results of the study can help to identify heart failure patients who are at risk for low perceived self-efficacy, low functional status, and a depressed mood. Nursing intervention to address these factors can then be developed and tested.     

The effect of clinic-based health promotion education on perceived health status and health promotion behaviors of adolescent and young adult cancer survivors.

More than 70% of children/adolescents diagnosed with cancer are long-term survivors. Little is known about the health perceptions and practices of this population, and limited previous studies have come exclusively from a risk reduction/health protection model rather than a health promotion model. This study was conducted to describe the perceived health status and health-promoting behaviors of adolescent/young adult cancer survivors. This study used Pender's revised health promotion model; perceived health status and health-promoting behaviors were measured using the General Health Index (GHRI) and the Health Promoting Lifestyle Profile II (HPLP-II). The sample consisted of 60 cancer survivors 2 years after completion of cancer treatment and attending a survivorship clinic. Mean baseline scores for the GHRI (76.66; SD, 10.41) indicate perceived health status is positive and similar to normative (noncancer survivor) adolescent/young adult samples. Surprisingly, there was no correlation between scores on the GHRI and the HPLP-II in this sample (r = 0.03).     

Stage-based interventions for low-fat diet with middle school students

Preventing obesity and cardiovascular disease at early ages is important; however, few effective interventions for early adolescents have been reported. In this study, low-income, culturally diverse students from an urban middle school (n = 60) received four classroom interventions with the use of a combined Health Promotion/Transtheoretical Model to control fat in diet and increase physical activity. A control group (n = 57) received the usual classroom education. Pretest percentage fat in diet was regressed on demographics, access to low-fat foods, perceived self-efficacy, benefits/barriers, and stage of change with results as proposed by the model [F(9,64) = 5.77; p =.000; adjusted R(2) = 0.35]. Posttest percentage fat in food was significantly less for the intervention group as compared with the control group (t = 2.06; df, 115; p =.04).     

Registered nurses' self-efficacy for assessing and responding to woman abuse in emergency department settings.

Enhanced knowledge regarding the factors that influence and support the self-efficacy of emergency department (ED) registered nurses and their provision of care to women who have experienced abuse is necessary for the promotion of optimal health care.The purpose of this study was to examine the self-efficacy of registered nurses with respect to assessing and responding to woman abuse in the ED. Study hypotheses and research questions were derived from Bandura's theory of self-efficacy. A secondary analysis (N = 158) of data from the Violence against Women: Health Care Provider Survey was completed. Originally, survey questions were not developed to operationalize the concepts outlined by Bandura. However, they were found to be good indicators. Four scales were developed from the item pool, validated through factor analysis and used to operationalize study variables. Positive relationships were found between self-efficacy information available to ED registered nurses and their self-efficacy for assessing and responding to woman abuse (r= .73, p < .001), self-efficacy expectations, and actual clinical responses related to woman abuse (r= .55, p < .001) and outcome expectancies related to assessing and responding to woman abuse (r = .56, p < .001). Hierarchical multiple regression examined the extent to which self-efficacy information, self-efficacy expectations and outcome expectancies predicted ED registered nurses' clinical responses to woman abuse. Overall, the model explained 40% of the variance in ED registered nurses' clinical responses to woman abuse. Results provide additional support for Bandura's theory and demonstrate that the clinical responses of ED registered nurses are complex and must be understood in terms of self-efficacy and the factors that support its development.     

Self-care of young adolescents with type 1 diabetes

The purpose of this study was to describe the universal and health deviation self-care of adolescents with Type 1 diabetes and the associations of basic conditioning factors with universal and health deviation self-care. Subjects for this study were 152 adolescents aged between 11 and 15 years with a diagnosis of Type 1 diabetes. Data were collected in the home setting of each adolescent and his or her family. The mean universal self-care scores ranged from 66.62% to 90%. The overall mean for this sample was 75.37, indicating that these adolescents took care of their self-care needs 75% of the time. Health deviation self-care was a mean of 27.26, indicating more positive self-care behaviors and treatment adherence. Health deviation and universal self-care were significantly and positively related (r = .36, p < .001). Ethnicity and adolescent sex were statistically significant in predicting universal self-care. Adolescent age was statistically significant in predicting health deviation self-care. Health deviation self-care decreases with age, suggesting that early adolescence or late school age is an appropriate time for interventions to strengthen self-care behaviors. Furthermore, the interrelationship of the two types of self-care supports the potential for a synergistic effect of intervention.     

Mediators of daily stress and perceived health status in adolescent girls

A causal model based on the transactional cognitive theory of psychological stress and coping was tested in a middle adolescent female population to determine the effects of daily stress, introspectiveness, and coping efforts on perceived health status. Daily stress was hypothesized to affect perceived health status both directly and through the mediating variables of introspectiveness and coping efforts. A sample of 159 female adolescents completed the Hassles Scale, the Ways of Coping Checklist-Revised, the Introspectiveness Scale for Adolescents and the General Health Rating Index. The causal model was tested using the LISREL VI program. Findings indicated that the model fit the data, indicating a plausible representation of the relationships among the variables identified (x2 = 15.76, df = 12, p less than .203). Daily stress was significantly negatively related to perceived health status through the mediating variables of introspection and problem-focused coping but not emotion-focused coping. Introspectiveness had a significant direct effect on perceived health status. Problem-focused coping was found to have a direct positive effect on perceived health status.     

中青年高血压患者治疗依从性的影响因素分析

目的探讨中青年高血压患者治疗依从性的影响因素,并分析其治疗依从性与健康信念的相关性。方法采用Champion健康信念模型量表、高血压患者治疗依从性量表对241例中青年高血压患者进行问卷调查。并采用SPSS16.0软件对资料进行分析,治疗依从性与健康信念相关性采用Pearson相关分析;治疗依从性单因素分析采用t检验、方差分析;治疗依从性多因素分析采用多元逐步回归分析。结果中青年高血压患者的健康信念总均分为(2.79±0.42)分;患者治疗依从性的总均分为(3.72±0.69)分;中青年高血压患者的治疗依从性与健康信念呈正相关(r=0.587,P0.01),其中自我效能和健康动力与治疗依从性呈正相关(r=0.801,r=0.748,P0.01),感知到的障碍与治疗依从性呈负相关(r=-0.521,P0.01)。进入治疗依从性回归方程的有感知到的障碍、健康动力和自我效能3个变量,该方程的多元相关系数R=0.790,决定系数R2=0.692。结论中青年高血压患者治疗依从性的主要影响因素有自我效能、健康动力和感知到的障碍,护理人员更应该在提高患者的自我效能、健康动力及克服采取治疗依从行为的困难上给予更多的帮助与指导。     

Evaluation of patient-perceived health status using the Medical Outcomes Survey Short-Form 36 in an intensive care unit population.

OBJECTIVE: Baseline patient functional status as assessed by providers is correlated with mortality after intensive care unit (ICU) admission. We wanted to see if patient self-perception of health status before admission to an ICU correlated with functional outcome. DESIGN: Prospective survey on a convenience sample. SETTING: Single urban university-affiliated Veterans Affairs Medial Center. PATIENTS: One hundred ninety-nine patients in surgical and medical/coronary ICUs. INTERVENTIONS: None. MEASUREMENTS: Patient-assessed baseline health status was monitored with the Medical Outcome Survey Short-Form 36 (SF-36), consisting of 36 questions that evaluate eight health status concepts. In addition, baseline functional status (Zubrod scale) was determined and severity of illness (Acute Physiology and Chronic Health Evaluation [APACHE] II) data were collected. Zubrod functional status, which includes mortality, was determined 6 wks and 6 months after ICU admission, and correlation coefficients were calculated. MAIN RESULTS: We found it feasible to collect SF-36 health status data on a 9% sample in this setting. Less than 1% of responses were completed by proxy. The SF-36 data were internally consistent, and several of its scales including general health perception and physical functioning correlated with patient Zubrod functional status (r2 = .08, p < .001; r2 = .14, p < .001) at 6 wks as did vitality (r2 = .04, p < .01), social function (r2 = .03, p < .05), and physical role function (r2 = .02, p = .053), although to a lesser extent. Similar correlations were also found with 6-month functional status. CONCLUSIONS: We conclude that use of the SF-36 is time efficient in an ICU setting and correlates with 6-wk and 6-month functional outcome. It correlates as well with functional outcome as either the baseline Zubrod functional status or the APACHE II severity of illness measurement. The five-question general health evaluation portion correlated almost as well with outcome as the more extensive 36-item questionnaire. Use of the SF-36 may define patient populations for comparison across hospitals. It may also target individuals with needs for additional posthospitalization care, including rehabilitation services or nursing home placement.     

A test of the health promotion model with blue collar workers

The health promotion model (Pender, 1987b) was tested with a volunteer sample of 179 blue-collar workers. Four psychological variables (importance of health, perceived health locus of control, health status, and self-efficacy), one modifying variable (selected demographics), and certain health-promoting behaviors were examined. Pearson product moment correlations and stepwise and hierarchical multiple regression techniques were used to analyze the data. Each of the psychological variables examined was predictive of health-promotive behaviors. Health status and self-efficacy were the most powerful predictors. The modifer role of demographics was also supported. The results suggest the health promotion model is potentially useful for explaining the occurrence of health-promotive behaviors among blue-collar workers.     

Self-efficacy with application to adolescent smoking cessation: a concept analysis

Title.  Self-efficacy with application to adolescent smoking cessation: a concept analysis.
Aim.  This paper is a report of a concept analysis of adolescent smoking cessation self-efficacy.
Background.  Smoking cessation is a key preventive care/health promotion strategy offered by nurses worldwide. Most programming is tailored to adults although the reasons for smoking, along with coping strategies, resources and developmental stage, differ in adolescence. Understanding of the concept of self-efficacy as it relates to the adolescent population will assist nurses in addressing smoking cessation behaviours with this population.
Data sources.  The CINAHL and Proquest Nursing databases were searched for papers published between 1977 and 2007 using the keywords self-efficacy, adolescents and smoking cessation. The Walker and Avant method of concept analysis was applied.
Findings.  Adolescent smoking cessation self-efficacy is the confidence, perceived capacity and perceived ability that the teen possesses to quit smoking. Identified antecedents include developmental stage, past life support, emotional support, coping strategies, resources and emotional status. Consequences are smoking cessation: positive or negative. Empirical measures are identified.
Conclusion.  Levels of self-efficacy have been shown to be an important consideration in the approach of nurses to smoking cessation counselling with the adolescent client. The theoretical definition for this concept will provide the basis for nurses to design appropriate interventions for use in smoking cessation programmes targeted to adolescents. This definition identifies the key attributes of this concept that should be addressed when caring for this population.     

Health-promoting behaviors of elderly korean immigrants in the United States

The purpose of this study was to explore health-promoting behaviors among elderly Korean immigrants, and to examine the relationships of their health-promoting behaviors with self-efficacy and perceived health status. One hundred ten elderly Korean immigrants residing in the United States were interviewed using a structured questionnaire. The mean score of health promoting behaviors of elderly Korean immigrants was 2.54 on the 5-point Likert scale. Nutrition was the subdomain with the highest mean score (M=3.01) and exercise was the subdomain with the lowest mean score (M=1.92). Both self-efficacy (r=0.49, p=0.01) and perceived health status (r=0.19, p=0.043) were significantly related to health-promoting behaviors. Education (F=3.61, p=0.016) and economic status (F=3.01, p=0.034) were significantly associated with health-promoting behaviors. This study showed poor practices of healthy lifestyles of elderly Korean immigrants. Low exercise scores indicated the need for community based exercise and health promotion programs for the elderly Korean immigrants population.     

Social Determinants of Adolescent Depression: An Examination of Racial Differences

Conventional behavior theories that assert adolescent risk behaviors are determined by peer and parental relationships are being challenged as research begins to consider broader socioenvironmental factors. This study, using data from the Longitudinal Study for Adolescent Health (Add Health), Wave II, Public Use Data, and the Social Determinants of Adolescent Risk Behaviors (SDOARB) framework, examines relationships among socioeconomic status (SES), academic performance, perceived peer prejudice, and perceived teacher discrimination as predictors of depressive symptoms among high school adolescents. Overall, the study found that GPA was a significant predictor of depressive symptoms across all three racial groups (Black, White, and Other Minority). Teacher discrimination predicted depressive symptoms among White and Other minority adolescents, but not Black adolescents. These findings suggest the need for interventions within schools for both students and teachers around racial differences in perceptions of prejudice and discrimination. Failure to address overt and covert subtleties of discrimination and prejudice within schools and policies which affect these interpersonal dynamics may have a significant impact on the overall mental wellbeing of adolescents.     

Predictors of condom use among Mexican adolescents

Mexican adolescents continue to be at increased risk for HIV infection due to inconsistent condom use. The purpose of this study was to identify predictors of condom use intentions and condom use among Mexican adolescents who participated in a randomized control trial designed to test a sexual-risk reduction intervention. Data from sexually active adolescents 17 to 21 years (n = 157) of age who were assigned to the control group were analyzed 48 months post intervention. Regression analysis showed that positive attitudes toward condoms, subjective norms, and control beliefs significantly explained intention to use condoms (R2 = .75, p < .001). Attitudes toward condoms (beta = .67, p <.001), technical skills (beta = .13, p = .01), and condom use self-efficacy (beta = .24, p < .001) were significant predictors of condom use intention. Compared to those who inconsistently used condoms, adolescents who used condoms consistently had greater intention to use condoms and greater impulse control. Findings suggest that attitudes and control beliefs should be further explored with Mexican adolescents in order to support consistent condom use.     

Research brief: sexual communication and knowledge among Mexican parents and their adolescent children.

This study describes the sexual knowledge and communication of Mexican parents and adolescents. Preintervention data were analyzed from 829 high school students (ages 14-17) and one of the parents of each. Differences were found between parents and adolescents in sexual knowledge (M = 16.16 vs. M = 14.92; t = 7.20, p < .001); specifically, parents had higher knowledge related to sexually transmitted diseases, HIV/AIDS, and condom use. Parents perceived more general communication (t [787] = 6.33, p < .001), and less discomfort talking about sex (t [785] = 4.69, p < .001) than adolescents. Parents with higher education levels scored higher in HIV knowledge and general communication. Fathers had higher total sexual knowledge, whereas mothers perceived higher sexual communication than fathers. There were no differences in knowledge and communication by parental socioeconomic level. Results suggest health care providers need to assist parents in developing specific knowledge and skills to support their adolescents' sexual decision-making.     

Adolescent mothers: resilience, family health work and health-promoting practices

AIMS: This paper reports a study examining the relationships among mother's resilience, family health promotion (i.e. health work) and mother's health-promoting lifestyle practices in single-parent families led by adolescent mothers by testing hypotheses derived from the Developmental Model of Health and Nursing. BACKGROUND: Research on families led by adolescent mothers has focussed primarily on negative maternal and child outcomes while ignoring the capacities of these families, including their efforts to promote the health and well-being of both mothers and children. METHODS: This replication study was conducted with convenience sample of 41 adolescent mothers recruited using a variety of strategies. Mothers were asked to provide verbal responses to items on three study instruments: The Resilience Scale, a measure of mother's resilience, the Health Options Scale, a measure of family health work and the Health Promoting Lifestyle Profile a measure of mother's health promoting lifestyle practices, as well as a demographic questionnaire. RESULTS: Consistent with the theory, moderate positive relationships were observed between mothers' resilience and both family health work (r = 0.34, P = 0.01) and mothers' health-promoting lifestyle practices (r = 0.42, P < 0.001). As predicted, moderate correlations were also observed between health work and mother's health promoting lifestyle practices (r = 0.62, P < 0.001). With the effects of employment status and professional support held constant, mother's resilience and health work explained 30.2% of the variance in mother's health-promoting lifestyle practices. CONCLUSIONS: The study validates theoretical relationships among concepts in the developmental model of health and nursing and contributes to better understanding health promotion in families led by adolescent mothers.     

Cardiovascular health in urban Chinese children and adolescents

Introduction: Cardiovascular diseases remain the leading cause of death and disease burden in China and worldwide. We aimed to evaluate the status of cardiovascular health among urban Chinese children and adolescents.

Methods: We conducted a cross-sectional study comprising 12,618 children and adolescents aged 6–18 years, who were recruited from Chinese urban areas during 2013–2015. The poor, intermediate, and ideal levels of 7 cardiovascular health metrics, including smoking, body mass index, dietary intake, physical activity, blood pressure, blood glucose, and total cholesterol were defined according to revised American Heart Association criteria.

Results: Ideal smoking status was the most prevalent health component (overall, 90.7%; males, 86.3% and females, 95.4%), whereas ideal health diet score (overall, 8.7%; males, 9.1% and females, 8.3%) was the least prevalent among urban Chinese children and adolescents. The majority (overall, 84.9%; males, 82.6% and females, 87.4%) of participants had 3–5 ideal metrics. The overall prevalence of ideal cardiovascular health (i.e. meeting all 7 ideal components) was extremely low (overall, 0.5%; males, 0.5% and females, 0.4%).

Conclusions: The prevalence of ideal cardiovascular health in urban Chinese children and adolescents is extremely low, particularly for physical activity and healthy dietary intake. Effective public health interventions are required to improve cardiovascular health in children and adolescents to reduce future cardiovascular risk.

• Key messages

• Ideal health diet score was the least prevalent health component among urban Chinese children and adolescents

• The prevalence of ideal cardiovascular health in urban Chinese children and adolescents was extremely low

• Effective public health interventions are required to improve cardiovascular health in children and adolescents to reduce future cardiovascular risk

     

Predictors of health behaviours in college students

AIM: This paper reports a study examining the direct effects of perceived stress, perceived availability of and satisfaction with social support, and self-efficacy, and examines the intermediary roles of perceived threat (perceived susceptibility x perceived severity), benefits, and barriers on alcohol behaviour, smoking behaviour, physical activity and nutrition behaviour, general safety behaviour and sun-protective behaviour in college students. BACKGROUND: Health behaviours formed during young adulthood may have a sustaining impact on health across later life. Entering college can be an exciting, yet stressful event for many adolescents and young adults as they face trying to adapt to changes in academic workloads, support networks, and their new environment. Coupled with these changes and new-found responsibilities, they have greater freedom and control over their lifestyles than ever before. However, researchers have shown globally that many college students engage in various risky health behaviours. METHOD: A cross-sectional sample of 161 college students enrolled in an introductory psychology course completed self-report questionnaires regarding stress; social support; self-efficacy; and components of the Health Belief Model including perceived threat, perceived benefits, perceived barriers; and common health behaviours. Step-wise multiple regression analysis was conducted and significant predictors were retained as modifiers in the path analysis. FINDINGS: Self-efficacy significantly predicted alcohol and smoking behaviour, physical activity and nutrition protective behaviour, general safety protective behaviour and sun-protective behaviour. Under high-perceived threat, self-efficacy was mediated by perceived barriers for binge drinking and moderated by perceived barriers for physical activity and nutrition behaviours. In addition, under high-perceived threat, self-efficacy was moderated by perceived threat for alcohol use at 30 days and 6 months. Under low threat, self-efficacy was mediated by perceived barriers for smoking behaviour and general safety protective behaviours. CONCLUSIONS: Future health promotion programmes with college students must use interventions that maximize self-efficacy and ultimately reduce barriers to adopting a healthy lifestyle.     

A public health nursing early intervention program for adolescent mothers: outcomes from pregnancy through 6 weeks postpartum

BACKGROUND: Adolescent pregnancy and parenting remain a major public concern because of their impact on maternal-child health and on the social and economic well-being of the nation. Federal welfare reform legislation has created an urgent need for community-based nursing intervention programs to improve health and social outcomes for disadvantaged adolescent mothers and to promote their self-sufficiency. OBJECTIVE: To evaluate the effects of an early intervention program (EIP) that uses a public health nursing model on health and social outcomes of adolescent mothers and their children and on the quality of mother-child interaction. METHODS: Pregnant adolescents referred to a county health department were randomly assigned to an experimental (EIP) or control (traditional public health nursing [TPHN]) group. The sample included 121 adolescents from predominantly minority and impoverished backgrounds who were followed from pregnancy through 6 weeks postpartum. Intense and comprehensive home visitation by public health nurses and preparation-for-motherhood classes were provided to adolescents in the EIP. Health outcomes were determined on the basis of medical record data. Other measures included maternal self-report on selected behaviors, nurse interviews, and the Nursing Child Assessment Teaching Scale (NCATS). RESULTS: Early findings indicate reduced premature birth and low-birth-weight (LBW) rates for young mothers receiving both forms of public health nursing care. No significant differences between groups were found for infant birth weight or type of delivery. Infants in the EIP had significantly fewer total days of birth-related hospitalization and rehospitalization than those in the TPHN group during the first 6 weeks of life (chi2(1) = 6.41; p = 0.01). Adolescents in the EIP demonstrated significantly more positive educational outcomes (e.g., lower school dropout rates) than those in the TPHN group (chi2(1) = 6.76; p < 0.009). CONCLUSIONS: The early findings of this study demonstrate that pregnant adolescents benefit from both traditional and more intense public health nursing care in terms of prenatal and perinatal outcomes. The EIP was associated with decreased infant morbidity during the first 6 weeks of life and decreased maternal school dropout. Long-term outcomes for the EIP are being evaluated.