Relationship between illness representation and self-efficacy

AIM: This paper reports a patient survey exploring the possible relationship between illness perception and self-efficacy following a cardiac event, and the implications this could have for nursing practice. BACKGROUND: Cardiac rehabilitation guidelines endorse the need to improve psychological care; suggesting that individualized support will improve the effectiveness of cardiac rehabilitation. Surveys, however, continue to identify that psychosocial factors are poorly assessed. Illness representation and self-efficacy are two prominent research approaches that have been developed as separate foci for the treatment of patients. METHOD: A cross-sectional survey with patients diagnosed with either myocardial infarction or angina over an 8-month period in two hospitals. The Illness Perception Questionnaire, General Self-Efficacy Questionnaire, Cardiac Diet Self-efficacy Instrument and Cardiac Exercise Self-efficacy Instrument were used, alongside two specifically-designed scales: the Diet Outcome Expectation and Exercise Outcome Expectation Scales. RESULTS: The results indicate that there is a significant relationship between illness perception and self-efficacy. The greater patients' perceived consequences of the heart condition, the lower was the general self-efficacy available to cope with the condition. Further, the longer the perceived time the condition will affect the patient, the higher the specific self-efficacy to maintain a change of diet or exercise regime. CONCLUSION: The findings identify that, in the initial phase of recovery, nursing practice needs to focus on the key variables of "consequence" and "timeline" in order to increase patients' confidence in their ability to cope (self-efficacy).     

Personal characteristics, health status, physical activity, and quality of life in cardiac rehabilitation participants

The purpose of this study was to examine the relationships between personal factors, health status, and adherence to physical activity behavior, and quality of life in cardiac rehabilitation participants. The record of 146 subjects, who met inclusion criteria were obtained from the University Cardiac Rehabilitation Database. Change scores in physical activity were used as a proxy for adherence. Participants who were categorized as not working, female gender, and at high-risk health status had lower means and lower improvement scores from repeated measures analysis of variance. This study found that some personal factors and health status are significant factors influencing the participant's adherence to physical activity recommendations and quality of life in this cardiac rehabilitation program.     

Initial efficacy of a cardiac rehabilitation transition program: Cardiac TRUST

The purpose of this pilot study was to test the initial efficacy, feasibility, and safety of a specially designed postacute care transitional rehabilitation intervention for cardiac patients. Cardiac Transitional Rehabilitation Using Self-Management Techniques (Cardiac TRUST) is a family-focused intervention that includes progressive low-intensity walking and education in self-management skills to facilitate recovery following a cardiac event. Using a randomized two-group design, exercise self-efficacy, steps walked, and participation in an outpatient cardiac rehabilitation (CR) program were compared in a sample of 38 older adults (17 Cardiac TRUST, 21 usual care). At discharge from postacute care, the intervention group trended toward higher levels of self-efficacy for exercise outcomes than the usual care group. During the 6 weeks following discharge, the intervention group had greater attendance in outpatient CR and a trend toward more steps walked during the first week. The feasibility of the intervention was better for the home health care participants than for those in the skilled nursing facility. The provision of CR during postacute care has the potential to bridge the gap in transitional services from hospitalization to outpatient CR for these patients at high risk for future cardiac events. Further evidence of the efficacy of Cardiac TRUST is warranted.     

Maternal confidence for labor: Development of the childbirth self-efficacy inventory

The Childbirth Self-Efficacy Inventory (CBSEI) is a self-report instrument that measures outcome expectancies and self-efficacy expectancies for coping with an approaching childbirth experience. The CBSEI scales have excellent internal consistency reliability (0.86 to 0.96) and factor analysis suggested that each CBSEl scale is unidimensional. Validity of the CBSEI was supported by significant positive correlations with the criterion variables of generalized self-efficacy, self-esteem, and internal health locus of control; and significant negative correlations with external health locus of control and learned helplessness. Validity was also supported by significantly higher self-efficacy scores for multiparous as compared to nulliparous pregnant women. © 1993 John Wiley & Sons, Inc.     

Perceived health status in urban minority young adolescents

PURPOSE: To describe perceptions of health status among a sample of urban minority adolescents and the contribution of demographics, intrinsic motivation, general self-efficacy, risk taking, and stressful life experiences on the adolescent's perception of health status. METHOD: Correlational design. A total of 71 adolescents were studied using the Adolescent Health Chart for perceived health status, the Health Self-Determinism Index for Children, the Self-Efficacy Scale, the Risk Taking Instrument, and the Life Events Checklist. RESULTS: There were no statistically significant effects of demographics on perceived health status. Scores of Perceived Health Status correlated with scores of self-efficacy (r = 0.56; p <.0001), risk-taking (r = 0.39; p <.001), negative events (r = 0.32; p <.01) and violent events (r = -0.41; p <.001). CLINICAL IMPLICATIONS: The study findings suggest that self-efficacy, risk taking, and life events are predictive of perceived health status in urban minority adolescents. The results contribute to the present body of knowledge about patterns of adolescent health as perceived by the adolescent. In addition to expanding the understanding of the minority adolescent experience in relation to health promotion attributes and health compromising behaviors, the results identify antecedents that are predictive of improved perceived health status for the urban adolescent.     

Associations between Health Behaviors,Health Self-Efficacy,and Long-Term Outcomes in Survivors of Childhood Cancer: A Cross-Sectional Study

ObjectivesMany survivors of childhood cancer experience multiple long-term chronic health conditions. Health behaviors are important because they contribute to chronic disease yet are highly modifiable. With growing pressure on cancer services, alternative models of care are required to address survivorship care needs. The authors sought to inform the development of a community-based model of cancer survivorship care for young people. This exploratory cross-sectional study aimed to assess the feasibility of study measures and processes, as well as investigate associations between various modifiable health behaviors, health self-efficacy, quality of life, and persistent symptoms.Data SourcesParticipants were recruited from a long-term follow-up clinic for childhood cancer survivors. A self-report survey was completed, and participants received an activity tracker. Bivariate regression analyses were used to explore the relationship between variables.ConclusionsThe study measures and processes were deemed feasible with >70% of eligible survivors enrolling in the study and completing >70% of study measures. Thirty participants (mean age 22 ± 4.4 years) were enrolled; 83.3% finished treatment ≥5 years previously and 36.7% were overweight or obese. Bivariate regression identified those with higher scores of health self-efficacy were more likely to meet physical activity guidelines, as were those who achieved more sleep and consumed greater servings of vegetables. Meeting the physical activity guidelines, was significantly positively associated with higher quality of life and self-efficacy.Implications for Nursing PracticeInterventions that target health self-efficacy have the potential to improve a range of health behaviors and long-term outcomes for survivors of childhood cancer. Nurses are ideally placed to use this knowledge to support patients with recommendations to optimise their recovery and rehabilitation.     

Effects of nurse-initiated telephone follow-up on self-efficacy among patients with chronic obstructive pulmonary disease

AIM: This paper reports a study to determine whether a nurse-initiated telephone follow-up programme could increase patients' self-efficacy in managing dyspnoea and decrease health care service use. BACKGROUND: Chronic obstructive pulmonary disease is a worldwide health problem and has been labelled a burdensome disease. Because of the fear of activity-induced dyspnoea, patients with chronic obstructive pulmonary disease lack the confidence to perform daily activities. Studies of cardiac and diabetic patients have shown that telephone follow-up care is an effective approach to increasing self-efficacy. However, little such research has been done with patients with chronic obstructive pulmonary disease. METHODS: This was a randomized controlled study. A total of 60 participants (30 telephone follow-up, 30 control) with chronic obstructive pulmonary disease were recruited from an acute care hospital in Hong Kong. The Chinese Self-Efficacy Scale was used to assess self-efficacy. Measures of health care use were numbers of visits to an accident and emergency department, hospitalizations, and unscheduled visits by physicians. FINDINGS: The self-efficacy scores (U = 272.5, P = 0.009) of patients who were followed up by telephone improved significantly compared with those of patients in the control group. Multiple regression analyses showed that telephone follow-up (Beta = 0.33, CI: 0.19-0.48, P = 0.001), the pulmonary rehabilitation programme (Beta = 0.44, CI: 0.16-0.72, P = 0.003), smoking (Beta = 0.34, CI: 0.09-0.57, P = 0.009), and health care use (Beta = -0.27, CI: -0.47-(-0.07), P = 0.008) were significant factors in predicting patient self-efficacy. CONCLUSIONS: Nurse-initiated telephone follow-up care was effective in increasing self-efficacy in managing dyspnoea. The study needs to be replicated in other setting to strengthen its external validity.     

University of Washington self-efficacy scale: a new self-efficacy scale for people with disabilities

Amtmann D, Bamer AM, Cook KF, Askew RL, Noonan VK, Brockway JA. University of Washington Self-Efficacy Scale: a new self-efficacy scale for people with disabilities.ObjectiveTo develop a self-efficacy scale for people living with multiple sclerosis (MS) and spinal cord injury (SCI) that can be used across diagnostic conditions.DesignThe scale was developed using modern psychometric methods including item response theory. Items were administered at 3 time-points of a longitudinal survey of individuals with MS and SCI.SettingSurvey participants with MS were recruited from the National MS Society, and participants with SCI were recruited from the Northwest Regional Spinal Cord Injury Model System and the Shepherd Center at the Virginia Crawford Research Institute in Atlanta, GA.ParticipantsAdults aged 18 years and older reporting a definitive diagnosis of MS (N=473) or SCI (N=253).InterventionsNone.Main Outcome MeasuresEvaluation of the new self-efficacy measure called the University of Washington Self-Efficacy Scale (UW-SES) included comparisons with the Chronic Disease Self-Efficacy Scale and other patient-reported outcome measures.ResultsUW-SES has excellent psychometric properties including well-functioning response categories, no floor effects, and low ceiling effects. A long form (17 items) and a short form (6 items) are available. The correlation between the score on the newly developed scale and the Chronic Disease Self-Efficacy Scale was high (.83), providing support for convergent validity. Higher self-efficacy scores were statistically significantly associated with better mental health, better physical health, less fatigue, less stress, less pain interference, less pain, fewer sleep problems, and lower depressive symptoms.ConclusionsThe UW-SES is a psychometrically sound instrument for measuring self-efficacy, validated in MS and SCI, and can be used across both conditions. Both the long form and the short form are available free of charge.     

Depression coping self-efficacy as a predictor of relapse 1 and 2 years following psychiatric hospital-based treatment

This longitudinal study involved 1 - and 2-year follow-up assessments of participants who received inpatient (n = 25) or partial hospital program (PHP) (n = 24) treatment for depression. The purposes of this study were to (a) compare 2-year follow-up depressive symptom and depression coping self-efficacy scores with posttreatment scores, (b) examine depression coping self-efficacy scores as a predictor of health care visit frequencies following treatment, and (c) examine differences in 2-year depressive symptom and depression coping self-efficacy scores between original treatment groups. Participant (n = 49) health records were reviewed for frequencies and types of health care visits at 1-year posttreatment. Twenty-six (52% response rate) participants completed the Depression Coping Self-Efficacy Scale, Center for Epidemiologic Studies Depression Scale, and Two-Year Follow-Up Questionnaire at 2-years posttreatment. One-year findings indicated posttreatment depression coping self-efficacy scores were associated with frequencies of psychiatric episodes of care. Relapse rates (> 25%) were consistent with previous reports. Despite maintenance of improvements in depressive symptom and depression coping self-efficacy scores, depressive symptom scores remained above cutoff levels at 2 years posttreatment. Two-year findings did not differ based on original treatment type. Findings support further research examining the DCSES as a predictor of relapse and a target for treatment.     

Validation of the cardiac health behavior scale for Korean adults with cardiovascular risks or diseases

AimThe purpose of this study was to validate the Cardiac Health Behavior Scale for Korean adults (CHB-K) to determine its validity and reliability.BackgroundCardiovascular diseases (CVDs) are one of the most important chronic diseases due to their high prevalence and mortality rates. Patients with cardiovascular risks or diseases need to perform appropriate cardiac health behaviors that help to prevent the progression of the disease and improve their health status.MethodsThis secondary analysis obtained data from two clinical trials of cardiac rehabilitation. Data from 298 patients with cardiovascular risks or diseases were analyzed for validation. Data analyses included correlation coefficients, t-tests, and exploratory and confirmatory factor analyses using SPSS (version WIN 22.0) and AMOS (version 20.0). The Self-Efficacy Scale was used to assess convergent validity, while reliability was assessed using Cronbach's alpha coefficients.ResultsFive main factors were verified: health responsibility, physical activity, diet habit (eating habit and food choice), stress management, and smoking cessation. A set of 21 items from the 25-item scale was verified after performing item analysis, factor analyses, and critical evaluation of the statistical results. The 21-item CHB-K (CHB-K21) exhibited acceptable validity, and the model of the CHB-K21 provided a good fit to the data. Most of the factors were found to be moderately correlated with SES scores (r = 0.45–0.52, p < 0.001). The CHB-K21 also demonstrated acceptable reliability (Cronbach's alpha = 0.83).ConclusionsThe CHB-K21 demonstrates strong validity and reliability. It can be used to assess cardiac health behaviors in Korean adults with cardiovascular risks or diseases.     

Development and testing of the Cholesterol-Lowering Diet Self-Efficacy Scale.

A cornerstone of treatment for hypercholesterolemia is dietary therapy. However, maintaining adherence to the therapeutic diet has been difficult for patients. There is evidence that self-efficacy is a predictor of positive behavior change like that involved in or necessary for initiating or maintaining recommended diet therapy for cholesterol reduction. This paper reports on two studies guided by Bandura's self-efficacy theory. The first study focuses on development and initial psychometric evaluation of an instrument measuring self-efficacy for adhering to a cholesterol-lowering diet in a sample of 44 cardiac rehabilitation patients; the second establishes psychometric properties of the instrument in a sample of 228 subjects treated for hypercholesterolemia. In both studies, subgroups completed the instrument a second time to provide data on the instrument's temporal stability. The Cholesterol-Lowering Diet Self-Efficacy Scale consists of 33 statements, some with branches for a total of 56 items. The scale measures several components of the eating habits domain related to adhering to a cholesterol-lowering eating plan, and shows good reliability and validity. Reported self-efficacy is related to prior persistence and past success in modifying and maintaining dietary changes, and also to concurrent measures of dietary adherence behaviors. The scale is psychometrically sound thus far and seems adequate in identifying success in achieving and maintaining a cholesterol-lowering eating plan.     

Cognitive Behavioral Therapy,Self-Efficacy,and Depression in Persons with Chronic Pain

Chronic pain is a complex and often disabling condition compounded by depression and poor self-efficacy. The purpose of this evidence-based project was to explore the relationship of cognitive behavioral therapy (CBT)–focused groups with self-efficacy and depression in persons with chronic pain at an intensive interdisciplinary 3-week pain rehabilitation center (PRC). The project sample consisted of 138 persons admitted to a PRC and scoring ≥27 on the Center for Epidemiological Study Depression Scale (CES-D) and then completing the Pain Self-Efficacy Questionnaire (PSEQ). After completing the PRC program, including CBT-focused groups, discharge CES-D and PSEQ scores were analyzed. A comparison group of CES-D scores from 134 persons admitted to the PRC from a 9-month time period preceding the addition of the CBT-focused groups was also examined. There was a significant increase in self-efficacy after participation in the intensive pain rehabilitation program including CBT-focused groups. Patient groups both before and after introduction of CBT-focused groups showed the same rate of improvement on the depression scores, suggesting that persons who participated in CBT-focused groups improved equally compared with persons who did not participate in these groups. Ninety-three percent of the participants expressed satisfaction with the CBT groups. This evidence-based practice is well supported in the literature and can be implemented with knowledgeable staff and engaged stakeholders.     

对住院患者骨质疏松症知识和健康信念的调查

目的　了解住院患者关于骨质疏松症 (OP)知识、健康信念和自我效能以及相关行为。方法　对广州某三甲医院的 12 2名住院患者 ,用根据Kim等人编制的OP量表修订的问卷进行调查。结果　 ( 1)知识问卷平均得分 10 .8,及格率 2 3 %。不同学历之间的知识得分有显著差异 (P <0 .0 5 ) ,随着学历的增高知识得分也增高。 ( 2 )对OP的易感性和严重性认识不足 ,不同年龄和学历间健康信念得分有显著差异 (P <0 .0 5 ) ,其中中年组的健康信念得分高于青年和老年组 ,高中组高于其他学历组。 ( 3 )OP自我效能得分平均 77.5分 ,但在实践中 ,只有 2 /3的人从事运动、1/3的人补钙。不同年龄之间自我效能得分有显著差异 (P <0 0 5 ) ,中年组高于青年和老年组。讨论　应加强OP的健康教育 ,并重点在得分低的组别 ,从而提高患者的OP知识和预防意识 ,增强其OP健康信念和自我效能 ,推动建立健康的生活方式和采取疾病预防行为     

The Spanish version of the Breastfeeding Self-Efficacy Scale-Short Form: reliability and validity assessment

BackgroundOnly a minority of infants are exclusively breastfed for the recommended 6 months postpartum. Breastfeeding self-efficacy is a mother's confidence in her ability to breastfeed and is highly predictive of breastfeeding behaviors. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was developed among English-speaking mothers to measure breastfeeding self-efficacy.ObjectivesTo translate the BSES-SF into Spanish and assess its psychometric properties.DesignMethodological study.SettingOne public hospital in Orihuela, Spain.ParticipantsA convenience sample of 135 in-hospital breastfeeding women was recruited on their second day postpartum.MethodsThe BSES-SF was translated into Spanish using forward translation, back-translation and pilot testing. Internal consistency, construct validity and predictive validity were assessed. A battery of self-report questionnaires was administered on the second day postpartum including: a questionnaire on sociodemographic variables and breastfeeding status, the translated BSES-SF, the Spanish adaptation of the General Self-Efficacy Scale and the Stress Management Self-Efficacy Scale. Also, data on breastfeeding status at three weeks postpartum were collected by telephone interviews.ResultsThe Cronbach's alpha coefficient for internal consistency was 0.92. The translated BSES-SF presented a unidimensional structure with factor loadings of >0.30. In addition, demographic response patterns and correlations with self-efficacy scales provided further evidence of construct validity. In-hospital BSES-SF scores significantly predicted exclusive breastfeeding at 3 weeks postpartum.ConclusionsThe results of this study indicate that the Spanish translation of the BSES-SF can be considered a valid and reliable measure of maternal breastfeeding self-efficacy in Spain.     

Interprofessional ethics education seminar for undergraduate health science students: A pilot study

To prepare for the modern collaborative healthcare system, health science academia is charged with educating future professionals to be competent members of the interprofessional team. The purpose of this pilot study was to assess self-efficacy for interprofessional education (IPE) in medical laboratory technology, dental hygiene, and nursing students before and after an IPE session. The specific topic of ethics was the focus of the session. The interprofessional seminar was designed to compare the codes of ethics from each programme through discussion and a case-based approach. The Self-Efficacy for Interprofessional Experiential Learning scale was used to collect quantitative data. A total of 75 participants rated self-efficacy for IPE before and after the educational offering. A paired sample t-test was used to analyse data. Significant results were found in students’ pre- and post-test scores that indicated increased levels of self-efficacy related to working as a collaborative team for the benefit of the patient. Overall, there was an increase in participants’ self-efficacy after collaborating with students from different health professions programmes. Healthcare students that learn together are more confident in their abilities to implement a team-structured approach, and understand that doing so will foster optimal patient wellbeing.     

Cognitive mechanisms in claustrophobia: An examination of reiss and McNally's expectancy model and Bandura's self-efficacy theory

This paper reports on two studies that examined predictions derived from Reiss and McNally's (1985) expectancy model of fear behavior and Bandura's (1988) self-efficacy theory. In Study 1 of 138 participants displaying marked claustrophobic fears, scales were developed to measure Suffocation Concerns, Entrapment Concerns, and Coping Self-Efficacy. In Study 2 of 202 participants displaying marked claustrophobic fears, confirmatory factor and reliability analyses showed that these scales reliably tapped relatively discrete constructs. Predictions derived from the Reiss and McNally expectancy model and Bandura's self-efficacy theory were examined using behavioral, subjective, and physiological measures taken during a claustrophobic Behavioral Approach Test (BAT). Coping Self-Efficacy accounted for unique variance in subjective fear and heart-rate reactivity, but did not produce significantly better classification of participants' behavior beyond the expectancy model variable set. The expectancy model variable set meaningfully predicted behavioral approach, with the interaction between Expected Anxiety and Anxiety Sensitivity adding significantly to the classification beyond all other variables. These findings suggest that the expectancy model and self-efficacy theory provide meaningful and nonredundant accounts of phobic reactions.     

Self-efficacy for health-related behaviors among deaf adults

The purpose of this quasi-experimental, pre-post-test study was to test the effectiveness of the Deaf Heart Health Intervention (DHHI) in increasing self-efficacy for health-related behaviors among culturally deaf adults. The DHHI targets modifiable risk factors for cardiovascular disease. A sample of 84 participants completed time-1 and time-2 data collection. The sign language version of the Self-Rated Abilities Scale for Health Practices (SRAHP) was used to measure self-efficacy for nutrition, psychological well-being/stress management, physical activity/exercise, and responsible health practices. Total self-efficacy scores were significantly higher in the intervention group than in the comparison group at time-2, controlling for scores at baseline (F [1, 81] = 26.02, p < .001). Results support the development of interventions specifically tailored for culturally deaf adults to increase their self-efficacy for health behaviors.     

The impact of subacute whiplash-associated disorders on functional self-efficacy: a cohort study

Self-efficacy is increasingly being recognized as an important factor to consider in medical research, especially in different pain conditions such as whiplash-associated disorders (WAD). When pain is not effectively treated or relieved, it may negatively affect patients' life situation and cause a decline in perceived self-efficacy. Knowledge of what level of self-efficacy can be considered an actual deficit in patients with WAD is, however, sparse. The purpose of this study is to analyze whether subacute WAD has an impact on self-efficacy beliefs. A cohort study was designed to identify the impact of WAD on self-efficacy beliefs. The exposed group consisted of 47 patients with subacute WAD following a whiplash trauma. The control group representing the general population consisted of 212 participants, and was randomly selected to match the distribution of age and sex in the exposed group. The Self-Efficacy Scale was used to assess the individuals' confidence in their ability to successfully carry out activities of daily living. In the exposed group, 47 responded (100%), and in the control group, 113 (53%) responded. The results show that the total scores on the Self-Efficacy Scale were significantly lower in the exposed group compared with the control group, concerning both the mean (P<0.001) and median (P<0.001) scores. In conclusion, patients with subacute WAD experience a decline in functional self-efficacy, which stresses the importance of incorporating these beliefs in clinical practice and research.