Berna G.M. Sol

The role of self-efficacy in vascular risk factor management: A randomized controlled trial

OBJECTIVE Given the large number of patients at high risk of vascular events, new strategies are needed to reduce vascular risk. We investigated whether self-efficacy promotion could change self-efficacy levels in patients with vascular diseases and whether baseline self-efficacy and changes in self-efficacy were related to changes in vascular risk factors. METHODS One hundred fifty-three recently referred patients with symptomatic vascular diseases (cerebrovascular, abdominal, or peripheral arterial) participated in a randomized trial investigating the effect of nursing care, as compared with usual care, on vascular risk factors. Nursing care consisted of self-efficacy promotion and medical treatment of vascular risk factors. Self-efficacy and vascular risk factors (smoking, BMI, waist, blood pressure, lipid, and glucose levels) were measured at baseline and after 1 year. RESULTS While total self-efficacy did not change over the 1-year intervention period in either treatment group, self-efficacy in choosing healthy food (mean +0.4+/-1.4, p-value 0.01) and in doing extra exercise (mean +0.3+/-1.3, p-value 0.03) increased in the intervention group. No relation was seen between baseline total self-efficacy or change in composite self-efficacy and change in vascular risk factors. CONCLUSION The nursing intervention did not influence total self-efficacy but did improve self-efficacy in choosing healthy food and doing extra exercise. Change in composite self-efficacy was not related to change in vascular risk factors in patients at high risk of developing (new) cardiovascular diseases. PRACTICE IMPLICATIONS Influencing self-efficacy in choosing healthy food and doing extra exercise could be incorporated in vascular risk reduction programs in addition to medical treatment of vascular risk factors.

The effect of self-efficacy on cardiovascular lifestyle.

Background: It is important that patients with vascular diseases adopt a healthy lifestyle so as to reduce vascular risk. Since self-efficacy is an important precondition for health behavior change in patients with chronic disease, we investigated whether self-efficacy was associated with cardiovascular lifestyle in patients with clinical manifestations of vascular diseases. Methods and design: In this observational cohort study, 125 patients who had recently been referred for cerebrovascular disease, coronary heart disease, or peripheral arterial disease participated in a 1-year self-management intervention. They completed a self-efficacy questionnaire and questions about their cardiovascular lifestyle at baseline and after 1 year. Logistic regression analyses were performed to quantify the impact of change in self-efficacy on physical activity, smoking behavior, alcohol consumption, and food choices. Results: Improved self-efficacy was associated with improved adherence to guidelines for physical activity (OR 3.5, 95%CI 1.0–11.0) and food choices (B 0.15, 95%CI 0.00–0.31). No such improvement was seen regarding adherence to guidelines for smoking or alcohol intake. Conclusion: In patients with vascular diseases, improvements in self-efficacy are associated with an improvement in cardiovascular lifestyle, namely, more exercise and better food choices.

The Effect of a Self-Management Intervention to Reduce Vascular Risk Factors in Patients with Manifestations of Vascular Diseases

Background: Self-management can improve health behaviors and influence reduction of vascular risk. We developed a 1-year self-management intervention and investigated its effect on vascular risk factors and quality of life in patients with different vascular diseases. Design and methods: This observational cohort study involved 223 patients (self-management group, n = 125; usual care group n = 98) with at least two modifiable vascular risk factors. Results: Patients in the self-management group achieved treatment goals for LDL-cholesterol (difference 13%; 95%CI 1–26) and HDL-cholesterol (difference 9% 95%CI 0–19) significantly more often than did patients in the usual care group. Mean systolic blood pressure decreased significantly by 5 mm Hg (95%CI − 9 to 0) in the self-management group and mean BMI increased significantly by 0.4 kg/m2 (95%CI − 0.8 to − 0.1) in the usual care group. No significant differences were seen in waist circumference, smoking, or triglycerides. General health (RAND36) improved more in the self-management group (by 8 points 95%CI 3–12) than in the usual care group. Conclusion: After 1 year, the self-management intervention was more effective than usual care on several important vascular risk factors in patients with vascular diseases. Practice implications: This self-management intervention used in a hospital population may be applicable in different care settings.

Social Support and Change in Vascular Risk Factors in Patients with Clinical Manifestations of Vascular Diseases

Background and aims: Vascular risk can be reduced by adequate medical treatment of vascular risk factors and by adopting a healthy lifestyle, a behavioral change that is influenced by social support. We investigated whether social support is associated with change in vascular risk factors in patients with vascular diseases during 1 year. Methods: 140 patients who had 2 modifiable vascular risk factors participated. Social support was measured with a questionnaire about the patients perception of active involvement, protective buffering, and overprotection. Results: Most types of social support were not associated with a change in vascular risk factors over 1 year. Having a partner was associated with a reduction in BMI of 1.4 kg/m2 (95%CI − 2.2 to − 0.5), less protective buffering was associated with a decrease in blood glucose of 0.47 mmol/l (95%CI 0.09–0.84), and less active involvement was associated with an increase in BMI of 0.42 kg/m2 (95%CI 0.05–0.78). Conclusion: Having a partner and active involvement are only associated with a decrease in BMI but not with changes in other vascular risk factors. Protective buffering is only associated with blood glucose whereas overprotection is not associated with changes in vascular risk factors.

Validation of a dutch self-efficacy scale for adherence to fluid allowance among patients on haemodialysis.

SUMMARY Many haemodialysis patients have problems limiting their fluid intake, and this might be influenced by their self-efficacy. Thus interventions to improve patients’ self-efficacy might lead to an improvement in their adherence to fluid restriction. The fluid intake appraisal inventory (FIAI) evaluates patients’ self-efficacy with regard to fluid intake. The aim of this study was to translate and validate the FIAI for use in the Netherlands. Four translators, seven experts, and four haemodialysis patients participated in the translation part of the study. Thirty-three patients from one dialysis centre in the Netherlands completed the Dutch FIAI. The instrument had good content validity (interdialytic weight gain was found to be negatively correlated with self-efficacy), internal consistency (Cronbachs alpha = 0.982), and stability (Spearmans rho = 0.823). These findings indicate that the Dutch FIAI can be used in clinical practice as a self-efficacy screening instrument for adult haemodialysis patients on fluid restriction.