Brenda M. DeVellis

The Role of Self-Efficacy in Achieving Health Behavior Change

The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.

Improving dietary behavior: the effectiveness of tailored messages in primary care settings.

OBJECTIVES To achieve the Healthy People 2000 objectives, public health professionals must develop effective dietary interventions that address psychosocial and behavioral components of change. This study tested the effect of individually computer-tailored messages designed to decrease fat intake and increase fruit and vegetable intake. METHODS Adult patients from four North Carolina family practices were surveyed at baseline and then randomly assigned to one of two interventions or to a control group. The first intervention consisted of individually computer-tailored nutrition messages; the second consisted of nontailored nutrition information based on the 1990 Dietary Guidelines for Americans. Patients were resurveyed 4 months postintervention. RESULTS The tailored intervention produced significant decreases in total fat and saturated fat scores compared with those of the control group (P < .05). Total fat was decreased in the tailored group by 23%, in the nontailored group by 9%, and in the control group by 3%. Fruit and vegetable consumption did not increase in any study group. Seventy-three percent of the tailored intervention group recalled receiving a message, compared with 33% of the nontailored intervention group. CONCLUSIONS Tailored nutrition messages are effective in promoting dietary fat reduction for disease prevention.

Healthy Coping, Negative Emotions, and Diabetes Management A Systematic Review and Appraisal

PURPOSE The purpose of this systematic review is to assess the literature pertinent to healthy coping in diabetes management and to identify effective or promising interventions and areas needing further investigation. METHODS A PubMed search identified 186 articles in English published between January 1, 1990, and July 31, 2006, addressing diabetes and emotion, quality of life, depression, adjustment, anxiety, coping, family therapy, behavior therapy, psychotherapy, problem solving, couples therapy, or marital therapy. RESULTS Connections among psychological variables, behavioral factors, coping, metabolic control, and quality of life are appreciable and multidirectional. Interventions for which well-controlled studies indicate benefits for quality of life and/or metabolic control include general self-management, coping/problem-solving interventions, stress management, support groups, cognitive-behavioral therapy, behavioral family systems therapy, cognitive-analytic therapy, multisystemic therapy, medications for depression, and the Pathways intervention integrating case management, support of medication, and problem-solving counseling. CONCLUSIONS Psychological, emotional, related behavioral factors, and quality of life are important in diabetes management, are worthy of attention in their own right, and influence metabolic control. A range of interventions that achieve benefits in these areas provide a base for developing versatile programs to promote healthy coping.

factors Affecting African-american Participation in Aids Research

Background: Although African Americans are disproportionately affected by the AIDS epidemic, they are underrepresented in AIDS research, particularly in AIDS clinical trials. This study examines a multidimensional construct of distrust and other factors that may affect willingness to participate in AIDS research. Methods: A total of 301 African Americans (aged ≥18 years) in Durham, North Carolina participated in a cross‐sectional survey. In‐person interviews, 20 to 25 minutes in length, were conducted with participants. Structural equation modeling was used to develop models exploring distrust and other factors affecting willingness to participate in AIDS research among African Americans. Results: Distrust was the strongest inverse predictor of willingness to participate in AIDS clinical trials. Distrust was not significantly associated with willingness to participate in AIDS surveys and educational interventions. Altruism, facilitators/ barriers, religiosity, and economic group membership were also significantly associated with willingness to participate in AIDS clinical trials. Only altruism was significantly associated with willingness to participate in AIDS surveys and educational interventions. Conclusions: Distrust about research institutions is a significant barrier to recruiting African Americans in AIDS clinical trials. Issues of distrust need to be acknowledged by researchers to develop better recruitment and retention strategies when conducting AIDS clinical trials in African‐American communities.

Arthritis and perceptions of quality of life: an examination of positive and negative affect in rheumatoid arthritis patients.

The utility of measuring both positive and negative affective states for assessing rheumatoid arthritis (RA) patients was examined in 3 independent samples of male and female RA patients (Sample A: 179 women, 48 men; Sample B: 177 women, 24 men; Sample C: 134 women, 38 men). Confirmatory factor analyses of each sample indicated that positive and negative affect constituted separate, negatively correlated factors. The relations among disease variables, coping, and affects were consistent with a model in which coping mediates the relationship between disease variables and positive and negative affect. Patients with higher pain and limitation from RA had higher levels of maladaptive coping, and maladaptive coping was associated with lower positive affect and higher negative affect. Those RAs with higher activity limitation also reported less adaptive coping, which was associated with less positive affect.

Risk perceptions and participation in colorectal cancer screening.

Compared individuals at high versus average risk for colorectal cancer (CRC) with respect to factors they cited as affecting their risk of developing CRC. We also examined the relationship of these risk-factor perceptions to perceived susceptibility and participation in a CRC screening test. All individuals in the high-risk group were informed that, as a sibling of someone with CRC, they were more likely to get this cancer themselves. We found minimal differences among siblings with respect to perceived susceptibility. Further, although high-risk siblings were more likely to participate in screening, only 20.2% cited heredity as a risk-increasing factor, and, among these siblings, there was no relationship between screening participation and the citation of any specific risk factors, including heredity. These findings demonstrate the need for more research examining how high-risk individuals process risk-relevant information and the effect of this information on health behavior.

Osteoporosis prevention in premenopausal women: using a stage model approach to examine the predictors of behavior.

The precaution adoption process model was used to examine the predictors of 2 behaviors recommended to reduce the risk of developing osteoporosis: calcium consumption and weight-bearing exercise. A total of 452 premenopausal women completed a mailed questionnaire assessing stage in the precaution adoption process and 12 knowledge and attitudinal variables. Participants were also given an opportunity to request information about osteoporosis. In all, 11 of the 12 knowledge and attitudinal variables were associated with calcium stage; 8 were associated with exercise stage. Information requests were associated with both calcium and exercise stage. Findings provide substantial support for the precaution adoption process model and suggest that the model can be usefully applied in this area to increase understanding of why many women do not practice behaviors that could reduce their risk of developing osteoporosis.

Evaluation of a Problem-Solving Intervention for Patients With Arthritis*

A pretest-posttest control group design was used to evaluate a patient education program designed to help people with rheumatoid arthritis (RA) cope with problems posed by their disease. One hundred and one patients were randomly assigned to an intervention or control group. All patients participated in a psychosocial interview in which problems arthritis had caused in their lives were assessed and actual and potential resources patients had for dealing with those problems were identified. In addition, individuals in the intervention group received a problem-solving intervention based, in part, on information collected during the psychosocial interview. Posttest measures showed that the problem-solving intervention helped patients solve their compliance problems and their lifestyle problems, although support for the latter finding was marginal (P < 0.10). All patients who participated in the study, regardless of group assignment, improved on a number of global measures of physical and psychological functioning. This unexpected finding is attributed to unintended positive effects of the psychosocial interview, although regression to the mean can not be definitively ruled out as a competing explanation.

The effect of conflicting medication information and physician support on medication adherence for chronically ill patients

OBJECTIVE This article explores the effect of conflicting information, defined as contradictory information about medication topics from different sources, on medication adherence in a sample of chronically ill patients. We specifically investigate whether conflicting information and physician support directly affect medication adherence or whether the effect is mediated by adherence self-efficacy and outcome expectations for medications. METHODS Vasculitis patients (n = 228) completed two on-line questionnaires which contained measures of conflicting information, adherence self-efficacy, outcome expectations, physician support, and medication adherence. We conducted a mediation analysis using a bootstrapping approach to generate point estimates and 95% confidence intervals to test the significance of each mediated effect. RESULTS A majority of patients (51.3%) received conflicting medication information. Conflicting information had a direct negative effect on medication adherence, which was not mediated by self-efficacy or outcome expectations. Alternatively, self-efficacy mediated the positive effect of physician support on medication adherence. CONCLUSION Patients who encounter conflicting medication information are less adherent to their medications. The presence of a supportive physician may counteract the negative effect of conflicting medication information. PRACTICE IMPLICATIONS Physicians should initiate conversations about conflicting medication information with their patients. Consensus-based guidelines that address medication discrepancies may also reduce the availability of conflicting information.

Illness attributions and hopelessness depression: the role of hopelessness expectancy.

According to hopelessness theory, hopelessness expectancy is the proximal, sufficient cause of hopelessness depression. Consequently, hopelessness expectancy is viewed as mediating the influence of all other factors on hopelessness depression. Using a longitudinal research design, we examined hopelessness expectancy as a mediator of the relation between illness attributions and hopelessness depression in a sample of 57 adults with rheumatoid arthritis. Although hopelessness expectancy was a strong predictor of hopelessness depression, it moderated rather than mediated the relation between attributions and depression. Finding support for a moderating rather than a mediating model is inconsistent with theory but is consistent with the findings of Riskind, Rholes, Brannon, and Burdick (1987).