Julia A. Dodge

Exploring Self-Efficacy as a Predictor of Disease Management

Self-efficacy is posited in social cognitive theory as fundamental to behavior change. Few health behavior studies have examined self-efficacy prospectively, viewed it as part of a reciprocal behavioral process, or compared self-efficacy beliefs in the same population across different behaviors. This article first discusses self efficacy in its theoretical context and reviews the available prospective studies. Second, it explores self-efficacy as a predictor of disease management behaviors in 570 older women with heart disease. Although the R 2 statistics in each case were modest, the construct is shown to be a statistically significant (p < .05) predictor at both 4 and 12 months postbaseline of several disease management behaviors: using medicine as prescribed, getting adequate exercise, managing stress, and following a recommended diet. Building self-efficacy is likely a reasonable starting point for interventions aiming to enhance heart disease management behaviors of mature female patients.

Self-Regulation of Health Behavior: The "take PRIDE" Program:

Social cognitive theory, in particular, the construct of self-regulation was the basis for developing an educational program for older adults with heart disease. This paper dis cusses the theoretical principles utilized and describes the program activities based on them. Data from an evaluation conducted with 246 older heart patients who took part in the education are used to illustrate how social cognitive theory constructs operated empirically.

Self-Management of Heart Disease by Older Adults Assessment of an Intervention Based on Social Cognitive Theory

A randomized, controlled trial involving 636 older individuals was conducted to evaluate an intervention to enhance self-management of heart disease. Program participants experienced less impact of illness on their psychosocial functioning (p <.05), especially their emotional behavior (p < .05) and alertness (p < .01). Compared to controls, male program participants experienced improvements in their physical functioning, specifically their ability to ambulate (p < .05) and the frequency and severity of their symptoms. Female program participants did not experience gains in physical functioning. Most group differences emerged by 12 months and decayed by the 18-month final evaluation. To accurately assess the pattern of change associated with a program of this type, evaluation over at least 18 months following program completion may be needed. Separate interventions for older men and women with heart disease appear warranted, as do follow-up activities at strategic points in time to sustain program effects.

Factors influencing quality of life in older women with heart disease.

Background.Better understanding of factors influencing the quality of life (QOL) of cardiac patients can guide treatment decisions. Objectives.To describe the impact of clinical and psychosocial factors on the QOL of older women with heart disease. Research design. Baseline and 12-month data from women participating in an intervention study. Subjects.Eligible participants, identified from medical records, were female, ≥60 years of age, and diagnosed with cardiac disease. A volunteer sample of 570 women (87% white) completed baseline interviews, with 485 women completing the 12-month assessment. Measures.Utilizing Wilson and Cleary’s conceptual framework (1995), measures of clinical, psychosocial, and functional status were examined for their associations with QOL. Results.At baseline, General Health Perceptions and Symptom Status accounted for 38% and 26%, respectively, of the variation in the QOL rating. Using logistic regression models, seven measures were significant predictors (P <0.05) of maintenance/improvement versus decline in QOL over 12 months: baseline QOL rating; baseline value and change in satisfaction with social activities over 12 months; change in satisfaction with physical activities; change in satisfaction with mental activities; and baseline value and change in perceived stress. For women who maintained or improved their satisfaction with social activities, the odds for also maintaining or improving QOL were 4.5 times the odds for women whose satisfaction with social activities deteriorated. Conclusions.Satisfaction with social activities and perceived stress are important predictors of subsequent QOL. Consideration of the impact of treatments on these factors may help to prevent deterioration of QOL among older female cardiac patients.

Longitudinal effects of social support on the health and functioning of older women with heart disease.

This study examined the effects of: 1) four dimensions of social support, 2) the number of close social ties, and 3) marital status on the physical and psychological health and functioning of 471 women aged 60 years and over with heart disease. Linear mixed models were used to assess the impact of each baseline social relations predictor on health outcomes at four-, 12-, and 18-month follow-up intervals. A second set of models examined the association between change in support variables over time with concomitant change in health outcomes. Results indicated that baseline emotional/informational support, positive social interaction, affectionate support, tangible support, number of close friends and relatives, and marital status all significantly predicted (p < .05) one or more health outcomes over time. Increases in positive social interaction and emotional support over time were significantly associated with concurrent improvement in all self-reported physical and psychological health outcomes. Interventions that enhance the availability of emotional/informational support and promote social interaction are needed for this population.

The impact of a disease-management program on the symptom experience of older women with heart disease

ABSTRACT This study describes the symptom experience of 570 older women with heart disease and evaluates a disease-management programs impact on symptoms over time. Women were randomly assigned to either usual care or a 4-week program (“Women take PRIDE”) designed to improve self-regulation skills by focusing on increasing physical activity. At 4 months follow-up, program women, compared to controls, reported fewer total symptoms (p = 0.01) and decreased symptom frequency (p = 0.02) and bothersomeness (p = 0.02). By 12 months, positive intervention effects emerged within the common cardiac and sleep and rest symptom categories. Program group women reported more improvements in symptoms likely to be affected by increasing physical activity at both follow-ups (p < 0.05).

Focusing on outcomes: Making the most of COPD interventions

A number of excellent intervention studies related to clinical and psychosocial aspects of chronic obstructive pulmonary disease (COPD) have been undertaken in the recent past. A range of outcomes have been examined including pulmonary function, health care use, quality of life, anxiety and depression, ambulation, exercise capacity, and self-efficacy. The purpose of this narrative review was to a) consider clinical, psychosocial, and educational interventions for people living with COPD in light of the health related outcomes that they have produced, b) identify the type of interventions most associated with outcomes, c) examine work related to COPD interventions as it has evolved regarding theory and models compared to work in asthma, and d) explore implications for future COPD research. Studies reviewed comprised large scale comprehensive reviews including randomized clinical trials and meta-analysis as these forms of investigation engender the greatest confidence in clinicians and health care researchers. Extant research suggests that the most significant improvements in COPD health care utilization have been realized from interventions specifically designed to enhance disease management by patients. A range of interventions have produced modest changes in quality of life. Evidence of impact for other outcomes and for a particular type of intervention is not strong. Research in other chronic diseases, particularly asthma, suggests that interventions grounded in learning theory and models of behavior change can consistently produce desired results for patients and clinicians. Use of a model of self-regulation may enhance COPD interventions. Although the extent to which COPD efforts can benefit from the experience in other conditions is a question, more outcome focused intervention studies using more robust theoretical approaches may enhance COPD results, especially regarding health care use and quality of life.

Heart Disease Management by Women: Does Intervention Format Matter?

A randomized controlled trial of two formats of a program (Women Take PRIDE) to enhance management of heart disease by patients was conducted. Older women (N = 575) were randomly assigned to a group or self-directed format or to a control group. Data regarding symptoms, functional health status, and weight were collected at baseline and at 4, 12, and 18 months. The formats produced different outcomes. At 18 months, the self-directed format was better than the control in reducing the number (p ≤ .02), frequency (p ≤ .03), and bothersomeness (p ≤ .02) of cardiac symptoms. The self-directed format was also better than the group format in reducing symptom frequency of all types (p ≤ .04). The group format improved ambulation at 12 months (p ≤ .04) and weight loss at 18 months (p ≤ .03), and group participants were more likely to complete the program ( p ≤ .05). The availability of different learning formats could enhance management of cardiovascular disease by patients.

The Evolution of an Innovative Heart Disease Management Program for Older Women: Integrating Quantitative and Qualitative Methods in Practice

Few studies in the literature describe how to combine quantitative and qualitative methods to enhance the development of health education interventions. This article describes the evolution and refinement of an innovative disease management program “take PRIDE” for older adults with heart disease. Over 15 years, information obtained from data collection methods including telephone interviews, focus groups, face-to-face interviews, and program process data illuminated and guided subsequent refinement of the program and led to new iterations for different participants. Qualitative and quantitative data were incorporated into the two key areas of program development (theoretical framework, objectives, format, and content) and evaluation (evaluation design, sampling, and measurement). Combining both types of data enhanced the opportunity to detect needed program changes, to increase understanding of the mechanisms by which the program effects were produced, and to enhance the relevance of the program to different groups of program participants.

Reducing Disparities in Diabetes: The Alliance Model for Health Care Improvements

Individuals in specific racial and ethnic groups experience the greatest prevalence and widest disparity in outcome for both type 1 and type 2 diabetes.1 The negative long-term consequences of the disease for these individuals are also higher and can be severe, including amputation, kidney disease, cardiovascular disease, and blindness.2 Better access to and higher quality of health care leads to improved diabetes control and fewer negative outcomes for people at risk of and diagnosed with the condition, especially, in low-income communities.2,3 Particular systems problems associated with poor results for those with diabetes include failure to adequately identify high-risk people, failure to follow recommended clinical treatment guidelines, lack of adequate provider education, inadequacy of patient self-management education, and minimal coordination of care.4 Each of these has been linked to inadequate information systems, insurance and payment options, deployment of clinical personnel, and application of evidence-based strategies for change and similar other deficiencies.5 It is widely agreed that to achieve sustainable change that reduces disparities, new and improved health care policies and systems are needed.6 Achieving such change within and across health care facilities and communities requires participation by key stakeholders in the problem.7 This view posits that solutions are complex (including adaptation of evidence-based strategies to new locales) and require engagement of diverse perspectives (including those of the people who experience the day-to-day burden of the health problem). Recent evidence has shown that collaborative community-wide approaches to enhancing health care delivery can generate far-reaching policy and system changes and improvements in health status.8 To support evidence-based means to reduce inequity in health status, the Alliance to Reduce Disparities in Diabetes was launched by the Merck Company Foundation in 2009. The foundation is providing up to