Mary L. Durham

Self-Efficacy and Health Behavior Among Older Adults*

Self-efficacy has a well-established, beneficial effect on health behavior and health status in young and middle-aged adults, but little is known about these relationships in older populations. We examined this issue as part of a randomized trial to determine the cost savings and changes in health-related quality of life associated with the provision and reimbursement of a preventive services package to 2,524 Medicare beneficiaries enrolled in Group Health Cooperative of Puget Sound. Baseline self-efficacy data were collected for all participants in five behavioral areas: exercise, dietary fat intake, weight control, alcohol intake, and smoking. Results reveal that efficacy and outcome expectations for these health behaviors are not independent. Correlational and factor analyses indicate two dimensions of efficacy expectations, one consisting of exercise, dietary fat, and weight control, and another consisting of smoking and alcohol consumption. Outcome expectations of the five behaviors form a single dimension. Older adults with high self-efficacy had lower health risk in all behaviors and better health. Regression analyses detected a positive association between socioeconomic status and health-related quality of life (p < .02), but the strength of the association declined (p < .11) after the self-efficacy measures entered the model, indicating that self-efficacy explains part of the association between socioeconomic status and health status. Interventions aimed at improving self-efficacy also may improve health status.

Socioeconomic status and exercise self-efficacy in late life

Self-efficacy, or assessments about ones ability to carry out particular tasks, has been shown to play a central role in the adoption and maintenance of exercise. The relationship between exercise self-efficacy and socioeconomic status (SES), however, has not been formally developed or tested, and the implications of SES for exercise interventions are not known. We hypothesize pathways through which income, education, and occupation affect self-efficacy and capitalize on the availability of responses from 1944 older HMO enrollees to investigate the direct and indirect associations of SES indicators with exercise self-efficacy. Direct associations of age and education are found. Indirect associations of age, income, education, and occupation operate primarily through previous exercise experience, satisfaction with amount of walking, depression, and outcome expectations. The potentially modifiable nature of exercise outcome expectations (i.e., belief in the benefits of exercise) in combination with its strong association with exercise self-efficacy argue in support of greater consideration of its role in attempts to improve exercise self-efficacy.

The impact of public policy and publicity on admissions to state mental health hospitals

This paper examines the impact of broadened Washington state civil commitment standards on utilization of the states mental hospitals. Included in the analysis is an assessment of the impact of a public event (a well-publicized murder case) which was in all likelihood a precursor to the laws revision. We also examine the different ways Washingtons two state hospitals managed the dramatic increase in civilly committed patients that occurred after the revision took effect. The findings indicate that the murder case, in which the defendant had been denied voluntary admission to a state hospital prior to the killing, resulted in an increase in involuntary admissions in the county where it occurred a full year before the standards were revised. The law itself had the effect of increasing commitments throughout the state, reducing the levels of voluntary admissions, and increasing the likelihood of involuntary admission for individuals previously admitted voluntarily, thus transforming a principally voluntary system into one which was primarily involuntary. Finally, it was found that the increased demand for services mandated by the broadened commitment standards was managed differently in the two state hospitals: one imposed a cap on admissions; the other phased out voluntary admissions at a rate roughly equal to the increase in commitments. These findings illustrate both the substantive impact of broadened civil commitment law and the importance, when assessing the impact of laws, of examining public events and administrative interventions which may have significant causal links with legal interventions.

Legal Intervention in Civil Commitment: The Impact of Broadened Commitment Criteria

Recent legal changes in Washington State have broadened the grave-disability criterion for civil commitment of the mentally ill. Analysis of data from state mental hospitals and from records of commitment authorities in Washingtons two largest counties revealed that, while there was an increase in the number of involuntary hospitalizations immediately before and after the changes in law, there was a virtual disappearance of voluntary patients in state hospitals. Moreover, expansion of the definition of “grave disability” resulted in a move toward a parens patriae-dominated civil commitment system. Analysis of the empirical consequences of the legal changes on commitment decisions is presented, along with the response of mental health officials and the public.