Tore Bonsaksen

Factors associated with self-efficacy in persons with chronic illness

Change of lifestyle may be necessary for persons with chronic illnesses in order to manage their health situation and reduce symptom distress. Success in changing lifestyle partly depends on a persons self-efficacy beliefs. This cross-sectional study explores social support, physical activity, and illness perceptions in relation to self-efficacy in a sample with morbid obesity and in a sample with chronic obstructive pulmonary disease (COPD). The linear regression analyses showed that higher physical activity and less emotional response to illness were directly associated with higher self-efficacy among persons with obesity, while more social support; fewer perceived consequences from illness; and more understanding of the illness were directly associated with higher self-efficacy among persons with COPD. The results indicate that obese persons are likely to benefit from increasing physical activity and from receiving emotional support. Persons with COPD may be empowered by being able to utilize cognitive coping strategies and by receiving social support.

Rasch analysis of the sense of coherence scale in a sample of people with morbid obesity – a cross-sectional study

BackgroundThe prevalence of morbid obesity is an increasing health problem in most parts of the world and is related to lower quality of life. Sense of coherence, or the perception that the world is meaningful and predictable, is considered a promising health resource for changing behaviour and adopting a healthier lifestyle. Thus, a valid and reliable instrument for measuring sense of coherence is needed to further research and clinical efforts in this area. The purpose of the study was to examine the psychometric properties of the 13-item Sense of Coherence scale and its sub-dimensions (Comprehensibility, Manageability, and Meaningfulness) in a sample of people with morbid obesity using a Rasch analysis approach.MethodsData were collected cross-sectionally in Norway in 2009 from 142 patients attending a mandatory patient education course for patients with morbid obesity on a waiting list for treatment. Participants completed a socio-demographic questionnaire and the 13-item Sense of Coherence scale at the beginning of the course. Evidence of rating scale functioning, internal scale validity, person-response validity, person-separation reliability and differential item functioning of the 13-item version were explored. The scale’s three sub-dimensions were also evaluated.ResultsA 12-item version of the scale demonstrated the best fit to the Rasch model and increased the variance explained without reducing the separation index. The three sub-dimensions demonstrated good fit but lacked unidimensionality and person-separation reliability. The Meaningfulness sub-dimension showed better psychometric properties than the Comprehensibility and Manageability sub-dimensions.ConclusionA 12-item version of the Sense of Coherence scale has better psychometric properties than the original 13-item version among persons with morbid obesity. Further studies should explore whether these questionable validity findings for the 13-item scale generalize to other populations and examine whether including other items from the longer 29-item version may improve the psychometric properties of an abbreviated Sense of Coherence measure.

Rasch analysis of the General Self-Efficacy Scale in a sample of persons with morbid obesity

BackgroundSelf-efficacy is needed for effectuating lifestyle changes, and it is therefore an important target related to health. The purpose of this study was to evaluate the psychometric properties of the General Self-Efficacy Scale (GSE) using Rasch analysis in a sample of adults with morbid obesity.MethodsA convenience sample of adults with morbid obesity was recruited from patient education courses. A total of 141 participants completed the GSE and a demographic questionnaire at the beginning of the course. The statistical approach included analysis of rating scale function, item fit to the Rasch partial credit model, unidimensionality, aspects of person-response validity, person-separation reliability, and differential item function. A version omitting items with poor fit to the Rasch model was also evaluated.ResultsThe rating scale did not advance monotonically for item #2 in the original 10-item version, and the first three GSE items did not demonstrate acceptable goodness-of-fit to the Rasch model. In a 7-item version omitting these three items, the rating scale functioned well for all items, and all items demonstrated good fit to the Rasch model. Both the 10-item and 7-item versions of the GSE partially met the criteria for unidimensionality. Neither version met the criterion for person response validity, although the results were slightly better for the 7-item than for the 10-item version. Both versions of the GSE demonstrated the ability to separate the respondents into three distinct levels of general self-efficacy. Several items had differential item function in relation to age, education or work status, but there were fewer in the 7-item version.ConclusionsFor adults with morbid obesity, a 7-item version of the GSE seems to have better psychometric properties than the original 10-item version.

A 1-year follow-up study exploring the associations between perception of illness and health-related quality of life in persons with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease with an increasing prevalence worldwide. Its potential consequences, including reduced function and reduced social participation, are likely to be associated with decreased health-related quality of life (HRQoL). However, illness perceptions and self-efficacy beliefs may also play a part in determining HRQoL in persons with COPD. The aim of this study was to explore the relationships between illness perceptions, self-efficacy, and HRQoL in a sample of persons with COPD in a longitudinal perspective. The context of the study was a patient education course from which the participants were recruited. Data concerning sociodemographic variables, social support, physical activity, illness perceptions, general self-efficacy, and HRQoL were collected before the course started and 1 year after completion. Linear regression was used in the analyses. The results showed that less consequences and less symptoms (identity) were associated with higher physical HRQoL (PCS) at baseline and at 1-year follow-up. Less emotional response was similarly associated with higher mental HRQoL (MCS) at both time points. Lower self-efficacy showed a borderline significant association with higher PCS at baseline, but was unrelated to MCS at both time points. Self-efficacy showed no influence on the associations between illness perceptions and HRQoL. In conclusion, the study showed that specific illness perceptions had a stable ability to predict HRQoL in persons with COPD, whereas self-efficacy did not. The associations between illness perceptions and HRQoL were not mediated by self-efficacy.

Trajectories of self-efficacy in persons with chronic illness: An explorative longitudinal study

Background: Self-efficacy is important for changing health behaviour in persons with chronic illness. Longer term trajectories have not been previously explored. Objective: This study’s objective was to explore the trajectories of self-efficacy in two different groups with chronic illnesses attending a patient education course. Design: The study design was a longitudinal, comparative cohort study with five time points during a one-year follow-up, using repeated measures analysis of variance. Setting and participants: Persons with morbid obesity (n = 55) and persons with chronic obstructive pulmonary disease (COPD; n = 56) were recruited at the start of patient education courses in Norway and followed-up four times the following year. Main outcome measure: The General Self-Efficacy Scale was the main outcome. Results: Obese persons showed a linear pattern of increasing self-efficacy during the follow-up period, whereas persons with COPD had an initial increase followed by a decrease in self-efficacy. Having paid work was associated with a more positive self-efficacy trajectory. Conclusion: The results provide support for the currently employed patient education course for morbidly obese persons. In contrast, persons with COPD may need more extensive and/or more frequent support in order to increase and maintain self-efficacy across time.

Exploring gender differences in quality of life

Purpose – The purpose of this study is to examine gender differences with regard to physical activity, psychiatric symptoms, and quality of life in patients with severe mental illness. In addition, associations between the variables are to be explored.Design/methodology/approach – A cross‐sectional design was employed. Eighteen patients, 12 men and six women, were assessed at admission to hospital with the International Physical Activity Questionnaire, the Hospital Anxiety and Depression Scale, and the WHO Quality of Life‐Bref. Mann‐Whitney U‐tests, Spearmans correlation coefficient, and partial correlation were used in the statistical analyses.Findings – Women had lower levels of quality of life and trended towards being more depressed than men, whereas men had more global psychiatric symptoms. When controlling for depression in the participants, the bivariate relationships between male gender and higher quality of life were weakened. The findings indicate that the initial association between gender and...

Group Climate as Predictor of Short- and Long-Term Outcome in Group Therapy for Social Phobia

Abstract A longitudinal study of 80 participants in cognitive and interpersonal group therapy for social phobia was conducted. The aim was to investigate the relationship between group climate and patients’ short-term and long-term outcome. Group climate data was collected every other week during treatment, whereas social phobia symptoms were assessed at admission, discharge, and one year follow-up. Abbreviated symptom assessments were performed weekly. Regression analyses and mixed models were used in the analyses. Engagement predicted symptom reduction during treatment, from pretreatment to follow-up, and from posttreatment to follow-up. During treatment, avoidance predicted higher symptomatic distress. The results imply that group engagement should be emphasized for patients with social phobia. Avoidance, on the other hand, should be addressed as a process that interferes with treatment progress.

Trajectories of illness perceptions in persons with chronic illness: An explorative longitudinal study

Accurate illness perceptions are essential to the self-management of chronic illness. This study explored trajectories of illness perceptions in persons with morbid obesity (n = 53) and persons with chronic obstructive pulmonary disease (n = 52) following a patient education course. Participants completed the Brief Illness Perception Questionnaire five times over a 1-year period. Repeated measures analysis of variance was employed. Over time, obese participants perceived shorter illness duration, fewer consequences, less emotional stress, and more personal control. Chronic obstructive pulmonary disease participants had initial increases in personal control and understanding, but these changes were not maintained throughout the follow-up period.

Associations Between Self-Esteem, General Self-Efficacy, and Approaches to Studying in Occupational Therapy Students: A Cross-Sectional Study

ABSTRACT The aim of this study was to explore associations between self-esteem, general self-efficacy, and the deep, strategic, and surface approaches to studying. Norwegian occupational therapy students (n = 125) completed questionnaires measuring study approaches, self-esteem, and general self-efficacy. Regression analyses were used to explore the direct relationships between self-esteem, general self-efficacy and the approaches to studying, after controlling for age, gender, prior higher education, and time spent on independent studying. General self-efficacy displayed positive associations with deep and strategic approaches to studying and a negative relationship with a surface approach to studying. Self-esteem was not significantly associated with approaches to studying.

Factors associated with self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease: A cross-sectional study

Living with chronic illnesses can be stressful and may negatively impact persons’ self-esteem. Personal factors, like self-efficacy and illness perceptions, and also factors related to the environment, activity, and participation may be associated with self-esteem in chronic illness populations. This cross-sectional comparative study explored sociodemographic variables, work, physical activity, illness perceptions, and general self-efficacy in relation to self-esteem in persons with morbid obesity and in persons with chronic obstructive pulmonary disease (COPD). The study had a cross-sectional design. A total of 223 eligible participants were recruited from patient education courses, and data were collected at baseline. Self-esteem was measured with The Rosenberg self-esteem scale; the general self-efficacy scale was used to measure self-efficacy, and brief illness perception questionnaire was also used. This is an instrument assessing cognitions about the illness and emotional responses towards it. Multivariate linear regression was used in the statistical analyses. In obese participants (n = 134), higher self-esteem was associated with lower emotional response, a shorter timeline, and higher general self-efficacy. In COPD participants (n = 89), higher self-esteem was associated with higher general self-efficacy. The independent variables accounted for 42.9% (morbid obesity) and 49.4% (COPD) of the self-esteem variance. In participants in both illness groups, higher self-efficacy was associated with increased self-esteem. A shorter timeline and lower emotional response to illness was related to higher self-esteem only for the obese participants. The results indicate that believing in one’s capacity to cope with everyday challenges is important for self-esteem in persons with morbid obesity and in persons with COPD, whereas illness perceptions related to the duration of illness and the coping with emotions also is important for self-esteem in persons with morbid obesity.