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Predicting self-efficacy using illness perception components: A patient survey
Abstract
To assess the measures of illness representation components in predicting measures of self-efficacy in patients with coronary heart disease.
A longitudinal design was adopted with predictor variables and dependent variables (general self-efficacy, diet self-efficacy and exercise self-efficacy) measured twice while participants were in hospital and 9 months following discharge. Change scores of the predictor variables can be calculated and dependent variables at baseline can be controlled.
A cohort sample of 300 patients admitted to hospital with coronary heart disease were given the questionnaire measuring their illness perception (illness representation components: identity, consequences, timeline and control/cure and outcome expectation for diet and exercise); self-efficacy (general, diet and exercise self-efficacy measures), demographic and illness characteristics and attendance on a cardiac rehabilitation programme. The patients were asked to complete the questionnaire in hospital before discharge following their cardiac diagnosis, and again, 9 months later, when participants were expected to be functioning independently of any rehabilitation programme.
Demographic and illness characteristics were found to have a more significant relationship with illness representation components than with specific self-efficacy. The relationship between illness representation components and specific self-efficacy changes overtime, consequence and timeline were significantly related to self-efficacy measures initially; however, symptom and control/cure were the variables that were significantly related to self-efficacy measures 9 months later. After statistically controlling individuals' baseline self-efficacy measures, demographic and illness characteristic effects, symptom and control/cure were found to make significant contributions to exercise and diet self-efficacy, respectively, 9 months later.
A significant relationship exists between illness representation and self-efficacy. There is potential to integrate both approaches to the assessment of psychosocial factors to provide effective individualized care in cardiac rehabilitation.
... Within the exercise literature, positive outcome expectations have been more frequently investigated than negative outcome expectations (Williams et al., 2005). Studies in cardiac rehabilitation indicate that positive outcome expectations are associated with attendance and adherence to cardiac rehabilitation (Lau-Walker, 2006), but not specifically to its exercise component (Williams et al.). Negative outcome expectations may be particularly relevant in cardiac rehabilitation given the potential occurrence of negative experiences during exercise, such as angina, pain, fatigue, and physical challenges. ...
... An initial study of a cardiac sample by Lau-Walker (2006) prospectively examined the link between social-cognitive theory and common sense model constructs and demonstrated that there was a relationship between illness perceptions and self-efficacy beliefs relative to exercise and diet. However, relationships between illness perceptions about cardiovascular disease and exercise-related social cognitions that predict adherence to exercise (e.g., self-regulatory efficacy and positive and negative outcome expectations) have yet to be examined in the same study. ...
... Relative to the first purpose, we based our hypothesis upon the tenets of social-cognitive theory and illness perception research by Lau-Walker (2006). It was hypothesized that individuals with stronger illness perceptions at cardiac rehabilitation program onset would have lower self-regulatory efficacy for exercise, lower positive outcome expectations, and greater negative outcome expectations. ...
Purpose/Objective: Two complementary frameworks, the common sense model, and social–cognitive theory, were used. The first purpose of this study was to compare 2 groups varying in their illness perceptions (strong vs. weak) on baseline differences in theory-based exercise cognitions (self-regulatory efficacy and outcome expectations), and health-related quality of life (HRQL). The second purpose was to examine illness perception group differences in cardiac rehabilitation exercise participation following 3 months of exercise therapy. Research Method/Design: Newly enrolled cardiac rehabilitation participants (N = 49) completed baseline measures of illness perceptions, self-regulatory efficacy, outcome expectations, and HRQL. Cardiac rehabilitation exercise minutes were measured at baseline (after 2 weeks of participation) and following 3 months of cardiac rehabilitation. Results: Individuals were successfully classified into strong and weak illness perception groups using cluster analysis. Analyses of variance indicated significant group differences on negative outcome expectations (p < .05), where the strong illness perception group reported greater negative outcome expectations. The strong illness perception group also reported significantly lower physical and mental HRQL as compared to their weak illness perception counterparts (p < .01). Parallel differences in cardiac rehabilitation exercise participation at 3 months were also observed (p < .05). Conclusions/Implications: This study was a first attempt to utilize the common sense model and social–cognitive theory to examine individuals engaged in rehabilitation to reduce cardiac risk. The findings suggest that complementary use of these 2 frameworks to study individual illness perception differences relative to psychological beliefs and adherence to exercise therapy may aid understanding of correlates of exercise adherence among cardiac rehabilitation participants.
... To examine predictive validity, we performed multiple regressions examining the relationships between the self-efficacy factor scores and the external measures of anxiety, depression, and illness perceptions measured at the end of the CR period after controlling for their baseline assessment. We hypothesized a positive impact of self-efficacy beliefs on well-being and on a more positive perception of the illness, as found in previous research [40,[52][53][54][55][56][57][58][59]. There is a considerable general overlap between self-efficacy and illness perceptions, given that both factors refer to beliefs that patients have about their illness experiences, and also illness representation is considered as a set of cognitive information gained prior to the illness which has a general effect on health behaviors. ...
... There is a considerable general overlap between self-efficacy and illness perceptions, given that both factors refer to beliefs that patients have about their illness experiences, and also illness representation is considered as a set of cognitive information gained prior to the illness which has a general effect on health behaviors. Nevertheless, self-efficacy is viewed as a product of personal experience, which is independently contextual to each specific health behavior [21,54,60,61]. This means that illness perception is generally associated with health outcome intentions whereas self-efficacy beliefs typically predict longterm behavior changes [62,63]. ...
... This means that illness perception is generally associated with health outcome intentions whereas self-efficacy beliefs typically predict longterm behavior changes [62,63]. Thus, given the findings of previous empirical research, we expected that self-efficacy beliefs could negatively predict anxiety, depression, and the negative dimensions of illness perceptions (consequences, timeline, identity, concern, and emotions) [52,54], while positively predicting the positive dimensions of illness perceptions (personal control, treatment control, and comprehensibility) [64]. ...
Self-efficacy beliefs have been shown to affect various effective health-promoting behaviors in patients. Unfortunately, availability of reliable and valid measures of self-efficacy in cardiovascular diseases (CVDs) is still very limited.
The aims of this study were to present a new scale measuring self-efficacy beliefs in managing CVD and to examine its psychometric properties.
The study involved 172 patients (mean age = 66.4 years; SD = 9.99 years; 76.2 % men) undergoing cardiovascular rehabilitation. Various psychological factors and CVD severity indicators were collected.
An Exploratory Structural Equation Model showed that the Cardiovascular Management Self-efficacy Scale has three factors: Cardiac Risk Factors, Adherence to Therapy, and Recognition of Symptoms. They all showed high internal consistency, and good convergent, discriminant, and predictive validity. Furthermore, these factors showed significant relations with CVD severity indicators.
The Cardiovascular Management Self-efficacy Scale could be a helpful instrument to monitor differences during interventions to improve good disease management.
... Recently, the implementation of self-management interventions in chronic illness has received a great deal of attention from health care professionals in certain regions of Mainland China. [12][13][14][15] This form of continuous health care service may be especially suitable for chronic disease patients from the Chinese ethnic group. These patients generally demonstrate inadequate health knowledge and behavior regardless of education level. ...
... 20,21 It can positively influence selfefficacy that mediates health-related behavioral changes of patients. [12][13][14][15] Higher self-efficacy is found to be associated with the reduction of anxiety and depression in patients living with COPD. 22 Multicomponent of self-management interventions can also improve health-related quality of life and lead to considerable cost-effectiveness. ...
Background
Self-management education programs (SMEPs) are potentially effective in the symptomatic management of COPD. Little is presently known about the effectiveness of these programs in Chinese COPD patients. The objective of this study was to evaluate the effectiveness of a specifically designed SMEP on levels of self-efficacy in Chinese patients with COPD.
Materials and methods
Based on the Medical Research Council framework for evaluating complex interventions, an exploratory phase randomized controlled trial was employed to examine the effects of an SMEP. Self-efficacy was the primary outcome using the COPD Self-efficacy Scale, measured at baseline and 6 months after the program. Qualitative data were sequentially collected from these patients via three focus groups to supplement the quantitative findings.
Results
The experimental group displayed significant improvement in their general self-efficacy (Z =−2.44, P=0.015) and specifically in confronting 1) physical exertion (Z =−2.57, P=0.01), 2) weather/environment effects (Z =−2.63, P<0.001) and 3) intense emotions (Z =−2.54, P=0.01). Three themes emerged from the focus groups: greater disease control, improved psychosocial well-being and perceived incapability and individuality. The connection of the quantitative and qualitative data demonstrated that individual perceptual constancy of patients could be a determining factor modulating the effectiveness of this type of intervention.
Conclusion
These findings highlight the potential putative benefits of an SMEP in Chinese patients with COPD. Further attention should be given to cultural considerations when developing this type of intervention in Chinese populations with COPD and other chronic diseases.
... Mishali, Omer, Heymann, 2011;Sarkar, Ali, Whooley, 2009;Schwarzer, 2008;Woodgate, Brawley, 2008). According to the British Association for Cardiac Rehabilitation self-effi cacy, besides illness representation, is the theoretical framework for long-term psychological support in individualised patient care aimed at reducing the cardio-vascular risk (including the change of risk behaviours; Lau-Walker, 2006). Apart from the impact it has on adherence to medical advice (and perhaps as a result of this impact?), ...
... It should be underlined that, irrespectively of the tested model, the role of specifi c self-effi cacy in explaining intention was higher than that of general self-effi cacy. One more time, also in relation to the situation of disease, Bandura's thesis was confi rmed (1997), according to which task-specifi c self-effi cacy has a greater predictive power, since an individual's beliefs that she/he is able to achieve a certain aim refer to the context (see also : Lau-Walker, 2006;Luszczynska, Gutiérrez-Dońa, Schwarzer, 2005). ...
The aim of the study was to confirm the mediation effects of the task-specific self-efficacy on the relationship
between the general self-efficacy and intention and planning considering treatment. The study comprised 265 subjects,
of which 165 were post-mastectomy women and 100 patients hospitalized due to acute coronary syndrome (ACS). The
variables were assessed using the Generalized Self-Efficacy Scale (GSES) and tools developed to examine the context
of treatment. The data were analyzed using the bootstrapping procedure. The results confirmed the indirect effects of
task-specific self-efficacy, both in women making a decision to undergo breast reconstruction, and in patients after ACS
formulating intention to change risk behaviours. As smoking was considered to be a moderator in the post-ACS group,
the obtained associations were observed only among the patients declaring quitting smoking. In view of the fact that taskspecific self-efficacy is susceptible to context (e.g. it may depend on quitting smoking), it is useful to assess it in order to
increase treatment effectiveness.
... This would reinforce patients' conviction in their own ability to adhere to healthcare professionals' recommended prescription regimens and lifestyle modifications. This hypothesis finds empirical corroboration in extant research findings (Lau-Walker, 2004;Lau-Walker, 2006;Knowles et al., 2020). ...
Background
Hypertension is increasingly prevalent among young and middle-aged populations in rural China, accompanied by suboptimal self-management. Given that this population forms the backbone of the labor force, enhancing their self-management capabilities is crucial for improving overall population health. Studies indicate that individuals with good health literacy are more likely to effectively manage their health.
Methods
Grounded in the health literacy skills framework, a model was constructed in this study to examine the impact of health literacy on self-management among young and middle-aged hypertensive patients in rural China. Meanwhile, the mediating roles of illness perception and self-efficacy were also verified. Using a multi-stage stratified random sampling method, 338 patients were recruited to participate in the study. Structural equation modeling was utilized to establish the relationship model, and bootstrap tests were carried out to examine the mediating effects.
Results
The average self-management score was 70.45 ± 11.36. Health literacy exhibited a positive correlation with self-management (standardized β = 0.372, p < 0.001). The mediating effects through illness perception and self-efficacy were 0.040 and 0.236, constituting 6.68 and 39.31% of the total effect, respectively.
Conclusion
Illness perception and self-efficacy serve as parallel mediators amid the association between health literacy and self-management. Implementing psychological counseling and health education is imperative for augmenting self-management competence and cultivating an adaptive coping mentality.
... Participants had moderate illness perception, and also high self-efficacy, and more than half of the participants adhered to the drug regimen. A person's interpretation and illness perception in the face of a health threat and higher self-efficacy can affect a person's confidence in developing a specific skill or ability to change health behaviors (Lau-Walker, 2006;Schwarzer & Warner, 2013). Since the responsibility for the successful management of a chronic disease should not rest solely with the patient (Wolf et al., 2007), health professionals, especially nurses, can play an effective role in this regard. ...
Introduction
Illness perception and self-efficacy in patients with coronary artery disease (CAD) may affect medication adherence, which is one of the most important challenges in disease management in this group of patients.
Objective
The present study aimed to investigate the factors influencing medication adherence in CAD patients, especially the effect of illness perception and self-efficacy.
Methods
This study was cross-sectional and conducted from April to September 2021. A total of 259 patients with confirmed CAD were selected by convenience sampling method based on inclusion criteria. Illness perception, self-efficacy, and medication adherence were investigated using Brief IPQ, SCSES, and MARS_10 questionnaires, respectively. The data were analyzed using the STATA software (version 14) and the regression path analysis method.
Results
Patients had moderate illness perception and high self-efficacy, and 61.8 of them adhered to their medication regimen. Greater illness perception, better self-efficacy, and higher education had a positive effect on medication adherence, and increasing age had a negative effect on it. The final path model shows a good fit of the data in the model (χ2: 0.37, df: 274, χ2/df: 0.36, CFI: 1, IFI: 0.95, TLI: 1.07, and RMSEA: 0.00).
Conclusion
The results of the present study suggest that patients’ illness perception can play an important role in predicting self-efficacy in disease management and the level of medication adherence in patients with CAD. To improve self-efficacy and medication adherence, future intervention studies should focus on the patient's illness perceptions and their improvement.
... When faced with a benign but potentially life changing diagnosis of a chronic disease (such as knee OA), people (in general) develop an organized pattern of perceptions about their condition and how it impacts their lives [10]. These illness perceptions vary between individuals and have been shown to affect physical function. ...
Knee pain is an early sign of later incident radiographic knee osteoarthritis (OA). However, the prevalence of knee pain in the general population is unknown. Additionally, it is unknown how people with knee pain choose to self-manage the condition and if the perception of the illness affects these choices. In this study, 9086 citizens between 60–69 years old in the municipality of Frederiksberg, Copenhagen, Denmark, were surveyed, of which 4292 responded. The prevalence of knee pain was estimated, and associations between illness perceptions (brief illness perception questionnaire [B-IPQ]), self-management strategies, and knee symptoms were assessed. The prevalence of knee pain was 21.4% of which 40.5% reported to use no self-management strategies (non-users). These non-users perceived their knee pain as less threatening and reported less severe symptoms than users of self-management strategies. Further, we found that a more positive illness perception was associated with less severe knee symptoms. In conclusion, among Danes aged 60–69 years, the knee pain prevalence is 21.4%, of which 40.5% use no treatment and perceive the condition as non-threatening. These non-users with knee pain represent a subpopulation being at increased risk of developing knee OA later in life, and there is a potential preventive gain in identifying these persons.
... Investigating these associations will help to understand adherence behavior better and develop more effective, targeted interventions to improve it. A few studies have examined the association between the aforementioned personal characteristics and illness perceptions (Hurt et al., 2014), finding significant associations between self-efficacy and illness perceptions (Lau-Walker, 2006), although these studies neither focused on diabetes patients nor looked at the relationship to adherence. ...
Background: Treatment adherence is associated with a number of personal characteristics (e.g., self-esteem, self-efficacy, locus of control) and illness perceptions. However, there is a lack of studies for Type 2 Diabetes Mellitus (T2DM). Aims: The aim of this study was to compare adherence behavior of British and Greek people with T2DM and examine the association between personal characteristics, illness perceptions, and adherence. Method: This was a cross-cultural, cross-sectional study. Five hundred eighty participants completed questionnaires, 208 males (35.9%) and 372 females (64.1%) with a mean age of 49 years. Regression analyses and t-tests were used. Results: Personal characteristics and illness perceptions predicted adherence and British patients reported better exercise adherence while Greek patients reported better diet and medication adherence; both groups reported suboptimal adherence. Self-efficacy, Health Locus of Control (HLoC), and illness perceptions were the main adherence determinants. Limitations: The use of self-reports and the convenience sampling method are the main limitations of this study. Conclusion: The findings address a significant gap in research and can inform future adherence-enhancing interventions to promote the well-being of people with T2DM.
... The latter is of importance as a person's belief in his or her ability to manage their disease is a powerful and well-recognized predictor of health-related behavior changes [6,36]. Additionally, even though it was not the aim of the present investigation, these findings also suggest that the eHealth tool was beneficial as a self-management tool for the users, as it seemed to have resulted in more substantial confidence in their ability to manage their disease, which is an essential factor to influence specific health behaviors [37][38][39][40]. The sense of hope in itself could also be a reason for the continued use of the eHealth tool among users since the perception of a clear benefit has been highlighted as a critical facilitator for eHealth usage. ...
BACKGROUND
Self-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. Though, there is a lack of knowledge about the usage of, and factors affecting the use of eHealth tools over time in people with COPD.
OBJECTIVE
This study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.
METHODS
The eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content, as well as pedometers were used as triggers to increase usage. After having access to the tool for three months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months access to the tool, seven (five women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and non-user/seldom-users depending on the number of logins and minutes of usage per month.
RESULTS
Three main categories; ambiguous impact basic conditions for usage and approaching capability emerged from the analysis, which, together with their subcategories, reflects the participants' experiences of using the eHealth tool. Non-user/seldom-users¬ reported low motivation, a higher need for technical support, a negative view about the disease and self-management and had problematic health literacy. The latter as measured by the communicative and critical health literacy scale. Users felt comfortable with IT-tools, had a positive view on triggers and had sufficient health literacy. Benefits including behavior changes, were mainly expressed after 12 months had passed, and among users.
CONCLUSIONS
Findings of this study indicate that level of motivation, comfortability with IT-tools as well as the level of health literacy seem to affect usage of an eHealth tool over time. Also, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months regarding behavioral changes, thus suggesting that eHealth tools can be a suitable media for supporting COPD-specific self-management skills – however not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.
CLINICALTRIAL
ClinicalTrials. gov: NCT02696187
INTERNATIONAL REGISTERED REPORT
RR2-doi:10.1136/bmjopen-2017-016851
... Self-efficacy is an individual's confidence to successfully behave in a certain way [9]. Therefore, health behaviors of MI patients need to be promoted by manipulating self-efficacy using self-efficacy-based intervention [10]. ...
strong> The lack of adherence to health behaviors in cardiac rehabilitation (CR) is the leading cause of recurrent myocardial infarction (MI) in Indonesia. This randomized control trial (RCT) study was conducted to examine the effect of a family based self-efficacy enhancing cardiac rehabilitation program on self-efficacy in cardiac health behaviors, health behaviors, and clinical outcomes among MI patients in Indonesia. Sixty MI patients who met the inclusion criteria were randomized by the modified stratified-block method and assigned into either the control group or the experimental group. The patients in the experimental group received the program during phase I over two days and continued to phase II of CR with weekly follow-up sessions. Patients were asked to complete the Self-Efficacy in Cardiac Health Behaviors Scale (SECHBS) and the Modified Myocardial Infarction Health Behaviors Questionnaire (Modified MIHBQ). The results revealed that self-efficacy, health behaviors, and clinical outcomes such as fasting blood glucose, total cholesterol, LDL, triglyceride, and BMI of the patients after receiving the intervention were significantly better than before receiving the intervention, except for blood pressure, and HDL levels. Self-efficacy, health behaviors, and clinical outcomes such as total cholesterol, LDL, and triglyceride were significantly better in patients in the experimental group than those in the control group ( p < .05), except for blood pressure, HDL, BMI, and blood glucose levels (p > .05). In conclusion, the family based self-efficacy enhancing cardiac rehabilitation program shows evidence of effectiveness in enhancing self-efficacy, health behaviors, and some clinical outcomes in MI patients.
... Besides predicting physical activity, self-efficacy for physical activity is related to the creation of positive beliefs about the disease. Nine months after diagnosis of ischemic heart disease, by controlling the baseline level of efficacy, demographic characteristics and severity of the disease, self-efficacy for physical activity is significantly associated with perception of less severe symptoms and higher personal and treatment control over disease among patients [22]. ...
Illness perception refers to patient’evaluation for his/her life with disease. According to the self-regulatory model (Leventhal, Brissette & Leventhal, 2003) the illness perception is subjective and is created by cognitive and emotional components. The unique combination between different parts of illness perception for every patient can predict the patient’s health behaviour including motivation and performing physical activity. The PURPOSE of this study is to examine the main predictors of illness perception and to evaluate the significance of ability for physical activity for construction of illness perceptions. METHODOLOGY: 237 patients with rheumatic arthritis, ankylosing spondylitis, hypertension and diabetes mellitus type 2 have been examined. Optimism and Negative expectancies Inventory (Velitchkov et al., 1993), Multidimensional Health Locus of control Scales (form C) (Wallston et al., 1994), Self Efficacy Chronic Disease Scales (Lorig, et al., 1996), Brief Illness perception Questionnaire (Broadbent, et al., 2006). OWN CONTRIBUTION AND RESULTS: The results of investigation supports the idea that the patients perception of illness controllability depends of health locus of control beliefs and self-efficacy for managing chronic illness. The most important are beliefs that illness depends on patients themselves and their confidence that they have ability at ones disposal to cope with everyday functioning and communicate with doctors. CONCLUSIONS: Self-efficacy for symptom management, Self-efficacy for physical activity and negative expectations are significant and strong predictors of illness perception among patients with chronic diseases and pain.
... Based on this tool, if patients smoked even one cigarette a day after CABG, they were categorized as being non-adherent. 17 The third section was about illness perception based on Weinman et al.'s tool, 22 which had 26 items of illness perception, each based on a 5-option Likert scale." My illness is a serious condition"," My illness will improve in time"," My illness will last for a long time" and "My treatment will be effective in curing my illness" are the examples of this questionnaire items. ...
Background
Coronary artery bypass grafting surgery (CABG) is a common treatment for coronary artery disease. The patient’s commitment to modify risk factors is necessary to achieve the desired after surgery outcomes. The current study aimed at determining illness perception of patients after CABG, its relation to smoking cessation, and detecting other predictors of smoking cessation.
Methods
The samples of the current cross sectional study were selected from a greater study that was done on patients’ adherence determining for 6 months after CABG surgery. Data collection was performed using a telephone questionnaire with 3 sections: personal and social information, smoking cessation, and illness perception. Data analysis was performed via descriptive statistics, independent t test, and multiple logistic regression analysis through SPSS version 16.
Results
The findings showed that 26.6% of the patients had not stopped smoking for 6 months after CABG, and the mean score of illness perception was 83.28 ± 6.11. The relationship between adherence to smoking cessation and illness perception was not significant. Regression logistics via backward selection to detect factors related to smoking cessation adherence after CABG showed only a lack of hypertension history could predict adherence to smoking cessation (OR = 0.199, P = 0.03).
Conclusions
Based on the results, about one-third of the subjects smoked cigarettes after CABG; therefore, it is critical to plan rehabilitation programs regarding smoking cessation after this surgery.
... Nessa investigação, realizada em Taiwan, Noruega, Porto Rico, Colômbia e Estados Unidos, a percepção de que pouco poderia ser feito para controlar a doença esteve associado com menos ações de autocuidado efetivas (Reynolds et al., 2009). Associação entre autoefi cácia e percepção de controle da doença também foi identifi cada em outras enfermidades, como doença cardíaca (Lau-Walker, 2006;Paryad, Hosseinzade, Kazemnejad, & Asiri, 2013) e diabetes em adolescentes (Griva, Myers, & Newman, 2000). Isso é bastante coerente, já que pessoas que se sentem capazes de prosseguir e acreditam que o tratamento ajuda no controle da doença são naturalmente mais propensas a ingerir a medicação conforme recomendação médica. ...
Parent training is a practice that aims to organize the behaviour repertory issued by the parents when dealing with their children behaviour, becoming a frequent strategy used to work with family relationship issues. Trough a systematic review of the national and international literature, this article analyzed the methodological features of empirical studies about training for children and/or teenagers parents, conducted in group. 27 articles were analyzed, published between 2006 and July 2014, indexed in the Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Scientific Electronic Library Online (SciELO), Medline and PsycInfo bases. In the data analysis, the following categories were focused: article title, author, publishing date, study objective, audience, sample size, delineation, strategies of intervention and the main results. The results indicated that the most used design was the randomized clinical trial. Furthermore, most of the interventions were focused on parents or parents and their children. In addition, it can be observed that the cognitive-behavioural techniques were the most utilized techniques for the parents training. The present article discusses the limitations and the contribution for this field of study.
... The common sense model of selfregulation in health and illness (CSM) (Leventhal et al., 1998) is the most widely used model to explain how people interpret and cope with current and potential health events or threats. The CSM posits that individuals facing a health threat go through several stages, including active processing of cognitive representations of the health threat (including personal ideas about disease etiology or causal beliefs) and using the representations formed to steer the development of action plans for coping with the problem (Lau-Walker, 2006). The CSM explicitly states that people"s cognitive representations of disease (including causal beliefs) directly influence the coping strategies they select to reduce the disease threat (Leventhal et al., 1998). ...
The study determined knowledge of risk factors for lifestyle induced chronic diseases among
secondary school students in Obio/Akpor LGA, Rivers State. The sample for the study consisted of 480
secondary school students. The sample was drawn using multistage sampling procedures. The
instrument for data collection was a researcher-designed structured questionnaire. Three experts
validated the instrument. Reliability of the instrument was established using Split-half method and
Spearman-Brown Correction Formula. The reliability coefficient of the instrument was 0.60. Data
analysis was performed using frequency and percentages while inferential statistics of Chi-square ( 2)
was employed to test the null hypotheses. Results showed that students had average knowledge
(57.8%) of risk factors for lifestyle induced chronic diseases. Recommendations such as
implementation of vigorous awareness campaign through health education on health risks of lifestyle
induced diseases in schools, integration of nutrition education into the curricula of subjects such as
Health Education, Home Economics, Biology and Health Science will help educate students on risk
factors for lifestyle induced chronic diseases were made. In addition, interventions directed at reducing
or modifying unhealthy lifestyles such as smoking, substance abuse/misuse and sedentary behaviours
should be designed and effectively implemented at schools.
... And those with gastrointestinal diseases reported lower levels of anxiety when they scored high on the General Self-Efficacy Scale (Barlow, Williams, & Wright, 1996;Luszczynska, Scholz et al., 2005). In addition, ill persons had more positive illness representations when they were highly self-efficacious (Lau-Walker, 2006). Older low-functioning adults were found to have a lower increase in disabilities when they reported higher general self-efficacy earlier on (Kempen, Sonderen, & Ormel, 1999). ...
The construct of perceived self-efficacy is the belief that one can perform novel or difficult tasks and attain desired outcomes, as spelled out in the Social Cognitive Theory (Bandura, 1997). This “can do”-cognition reflects a sense of control over one’s environment and an optimistic belief of being able to alter challenging environmental demands by means of one’s own behavior. Hence, it represents a self-confident view of one’s capability to deal with certain stressors in life.
... Patienten mit chronischen Erkrankungen (Walker 2006; French et al. 2006; Kaptein et al. 2006; Ponzo et al. 2006; Fowler & Baas 2006; Scharloo et al. 2005; Treharne et al. 2005). Eine Vielzahl an Untersuchungen wurde bei kardiologischen Patienten durchgeführt. ...
Hintergrund: Westliche Studien zeigen, dass subjektive Vorstellungen von Krankheitsursachen die Lebensqualität, das emotionale Befinden und Krankheitsverhalten von Patienten vielfältig beeinflussen. Zusammenhänge von Krankheitsattribution, psychischen und somatischen Variablen konnten nachgewiesen werden. Diese Studie unter¬sucht, inwiefern ambulante Patienten eines chinesischen Allgemeinkrankenhauses in bio¬physikalischen und psychosozialen Faktoren eine Ursache ihrer Erkrankung sehen und ob sich Zusammenhänge zwischen psychosozialen, somatischen Faktoren, der Abteilungszugehörig¬keit und dem Attributionsstil nachweisen lassen. Biophysikalische Faktoren wurden definiert als Umweltverschmutzung, psychosoziale als Stress, Familien¬probleme und Überarbeitung.
Methoden: 174 Patienten des Zweiten Volkskrankenhauses in Kunming, davon 106 aus der Ambulanz für TCM und 66 aus der Ambulanz für Psychosomatik, wurden in die Studie ein-geschlossen. Erfasst wurden die Krankheitsattribution (Modul „Krankheitsursache und Be-handlung“ des IPQ-R), Krankheitswahrnehmung (B-IPQ), Belastung durch körperliche Beschwerden (PHQ-15), Depression (PHQ-9), Angststörungen (GAD-7), funktionelle Ge¬sundheit und Wohlbefinden (SF-12) und Gesundheitsängste (Whiteley-7). Es wurden deskriptive Auswertungen, multivariate Varianzanalysen und logistische Regressionen in SPSS Version 20.0 durchgeführt.
Ergebnisse: 84 Patienten attribuieren biophysikalisch, 66 Patienten psychosozial. Bei 45 Pa-tienten liegen beide Attributionsstile vor. Es besteht eine Assoziation von biophysikalischer Attribution und erhöhter Belastung durch körperliche Beschwerden, der Abteilung für TCM und geringer körperlicher Gesundheit. Ein psychosozialer Attributionsstil ist mit erhöhter Belastung durch körperliche Beschwerden, depressiver Symptomatik und Symptomen einer Angststörung assoziiert. Patienten der Abteilung für TCM sehen eher in Umweltver¬schmutzung eine Krankheitsursache, Patienten der Psychosomatik in ihrem emotionalen Be¬finden. Symptome einer Angst¬störung sind Prädiktoren eines psychosozialen Attributionsstils. Prädiktorvariablen eines biophysikalischen Attributionsstils sind körperliche Beschwerden, geringe körperliche Gesundheit, die Zu¬gehörigkeit zur Abteilung für TCM und ein beeinträchtigtes Wohlbefinden.
Schlussfolgerung: Chinesische Patienten sehen in psychosozialen Belastungen und Umwelt-verschmutzung eine Ursache ihrer Erkrankung. Insbesondere Patienten in der TCM beziehen ihre biophysikalische Umwelt in ihre Krankheitskonzepte ein. Beide Attributionsstile sind mit verschiedenen psychischen und somatischen Variablen assoziiert. Weitere Studien sollten diese Zusammenhänge auch im transkulturellen Vergleich eingehender untersuchen und ihre Relevanz für Therapieverlauf und Krankheitsverhalten der Patienten analysieren.
... As a physiological and emotional state, poor health will lower selfefficacy inasmuch as a sick person feels less assured of his ability to take responsibility for his own health outcomes and instead relies on external aid and treatment (Bandura 1977(Bandura , 1986. Indeed, illness cognitions were negatively associated with control/coping beliefs in a meta-analysis of the commonsense model of illness representations (Hagger and Orbell 2003) consistent with the notion that poor health perceptions undermine perceived self-efficacy and ability to cope via health-protective behaviors (see also Lau-Walker 2006). Hence, the second mechanism proposes that remedies associated with illness will reduce consumer self-efficacy and, in turn, the perceived ability to engage in complemen-tary health-protective behaviors-thereby undermining a healthy lifestyle. ...
This research investigates consumer reactions to the marketing of drugs and supplements and the consequences for a healthy lifestyle. A series of experiments provides evidence that drug marketing undermines intentions to engage in health protective behaviors (i.e., a boomerang effect). The boomerang arises from two psychological mechanisms: (1) drugs reduce risk perceptions and perceived importance of, and motivation to engage in, complementary health-protective behaviors, and (2) drugs are associated with poor health that reduces self-efficacy and perceived ability to engage in complementary health-protective behaviors. A combined intervention accompanying a drug remedy that targets both motivation and ability mitigates the drug boomerang on a healthy lifestyle.
... Individuals with hypertension, who accepted chronic character of their condition, were more likely to participate in and sustain the treatment regimen (34). Moreover, the timeline (longer perspective) was identified as a positive predictor of exercise and diet self-efficacy after cardiac event (35). All these data are consistent with our findings regarding self-management in MS. ...
Self-management of a disease is considered one of the most important factors affecting the treatment outcome. The research on the correlates of self-management in multiple sclerosis (MS) is limited. The aim of this study was to determine if personal factors, such as illness perception, treatment beliefs, self-esteem and self-efficacy, are correlates of self-management in MS.
This cross-sectional study included 210 patients with MS who completed Multiple Sclerosis Self-Management Scale - Revised, Brief Illness Perception Questionnaire, Treatment Beliefs Scale, Rosenberg Self-Esteem Scale, and Generalized Self-Efficacy Scale. The patients were recruited from a MS rehabilitation clinic. Demographic data and illness-related problems of the study participants were collected with a self-report survey. Correlation and regression analyses were performed to determine associations between variables.
Four factors: age at the time of the study (β = 0.14, P = 0.032), timeline (β = 0.16, P = 0.018), treatment control (β = 0.17, P = 0.022), and general self-efficacy (β = 0.19, P = 0.014) turned out to be the significant correlates of self-management in MS. The model including these variables explained 25% of variance in self-management in MS.
Personal factors, such as general self-efficacy, perception of treatment control and realistic MS timeline perspective, are more salient correlates of self-management in MS than the objective clinical variables, such as the severity, type, and duration of MS.
© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
... Using their experience and skill, physical therapists should be able to reinforce self-efficacy of knee function. Strategies to reinforce self-efficacy are considered effective for other diagnoses such as heart disease, whiplash associated disorders, osteoarthritis and persistent back pain 3,28,66,76 . Strategies to reinforce self-efficacy of knee function have not, however, been evaluated. ...
... 44 Illness perception were described by Leventhal as a cognitive response to a health threat and a scale, i.e. illness perception questionnaire, was developed to assess the perception of a patient. 45 Studies in illness perception showed good correlations with illness behaviour and clinical outcomes, [46][47][48][49][50] and thus should be considered to be applied in epilepsy stigma studies. ...
Stigma is conceptually broad and culturally variable. Understanding stigma from the conceptual theories, culturally application based on the word stigma in other languages, the definition of stigma and its synonyms, as well as the medical implications in other stigmatized disease such as AIDS, will help us to understand the complexity of stigma in epilepsy. This review investigated the meaning and types of stigma from different perspectives, leading to staging stigma into 5 levels, i. e. social identity, stereotype, prejudice, discrimination and social disability. In addition to the conventional categorization of stigma into social, felt, self-perceived or internalized stigma, new categories of stigma i. e. personal and general attitudes towards epilepsy based on a newly developed Public Attitudes Toward Epilepsy ( PATE) scale was introduced. Courtesy stigma was further elaborated in related to Asian culture. Based on well-established and recently developed theories, the causation and impact of epilepsy stigma was discussed in an Asian context, especially from the aspects of language and society values which are culturally specific. Integrating these theories of causation, illness and stereotype perceptions were proposed to be the mediating mechanism of stigma, which led to the development of a practical and multi-dimensional stigmatization model, aiming to guide, widen and deepen the scope of future stigma research in epilepsy. Using the established model, together with review of related studies, research priorities in epilepsy stigma research especially in Asia focusing on five aspects, i. e. expanding population studies especially on significant others, understanding stigma from personal attitude perspective, investigating the cultural and social causation of stigma, and the impacts of stigma on patients as well as the family members, were proposed.
... 26 Research has demonstrated illness perceptions to be associated with self-efficacy beliefs in various clinical groups, including COPD, 27,28 but also that these relationships may change over time. 29 CSM suggests that coping behaviors originate from the person's perception of the illness, while Bandura's self-efficacy theory posits that specific coping behaviors are likely to occur only if the person believes that he or she can perform the actions involved in the coping behavior. Physical activity is one such coping strategy for persons with COPD, 30 and increased physical activity and improved exercise endurance have been associated with improvements in quality of life. ...
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.
... In a study of patients with Parkinson's disease, illness perceptions differed between depressed and nondepressed participants, and also according to disease stage (Hurt et al, 2012). Moreover, associations between illness perceptions and outcome have been dependent on factors like phases of treatment (Lau-Walker, 2006) and self-perceived health status (Karademas, 2012). These studies underscore the importance, as well as the complex dynamics, of illness perceptions for individuals' health, well-being, and coping resources, and indicate that modifying them can be one relevant aspect of educational interventions. ...
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.
... Since the SRM hypothesizes that illness representations might be affected directly and indirectly by the social context [11], it is reasonable to assume that gender plays a role in their construction. A limited number of studies have examined the associations between gender and illness representations, using the SRM as a theoretical framework [12][13][14][15][16][17], and they have not reached consistent conclusions regarding the impact of gender on all the dimensions of illness representations. For instance, some studies [16,17] found that, compared to men, women tended to report more symptoms and a lesser feeling of control. ...
Background
Although osteoporosis is a major public concern, little research attention has been paid to evaluating the manner in which osteoporotic patients perceive their illness.The aim of the current study was to examine osteoporotic patients’ cognitive and emotional illness representations and to see, specifically, if any differences could be correlated with gender.MethodsA convenience sample of 102 women and 100 men (mean age 66 years in both groups) who were diagnosed with osteoporosis, and who were attending bone and mineral clinics at four major medical centers in Israel, participated in the study. Participants were interviewed face-to-face at the clinics or in their homes, using an adapted version of the Illness Perceptions Questionnaire (IPQ). Emotional illness representations were assessed using the state anxiety subscale from the State-Trait Personality Inventory (SPTI).ResultsParticipants perceived osteoporosis as a chronic but controllable disease. They perceived the disease as having few symptoms and mild consequences on their lives.Conclusions
Osteoporotic patients maintained a logical cognitive and emotional structure of their illness. Regarding gender differences, findings showed that women were more pessimistic than men regarding most of the illness representations’ dimensions. Gender differences in illness representations suggest women and men may benefit from different intervention programs, tailored according to their unique perceptions.
... Möglicherweise kann der Zusammenhang zwischen Selbstwirksamkeit und kognitiven Repräsentationen durch die Verwendung bereichsspezifischer Maße der Selbstwirksamkeit differenzierter erfasst werden, worauf z. B. eine Studie an Patienten mit KHK hindeutet (Lau-Walker, 2006). ...
Zusammenfassung. Ziel der Studie war es, die deutschsprachige Version des Illness Perception Questionnaire-Revised (IPQ-R) psychometrisch zu evaluieren. Hierbei wurden die faktorielle Validitat, Konstruktvaliditat und konkurrente Kriteriumsvaliditat bestimmt sowie die interne Konsistenz und Test-Retest-Reliabilitat analysiert. Die Mehrzahl der Analysen wurden in einer Querschnittsstudie an N = 817 Patienten aus sechs Rehabilitationskliniken durchgefuhrt. Die Prufung der konkurrenten Kriteriumsvaliditat erfolgte an einer Teilstichprobe dieser Patienten in Kontrastierung zu einer Stichprobe von N = 58 Akutpatienten. Die Test-Retest-Reliabilitat wurde anhand einer Stichprobe von N = 45 Patienten aus zwei Rehabilitationskliniken ermittelt. Die faktorielle Struktur des Original-Fragebogens kann insgesamt bestatigt werden. Die Cronbachs Alpha-Koeffizienten liegen mit Werten zwischen .70 und .87 in einem befriedigend bis guten Bereich, lediglich die Skala „Behandlungskontrolle” weist mit einem α von .58 einen in...
... Our data show that individuallevel variables affect illness-specific representations. This goes beyond previous research reporting a relation between self-efficacy and control representations (Griva et al., 2000;Lau-Walker, 2006) in that we show that this relation pertains to different illnesses within one person. Our study shows for the first time that these personal characteristics could transfer across different illnesses nested within one person. ...
The Common-Sense Model assumes that individuals form subjective representations about their illnesses, which in turn guide cognitive and behavioural responses. This assumption is complicated in individuals with multimorbidity, and it is an open question to which degree illness-specific and person-level factors determine the representations of specific illnesses. This study examines the structure and interrelations of illness representations in multimorbidity employing a hierarchical framework based on Cognitive Theory.
Multiple illness representations were assessed in 305 people aged 65 and older using two Brief Illness Perception Questionnaires. Multilevel modelling was used to explore the relations between illness representations and to explain how two illness-specific representations--personal control and treatment control--were determined by a person-level factor, self-efficacy.
Self-efficacy had significant main (B = 0.29; p < 0.01 for personal control; B = 0.19; p < 0.05 for treatment control) and interaction effects (B = 0.38; p < 0.01 personal control on self-efficacy × timeline; B = -0.31; p < 0.05 treatment control on self-efficacy × coherence).
This study suggests that illness-specific representations of older people with multimorbidity are a product of both illness-specific and person-level factors, such as self-efficacy. Strengthening individual self-efficacy may improve illness controllability regardless and on top of illness-specific information.
... The common sense model of self-regulation in health and illness (CSM) [4] is the most widely used model to explain how people interpret and cope with current and potential health events or threats. The CSM posits that individuals facing a health threat go through several stages, including active processing of cognitive representations of the health threat (including personal ideas about disease etiology or causal beliefs) and using the representations formed to steer the development of action plans for coping with the problem [5] . The CSM explicitly states that people's cognitive representations of disease (including causal beliefs) directly influence the coping strategies they select to reduce the disease threat [4] . ...
There is concern that raising awareness about the role of genetics in chronic disease etiology could undermine public belief that lifestyles are important, leading to adverse effects on public health. We tested the hypothesis that people who believe genetics influence chronic disease risk are less likely to believe lifestyles play a role.
Open-ended questions about cancer and heart disease risk factors were included in a population-based survey of 1,747 British adults. Responses were coded for causal beliefs about genetics and lifestyle (smoking, diet, alcohol, exercise).
One third of the respondents identified genetic factors as influencing cancer (35%) and heart disease (36%) risk. Identifying genetic risk was associated with female gender, older age and education for both diseases, as well as with family history for heart disease. Individuals identifying genetic influences on cancer risk were more likely to identify diet (p < 0.001) and exercise (p < 0.05), and mentioned more lifestyle factors overall (p < 0.05), independent of demographics and family history. Patterns were similar for heart disease.
People who recognize that genetics influence chronic disease risk appear more, not less, likely to recognize the role of lifestyles, contradicting suggestions that the public takes an 'either/or' view of the etiology of these potentially preventable diseases.
... Effective patient self-management (self-efficacy) support needs to address patients' 'confidence' in their ability to manage specific activities rather than just convincing patients the 'value, of such activities. Hence, generic educational of material on diet that focuses only on improving health outcomes is unlikely to effectively strengthen patients' diet self-management [16,17]. ...
... As a physiological and emotional state, poor health will lower self-efficacy inasmuch as a sick person feels less assured of their ability to take responsibility for their own health outcomes and instead relies on external aid and treatment (Bandura 1977(Bandura , 1986. Indeed, illness cognitions were negatively associated with control/coping beliefs in a meta-analysis of the common-sense model of illness representations (Hagger and Orbell 2003), consistent with the notion that poor health perceptions undermine perceived selfefficacy and ability to cope via health-protective behaviors (see also Lau-Walker 2006). Hence, the second mechanism proposes that remedies associated with illness will reduce consumer selfefficacy and, in turn, perceived ability to engage in complementary health-protective behaviors-thereby undermining a healthy lifestyle. ...
This research investigates consumer reactions to the marketing of drugs and supplements and the consequences for a healthy lifestyle. A series of experiments provides evidence that drug marketing undermines intentions to engage in health-protective behaviors (i.e., a boomerang effect). The boomerang arises from two psychological mechanisms: (1) drugs reduce risk perceptions and perceived importance of, and motivation to engage in, complementary health-protective behaviors, and (2) drugs are associated with poor health that reduces self-efficacy and perceived ability to engage in complementary health-protective behaviors. A combined intervention accompanying a drug remedy that targets both motivation and ability mitigates the drug boomerang on a healthy lifestyle. (c) 2008 by JOURNAL OF CONSUMER RESEARCH, Inc..
Objective Even though the importance of illness perception in the clinical course of many physical diseases and certain mental disorders has been well documented, little is known about illness perception in bipolar disorder. This study reveals the relationship between illness perception, coping styles, and self-efficacy in patients with bipolar disorder. Secondly, to investigate the effects of these variables on the clinical course. Material and Method In this cross-sectional study, we evaluated a cohort of 157 subjects with bipolar disorder recruited from March 2021 to September 2021. Illness perception was measured using the Turkish version of the Brief Illness Perception Questionnaire. Self-efficacy was assessed using the Self-Efficacy Scale. Coping was evaluated using the Ways of Coping Questionnaire. Results Of 157 patients who had bipolar disorder ages’ mean was 42.08±12.92. 84 (53.5%) of these participants were female, 73 (46.5%) of them were male. Brief Illness Perception Questionnaire had a negative correlation between General Self-Efficacy Scale (p
Background
Self-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD.
Objective
This study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.
Methods
The eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months’ access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month.
ResultsThree main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants’ experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users.
Conclusions
Findings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.
Trial RegistrationClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187
International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2017-016851
The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients’ illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients’ self-efficacy, promote patients’ resilience, and better function.
Objective
This study explored the perceptions, needs and preferences for chronic disease self‐ management (SM) and SM support among men experiencing homelessness.
Design
A qualitative interpretive approach was used. Eighteen semi‐structured interviews were conducted with 18 homeless men with a chronic disease at an emergency overnight shelter of Welcome Hall Mission (WHM) in Montreal, Quebec. Interviews were audio‐recorded, transcribed verbatim and thematically analysed.
Results
The majority of participants perceived SM as important, described confidence to perform medical SM behaviours, and creatively adapted their SM behaviours to homelessness. Emotional SM was described as most challenging, as it was intertwined with the experience of homelessness. Three vulnerable groups were identified: (a) those with no social networks, (b) severe physical symptoms and/or (c) co‐morbid mental illness. The preferred mode of delivery for SM support was through consistent contacts with health‐care providers (HCPs) and peer‐support initiatives.
Discussion and Conclusions
Despite competing demands to fulfill basic needs, participants valued chronic disease SM and SM support. However, SM support must address complex challenges relating to homelessness including emotional SM, multiple vulnerabilities and barriers to forming relationships with HCPs.
Background: Immune treatments of multiple sclerosis (MS) can be classified in first-line and second-line approaches. While in both treatment efficacy is often not easy to assess in the short-term, treatment and illness beliefs may differ in first-line and second-line treated patients. The current study aimed to assess differential beliefs about medicine and illness perception between these groups based on the hypothesis that they are closely connected to adherence behaviour.
Methods: An online survey through the website of the German MS Society was performed investigating beliefs about immune treatments as well as the patients’ illness perceptions with validated questionnaires. Demographic factors, disability and self-reported adherence rates were studied as moderator variables.
Results: In total, 630 patients participated. Data of 433 first-line treated and 192 second-line treated patients with MS (PwMS) were analysed. Necessity beliefs and also concerns beliefs were significantly higher in second-line treated PwMS (MANCOVA p =.001 and p =.006) and generally in patients with higher disability, while illness perception did not differ between groups. Self-assessed adherence rates were around 70% for oral treatments and injectables irrespective of first-line or second-line. Nonadherence was below 5% for infusion treatments. However, most patients reported only single omissions.
Conclusion: The current study reveals differential behavioural attitudes between first-line versus second-line-treated PwMS. However, follow-up studies are needed to further unravel the relationship between behavioural attitudes and treatment adherence.
Background: It is generally accepted that diet is a key factor in increasing the risk of atherosclerosis and ischemic heart disease (IHD). Lifestyle changes can reduce the incidence of atherosclerosis. Psychological interventions are of the effective approaches to control dietary adherence. The aim of this study was to determine the effect of cognitive behavioral therapy (CBT) on the dietary adherence of IHD patients admitted to the critical care unit (CCU) of Ali ibn Abi Talib Hospital in Rafsanjan, Iran, 2018. Methods: A randomised controlled trial was conducted through face-to-face interview on 50 patients admitted to the CCU. The samples were selected based on inclusion criteria and minimization method. The CBT was performed on the case group for three months. The researcher completed the food frequency questionnaire (FFQ) in three periods of baseline, one month and three months after the last session of intervention. Finally, the data were analyzed by SPSS version 18 software using independent t-test, paired t-test, Chi-square and Fisher tests. Results: Overall, 50 IHD patients (25 controls, 25 cases) were enrolled in our study, consisting of 17 females (10 cases, 7 controls) and 33 males (15 cases, 18 controls). The mean age of patients participating in this study was 61 years. The mean score of dietary adherence in case and control groups at the baseline did not differ significantly (P> 0.05), but showed a significant increase after one and three months of intervention for the case group (p
According to the common-sense model of self-regulation, individuals form lay representations of illnesses that guide coping procedures to manage illness threat. We meta-analyzed studies adopting the model to (a) examine the intercorrelations among illness representation dimensions, coping strategies, and illness outcomes; (b) test the sufficiency of a process model in which relations between illness representations and outcomes were mediated by coping strategies; and (c) test effects of moderators on model relations. Studies adopting the common-sense model in chronic illness (k = 254) were subjected to random-effects meta-analysis. The pattern of zero-order corrected correlations among illness representation dimensions (identity, consequences, timeline, perceived control, illness coherence, emotional representations), coping strategies (avoidance, cognitive reappraisal, emotion venting, problem-focused generic, problem-focused specific, seeking social support), and illness outcomes (disease state, distress, well-being, physical, role, and social functioning) was consistent with previous analyses. Meta-analytic path analyses supported a process model that included direct effects of illness representations on outcomes and indirect effects mediated by coping. Emotional representations and perceived control were consistently related to illness-related and functional outcomes via, respectively, lower and greater employment of coping strategies to deal with symptoms or manage treatment. Representations signaling threat (consequences, identity) had specific positive and negative indirect effects on outcomes through problem- and emotion-focused coping strategies. There was little evidence of moderation of model effects by study design, illness type and context, and study quality. A revised process model is proposed to guide future research which includes effects of moderators, individual differences, and beliefs about coping and treatment. (PsycINFO Database Record
Die Selbstwirksamkeitserwartung (self-efficacy-belief, perceived self-efficacy) bezeichnet die Überzeugung, durch eigene Fähigkeiten solche Handlungen ausführen zu können, die zu den gewünschten Zielen führen. Empirische Untersuchungen zeigen, dass Menschen mit einem starken Glauben an die eigene Kompetenz und Effizienz eine größere Ausdauer bei Leistungsaufgaben, eine niedrigere Anfälligkeit für Angststörungen und Depressionen und insgesamt mehr Erfolge im Berufsleben aufweisen.
The illness perception of people living with HIV/AIDS (PLWHA) is an important variable, poorly studied worldwide. The aimed was investigate the association between illness perception and anxiety, depression and self-efficacy in people living with HIV/AIDS. The sample consisted of 28 PLWHA, that responded to sociodemographic and medical-clinical questionnaires, Brief Illness Perception Questionnaire (Brief IPQ), Hospital Anxiety and Depression Scale (HADS) and Self-efficacy for Following Anti-retroviral Prescription Scale. The authors conducted statistical analyzes of the data, been carried Spearman correlation tests. Was observed a statistically significant positive correlation between illness perception and anxiety (r = .64; p
Heart disease is an increasingly common chronic medical condition that affects not only patients but their families. Because this condition has significant psychosocial impact, effective treatment requires an integration of psychosocial treatment—including individual, couples, and family counseling—with conventional medical treatment. Individual psychological dynamics as well as couple and family dynamics that influence the treatment process are described along with implications for family counseling. An illustrative case example is included.
In this age of accountability, and irrespective of whether they work in health-care settings or conventional mental health settings, all therapists will be increasingly expected to provide effective psychosocial treatment to individuals and families who face co-morbid medical conditions. Statistics these conditions are daunting: 75 percent of adults over age 65 and 50 percent of Americans constantly experience chronic medical symptoms, and prevalence rates of chronic medical conditions that are more than three times higher than mental illness. While it can be helpful to conceptualize treatment in terms of individual dynamics and utilize cognitive behavioral strategies, it can be much more effective to conceptualize family as well as individual dynamics and to utilize systemic interventions when indicated. Effective Treatment of Individuals and Families Facing Medical Conditions addresses the need for these types of interventions. It provides background information on 12 common medical conditions, and includes discussions of family dynamics as well as medical and psychosocial treatments. While recognizing the role of personality, culture, and illness dynamics, it emphasizes the centrality of family dynamics in conceptualizing and implementing interventions.
Aim and Background: Schemas are cognitive patterns that have a major impact on the perception and behavior. Therefore, it is necessary to investigate their role in determining and changing health related behaviors in MS patients. The purpose of this study is to investigate the mediating effect of illness perception on the relationship between early maladaptive schemas in the domain of rejection and disconnection and the level of motor disability in MS patients.
Methods and Materials: 104 participants with MS, who referred to the MS Commission in Isfahan, were selected randomly. The research tools were Young Schema Questionnaire-Short Form (YSQ-SF), the Brief Illness Perception Questionnaire (Brief IPQ). The level of motor disability was assessed by Expanded Disability Status Scale (EDSS). Data were analyzed using hierarchical multiple regression and Sobel Test.
Findings: Early maladaptive schemas in the domain of rejection and disconnection significantly predicted illness perception (P≤0.001) and motor disability (between P≤0.000 to P ≤ 0.012),and illness perception significantly predicted motor disability (P ≤ 0.000). Therefore, early maladaptive schemas, with the mediate role of illness perception, predict the level of disability.
Conclusions:
Results supported that those MS patients with early maladaptive schemas in the domain of rejection and disconnection, have a higher level of negative perception to their illness and subsequently, higher level of disability. These results can be helpful in planning for providing psychological interventions to improve quality of life and increase health related behavior in MS patients.
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.
Asthma is an increasingly common chronic medical condition that affects not only patients but their families. Because this condition has significant psychosocial impact, effective treatment requires an integration of psychosocial treatment—including individual, couples, and family counseling—with conventional medical treatment. Individual psychological dynamics as well as couple and family dynamics that influence the treatment process are described along with implications for family counseling. An illustrative case example is included.
Partner support facilitates successful recovery and adjustment following an acute cardiac event (myocardial infarction or coronary revascularisation), but there is limited research examining the partner experience after an acute cardiac event. A computerised literature search was conducted to identify quantitative research investigating the psychosocial impact of an acute cardiac event on the patient's partner. The research base is limited, somewhat methodologically weak and outdated in relation to advances in cardiac care, and little attention has been paid to the experience of non-Caucasian couples, same sex couples or male partners. However, we found that partners are at significant risk of experiencing distress, anxiety and depression that may extend beyond the immediate recovery phase, and may contribute to adverse patient outcomes. Partners contend with significant disruption to their daily functioning and may engage in substantial caregiving responsibilities. Partners describe a lack of social support and information which may contribute to the high levels of distress. Marital and sexual functioning can also be adversely affected. Partner coping strategies and illness perceptions may contribute to adjustment. The findings of this review reveal that partner experience may play an important role in both partner and patient adjustment to an acute cardiac event and there is considerable scope for updating and extending current knowledge of partner experience.
Depressive disorders are a wide spread and often chronic health problem leading to substantial impairment of the
patient and elevated health-care costs. Illness representations are known to be correlated with the success in coping with the
illness. This can be presumed particularly in the case of depression as here dysfunctional cognitive appraisal processes are not
only linked to coping with the disease but also with its aetiology. This study aims at exploring associations between illness
representation dimensions and depressive symptoms as well as positive affect reported by 60 inpatients of a psychosomatic
rehabilitation-clinic cross-sectionally and in follow ups at discharge and 3 months after discharge. Furthermore, participants
were randomly assigned to an expressive writing or control writing group in order to explore the effects of expressive writing
as an adjunct therapy. Results show that the perceived time line, consequences, and emotional representations of the illness
are associated with an increased number of depressive symptoms. Longitudinally, control-related beliefs at baseline were
linked with the course of depression and positive affect at discharge and 3 months after. Coherence was only associated with
positive affect and not with depressive symptoms. Even though expressive writing did not add significantly to the inpatient
treatment in this small group, patients with elevated emotional representations tended to benefit from the expressive writing
task, especially at the follow up points of measurement.
This randomized controlled trial examined a discharge nursing intervention aimed at promoting self-regulation of care for early discharge interventional cardiology patients. The purpose of this study was to compare medication adherence, patient satisfaction, use of urgent care, and illness perception in patients with cardiovascular disease undergoing interventional revascularization procedures who receive usual care and those who receive a discharge nursing intervention.
The Knee Self-Efficacy Scale (K-SES) has good reliability, validity, and responsiveness for patients' perceived knee-function self-efficacy during rehabilitation after an anterior cruciate ligament (ACL) injury. Preoperative knee-function self-efficacy has also been shown to have a predictive ability in terms of outcome 1 y after ACL reconstruction.
To evaluate a new clinical rehabilitation model containing strategies to enhance knee-function self-efficacy.
A randomized, controlled study.
Rehabilitation clinic and laboratory.
40 patients with ACL injuries.
All patients followed a standardized rehabilitation protocol. Patients in the experimental group were treated by 1 of 3 physiotherapists who had received specific training in a clinical rehabilitation model. These physiotherapists were also given their patients' self-efficacy scores after the initial and 4-, 6-, and 12-mo follow-ups, whereas the 5 physiotherapists treating the patients in the control group were not given their patients' self-efficacy scores.
The K-SES, the Tegner Activity Scale, the Physical Activity Scale, the Knee Injury and Osteoarthritis Outcome Score, and the Multidimensional Health Locus of Control.
Twenty-four patients (12 in each group) completed all follow-ups. Current knee-function self-efficacy, knee symptoms in sports, and knee quality of life improved significantly (P = .05) in both groups during rehabilitation. Both groups had a significantly (P = .05) lower physical activity level at 12 mo than preinjury. No significant differences were found between groups.
In this study there was no evidence that the clinical rehabilitation model with strategies to enhance self-efficacy resulted in a better outcome than the rehabilitation protocol used for the control group.
Die Kognition Selbstwirksamkeit, von Bandura beschrieben und von Schwarzer entscheidend weiterentwickelt, ist ein interessantes und immer noch viel versprechendes Konzept zur Erklärung von Verhalten zu bestimmten Zeitpunkten sowie von Veränderungen über die Zeit. Die Studie zeigt, dass die Selbstwirksamkeit bei Patienten mit unterschiedlichen psychischen Störungen verschieden hoch ist. Patienten, die unter Angst, Depression und Essstörung leiden, haben eine sehr geringe Kompetenzerwartung. Wird die Diagnose sexuelle Funktionsstörung oder somatoforme Störung gestellt, ist sie meist verbunden mit einer relativ hohen Selbstwirksamkeit. Weiterhin leiden Patienten mit einer geringen Selbstwirksamkeit stärker unter Angst, Depressionen, körperlichen und interpersonellen Problemen als Patienten mit einer hohen Kompetenzerwartung. In der untersuchten stationären Therapie steigt die Selbstwirksamkeit über die gesamte Zeit gesehen an, die körperbezogene Selbstwirksamkeit stark, die leistungs- und kommunikationsbezogene Selbstwirksamkeit etwas weniger. Als letzter Punkt wird in der Studie deutlich, dass Patienten mit einer geringen Selbstwirksamkeit mehr Beruhigungs- und Schmerzmedikamente fordern als diejenigen mit einer hohen Kompetenzerwartung. Diese Ergebnisse sind wichtig für die optimale Behandlung von Patienten mit psychischen Problemen und könnten bei weiterer Erforschung ebenfalls für andere Erkrankungen bzw. Patientengruppen noch entscheidendere Bedeutung in der Akut- und Langzeittherapie haben. The cognition "self-efficacy", described by Bandura and decisively developed by Schwarzer, is an interesting and still promising concept to explain behavior at a fixed point as well as changing over a period of time. The study shows that self-efficacy is varying by patients with different psychic diseases. Patients with anxiety, depression and eating disorders have a low self-efficacy. Related to the diagnosis sexual or somatoform dysfunction is often a high self-efficacy. Furthermore patients with a low self-efficacy suffer from a higher level of anxiety, depression, physical and interpersonal problems. In the analysed stationary therapy self-efficacy rises over the whole time, the body-related self-efficacy strongly, the activity and communication-related self-efficacy a little less. The last important point of the study describes, that patients with a low self-efficacy demand more analgetics and depressants than patients with a high self-efficacy. The results are important for the optimal treatment of patients with psychic problems and could also be of great importance for further research of other diseases respectively patients in both acute and long term therapy.
Despite the well-documented benefits of exercise, adherence among patients with coronary heart disease (CHD) has been low during and after cardiac rehabilitation (CR) as well as among patients not attending CR. Therefore, an understanding of the factors that influence exercise in this population is crucial to assist in the development of effective interventions. The goal of this review was to document the correlates of exercise of CHD patients in all CR contexts from a social-ecological perspective that addresses multiple levels of influence on exercise. The search strategy included PubMed, PsychINFO and Web of Science databases. In all, 121 studies, examining 32 different correlates of exercise, with a total of 25 217 participants were included. Across all CR contexts, six variables were consistently related to exercise (self-regulatory self-efficacy, health status, intention, perceived control, beliefs/benefits and previous physical activity). Several variables were also related to exercise in three of four contexts (e.g. task self-efficacy, perceived barriers, attitude, action planning, sex and employment status). Many of the variables consistently related to exercise may be amenable to change through the development and implementation of appropriate interventions. Specific suggestions are made for each relevant variable to assist CR staff and other healthcare practitioners in 32 promoting exercise among CHD patients. Current gaps in literature such as a lack of prospective studies and research examining broader (e.g. policy level) correlates are also discussed.
Marital status has been clearly linked to subsequent health outcomes in those with established coronary heart disease (CHD). This robust association may be because of both pathophysiological and behavioural mechanisms.
We employed meta-regression to examine the association between marital status and attendance at outpatient cardiac rehabilitation (CR) in published studies.
We searched electronic databases, for example, Medline and Science Citation Index, for published studies that reported an association between a measure of marital or partnered status and CR attendance in patients with diagnosed CHD.
Eleven studies were identified which incorporated 6,984 CHD patients. Being married/partnered was associated with significantly higher odds of attending CR. Using a fixed effects model, the pooled odds ratio of CR attendance was 1.72 [95% confidence interval (CI) 1.50-1.97] for those who were married/partnered. There was no evidence of heterogeneity of effects (P=0.42) or publication bias (P=0.12).
CHD patients who are married or have a partner are between 1.5-2 times more likely to attend CR. Associations between marital status and CR attendance may partly explain CHD outcomes.
Reviews findings and theoretical implications of studies concerned with initiation, maintenance, and therapy of cigarette smoking in children and adults. The following conclusions are offered: (a) Recent increases in success rates may be due to changes in the social environment that multiply the action of previously unsuccessful procedures, (b) current interventions are based on communication and behavioral models that ignore features unique to smoking, (c) methodological refinements of current interventions are unlikely to increase success rates significantly, (d) prevention studies should be directed toward critical steps in the developmental history of smoking (e.g., preventing initial attempts and retarding regular usage), and (e) studies of cessation and withdrawal must consider findings and theories of nicotine dependence. Also discussed are the development of craving and its elimination. (9 p ref)
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
Tested the self-efficacy hypotheses that (1) personal mastery expectations are the primary determinants of behavioral change and (2) individual differences in past experiences and attribution of success to skill or chance result in different levels of generalized self-efficacy expectations. A Self-Efficacy Scale was developed and tested with 376 college students. Factor analysis yielded 2 subscales: a General Self-Efficacy subscale (17 items) and a Social Self-Efficacy subscale (6 items). Confirmation of several predicted conceptual relationships between the Self-Efficacy subscales and other personality measures (i.e., Locus of Control, Personal Control, Social Desirability, Ego Strength, Interpersonal Competence, and Self-Esteem) provided evidence of construct validity. Positive relationships between the Self-Efficacy Scale and vocational, educational, and military success established criterion validity. (15 ref) (PsycINFO Database Record (c) 2013 APA, all rights reserved)
The Illness Perception Questionnaire (IPQ) is a new method for assessing cognitive representations of illness. The IPQ is a theoretically derived measure comprising five scales that provides information about the five components that have been found to underlie the cognitive representation of illness. The five scales assess identity - the symptoms the patient associates with the illness, cause - personal ideas about aetiology, time-line - the perceived duration of the illness, consequences - expected effects and outcome and cure control - how one controls or recovers from the illness. The IPQ has a specific number of core items but allows the user to add items for particular patient groups or health threats. Data is presented supporting the reliability and validity of the IPQ scales in different chronic illness populations.
This paper disentangles a number of closely related cognitions by dividing them into the categories of defensive and functional optimism. Optimistic biases in risk perception are discussed that may represent barriers in the adoption of preventive health behaviors. Instead of defensive optimism, some sense of vulnerability is seen as indispensable for behavioral change operating jointly with beliefs about positive health outcomes, instrumental actions, and appropriate coping resources. A distinction is made between three kinds of functional optimism that depend either on attributional style, outcome expectancies, or personal agency. Findings are presented that corroborate the strength of these constructs in predicting health outcomes. In terms of health behavior change, it is argued that optimistic self-beliefs are the most beneficial because of their operative power that helps to set goals, initiate actions, and maintain motivation.
The self-concept has emerged as an important component of organizational paradigms. This article reviews the conceptual meanings of self-esteem and self-efficacy, clarifies the relation-ship between the two perceptions of the self, and discusses how an understanding of them can lead to better organization management. An empirical examination explored the intervening role of organization-based self-esteem in the relationship between generalized self-efficacy and explored two outcomes-employees' job performance and job-related affect (job satisfaction). Organization-based self-esteem emerged as the stronger predictor of ratings of performance and employee satisfaction, and it appears to act as a mediator in the relationship between generalized self-efficacy and these employee responses. The managerial implications of these results are discussed.
Addresses the centrality of the self-efficacy mechanism (SEM) in human agency. SEM precepts influence thought patterns, actions, and emotional arousal. In causal tests, the higher the level of induced self-efficacy, the higher the performance accomplishments and the lower the emotional arousal. The different lines of research reviewed show that the SEM may have wide explanatory power. Perceived self-efficacy helps to account for such diverse phenomena as changes in coping behavior produced by different modes of influence, level of physiological stress reactions, self-regulation of refractory behavior, resignation and despondency to failure experiences, self-debilitating effects of proxy control and illusory inefficaciousness, achievement strivings, growth of intrinsic interest, and career pursuits. The influential role of perceived collective efficacy in social change and the social conditions conducive to development of collective inefficacy are analyzed. (21/2 p ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved). © 1982 American Psychological Association.
Self-efficacy has been documented as a strong predictor of health behaviors. Unfortunately, availability of reliable and valid measures of self-efficacy for a range of health behaviors is still limited. This study validated two measures of cardiac risk factor self-efficacy: the Cardiac Diet Self-Efficacy Instrument (CDSEI) and the Cardiac Exercise Self-Efficacy Instrument (CESEI). A sample of 370 cardiac rehabilitation participants provided data for principal factor analyses showing the unidimensionality of each instrument. Known groups construct validity was supported by a comparison of CDSEI and CESEI scores for cardiac rehabilitation participants and marathon runners. The value of CDSEI and CESEI scores in predicting subsequent exercise and diet performance was demonstrated with a third group of cardiac rehabilitation participants. Stability and internal consistency estimates in the .80s and .90s, respectively, support the scales' reliabilities.
Reviews findings and theoretical implications of studies concerned with initiation, maintenance, and therapy of cigarette smoking in children and adults. The following conclusions are offered: (a) Recent increases in success rates may be due to changes in the social environment that multiply the action of previously unsuccessful procedures, (b) current interventions are based on communication and behavioral models that ignore features unique to smoking, (c) methodological refinements of current interventions are unlikely to increase success rates significantly, (d) prevention studies should be directed toward critical steps in the developmental history of smoking (e.g., preventing initial attempts and retarding regular usage), and (e) studies of cessation and withdrawal must consider findings and theories of nicotine dependence. Also discussed are the development of craving and its elimination. (9 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To examine whether patients' initial perceptions of their myocardial infarction predict subsequent attendance at a cardiac rehabilitation course, return to work, disability, and sexual dysfunction.
Patients' perceptions of their illness were measured at admission with their first myocardial infarction and at follow up three and six months later.
Two large teaching hospitals in Auckland, New Zealand.
143 consecutive patients aged under 65 with their first myocardial infarction.
Attendance at rehabilitation course; time before returning to work; measures of disability with sickness impact profile questionnaire for sleep and rest, social interaction, recreational activity, and home management; and sexual dysfunction.
Attendance at the rehabilitation course was significantly related to a stronger belief during admission that the illness could be cured or controlled (t = 2.08, P = 0.04). Return to work within six weeks was significantly predicted by the perception that the illness would last a short time (t = 2.52, P = 0.01) and have less grave consequences for the patient (t = 2.87, P = 0.005). Patients' belief that their heart disease would have serious consequences was significantly related to later disability in work around the house, recreational activities, and social interaction. A strong illness identity was significantly related to greater sexual dysfunction at both three and six months.
Patients' initial perceptions of illness are important determinants of different aspects of recovery after myocardial infarction. Specific illness perceptions need to be identified at an early stage as a basis for optimising outcomes from rehabilitation programmes.
Two key recommendations of recent guidelines are
that cardiac rehabilitation requires the skills of a range
of professionals and that the patient should receive a
menu based programme after an individual assess
ment of needs. A previous survey of 25 cardiac
rehabilitation programmes found little congruence
with these guidelines and noted that physicians were
particularly unlikely to be involved. We extended this
inquiry to include all of the discoverable rehabilitation
programmes in the United Kingdom.
Many patients fail to attend cardiac rehabilitation. Attempts to identify sociodemographic or clinical predictors of non-attendance have not been very successful; therfore, this study aimed to determine whether the illness beliefs held during hospitalisation by patients who had suffered acute myocardial infarction or who had undergone coronary artery bypass graft surgery could predict cardiac rehabilitation attendance.
152 patients were prospectively studied of whom 41% had attended cardiac rehabilitation at six months.
In addition to being older, less aware of their cholesterol values, and less likely to be employed, non-attenders were less likely to believe their condition was controllable and that their lifestyle may have contributed to their illness.
It should now be determined whether interventions aimed at optimising certain perceptions could promote cardiac rehabilitation uptake among those patients who could benefit the most.
Several authors (e.g., J.T. Austin & H.J. Klein, 1996; R. Kanfer, 1990b, 1992) have urged researchers to examine comprehensive models of distal individual differences as predictors of proximal motivational processes and performance. Two field studies in an academic setting tested a model of relationships among trait-like individual differences (cognitive ability, general self-efficacy, and goal orientation), state-like individual differences (state anxiety, task-specific self-efficacy, and goals), and learning performance. Most hypothesized relationships among these constructs received support when tested on 2 samples, when examining different performance episodes, and when using different goal orientation and state-anxiety measures. In general, state-like individual differences were found to mediate the relationships between trait-like individual differences and learning performance. Implications of these results are discussed and suggestions for future research are provided.
A coronary event has major psychological, as well as physical, consequences. The recent British Cardiac Society's Working Party Report on Cardiac Rehabilitation acknowledges the importance of comprehensive rehabilitation programmes incorporating a psychological input. Psychological intervention as part of cardiac rehabilitation serves two purposes: to maximise psychosocial recovery, including return to customary activities such as work and sexual relationships, and to facilitate the secondary prevention of coronary heart disease. The latter involves providing behavioural change strategies for a range of lifestyle factors from stress identification and management, through dietary, smoking and physical activity change, to increasing adherence to medication regimes.
Psychological interventions have proven successful in decreasing general morbidity in the year after coronary events and in reducing reinfarction-related mortality. Little is understood about the mechanisms by which psychological interventions may operate. However, a recent seminal study of intensive lifestyle modification in cardiac patients has demonstrated that it is possible to achieve regression of atherosclerosis (although the authors themselves caution that their intensive methods are unlikely to be applicable in most patient settings). More general discussion of the relationship between psychological factors and coronary disease is available. With regard to enhancement of psychosocial recovery, early work documented positive effects of exercise-only programmes on psychosocial functioning.
Background:
Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence.
Objective:
To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease.
Methods:
We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies.
Results:
The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of 0.34, -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99).
Conclusions:
The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.(Arch Intern Med. 1996;156:745-752)
Adolescents' beliefs in their personal control affects their psychological well-being and the direction their lives take. Self-Efficacy in Changing Societies analyzes the diverse ways in which beliefs of personal efficacy operate within a network of sociocultural influences to shape life paths. The chapters, by internationally known experts, cover such concepts as infancy and personal agency, competency through the life span, the role of family, and cross-cultural factors.
[examines] an arthritis self-management program to teach patients how to cope with the consequences of their chronic disease / found that patients' perceived self-efficacy to cope with their ailment was mediating the outcomes of this program / this was particularly true for pain and depression (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objectives: To identify: 1. All the cardiac rehabilitation units in the UK together with the names and addresses of their co-ordinators and the different health professionals involved. 2. The range of patient diagnoses treated. 3. The before and after assessment procedures used. 4. The provision of ongoing support for patients when they leave the programme. 5. Their arrangements for secondary prevention and knowledge of local protocols and arrangements for long-term care.Design : Questionnaire and telephone surveys. Main outcome measures: Names and addresses of all cardiac rehabilitation co-ordinators, the disciplines of their staff, the conditions which they treat, the treatments offered and the outcomes measured together with knowledge of and provision for long-term secondary prevention. Results: 300 centres were identified. Of the 294 who returned questionnaires, nearly all provided a mixture of exercise training, education and stress management. Age was an exclusion factor in 14%. Outcomes in the form of exercise tolerance was measured by 22%, psychological function by 60% and quality of life by 51%. Staffing included nurses, physiotherapists and dieticians in over 80% and doctors and pharmacists in over 60%. Psychologists and social workers were involved in less than 30%. The majority of co-ordinators were involved with or aware of secondary prevention initiatives in their area.
Objectives. To assess the utility of measures of affect and social-cognitive variables in predicting risk behaviours for coronary heart disease in post-myocardial infarction (MI) patients. Design. A longitudinal design was adopted with predictor variables measured while participants were in hospital and dependent variables (exercise, alcohol consumption, diet and smoking) measured 3 months following discharge. Method. A random sample of 43 patients with a first MI were identified on the wards and given a questionnaire measuring anxiety and depression, and measures of outcome and self-efficacy expectancies and intentions relevant to each risk behaviour. Thirtyseven participants completed further behavioural measures at 3-month follow-up (excluding those who died in the follow-up period), a 90% completion rate. Results. Social cognition measures were predictive of later behaviour, and in particular light exercise. Here, intentions accounted for 51% of the variance in behaviour explained after partialling out pre-MI levels of exercise. Affect was less predictive, explaining only 7% of the variance in light exercise. Conclusions. Beliefs and intentions about future risk behaviour are formulated in the immediate post-infarction period. Future rehabilitation programmes would benefit from some intervention, probably educational, at this early stage.
Now that cardiac rehabilitation (CR) has been shown to be an efficient and effective use of resources, resulting in reduced mortality and morbidity, it is essential that as many people as possible are given the opportunity to benefit from it. But, despite proven benefits, uptake of services can be low. The aim of this research was to develop and implement a psychological intervention to influence patients' beliefs about recovery and cardiac rehabilitation, in order to increase their attendance rates at a CR programme. The intervention was based on the Theory of Planned Behaviour and took the form of two letters given to patients post myocardial infarction (n = 87). Using a randomized control trial design, attendance rates for those patients who received the intervention letters were compared with patients in a control group who received nominal letters. Attendance rates for the experimental group were significantly higher than those in the control group (P <0.0025). This study shows that an intervention in the form of two letters given to patients can increase the number of people who attend a cardiac rehabilitation programme.
Self-efficacy is increasingly used as a predictor of health behavior. The purpose of this study was to examine the impact of exercise self-efficacy on exercise behaviors and outcomes. A one-group pre-test/post-test design was used. The treatment, a 12-week exercise training program, was executed between the pre- and post-tests. Exercise self-efficacy was measured prior to training and at the 4th, 8th and 12th weeks of training. Estimated VO2max, fatigue, anxiety, depression, and quality of life (QOL) were assessed prior to exercise training and after 12 weeks of training. Compliance rate and exercise intensity were computed at the 4th, 8th and 12th weeks of training. Results of this study revealed no relationship between exercise self-efficacy and compliance rate, nor between exercise self-efficacy and exercise intensity. The change in exercise self-efficacy after exercise training, rather than the initial self-efficacy level, was significantly related to exercise outcomes. Exercise intensity was more important in predicting the improvement of VO2max than was compliance rate. In contrast, compliance rate was more important in predicting the improvement of QOL than was exercise intensity.
Background:
The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Circulatory diseases, including myocardial infarction (MI) and stroke, kill more people than any other disease. Cardiac rehabilitation aims to restore patients who have suffered myocardial infarction to optimal health through exercise only based rehabilitation or comprehensive cardiac rehabilitation (eg. smoking cessation advice, diet and counselling as well as exercise). Data from two published and widely cited meta-analyses (Oldridge 1988, O'Connor 1989) of over 4,000 patients each have demonstrated that patients randomised to exercise-based cardiac rehabilitation after MI have a statistically significant reduction in all-cause and cardiac mortality of about 20 to 25% compared to patients receiving conventional care. However, the trials included were small and often of poor methodological quality. Incomplete literature review methods may have resulted in publication bias thereby resulting in an over-estimate of the benefit of cardiac rehabilitation. The randomised controlled trials used in the reviews have focused almost exclusively on low-risk, middle-aged males post MI, thereby excluding women and the elderly.
Objectives:
To determine the effectiveness of exercise only rehabilitation and exercise in addition to other rehabilitation interventions (termed comprehensive cardiac rehabilitation) compared with usual care on the mortality, morbidity, health-related quality of life (HRQoL) and modifiable cardiac risk factors of patients with coronary heart disease.
Search strategy:
Electronic databases were searched for randomised controlled trials, using standardised trial filters, from the earliest date available to December 31st 1998.
Selection criteria:
Men and women of all ages, in both hospital-based and community-based settings, who have had myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, or who have angina pectoris or coronary artery disease defined by angiography have been included. Studies involving participants following heart transplant, heart valve surgery or heart failure have been excluded. Follow up periods of less than 6 months were excluded.
Data collection and analysis:
Studies were selected independently by two reviewers, and data extracted independently. Authors were contacted where possible to obtain missing information.
Main results:
The current systematic review has allowed analysis of an increased number of patients from approximately 4500 in the earlier meta-analyses to 7683 (2582 in exercise only and 5101 in the comprehensive cardiac rehabilitation group). The quality of reporting overall was poor, with generally high losses to follow up. The pooled effect estimate for total mortality for the exercise only intervention shows a 27% reduction in all cause mortality (random effects model OR 0.73 (0.54, 0.98)). Similarly, comprehensive cardiac rehabilitation reduced all cause mortality compared to usual care, but to a lesser degree (OR 0.87 (0.71, 1.05)). Total cardiac mortality was reduced by 31% (random effects model OR 0.69 (0.51, 0.94)) and 26% (random effects model OR 0.74 (0.57, 0.96)) in the exercise only and comprehensive cardiac rehabilitation intervention groups respectively when compared to usual care. Neither intervention had any effect on the ocurrence of non-fatal myocardial infarction. There was a significant net reduction in total cholesterol in the comprehensive cardiac rehabilitation group (pooled WMD random effects model -0.57 mmol/l (-0.83, -0.31)), but not the exercise only rehabilitation group. Similarly, LDL was significantly reduced in the comprehensive cardiac rehabilitation group (pooled WMD random effects model -0.51 mmol/l (-0.82, -0.19). The effect of exercise only rehabilitation or comprehensive cardiac rehabilitation interventions on revascularisation rates, blood pressure or smoking behaviour could not be determined by this meta-analysis due to the small number of trials reporting these outcomes and heterogeneity between trials. It was not possible to combine the data from studies reporting HRQoL as an outcome. Eighteen different instruments were used to assess HRQoL in the 11 studies reporting it as an outcome. The data are presented qualitatively, only one trial reporting significant improvements with the intervention.
Reviewer's conclusions:
Exercise-based cardiac rehabilitation appears to be effective in reducing cardiac deaths but the evidence base is weakened by poor quality trials. It is not clear from this review whether exercise only or a comprehensive cardiac rehabilitation intervention is more beneficial. The population studied in this review is still predominately male, middle aged and low risk. Identification of the ethnic origin of the participants was seldom reported. (ABSTRACT TRUNCATED)
The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of per- sonal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of ob- stacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more de- pendable the experiential sources, the greater are the changes in perceived self- efficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and be- havioral changes. Possible directions for further research are discussed.
The present study adopted a social cognitive framework to examine the role played by perceptions of personal efficacy in adherence to exercise behavior in sedentary middle-aged adults. Subjects were followed for 5 months in order to study the process of exercise as it moved through the adoption to maintenance stage of the behavior. Participation rates paralleled those reported elsewhere in the literature. Path analytic techniques examined the role over time of efficacy, perceptual, and behavioral indicators of frequency and intensity of exercise. Self-efficacy cognitions were shown to predict adoption of exercise behavior but previous behavior proved to be the strongest predictor of subsequent exercise participation. Results are discussed in terms of examining process versus static design models in exercise and physical activity research. Implications for future research and health promotion are suggested.
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.
Evidence pertaining to the efficacy of cognitive-behavioural interventions, broadly defined, in cardiac rehabilitation is reviewed. Primary concerns lie with risk reduction and with the amelioration of psychological distress following myocardial infarction. The available data permit few definitive conclusions. The available data, on balance, suggest that programmes targeted at reducing Type A behaviours, smoking cessation, increasing exercise, or which teach stress management techniques, may be effective in reducing psychological distress and increasing effective coping, although frequently only in the short-term; it is more difficult to point to long-lasting advantage in this context. In addition, psychological interventions of this sort would seem to be associated with positive behavioural change. However, there is, as yet, little concerted evidence that such changes afford benefits in terms of coronary heart disease mortality or morbidity. Nevertheless, the pessimism of these conclusions may reflect shortcomings in study design and the failure to optimally match patients to programmes rather than an intrinsic lack of efficacy of the interventions.
We examined the personal models of osteoarthritis (OA) of 61 patients over 60 years of age. Models were elicited using a structured interview. Shared beliefs included perceiving OA as a serious, painful, chronic, and incurable condition that can be managed by recommended medical treatment. Considerable individual differences were found on six personal-model constructs: Symptoms, Seriousness, Cause, Control, Helpfulness of Treatment, and Negative Feelings about Treatment. The constructs of Symptoms and Seriousness were consistently related to a variety of important outcomes. For example, participants with higher scores on Symptoms and Seriousness reported higher levels of self-management (both concurrently and prospectively), reported more utilization of medical services, and experienced a poorer quality of life. The implications for the design of health-education materials and for patient-provider interactions are discussed.
Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence.
To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease.
We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies.
The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of -0.34 [corrected], -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99).
The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.
To evaluate rehabilitation after myocardial infarction.
Randomised controlled trial of rehabilitation in unselected myocardial infarction patients in six centres, baseline data being collected on admission and by structured interview (of patients and spouses) shortly after discharge and outcome being assessed by structured interview at six months and clinical examination at 12 months.
Six district general hospitals.
All 2328 eligible patients admitted over two years with confirmed myocardial infarction and discharged home within 28 days.
Rehabilitation programmes comprising psychological therapy, counselling, relaxation training, and stress management training over seven weekly group outpatient sessions for patients and spouses.
Anxiety, depression, quality of life, morbidity, use of medication, and mortality.
At six months there were no significant differences between rehabilitation patients and controls in reported anxiety (prevalence 33%) or depression (19%). Rehabilitation patients reported a lower frequency of angina (median three versus four episodes a week), medication, and physical activity. At 12 months there were no differences in clinical complications, clinical sequelae, or mortality.
Rehabilitation programmes based on psychological therapy, counselling, relaxation training, and stress management seem to offer little objective benefit to patients who have experienced myocardial infarction compared with previous reports of smaller trials.
The present cross-sectional study analyzed the extent to which illness perceptions and coping strategies (as measured by the Illness Perception Questionnaire and the Utrecht Coping List, respectively) are associated with levels of daily functioning, as indicated by the Medical Outcomes Study SF-20, and disease-specific measures in 244 adults: 84 with rheumatoid arthritis (RA); 80 with chronic obstructive lung disease (COPD); and 80 with psoriasis. The results of stepwise regression analyses indicated that a strong illness identity, passive coping, belief in a long illness duration, belief in more severe consequences, and an unfavorable score on medical variables were associated with worse outcome on disease-specific measures of functioning and on general role and social functioning. Coping by seeking social support and beliefs in controllability/curability of the disease were significantly related to better functioning. The implications of these findings for future interventions and research are discussed.
A framework for the study of coping, illness behaviour and outcomes
This paper presents a theoretical framework for the study of coping, illness attribution, health behaviour and outcomes. It is based upon models developed within health psychology and aims to provide a theoretical basis for nurse researchers to utilize psychosocial variables. It is an interactionist model which views outcomes as dependent upon both situation and person variables. The situation is viewed as the health threat or illness symptoms as well as the psychosocial context within which the person is operating. This context includes socio‐economic factors, social support, social norms, and external factors such as the mass media. The experience of health threat is dependent upon individual appraisal, and the framework incorporates Folkman and Lazarus' transactional model of stress, as well as Leventhal's illness representation model. Behaviour and the perception of threat are also dependent upon outcome expectancies and the appraisal of one's own coping resources, and so the concepts of locus of control and self‐efficacy are also incorporated. This framework allows one to identify determinants of behaviour and outcome, and will aid nurses in identifying areas for psycho‐social intervention.
To determine whether coping strategies and illness perceptions would be predictive of outcome in a longitudinal study of patients with rheumatoid arthritis (RA).
A group of 71 patients with RA was examined on 2 occasions, one year apart. Multiple regressions were used to examine which of the illness perceptions and coping strategies explained variance on the outcome variables: visits to the outpatient clinic, number of hospital admissions, Health Assessment Questionnaire, pain, tiredness, the Hospital Anxiety and Depression Scale.
Belief in adverse consequences of the disease was associated with more visits to the outpatient clinic. more tiredness, and higher anxiety scores. Less perceived control and less expression of emotion were associated with more hospital admissions. High scores on coping involving fostering reassuring thoughts were associated with more functional disability. More passive coping was associated with more functional disability and higher anxiety scores. More perceived symptoms were associated with more pain, more tiredness, and more depression. More avoidant coping was associated with more tiredness. Belief that the illness will last a long time was associated with higher anxiety scores.
Our longitudinal data show that, after statistically controlling for the potential effects of intervening medical variables, coping strategies and illness perceptions contribute to health outcome in patients with RA. Implications for patient management are discussed.
This study was designed to examine whether a brief hospital intervention designed to alter patients' perceptions about their myocardial infarction (MI) would result in a better recovery and reduced disability.
In a prospective randomized study, 65 consecutive patients with their first MI aged were assigned to receive an intervention designed to alter their perceptions about their MI or usual care from rehabilitation nurses. Patients were assessed in hospital before and after the intervention and at 3 months after discharge from hospital.
The intervention caused significant positive changes in patients' views of their MI. Patients in the intervention group also reported they were better prepared for leaving hospital (p<.05) and subsequently returned to work at a significantly faster rate than the control group (p<.05). At the 3-month follow-up, patients in the intervention group reported a significantly lower rate of angina symptoms than control subjects (14.3 vs. 39.3, p<.03). There was no significant differences in rehabilitation attendance between the two groups.
An in-hospital intervention designed to change patients' illness perceptions can result in improved functional outcome after MI.
Numerous cardiac rehabilitation national guidelines consistently endorse the need for psychological support to create effective individualized care. Recent surveys suggest that the psychological factors remain poorly assessed and the measurement of psychological parameters remains patchy.
To examine cardiac rehabilitation practitioners' perception and understanding of the importance of patient expectations and their capacity to assess and utilize these expectations to develop individualized care.
A survey of cardiac rehabilitation professionals from 10 hospitals in the south-east of England. The questionnaire used in the survey was developed from content analyses of the current cardiac rehabilitation literature and expectancy theory articulated in Bandura's writings.
The results of the study show that cardiac rehabilitation practitioners are very aware of the general importance of patient expectations but have little structured support in the development of techniques to either assess these expectations or to utilize them in a therapeutic context. This leaves them unsure about the extent to which patients do receive individualized care and how best to develop their own practice in this regard.
This study suggests that there is a need for the development of a structured assessment tool, which has a sound theoretical basis to assess patients' expectation if good practice is to be established in providing individualized car in cardiac rehabilitation.
This paper analyses the two prominent psychological theories of patient response--illness representation and self-efficacy--and explore the possibilities of the development of a conceptual individualized care model that would make use of both theories.
Analysis of the literature established common themes that were used as the basis to form a conceptual framework intended to assist in the joint application of these theories to therapeutic settings.
Both theories emphasize personal experience, pre-construction of self, individual response to illness and treatment, and that the patients' beliefs are more influential in their recovery than the severity of the illness. Where the theories are most divergent is their application to therapeutic interventions, which reflects the different sources of influence that each theory emphasizes. Based on their similarities and differences it is possible to integrate the two theories into a conceptual care model.
The Interactive Care Model combines both theories of patient response and provides an explicit framework for further research into the design of effective therapeutic interventions in rehabilitation care.
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