Self-efficacy and health behaviour: A review

Associations between Health Behaviors, Health Self-Efficacy, and Long-Term Outcomes in Survivors of Childhood Cancer: A Cross-Sectional Study

OBJECTIVES

Many survivors of childhood cancer experience multiple long-term chronic health conditions. Health behaviors are important because they contribute to chronic disease yet are highly modifiable. With growing pressure on cancer services, alternative models of care are required to address survivorship care needs. The authors sought to inform the development of a community-based model of cancer survivorship care for young people. This exploratory cross-sectional study aimed to assess the feasibility of study measures and processes, as well as investigate associations between various modifiable health behaviors, health self-efficacy, quality of life, and persistent symptoms.

DATA SOURCES

Participants were recruited from a long-term follow-up clinic for childhood cancer survivors. A self-report survey was completed, and participants received an activity tracker. Bivariate regression analyses were used to explore the relationship between variables.

CONCLUSIONS

The study measures and processes were deemed feasible with >70% of eligible survivors enrolling in the study and completing >70% of study measures. Thirty participants (mean age 22 ± 4.4 years) were enrolled; 83.3% finished treatment ≥5 years previously and 36.7% were overweight or obese. Bivariate regression identified those with higher scores of health self-efficacy were more likely to meet physical activity guidelines, as were those who achieved more sleep and consumed greater servings of vegetables. Meeting the physical activity guidelines, was significantly positively associated with higher quality of life and self-efficacy.

IMPLICATIONS FOR NURSING PRACTICE

Interventions that target health self-efficacy have the potential to improve a range of health behaviors and long-term outcomes for survivors of childhood cancer. Nurses are ideally placed to use this knowledge to support patients with recommendations to optimise their recovery and rehabilitation.

An exploration of prenatal breastfeeding self-efficacy: a scoping review protocol

Objective: To synthesise the evidence on prenatal breastfeeding self-efficacy, including identifying concepts and theoretical frameworks that underpin its development, the evidence on its measurement, interventions used to improve it, and association with breastfeeding outcomes. Background: Breastfeeding self-efficacy is described as a woman's self-belief and confidence in her perceived ability to breastfeed. It is a modifiable measure that is strongly associated with breastfeeding outcomes such as initiation, exclusivity, and duration. Interventions aimed at increasing self-efficacy are often in the postnatal period and have been shown to be effective at improving breastfeeding outcomes. The prenatal period appears to be underexplored in the literature and yet focusing on enhancing it may have the potential for further improvements in self-efficacy and on subsequent breastfeeding outcomes. A comprehensive knowledge synthesis on prenatal breastfeeding self-efficacy is lacking. Methods: The search will include databases across health, psychology, sociology, and the grey literature on breastfeeding guidance. Once the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period) is met, sources of evidence from any contextual setting will be eligible for inclusion. Limits will not be applied on geographic location or year of publication. The PRISMA-ScR flow diagram of search and study selection will be used to report final figures. Two independent reviewers will perform title and abstract screening and full text review. Data will be charted to provide a logical and descriptive summary of the results that align with the objectives. Conclusion: The results will provide an understanding of what has been done in the space and what gaps exist, informing recommendations for the timing of measurement and the design of prenatal interventions.

Self efficacy of pregnant women in areas affected by Covid 19

Objective

Self efficacy is an important factor that plays a role in dealing with stress during pregnancy, especially during the Covid 19 pandemic era. This study aims to determine the self efficacy of pregnant women during the Covid 19 pandemic era.

Method

This is quantitative research with a cross-sectional design. The number of research subjects was 99 taken from the entire population or total sampling. Data were collected using the General Self-Efficacy Scale and analyzed by logistic regression.

Results

The result showed that the Profession and education of the research subjects have an effect on the self efficacy of pregnant women with a significance value of <0.05.

Conclusions

In Conclusion, profession is the most influential factor on the self efficacy of pregnant women in the Bandarharjo Village, North Semarang, Semarang, Central Java with an OR value of 0.101 and p-value 0.001.

Health Behavior and Associated Factors in Young Adult Cancer Patients

Objectives: Having cancer in young adulthood increases the risk of adverse long-term health effects. These risks can be influenced by one's health behavior (HB). The aim of this study is therefore to investigate the presence of health behavior in adolescents and young adults (AYAs) and to identify associated factors. Design: Young cancer patients (18-39 years old at time of diagnosis) were surveyed at baseline and 12 months later via online or as a paper-pencil version. Methods: A spectrum of indicators for HB was assessed via seven items from the Questionnaire of Multiple Health Behavior (MHB). Multiple linear regression analyses were conducted to determine factors associated with patients' HB indicators. Results: Five-hundred and fourteen AYAs (75% women) reported the highest level of health-conscious behavior for "avoidance of consumption of nicotine," "follow medical recommendations," and "being considerate in road traffic." Less health-conscious behavior was reported for "keeping an appropriate and balanced diet" and "physical activity." Significant improvements from baseline to the follow-up were observed for "regularly attending health screening" (Hedges' g = 0.44). The analyzed factors explained up to 10% of the HB indicators. Women reported significantly more health-conscious behavior than men in four out of seven HB indicators. Higher quality of life (QoL) was associated with more health behavior in three out of seven HB indicators. Conclusion: Findings show a predominantly health-conscious lifestyle in AYA cancer patients, though we also found harmful behavior which needs to be better approached-e.g., through improving AYAs' health education. AYA men should be particularly targeted in specific prevention and health promotion measures. Future work should identify other factors associated with HB to evaluate targets for intervention.

Behavioural response to the Covid-19 pandemic in South Africa

Background

Given the economic and social divide that exists in South Africa, it is critical to manage the health response of its residents to the Covid-19 pandemic within the different socio-economic contexts that define the lived realities of individuals.

Objective

The objective of this study is to analyse the Covid-19 preventive behaviour and the socio-economic drivers behind the health-response behaviour.

Data

The study employs data from waves 1 and 2 of South Africa’s nationally representative National Income Dynamics Study (NIDS)—Coronavirus Rapid Mobile Survey (CRAM). The nationally representative panel data has a sample of 7073 individuals in Wave 1 and 5676 individuals in Wave 2.

Methods

The study uses bivariate statistics, concentration indices and multivariate estimation techniques, ranging from a probit, control-function approach, special-regressor method and seemingly unrelated regression to account for endogeneity while identifying the drivers of the response behaviour.

Findings

The findings indicate enhanced behavioural responsiveness to Covid-19. Preventive behaviour is evolving over time; the use of face mask has overtaken handwashing as the most utilised preventive measure. Other measures, like social distancing, avoiding close contact, avoiding big groups and staying at home, have declined between the two periods of the study. There is increased risk perception with significant concentration among the higher income groups, the educated and older respondents. Our findings validate the health-belief model, with perceived risk, self-efficacy, perceived awareness and barriers to preventive strategy adoption identified as significant drivers of health-response behaviour. Measures such as social distancing, avoiding close contact, and the use of sanitisers are practised more by the rich and educated, but not by the low-income respondents.

Conclusion

The respondents from lower socio-economic backgrounds are associated with optimism bias and face barriers to the adoption of preventive strategies. This requires targeted policy attention in order to make response behaviour effective.

Parental Self-Efficacy as a Predictor of Children's Nutrition and the Potential Mediator Effect between the Health Promotion Program "Join the Healthy Boat" and Children's Nutrition

Overweight and obesity, as well as their associated risk factors for diseases, are already prevalent in childhood and, therefore, promoting healthy eating is important. Parental self-efficacy (PSE) and early health-promotion can be helpful in promoting healthy eating. The aim of this study was to examine the influence of PSE on children's nutrition behavior and identify PSE as a mediator between an intervention and children's nutrition. The kindergarten-based health-promotion program "Join the Healthy Boat" was evaluated in a randomized controlled trial with 558 children (4.7 ± 0.6 years; 52.3% male) participating at both times. Linear and logistic regressions as well as mediation analyses with potential covariates such as parental outcome expectancies or parental nutrition were carried out using questionnaire data. In children, PSE was positively associated with fruit and vegetable intake (β = 0.237; p < 0.001) and showed a protective effect on soft drink consumption (OR 0.728; p = 0.002). Parental nutrition was a stronger predictor of children's intake of fruit, vegetables (β = 0.451; p < 0.001), and soft drinks (OR 7.188; p < 0.001). There was no mediator effect of PSE. However, outcome expectancies were associated with PSE (β = 0.169; p = 0.032). In conclusion, interventions should promote self-efficacy, outcome expectancies, and healthy nutrition for parents as well in order to strengthen the healthy eating habits of children.

Psychometric properties of the Hungarian version of the eHealth Literacy Scale

BACKGROUND

We adapted the eHealth Literacy Scale (eHEALS) for Hungary and tested its psychometric properties on a large representative online sample of the general population.

METHODS

The Hungarian version of eHEALS was developed using forward-backward translation. For the valuation study, 1000 respondents were recruited in early 2019 from a large online panel by a survey company. We tested internal consistency, test-retest reliability and construct and criterion validity using classical test theory, as well as item characteristics using an item-response theory (IRT) graded response model (GRM).

RESULTS

55% of respondents were female, and 22.1% were ≥ 65 years old. Mean eHEALS score was 29.2 (SD: 5.18). Internal consistency was good (Cronbach's α = 0.90), and test-retest reliability was moderate (intraclass correlation r = 0.64). We identified a single-factor structure by exploratory factor analysis, explaining 85% of test variance. Essential criteria for GRM analysis were met. Items 3 and 4 (search of health resources) were the least difficult, followed by items 5 and 8 (utilisation of health information), and then items 1 and 2 (awareness of health resources). Items 6 and 7 (appraisal of health resources) were most difficult. The measurement properties of eHEALS were not affected by gender, age, education or income levels. Female gender, older age, intensity of health information seeking, formal health education and visit at the electronic health-record website were associated with higher eHEALS scores, as well as best and worst self-perceived health states, BMI < 25 and participation at health screenings over the past year.

CONCLUSIONS

The Hungarian eHEALS is a useful and valid tool for measuring subjective eHealth literacy.

Self-efficacy moderates the relationship between health comparisons and social exclusion: results of the German ageing survey

Background

Little is known about the consequences of health comparisons. Negative health comparisons might, for example, result in emotions such as anger or frustration. These negative emotions might intensify feelings of social exclusion. Thus, the objective of the current study was to investigate whether health comparisons are associated with social exclusion. Moreover, it was examined whether the relation between health comparisons and social exclusion is moderated by self-efficacy.

Methods

We analyzed cross-sectional data of N = 7838 individuals from the German Ageing Survey. The German Ageing Survey is a representative sample of community-residing individuals aged 40 and over. An established social exclusion scale was used. The degree of self-efficacy was measured according to Schwarzer and Jerusalem. Health comparisons were measured with the question “How would you rate your health compared with other people your age” (Much better; somewhat better; the same; somewhat worse, much worse).

Results

Multiple linear regressions revealed that negative health comparisons were associated with feelings of social exclusion in men, but not women. Furthermore, positive health comparisons were weakly associated with decreased feelings of social exclusion in men. The association between negative as well as positive health comparisons and social exclusion in men was significantly moderated by self-efficacy.

Conclusions

The findings of the present study suggests that negative health comparisons are associated with feelings of social exclusion in men. In conclusion, comparison effects are not symmetric and predominantly upwards among men in the second half of life. Strengthening self-efficacy might be fruitful for attenuating this relationship.

Parental psychosocial predictors of secondhand smoke exposure (SHSe) for children with cancer

Children with cancer are at greater risk for the negative consequences of secondhand smoke exposure, making the identification of predictors of exposure critical. The current study investigated the impact of parents' psychosocial variables (perceived stress and vulnerability, self-efficacy), as well as health-related and demographic variables, on children's current exposure levels. Data were from 135 families whose children (M = 8.6 years old) lived with a smoker and were being treated for cancer. Self-efficacy was the consistent significant psychosocial predictor of exposure and the time since a child's diagnosis was indicative of lower exposure when limiting the sample to only smoking parents (n = 95). Both predictors of exposure have implications on motivation for behavioral change and may be suggestive of a teachable moment. Interventions may profit from tailoring programs to families based on these predictors of exposure, in particular for tobacco-based interventions for parents of medically compromised children, such as children with cancer.

Zur wahrgenommenen Förderlichkeit multipler Gesundheitsverhaltensweisen für die Gesundheitserhaltung

Zusammenfassung. Ziel dieser Online-Studie war die Einschätzung der wahrgenommenen Förderlichkeit multipler Gesundheitsverhaltensweisen für die Gesundheitserhaltung in einer heterogenen Stichprobe von Gesundheitsexperten (Mediziner, Psychologen und andere Gesundheitsberufe) und Laien (Schüler/Studierende und gesundheitsferne Berufe). Fünfhundertundacht Personen (53% Frauen) im mittleren Alter von 34.4 Jahren schätzten ein, inwieweit sich 39 Verhaltensweisen förderlich oder hinderlich auf die Gesundheitserhaltung einer Person im Allgemeinen auswirken. Diese spezifischen Konsequenzerwartungen unterschieden sich deutlich, so dass sehr wirksame und weniger wirksame Verhaltensweisen identifiziert werden konnten. Eine Hauptkomponentenanalyse mit obliquer Rotation ergab eine Lösung mit fünf unabhängigen Komponenten, die 44.3% der Varianz erklärten und als abhängige Variablen in eine altersadjustierte 5 × 2 MANCOVA (Fachlichkeit × Geschlecht) eingingen. Der signifikante multivariate Haupteffekt für Fachlichkeit war auf Vorsorgeverhalten und Sicherheitsorientiertes Verhalten zurückzuführen, wobei insbesondere Mediziner die stärksten Gesundheitskontingenzen wahrnahmen. Der signifikante multivariate Haupteffekt für Geschlecht ging auf Psychosoziales Regulationsverhalten, Substanzenbezogene Abstinenz, Vorsorgeverhalten und Selbstpflegeverhalten zurück, wobei Frauen erwartungsgemäß stärkere Kontingenzen wahrnahmen als Männer. Auf Gesundheitserhaltung bezogene Konsequenzerwartungen sind das Ergebnis einer Berufs- und Geschlechtersozialisation und damit prinzipiell veränderbar. Als Voraussetzung für die Entwicklung von Kompetenzerwartungen sollten Konsequenzerwartungen im Rahmen von Interventionsmaßnahmen mehr Beachtung finden.

A psycho-educational intervention focused on communication for caregivers of a family member in the early stage of Alzheimer’s disease: Results of an experimental study

A psycho-educational intervention focused on communication was conceived for caregivers of family members in the early stage of Alzheimer’s disease (i.e., persons with dementia), and tested on five proximal outcome variables: caregiver knowledge, perceptions of communication difficulties and degree of perceived disturbance related to these difficulties, self-efficacy and skills. Guided by a theoretical framework that encompassed geragogy, the McGill model of nursing and self-efficacy theory, the intervention was evaluated via an experimental design with pre-post tests. Fifty family caregivers were randomly assigned to an experimental group (intervention program), or to a control group (information flier on communication and memory). Statistically significant effects were found on four dependent variables: caregiver knowledge, degree of disturbance related to communication difficulties, self-efficacy and skills. No significant effects were observed in regard to the perceived presence of communication difficulties. This communication program serves as a useful tool to prepare caregivers for their new role.

The eternal quest for optimal balance between maximizing pleasure and minimizing harm: The compensatory health beliefs model

Particularly in the health domain, humans thrive to reach an equilibrium between maximizing pleasure and minimizing harm. We propose that a cognitive strategy people employ to reach this equilibrium is the activation of Compensatory Health Beliefs (CHBs). CHBs are beliefs that the negative effects of an unhealthy behaviour can be compensated for, or "neutralized," by engaging in another, healthy behaviour. "I can eat this piece of cake now because I will exercise this evening" is an example of such beliefs. Our theoretical framework aims at explaining why people create CHBs and how they employ CHBs to regulate their health behaviours. The model extends current health behaviour models by explicitly integrating the motivational conflict that emerges from the interplay between affective states (i.e., cravings or desires) and motivation (i.e., health goals). As predicted by the model, previous research has shown that holding CHBs hinder an individual's success at positive health behaviour change, and may explain why many people fail to adhere to behaviour change programs such as dieting or exercising. Moreover, future research using the model and implications for possible interventions are discussed.

Early detection of testicular cancer: revisiting the role of self-efficacy in testicular self-examination among young asymptomatic males

Research suggests that self-efficacy is an important factor in behaviors that facilitate the early-detection of various cancers. In general people with high self-efficacy are more likely to attend cancer screening sessions or perform bodily self-exams. However, there is a paucity of research focusing on testicular cancer and testicular self-examination (TSE). The effect of self-efficacy on TSE remains unclear especially given the relative obscurity of the testicular cancer threat, and appropriate clinical- and self-detection procedures, in the young asymptomatic male population. Thus, the present study tested the interaction of self-efficacy with young men's appraisals of the threat of testicular cancer. The study was based on 2 × 2 × 2 mixed factorial experimental design. Over 100 young asymptomatic men were exposed to a health warning about testicular cancer and randomly assigned to high/low self-efficacy, vulnerability, and severity conditions. High self-efficacy increased motivation to perform TSE given high vulnerability, but damaged attitudes to self-exams given low vulnerability and severity estimates. High self-efficacy also facilitated subsequent TSE. Overall, these findings support preexisting notions of self-efficacy but raise new questions about the moderating effects of threat appraisals.

Adherence behaviour with psychotropic medication is a form of self-medication

Adherence with psychotropic medication is at least at poor as adherence with medication for physical health problems. There has been an assumption this was due to loss of insight resulting from psychiatric disorders themselves. Consequently, interventions have focussed on treating the underlying psychiatric disorder and generating psychological strategies to promote awareness. Recent surveys of patient preferences for information and involvement in health care decisions highlight that most individuals want to participate in the process of medical care. Patients often have strong pre-existing beliefs about different therapeutic options. This is supported by the self-determination theory which distinguishes between autonomous behaviour and behaviours that are influenced by external forces. When considering the patient perspective in medication adherence, it is useful to consider the self-medication hypothesis. This can equally be applied to prescribed and non-prescribed drugs. The self-medication hypothesis states that patients decide to start, adjust or stop prescribed medication according to perceived health needs. Such decisions are often conducted intentionally and rationally, given the information available to the patient and their understanding of their condition. In this narrative review, the evidence for and against intentionality in psychotropic adherence behaviour is examined. Studies of compliance and related predictors are examined in depression, schizophrenia and bipolar affective disorder. Results suggest that although concordance depends on patient, illness and clinician factors, patient choice is usually the final common pathway. Illness severity and insight is important in some cases but can act in concert with cognitive factors. Individuals appear to prefer to take medication "as required" (symptomatically) rather than prophylactically. Significant influences upon self-medication habits are prior health beliefs, medication attitudes, adverse effects and adequacy of communication from the health care professional. The self-medication hypothesis applied to prescribed psychotropic medication should assist rather than heed clinicians in improving adherence by taking a patient centred approach and where possible promoting patient autonomy.

The association between somatization and perceived ability: roles in dysmenorrhea among Israeli Arab adolescents

OBJECTIVE

The aim of this study was to investigate whether somatization and attitudes toward menstruation predict the incidence of pain intensity and dysmenorrhea among Israeli Arab adolescent females.

METHODS

Participants were 160 Israeli Arab adolescents, including 50 Muslims, 50 Christians, and 60 Druze. A 20-item questionnaire was used to assess attitudes regarding menstruation. The short version of the Brief Symptom Inventory was used to measure the level of somatization.

RESULTS

Factor analysis of the Attitudes Toward Menstruation Instrument revealed two significant composites: perceived ability and impurity during menstruation. High levels of somatization predicted pain intensity and low levels of perceived ability predicted the prevalence of dysmenorrhea. Although the Israeli Muslim adolescents revealed higher levels of somatization as compared with their Christian and Druze counterparts and the Druze revealed the lowest levels of perceived ability compared with the other subgroups, no significant role for ethnicity and impurity was found. No differences were found between groups in scores of menstrual pain and prevalence of dysmenorrhea. Higher levels of somatization and lower levels of perceived ability, as well as a greater portion of Muslim and Druze and higher levels of religiosity, were found among rural residents.

CONCLUSIONS

The role of cultural variables and personality traits in the complexity of dysmenorrhea as a socio-bio-psychological phenomenon is proposed in light of contemporary interactive models. It is suggested that within the Israeli Arab minorities the impact of cultural background on health affects more the perceptual and cognitive levels and are not generalized to overt behavior and morbidity such as dysmenorrhea.

Role of physical activity and eating behaviour in weight control after treatment in severely obese children and adolescents

AIM

To investigate the role of physical activity and eating behaviour in weight control 1.5 y after a weight-reduction programme in severely obese children.

METHODS

Forty-seven children (13.4 +/- 2.1 y) were measured 1.5 y after the completion of a 10-mo residential treatment programme. Stature and body mass were measured; physical activity, fat and fibre intake, and self-efficacy in relation to physical activity and healthy eating behaviour were assessed using validated structured interviews. The total sample was divided into four subgroups according to unhealthy versus healthy physical activity and eating behaviour at follow-up.

RESULTS

One-and-a-half years after treatment, subjects had regained 34 +/- 19% overweight, but were on average still 20 +/- 19% less overweight than before treatment (p < 0.001). The four subgroups did not differ in level of overweight at the beginning or end of treatment. At follow-up, there was a significant difference in overweight between the four subgroups (p < 0.05). The least healthy group (unhealthy physical activity and unhealthy eating behaviour) had a significantly higher level of overweight 1.5 y after treatment (183 +/- 36%) in comparison with the other groups (unhealthy physical activity and healthy eating: 150 +/- 21%; healthy physical activity and unhealthy eating: 156 +/- 14%; healthy physical activity and healthy eating: 138 +/- 16%) (p < 0.05), whilst the healthiest group showed the lowest level of overweight after treatment when compared to the other groups (p < 0.05).

CONCLUSION

Results suggest that both physical activity and nutritional habits play an important role in weight maintenance after initial weight loss in obese children and that one healthy behaviour can not compensate for another unhealthy behaviour.

Multiples Gesundheitsverhalten und Vulnerabilität im Geschlechtervergleich

Zusammenfassung. Mit dem neu entwickelten Fragebogen zum Multiplen Gesundheitsverhalten (MGV-39) wurde das Spektrum habituellen gesundheitsbezogenen Verhaltens einer studentischen Stichprobe erfasst. Die erhobenen 39 Verhaltensbereiche wiesen eine gute interne Konsistenz auf, was die Bildung eines Summenscores (MGV) erlaubte. In einer Hauptkomponentenanalyse ließen sich die 39 Verhaltenskategorien auf sechs Dimensionen reduzieren: Aktive Lebensgestaltung, Compliance, Substanzvermeidung, Sicherheitsorientierung, Ernährung und Hygiene. Der MGV-39 erwies sich als sensitiv für Geschlechtsunterschiede; das in der Literatur beschriebene Defizit von Männern in der Compliance, Substanzvermeidung, Sicherheitsorientierung und Hygiene (sowie im MGV) konnte repliziert werden. In einem weiteren Schritt wurde der Zusammenhang zwischen MGV und Vulnerabilität aus einer Geschlechterperspektive beleuchtet. Die Ergebnisse eines additiven hierarchischen Regressionsmodells wiesen auf, dass höheres Alter, weibliches Geschlecht, eine geringe Krankheitsanfälligkeit und eine hohe subjektive Gesundheit mit einem protektiven Verhaltensstil zusammenhingen: Personen schließen aus ihrem habituellen MGV auf ihre gegenwärtige und zukünftige Vulnerabilität. Die Überprüfung der Wechselwirkungen in einer moderierten hierarchischen Regression zeigte, dass das Geschlecht den Zusammenhang zwischen MGV und subjektiver Gesundheit moderierte. Für Männer war der Zusammenhang stärker ausgeprägt als für Frauen.

Cognitive-behavioural predictors of children's tolerance of laboratory-induced pain: implications for clinical assessment and future directions

This study sought to investigate cognitive-behavioural predictors of children's tolerance for laboratory-induced cold-pressor pain. It was hypothesised that pain tolerance, as measured by immersion time, would be greater in children who were high in self-efficacy for pain, high in self-reported use of cognitive-coping strategies, and low in emotion-focused coping strategies such as catastrophising. Age and sex differences were also examined in post hoc analyses. Children between the ages of 7 and 14 years (N = 53) participated in the study. Offering partial support for the hypotheses, use of cognitive distraction was found to be associated with greater pain tolerance, while use of internalising/catastrophising was associated with lower pain tolerance. Older boys tended to have greater pain tolerance than younger boys, whereas younger and older girls had intermediate pain tolerance levels. Self-efficacy for pain, in general, was found to be positively correlated with age. The results support efforts to identify children who, because they have lower confidence or lower skills in coping with distress, may need extra support and preparation for painful procedures. Further research is needed to investigate these findings within a clinical pain context.

Self-regulation training enhances dietary self-efficacy and dietary fiber consumption

OBJECTIVE

To evaluate the effectiveness of incorporating two self-regulation strategies (goal setting and self-monitoring) into a nutrition education class to enhance dietary fiber self-efficacy and foster a positive change in dietary fiber consumption.

DESIGN

College students in an introductory nutrition class (n = 113) were randomly assigned to one of four treatment conditions: goal setting, self-monitoring, goal setting and self-monitoring, and no goal setting and no self-monitoring. Twenty-six college students from an introductory health class served as the control group.

STATISTICAL ANALYSES

The main and interaction effects of goal setting and self-monitoring on postintervention variables were analyzed using analysis of covariance with baseline intake levels as the covariate. Analysis of variance was used to examine differences in the mean changes between the groups. Path analysis was conducted to analyze the causal linkage among the pretest and intervening variables to predict postintervention knowledge, self-efficacy, and fiber consumption.

RESULTS

Goal setting had a significant main effect on dietary fiber self-efficacy and on dietary fiber consumption Subjects who set goals scored 15% higher on the dietary fiber self-efficacy scale and consumed 91% more fiber than subjects who did not set goals. Self-monitoring had no significant main effect on either dietary fiber self-efficacy or dietary fiber consumption. There was no significant interaction between goal setting and self-monitoring. Changes in dietary fiber scores differed between the groups. Increases in dietary fiber for the goal setting and self-monitoring group were significantly higher than the goal-setting, self-monitoring, no goal setting and no self-monitoring, and control groups. In addition, the goal setting only group had significantly greater increases in fiber intake than the self-monitoring, no goal setting and no self-monitoring, and control groups. Changes in self-efficacy scores were significantly different between the groups. The goal setting and goal setting and self-monitoring groups had significantly higher self-efficacy scores than the control group. Path analysis revealed that both goal setting and self-monitoring affected dietary fiber consumption through knowledge and dietary fiber self-efficacy, goal setting had a strong direct effect on fiber consumption, and postintervention knowledge affected fiber consumption only through self-efficacy.

APPLICATIONS/CONCLUSIONS

Our findings suggest that dietary change requires active self-regulation of food intake. Combining goal setting and self-monitoring significantly enhances dietary behavior change. This strategy can easily be incorporated into nutrition education or counseling programs to enhance dietary behavior change.