Validity of the Perceived Health Competence Scale in a UK primary care setting

Determination of body image and self-efficacy levels in patients after cornea transplantation

PURPOSE

The study aimed to determine body image and levels after surgery in cornea transplant patients.

MATERIALS AND METHODS

The population of this cross-sectional study was composed of 383 patients presented to the Eye Bank unit of a University Hospital after corneal transplantation. Sample size of 193 patients was calculated with 0.5 power, a margin of error of 5%, representing 95% of the universe. The data were collected through face-to-face interviews with the patients by the researcher and the study was completed with 178 patients in September-November 2022. The data were collected using a Patient Information Form, the Body Image Scale, and the General Self-Efficacy Scale. Parametric tests, Pearson Correlation, Student's t-test, and One-Way Analysis of Variance tests were performed were used in the data analysis.

RESULTS

It was determined that the mean Body Image Scale score of the transplant patients participating in the study was 159.41 ± 36.99 and the mean Self-Efficacy Scale score was 30.37 ± 8.31. When the comparison of the mean scores was examined, the difference between the mean scores of gender, marital status, occupation, and body image scale was statistically significant (p < .05), while the difference between the self-efficacy mean scores was not statistically significant (p > .05). There was a positive, moderately strong significant relationship between body image and the self-efficacy of the patients (p < .01) (r = .57).

CONCLUSION

It was found that the patient's body image and self-efficacy levels were high, and self-efficacy increased as the body image increased.

Brief intervention to reduce fatigue impact in patients with inflammatory arthritis: design and outcomes of a single-arm feasibility study

OBJECTIVES

Patients with inflammatory arthritis report that fatigue is challenging to manage. We developed a manualised, one-to-one, cognitive-behavioural intervention, delivered by rheumatology health professionals (RHPs). The Fatigue - Reducing its Effects through individualised support Episodes in Inflammatory Arthritis (FREE-IA) study tested the feasibility of RHP training, intervention delivery and outcome collection ahead of a potential trial of clinical and cost-effectiveness.

METHODS

In this single-arm feasibility study, eligible patients were ≥18 years, had a clinician-confirmed diagnosis of an inflammatory arthritis and scored ≥6/10 on the Bristol Rheumatoid Arthritis Fatigue (BRAF) Numerical Rating Scale (NRS) Fatigue Effect. Following training, RHPs delivered two to four sessions to participants. Baseline data were collected before the first session (T0) and outcomes at 6 weeks (T1) and 6 months (T2). The proposed primary outcome was fatigue impact (BRAF NRS Fatigue Effect). Secondary outcomes included fatigue severity and coping, disease impact and disability, and measures of therapeutic mechanism (self-efficacy and confidence to manage health).

RESULTS

Eight RHPs at five hospitals delivered 113 sessions to 46 participants. Of a potential 138 primary and secondary outcome responses at T0, T1 and T2, there were 13 (9.4%) and 27 (19.6%) missing primary and secondary outcome responses, respectively. Results indicated improvements in all measures except disability, at either T1 or T2, or both.

CONCLUSIONS

This study showed it was feasible to deliver the intervention, including training RHPs, and recruit and follow-up participants with high retention. While there was no control group, observed within-group improvements suggest potential promise of the intervention and support for a definitive trial to test effectiveness.

From ability to behavior: A scenario-based assessment of health competence predicts daily health behaviors

Recent findings have suggested that we can gain new insights into health decision-making and behavior through the use of a scenario-based approach to health competence (HC). The present research sought to investigate whether and how such individual differences would matter in the conduct of daily life, within two daily diary studies (N = 260). In Study 1, participants receiving higher HC scores were more active in dealing with daily stressors or problems; by contrast, low-HC individuals were more prone to impulsive and antisocial behaviors. Based on these promising results, the Study 2 protocol was a more extensive one. Participants who received higher HC scores thought about their health more often and engaged in diverse healthy behaviors more frequently. Conversely, low-HC individuals were prone to risky and unhealthy daily behaviors. In total, the findings provide key evidence in favor of a new approach to HC and its behavioral manifestations.

Beyond Access Block: Understanding the Role of Health Literacy and Self-Efficacy in Low-Acuity Emergency Department Patients

Background: Health literacy, self-efficacy, and patient satisfaction are factors associated with healthcare utilization. The relationships among these factors and their combined impact on patients’ self-rated health have historically been studied in chronic disease populations. This study assessed low-acuity emergency department (ED) patients’ ratings of these factors, the relationships among these factors, and their effect on re-presentation rates to the ED.

Methods: In this single-arm cohort survey, patients provided demographic data, completed health literacy and self-efficacy assessments prior to being seen by a physician, and completed a discharge perceptions questionnaire that included a global satisfaction question at the time of departure. Three months later, patients answered a telephone survey to measure post-ED visit health outcomes.

Results: Health literacy (r=0.114, P=0.023) and self-efficacy (r=0.469, P<0.001) were both independently and positively associated with self-rated health. Neither factor was associated with patient satisfaction. Self-rated health was negatively associated with return ED visits (r=–0.137, P=0.011).

Conclusion: Existing research shows that health literacy has a linear association with self-efficacy and self-rated health. The results of this study suggest that in the context of low-acuity ED patients, health literacy and self-efficacy affect patients’ understanding of their health status (self-rated health) but do not lead to better utilization of healthcare resources. Improvement of health literacy and self-efficacy, specifically to increase self-rated health, may provide a future avenue of intervention to reduce low-acuity ED patient re-presentation.

Perceived health competence predicts anxiety and depressive symptoms after a three-year follow-up among adolescents and adults with congenital heart disease

Background:

Congenital heart disease places survivors at increased risk for cardiovascular complications as they age and requires long-term medical management. Perceived health competence, or how capable one feels in managing one’s health, is linked to emotional adjustment in various disease populations, but has not been investigated among congenital heart disease survivors.

Aim:

The purpose of this study was to examine the relationship of perceived health competence at baseline (T1) as a predictor of anxiety and depressive symptoms three years later (T2).

Methods:

Congenital heart disease survivors ( n=125; MT1age=27; 58.6% female; severity of cardiac lesion: 25% simple, 44% moderate, 31% complex) were recruited from a pediatric and an adult hospital as part of a larger study. Participants completed the Perceived Health Competence Scale and the Youth or Adult Self-Report at T1 for anxiety and affective/depressive symptoms. At T2, participants completed the Hospital Anxiety and Depression Scale. New York Heart Association functional class, a measure of functional impairment, was abstracted from medical charts at T2.

Results:

Lower T1 perceived health competence was significantly associated with greater emotional distress at T1 (depression r=−0.47; anxiety: r=−0.45), as well as greater T2 functional impairment ( r=−0.41). T1 perceived health competence also predicted T2 anxiety and depressive symptoms, which remained significant when including T1 anxiety and depressive symptoms and T2 functional impairment.

Conclusion:

Congenital heart disease survivors who feel more competent in managing their health may be less likely to experience future anxiety and depressive symptoms. Perceived health competence may be a worthwhile target for psychosocial intervention to promote emotional wellbeing among congenital heart disease survivors and ensure the best outcomes.

Depressed Mood, Perceived Health Competence and Health Behaviors: aCross-Sectional Mediation Study in Outpatients with Coronary Heart Disease

BACKGROUND

Identifying potential mechanisms that link depressed mood with worse health behaviors is important given the prevalence of depressed mood in patients with coronary heart disease (CHD) and its relationship with subsequent mortality. Perceived health competence is an individual's confidence in his/her ability to successfully engineer solutions to achieve health goals and may explain how depressed mood affects multiple health behaviors.

OBJECTIVE

Examine whether or not perceived health competence mediates the relationship between depressed mood and worse health behaviors.

DESIGN

A cross-sectional study conducted by the Patient-Centered Outcomes Research Institute-funded Mid-South Clinical Data Research Network between August 2014 and September 2015. Bootstrapped mediation was used.

PARTICIPANTS

Patients with coronary heart disease (n = 2334).

MAIN MEASURES

Two items assessing perceived health competence, a single item assessing depressed mood, and a Health Behaviors Index including: the International Physical Activity Questionnaire (IPAQ); select items from the National Adult Tobacco Survey and the Alcohol Use Disorder Inventory Test; and single items assessing diet and medication adherence.

KEY RESULTS

Depressed mood was associated with lower perceived health competence (a = - 0.21, p < .001) and lower perceived health competence was associated with worse performance on a Health Behaviors Index(b = 0.18, p < .001). Perceived health competence mediated the influence of depressed mood on health behaviors (ab = - 0.04, 95% CI = - 0.05 to - 0.03). The ratio of the indirect effect to the total effect was used as a measure of effect size (P_M = 0.26, 95% CI: 0.18 to 0.39).

CONCLUSIONS

Depressed mood is associated with worse health behaviors directly and indirectly via lower perceived health competence. Interventions to increase perceived health competence may lessen the deleterious impact of depressed mood on health behaviors and cardiovascular outcomes.

Impact of inherent aspects of body image, eating behavior and perceived health competence on quality of life of university students

The aim of this study was to assess the impact of inherent aspects of body image, eating behavior and perceived health competence on quality of life of university students. Participants completed the instruments Body Shape Questionnaire (reduced version, BSQ-8B), Male Body Dissatisfaction Scale (reduced version, MBDS-R), Three-Factor Eating Questionnaire (reduced version, TFEQ-18), Perceived Health Competence Scale (bifactorial version, PHCS-B), World Health Organization Quality of Life Questionnaire-Short Form (WHOQoL-bref) and a questionnaire for characterization of sample. Psychometric properties of instruments were previously evaluated by confirmatory factor analysis. A hypothetical model for each sex was developed and tested. In both model surveys the aspects of the body image (BSQ-8B: body shape concern; MBDS-R: musculature and general body appearance), of eating behavior (TFEQ-18: cognitive restriction, emotional eating, and uncontrolled eating) and of the perceived health competence (PHCS-B: expectations of achieving the desired health results and competence in health behaviors) were used as direct predictors on quality of life (WHOQoL-bref). The variables age, medication use for body change, food supplement use for body change, and body mass index (BMI) were inserted in the aspects of the body image. The variables course shift, initial expectation regarding the course, self-reported performance in the course, concomitant work activities to studies, and economic class were inserted into the quality of life. The model surveys were evaluated using structural equation modeling. A level of significance of 5% was used. A total of 2,198 university students (female = 63.5%), including 1,151 Brazilians and 1,047 Portuguese, participated of study (locally representative samples). The average age of women was 20.8 ± 2.4 years and of men was 21.3 ± 3.3 years. The psychometric properties of the instruments were adequate, except for the PHCS, which was adjusted for each sex. The models presented variance explained of 54% and 49% for women and men, respectively. In both sexes, the students' perceived health competence and academic variables contributed significantly to their quality of life, and age, BMI, and medication and supplement use were significant factors relating to how a student views his or her body image. Women's quality of life was associated with body shape concern and emotional eating aspects. Men's quality of life was associated with general body appearance and cognitive restriction aspects. These results can be used to create and implement educational programs to improve quality of life of university students.

Sex Differences in the Association of Perceived Ambiguity, Cancer Fatalism, and Health-Related Self-Efficacy with Fruit and Vegetable Consumption

Adequate fruit and vegetable (FV) consumption is promoted as a means of preventing chronic health conditions, such as cardiovascular disease and cancer. This study investigated whether perceived ambiguity about cancer prevention recommendations, fatalistic beliefs about cancer, and health-related self-efficacy were associated with FV consumption and whether sex moderated these associations. Data from the five most recent waves (spanning 2011 to 2017) of the nationally representative Health Information National Trends Survey (N = 16,965) were used. Participants reported levels of perceived ambiguity, cancer fatalism, health-related self-efficacy, and daily FV consumption. Perceived ambiguity and cancer fatalism were negatively associated with FV consumption, ps <.001, whereas health-related self-efficacy was positively associated with FV consumption, b = 0.34, p < .001. Sex moderated these associations, ps <.05. Perceived ambiguity and cancer fatalism were more strongly associated with less FV consumption for men, bs < -0.31, ps <.001, than women, bs < -0.14, ps <.01. In contrast, health-related self-efficacy was more strongly associated with more FV consumption for women, b = 0.43, p < .001, than men, b = 0.26, p < .001. These results suggest that tailoring health messaging to target sex-specific barriers may improve their effectiveness.

Fostering Oral Hygiene Habits and Self-Regulation Skills: An Intervention With Preschool Children

The purpose of this study was to evaluate a program to promote self-regulation for self-care skills in preschool-aged children focused on oral habits and good oral health. Participants were 210 Mexican children aged 4 to 5 years who attended the Children's Assistance Community Centers (CAIC in Spanish). Findings showed that children who participated in the program, compared with those who did not, decreased significantly the teeth-bacteria plaque. The former also improved their self-regulation skills and dental hygiene habits. Data highlighted the key role of close adults in promoting young children's self-regulation for self-care focusing on dental hygiene habits.

Health-Promoting Home and Workplace Neighborhoods: Associations With Multiple Facets of Men's Health

Despite the importance of healthy settings for health promotion, little is known about how neighborhood characteristics affect men's health. The present study aims to explore the associations between perceptions of home and workplace neighborhoods with diverse health outcomes, and to examine mediating mechanisms. A sample of 669 men members of labor unions in Quebec, Canada, completed a questionnaire assessing social and physical aspects of their work and home neighborhoods (the Health-Promoting Neighborhood Questionnaire) as well as subjective and objective health outcomes (perceived health, positive mental health, body mass index) and potential mediators (health behaviors, self-efficacy). Structural equation modeling (path analysis) revealed that the Health-Promoting Neighborhood Questionnaire was associated with all three health outcomes, either directly or indirectly through health behaviors and self-efficacy. Both home and workplace neighborhoods were associated with men's health, home neighborhood being more strongly associated. The findings suggest that physical and social aspects of neighborhood might contribute to men's health. The study highlights positive environmental levers for urban planners, policy makers, and health professionals to promote men's health.

Perceived health competence predicts health behavior and health-related quality of life in patients with cardiovascular disease

OBJECTIVE

Evaluate the effect of perceived health competence, a patient's belief in his or her ability to achieve health-related goals, on health behavior and health-related quality of life.

METHODS

We analyzed 2063 patients hospitalized with acute coronary syndrome and/or congestive heart failure at a large academic hospital in the United States. Multivariable linear regression models investigated associations between the two-item perceived health competence scale (PHCS-2) and positive health behaviors such as medication adherence and exercise (Health Behavior Index) as well as health-related quality of life (5-item Patient Reported Outcome Information Measurement System Global Health Scale).

RESULTS

After multivariable adjustment, perceived health competence was highly associated with health behaviors (p<0.001) and health-related quality of life (p<0.001). Low perceived health competence was associated with a decrease in health-related quality of life between hospitalization and 90days after discharge (p<0.001).

CONCLUSIONS

Perceived health competence predicts health behavior and health-related quality of life in patients hospitalized with cardiovascular disease as well as change in health-related quality of life after discharge.

PRACTICE IMPLICATIONS

Patients with low perceived health competence may be at risk for a decline in health-related quality of life after hospitalization and thus a potential target for counseling and other behavioral interventions.

Caregiver burden and perceived health competence when caring for family members diagnosed with Alzheimer's disease and related dementia

PURPOSE

To identify if there is a relationship between perceived health competence and burden of care of informal caregivers of family members with Alzheimer's disease and related dementia (ADRD).

DATA SOURCES

Informal caregivers 18 years and older who received services from the Alzheimer's Resource of Alaska were invited to complete a survey.

CONCLUSIONS

Findings indicate that there was a negative correlation between perceived health competence and burden of care (N = 64, r = -.54, p < .001). Additionally, there was a negative correlation within the three subscales of the Modified Montgomery-Borgatta Caregiver Burden Scale: objective burden (r = -.65, p = < .001), stress burden (r = -.41, p = .001), and relationship burden (r = -.29, p = .021, p = .001).

IMPLICATIONS FOR PRACTICE

Based on the findings of an association between increased caregiver burden and the perception of decreased health competence, nurse practitioners (NPs) can play an important role in assessing caregiver burden. The results of this study enlighten NPs about informal caregiver burden and will help guide discussions and assessments during routine healthcare visits with the goal of achieving optimal health for informal caregivers.

A narrative review of the evaluation and selection of instruments which assess self-efficacy amongst patients with essential hypertension

Hypertension is a chronic disease that is mostly managed by the patients themselves inbetween consultation with their physicians. Self-efficacy, which is an individual’s belief in their capabilities to produce given attainments, is a desirable quality to enable the person to take charge of their health and any long-term illness. Assessment of self-efficacy is thus pivotal in developing a holistic patient-centric care plan to optimize their disease control. For hypertension, self-efficacy is associated with better self-care and outcomes of the disease.

This literature review aims to identify self-efficacy assessment instruments, evaluate their origin, quality and development, compare their strengths and limitations, and applicability in specific target population.

Searches performed using PubMed, Scopus and The Cochrane Library eventually yielded 34 relevant articles and 12 instruments. All instruments were validated in specific populations. Two instruments were specific to hypertension, two instruments measured multiple domains of self-management, while medication adherence was the most common single domain assessed. To select an appropriate instrument, one should take into consideration the clinical context and study design. An algorithm is proposed to facilitate the selection of instrument that is best suited for the specific purpose.

How attempts to meet others' unrealistic expectations affect health: health-promoting behaviours as a mediator between perfectionism and physical health

The traits of perfectionism have been associated with health and longevity. Theoretically and empirically, health behaviours are considered a primary mechanism through which such associations of personality and health occur. However, scant evidence to date indicates behaviours did not mediate between perfectionism and health as anticipated. The aim of the current research was therefore to rigorously examine whether health behaviours mediated associations of perfectionism and physical health-related quality of life (HRQL). A sample of 263 students completed questionnaires measuring subtypes of perfectionism, HRQL, self-efficacy and health-promoting behaviours. Hierarchical regression analyses investigated predictors of physical HRQL and health-promoting behaviours. Non-parametric bootstrapping techniques assessed whether health-promoting behaviours mediated significant associations between perfectionism and physical HRQL. Socially prescribed perfectionism (SPP) significantly predicted poorer physical HRQL, and this association was mediated by health-promoting behaviours, a unique finding. Self-oriented perfectionism did not significantly predict physical HRQL, but was linked with more numerous health-promoting behaviours. In conclusion, results suggest that individuals higher in SPP, who are overly concerned with evaluation by others and with meeting perceived unrealistically high standards of performance, performed fewer health-promoting behaviours, and this mediated the association between SPP and poorer physical HRQL. More broadly, perfectionism predicted physical HRQL and engagement or lack thereof in health-promoting behaviours and should be considered as part of health promotion strategies.

Health literacy -- a heterogeneous phenomenon: a literature review

BACKGROUND AND AIM

A growing responsibility on the part of individuals to make decisions in health issues implies the need of access to health information and personal skills to comprehend the information. Health literacy comprises skills in obtaining, understanding and acting on information about health issues in ways that promote and maintain health. A lack of health literacy may have effects at both the individual and societal levels. There are thus reasons for health care professionals to gain a comprehensive understanding of health literacy. The aim of this review was to explore how health literacy is described in the scientific literature and to give a synthesis of its different meanings.

METHODS

The review was based on approximately 200 scientific articles published 2000-2008. The analysis process was inspired by the methods of narrative literature review.

FINDINGS AND CONCLUSIONS

Two different approaches to health literacy became visible, one in which health literacy is expressed as a polarized phenomenon, focusing on the extremes of low and high health literacy. The definitions of health literacy in this approach are characterized by a functional understanding, pointing out certain basic skills needed to understand health information. The other approach represents a complex understanding of health literacy, acknowledging a broadness of skills in interaction with the social and cultural contexts, which means that an individual's health literacy may fluctuate from one day to another according to the context. The complex approach stresses the interactive and critical skills needed to use information or knowledge as a basis for appropriate health decisions. We conclude that health literacy is a heterogeneous phenomenon that has significance for both the individual and society. Future research will aim at the development of assessments that capture the broadness of skills and agents characteristic for health literacy as a complex phenomenon.