Older women: social cognitive theory correlates of health behavior

Factors Associated With Dietary Behaviors Among Malaysian Adults: Application of the Social Cognitive Theory

Background: Dietary behavior applying theory-based approaches is seldom documented in the general adult population. Thus, the objective of this study was to determine the eating behavior of Malaysian adults and the demographic factors that were associated with positive eating habits. Methods: In this cross-sectional survey, the convenience sampling technique was used to sample Malaysian adults aged 18 or older. The questionnaire was based on constructs from Bandura’s Social Cognitive Theory (SCT), which has six scales or constructs, including self-efficacy, intentions, situation, social support, behavioral strategies, and outcome expectations and expectancies. All the six constructs demonstrated adequate model fit using confirmatory analysis fit by the developers and good internal reliability using Cronbach’s alpha in this study. The data were descriptively analyzed, and subsequently, logistic regressions were performed, assessing demographic factors associated with healthy eating habits. The variables achieving a P value<0.05 were considered statistically significant. Results: A total of 461 respondents completed the questionnaire. Good social support (83.30%), outcome expectations (90.24%) and expectancies (92.41%), and the situation in relation to healthy eating (88.94%) were frequently observed among the respondents. The sentence has been revised to express the idea more clearly. "However, the observations in these dimensions were not necessarily translated into good self-efficacy (33.41%), intentions (39.91%), and behavioral strategies relating to healthy eating (53.15%). Additionally, demographic variables such as ethnicity, age, and region were significantly associated with the positive attitude observed on the questionnaire constructs. Conclusion: In summary, the findings of the study revealed that many Malaysians have poor self-efficacy, intentions, and behavioral strategies when it came to eating healthy. The demographic factors significantly associated with dietary behaviors should be targeted in future interventional studies and awareness programs.

Mental imagery interventions to promote face covering use among UK university students and employees during the COVID-19 pandemic: study protocol for a randomized controlled trial

BACKGROUND

The 2020 COVID-19 pandemic has witnessed wide-ranging efforts to minimize the spread of the virus and to protect those most vulnerable to becoming unwell following viral infection. Core COVID-19 preventive measures include social distancing, regular hand washing, and wearing face coverings in public places. Understanding links between social cognitive factors relating to beliefs/skills is important in the context of the COVID-19 pandemic, as this can suggest which factors might be targeted via behaviour change interventions to promote adherence to COVID-19 preventative behaviours. In this context, mental imagery exercises-self-directed imagining of an anticipated outcome or processes linked to a defined behaviour/activity-offer a well-evidenced, relatively simple behaviour change intervention. In the mental imagery invention reported in this protocol, individuals will be randomly assigned to one of four separate conditions (outcome imagery, process imagery, outcome and process imagery, control).

METHODS

The primary objective of this randomized controlled study is to assess the effectiveness of a mental imagery intervention on wearing face coverings, as a defined core COVID-19 preventative behaviour. Participants will consist of UK university students and university employees of any age. Participants will be randomized to complete an 'outcome imagery' or a 'process imagery' exercise, both exercises (i.e. a combined condition) or neither exercise (i.e. a control condition). A total of 260 individuals will be recruited into the study. Outcomes for all study condition arms will be assessed at baseline (Time 1), immediately post-intervention (Time 2), and at 1-month follow-up (Time 3). The primary outcome is frequency of wearing face covering, as reported at T2 and T3. Secondary outcomes include intervention effects on face covering attitudes, social norms, perceived behavioural control and barrier self-efficacy at T2 and T3. Putative moderators of intervention effects are conscientiousness, narcissism and 'light triad' personality traits.

DISCUSSION

This trial will contribute toward the currently sparse evidence base concerning behaviour change techniques designed to promote COVID-19 preventative behaviours among UK university students and university employees.

TRIAL REGISTRATION

ClinicalTrials.gov (U.S. National Library of Medicine) NCT04583449 . Retrospectively registered on 20 October 2020.

Reliability of the Swedish version of the multidimensional outcome expectations for exercise scale (MOEES-SW) in a cardiac population

Purpose: Translate and adapt the Multidimensional Outcome Expectations for Exercise Scale (MOEES) into Swedish language and to explore psychometric properties, in terms of test-retest reliability, internal consistency as well as factor structure and floor and ceiling effects, of the Swedish version of MOEES in cardiac patients.Materials and methods:This prospective psychometrical study set in a Swedish cardiac rehabilitation outpatient clinic included 74 patients; age ³18 years after acute coronary syndrome or that had undergone cardiac surgery. Translation and adaptation procedure of the MOEES followed established international guidelines. To evaluate test-retest reliability, relative (intra-class correlation coefficient ICC, 2.1)and absolute reliability (standard error of measurement (SEM) standard error of measurement % (SEM%), percentage of absolute agreement and Kappa coefficient for each item were calculated. Internal consistency was assessed with Cronbach´s alpha. The original 3-factor structure was tested with a confirmatory factor analysis. Floor and ceiling effects were calculated. Results: In total, 60 patients, mean age 65 years, were included in the study. The test-retest showed for the three outcome expectations subscales (Physical, Self-evaluative and Social) ICC-values of 0.40 (CI 95% 0.20-0.58), 0.57 (0.39-0.71) and 0.72 (0.57-0.83), respectively. In general, the Kappa coefficients were low and varied between 0.11 and 0.44. Two questions had low loadings in the confirmatory factor analysis (<0.5) , contributing to a weak fit of the model. There was no floor effect, but the subscales physical and self-evaluative outcome expectation showed ceiling effects. Conclusion:This is the first study to analyse test-retest reliability of the translated version of MOEES into Swedish in cardiac patients and shows need for further development of the instrument before use in clinical practice and research.

Psychosocial and cultural determinants of dietary intake in community-dwelling older adults: A Determinants of Diet and Physical Activity systematic literature review

OBJECTIVES

Knowledge of factors determining dietary intake is important to develop targeted strategies to prevent malnutrition and age-related diseases. The aim of the present systematic review was to analyze the state of the art regarding the role of social status, cultural aspects, and psychological distress on dietary intake in community-dwelling older adults.

METHODS

A systematic search was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedure. Titles, abstracts, and full texts were screened for predefined inclusion and exclusion criteria.

RESULTS

Thirty-nine studies were included. Seven different groups of psychosocial and cultural determinants were associated with dietary intake. Family structure and living situation (e.g., loneliness, marital status), educational level, and income were the most important determinants associated with dietary choices and eating behavior. Less frequently, social assets, demographic parameters, psychosocial status, and awareness of current dietary recommendations were associated with the quality of the eating pattern.

CONCLUSIONS

The results of our review indicate heterogeneity of the studies in the field of social and psychological determinants of dietary patterns in older adults, but some important conclusions can be drawn. Further research harmonizing and integrating approaches and methodologies are required to better understand the determinants of dietary intake and the complexity of their interactions.

Factors associated with physical activity of women aged over 75 in South Korea

Physical activity (PA) and the activity-related factors of aged women dwelling in a city community of Korea were examined for 253 participants aged over 75, regarding their socio-demographic characteristics, health status, physical performance, depression, cognitive function, self-efficacy, outcome expectations, and PA. Descriptive statistics, analysis of covariance, Pearson correlation, and multiple regressions were performed to analyze cross-sectional data. The data indicated the participants carry out low-intensity physical activities, such as house chores, light gardening, and walking for pleasure. Moderate and vigorous-intensity physical activities were performed rare. The frequency per week was 15.62±8.60 for all listed activities. Frequency of PA decreased significantly in participants aged over 80, of poor perceived health, depression, and cognitive decline. There was a negative correlation between PA and the figure 8 walks (r=−0.20, P=0.002). PA showed significantly positive correlation with self-efficacy (r=0.34, P=0.001) and outcome expectations (r=0.36, P=0.001). In a regression analysis, explanation rate of factors influencing PA was 21.9 % (P=0.001). Outcome expectations (β=0.23), cognitive function (β= −0.20), and self-efficacy (β=0.19) influenced the PA. These findings indicate that interventions stimulating cognitive function and enhancing positive expectation and self-confidence should be included for PA promotion of older women aged 75 years and over.

Psychopathological correlates of eating behavior among Portuguese undergraduate students

OBJECTIVES

The aim of this study was to explore the relationships between eating behavior dimensions and psychopathological symptoms among Portuguese undergraduate students.

METHODS

We studied 258 participants (62.4% women) regarding eating behavior dimensions (emotional, external and binge eating, flexible and rigid control of eating behavior, and eating self-efficacy), psychopathological distress (as assessed by the Brief Symptom Inventory), and body mass index. In addition to studying bivariate associations between eating behavior dimensions and psychopathological subscales and indexes, what we believe to be a novel analytical approach, considering simultaneously the effects of the overall level of psychopathological distress and the relevance of specific symptoms on the eating behavior dimensions.

RESULTS

Emotional, external, and binge eating had positive correlations with psychopathological symptomatology, whereas eating self-efficacy was negatively associated.

CONCLUSIONS

Multivariate analysis showed that the overall level of psychopathological distress (combined with body mass index, among women) had a larger effect on eating behavior than the relevance of specific symptoms.

RelAte: pilot study of the effects of a mealtime intervention on social cognitive factors and energy intake among older adults living alone

Mealtime interventions typically focus on institutionalised older adults, but we wanted to investigate whether they may also be effective among those living independently. Using a randomised controlled trial design, we assessed the effects of a novel mealtime intervention on self-efficacy, food enjoyment and energy intake. A total of 100 adults living alone aged over 60 years were randomised to the treatment or control conditions: all received a guidebook on nutrition and culinary skills. Treatment group participants received a weekly visit from a trained volunteer who prepared and shared a meal with them. Participants in the treatment group showed improvements relative to those in the control group at borderline significance (P=0·054) for self-efficacy and at significance for food enjoyment. Significant improvements were observed in female participants in the treatment but not in the control group in energy intake (although following corrections for multiple comparisons, only the effect on food enjoyment remained significant). These findings will inform the design of future complex interventions. For this type of intervention to be successful, more focus has to be placed on making interventions more personalised, potentially according to sex. Findings are important for nutritional sciences as they indicate that, in order to improve energy intake and food enjoyment among older adults, multimodal nutritional interventions including social components may be successful.

Perceptions and Experiences of Heart Disease: A Literature Review and Identification of a Research Agenda in Older Women

BACKGROUND

Following diagnosis of heart disease women have poorer health related outcomes compared with men. Nursing science lacks well-evaluated interventions to address the specific rehabilitative needs of older women with heart disease. This paper seeks to inform the development of nursing intervention studies by a review of published studies on the experiences and rehabilitative needs of older women with heart disease.

METHODS

The CINAHL, MEDLINE, FAMILY and PsychINFO databases were searched, identifying literature published from 1982 and written in English. Keywords used were women, old* (old, older) women, elderly women and: heart disease, heart failure, cardiac and rehabilitation. Hand searching of nursing and medical textbooks also occurred. These searches resulted in over 120 articles that met the criteria of describing experiences, perceptions, psychological responses and support rehabilitative needs of older women.

RESULTS

Older women present with symptoms that are different from those derived from a male-dominated research agenda and further there is a paucity of data related to evaluation of interventions tailored to the needs of women. Key themes emerging from the literature review include not only that older women compared with men have a poorer prognosis and experience greater disability moreover they: (1). are at a higher risk of psychosocial distress; (2). have a greater need for instrumental support and social support; (3). have an altered perception of risk; and (4). demonstrate the need for specific rehabilitation programs, tailored to their needs.

CONCLUSION

Future research should develop and evaluate intervention studies that better meet the unique needs of older women with heart disease. Particular emphasis needs to be on psychosocial aspects, given evidence that identify these are major concerns for women.

Investigating the psychosocial determinants of physical activity in older adults: A qualitative approach

Objective: Despite the benefits of physical activity (PA), only one-third of older adults meet the recommended levels. The present study focused on psychosocial determinants of PA following retirement. Social cognitive theory (SCT) was used to better understand pre- and post-retirement adults’ thoughts about PA, the reasons why some individuals are more active than others, and how PA is incorporated into daily life after retirement.

Design: Seven focus groups of older adults (N = 37, M = 64, SD = 5.20; males = 20) representing a range of PA levels and retirement length participated in one of seven focus groups.

Results: Aligned with SCT, self-efficacy beliefs along with perceptions about barriers and benefits of PA were among the major determinants of PA. Findings highlighted the importance of social support, positive outcome expectations and self-regulatory strategies as motivators. The lack of structure in retirement was a hindrance to incorporating PA into daily routine but, when incorporated, PA provided a sense of purpose in the lives of retired individuals.

Conclusion: It is important to understand the meaning of retirement as a life transition and how it affects beliefs about PA to inform SCT-based health promotion interventions targeting individuals in retirement age.

Social cognitive theory and physical activity: a systematic review and meta-analysis

This review investigated three research questions (i) What is the utility of social cognitive theory (SCT) to explain physical activity (PA)?; (ii) Is the effectiveness of SCT moderated by sample or methodological characteristics? and (iii) What is the frequency of significant associations between the core SCT constructs and PA? Ten electronic databases were searched with no date or sample restrictions. Forty-four studies were retrieved containing 55 SCT models of PA. Methodological quality was assessed using a standardized tool. A random-effects meta-analysis revealed that SCT accounted for 31% of the variance in PA. However, methodological quality was mostly poor for these models. Methodological quality and sample age moderated the PA effect size, with increases in both associated with greater variance explained. Although self-efficacy and goals were consistently associated with PA, outcome expectations and socio-structural factors were not. This review determined that SCT is a useful framework to explain PA behaviour. Higher quality models explained more PA variance, but overall methodological quality was poor. As such, high-quality studies examining the utility of SCT to explain PA are warranted.

Eating behaviour among undergraduate students. Comparing nutrition students with other courses

Our main aim was to compare eating behaviour between Portuguese undergraduate nutrition students and students attending other courses. Several eating behaviour dimensions were compared between 154 nutrition students and 263 students from other areas. Emotional and external eating were assessed by the Dutch Eating Behavior Questionnaire, dietary restraint was measured using the flexible and rigid control of eating behaviour subscales, binge eating was measured using the Binge Eating Scale, and eating self-efficacy using the General Eating Self-Efficacy Scale. Higher levels of flexible and rigid control were found in nutrition students from both sexes when compared to students from other courses. Female nutrition students also presented higher binge eating levels than their colleagues from other courses. To our knowledge no other work has previously assessed all eating behaviour dimensions considered in the current study among nutrition students. Besides the results by themselves, the data obtained from this study provide several clues to further studies to be developed regarding the still rarely approached issue of eating behaviour among nutrition students.

Eating behavior in Portuguese higher education students: the effect of social desirability

OBJECTIVES

The aim of this study was to relate social desirability with eating behavior dimensions among higher education students in Portugal, and to assess the effect of social desirability on the association between pairs of eating behavior dimensions.

METHODS

Data from 266 higher education students (62.8% women) aged between 18 and 27 y were evaluated. Social desirability and several eating behavior dimensions (emotional and external eating, flexible and rigid restraint, binge eating, and eating self-efficacy) were assessed.

RESULTS

In both women and men, social desirability showed negative associations with emotional, external, and binge eating, and positive associations with eating self-efficacy. For the majority of the correlations, the control for social desirability led to a decrease in the strength of the association: Social desirability showed a greater effect on the associations between external and binge eating, external eating and eating self-efficacy, binge eating and eating self-efficacy, and emotional and external eating.

CONCLUSION

This study demonstrated that social desirability should be considered when assessing the dimensions of eating behavior, namely eating self-efficacy and dimensions related to overeating.

Eating behaviour patterns and BMI in Portuguese higher education students

Our aim was to determine prototypical patterns of eating behaviour among Portuguese higher education students, and to relate these patterns with BMI. Data from 280 higher education students (63.2% females) aged between 18 and 27 years were analysed. Several eating behaviour dimensions (emotional and external eating, flexible and rigid restraint, binge eating, and eating self-efficacy) were assessed, and eating styles were derived through cluster analysis. BMI for current, desired and maximum self-reported weights and the differences between desired and current BMI and between maximum and current BMI were calculated. Women scored higher in emotional eating and restraint, whereas men showed higher eating self-efficacy. Men had higher current, desired and maximum BMI. Cluster analysis showed three eating styles in both male and female subsamples: "Overeating", "High self-efficacy" and "High restraint". High self-efficacy women showed lower BMI values than the others, and restrictive women had higher lost BMI. High self-efficacy men showed lower desired BMI than overeaters, and lower maximum and lost BMI than highly restrictive ones. Restrictive women and men differ on important eating behaviour features, which may be the cause of differences in the associations with BMI. Eating self-efficacy seems to be a central variable influencing the relationships between other eating behaviour dimensions and BMI.

Development and initial validation of the determinants of physical activity questionnaire

BACKGROUND

Physical activity interventions are more likely to be effective if they target causal determinants of behaviour change. Targeting requires accurate identification of specific theoretical determinants of physical activity. Two studies were undertaken to develop and validate the Determinants of Physical Activity Questionnaire.

METHODS

In Study 1, 832 male and female university staff and students were recruited from 49 universities across the UK and completed the 66-item measure, which is based on the Theoretical Domains Framework. Confirmatory factor analysis was undertaken on a calibration sample to generate the model, which resulted in a loss of 31 items. A validation sample was used to cross-validate the model. 20 new items were added and Study 2 tested the revised model in a sample of 466 male and female university students together with a physical activity measure.

RESULTS

The final model consisted of 11 factors and 34 items, and CFA produced a reasonable fit χ2 (472) = 852.3, p < .001, CFI = .933, SRMR = .105, RMSEA = .042 (CI = .037-.046), as well as generally acceptable levels of discriminant validity, internal consistency, and test-retest reliability. Eight subscales significantly differentiated between high and low exercisers, indicating that those who exercise less report more barriers for physical activity.

CONCLUSIONS

A theoretically underpinned measure of determinants of physical activity has been developed with reasonable reliability and validity. Further work is required to test the measure amongst a more representative sample. This study provides an innovative approach to identifying potential barriers to physical activity. This approach illustrates a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.

MyPyramid-omega-3 fatty acid nutrition education intervention may improve food groups and omega-3 fatty acid consumption in university middle-aged women

This study was conducted to assess the impact of a nutrition education intervention on food groups and omega-3 (n-3) fatty acid consumption in middle-aged women. We hypothesized that participants who received educational materials about n-3 fatty acids would have a higher consumption of foods rich in n-3 fatty acids than the MyPyramid group. The first phase of this study used the qualitative method to identify the beliefs and interests of middle-aged women about the topic of nutrition. Data were collected using semistructured individual interviews. Phase 2 was a quantitative study to assess the effectiveness of MyPyramid to improve dietary intake and self-efficacy after a 6-week online nutrition education intervention using a blog for university middle-aged female staff. The impact of n-3 fatty acid education on food consumption and self-efficacy was also assessed. Eight female staff (aged 45-65 years) in a Midwestern university participated in the interviews. Data were coded, and 3 themes emerged: "health," "lifestyle," and "availability." Eighty-eight middle-aged women participated in the intervention study and were randomized into either an intervention group or a control group. The overall consumption of the food groups was lower than the MyPyramid recommendation, except in the meat and beans group. There was a trend that participants were less certain to include n-3 fatty acids than whole grains in their diets. Using MyPyramid and supplementary information about n-3 fatty acids did not significantly affect participants' dietary consumption or self-efficacy to increase consumption from the food groups or to increase n-3 fatty acid consumption. Blog-based nutrition education is acceptable for this target population.

The perceived importance of physical activity: associations with psychosocial and health-related outcomes

BACKGROUND

The purpose of this study was to assess the extent to which participation in a 12-month exercise program changed the degree of importance that older adults attached to physical activity. In addition, associations among changes in physical activity importance and health-related and psychosocial outcomes were examined.

METHODS

Community-dwelling older adults (N = 179) were recruited to participate in a 12-month exercise trial examining the association between changes in physical activity and fitness with changes in brain structure and psychological health. Participants were randomly assigned to a walking condition or a flexibility, toning, and balance condition. Physical, psychological, and cognitive assessments were taken at months 0, 6, and 12.

RESULTS

Involvement in a 12-month exercise program increased the importance that participants placed on physical activity; this positive change was similar across exercise condition and sex. Changes in importance, however, were only associated with changes in physical health status and outcome expectations for exercise midway through the intervention. There were no significant associations at the end of the program.

CONCLUSIONS

Regular participation in physical activity can positively influence the perceived importance of the behavior itself. Yet, the implications of such changes on physical activity-related outcomes remain equivocal and warrant further investigation.

Item-Response-Theory Analysis of Two Scales for Self-Efficacy for Exercise Behavior in People With Arthritis

Benefits of physical activity for those with arthritis are clear, yet physical activity is difficult to initiate and maintain. Self-efficacy is a key modifiable psychosocial determinant of physical activity. This study examined two scales for self-efficacy for exercise behavior (SEEB) to identify their strengths and weaknesses using item response theory (IRT) from community-based randomized controlled trials of physical activity programs in adults with arthritis. The 2 SEEB scales included the 9-item scale by Resnick developed with older adults and the 5-item scale by Marcus developed with employed adults. All IRT analyses were conducted using the graded-response model. IRT assumptions were assessed using both exploratory and confirmatory factor analysis. The IRT analyses indicated that these scales are precise and reliable measures for identifying people with arthritis and low SEEB. The Resnick SEEB scale is slightly more precise at lower levels of self-efficacy in older adults with arthritis.

Relationships among nutritional self-efficacy, health locus of control and nutritional status in older Taiwanese adults

AIM

The purpose of this study was to examine the relationships among selected demographic characteristics, nutrition self-efficacy, health locus of control and nutritional status in older Taiwanese adults.

BACKGROUND

The number of older adults in Taiwan is increasing, and they have been shown to have poor nutritional status. However, little is known about the factors that lead to poor nutritional status in this population.

DESIGN

Correlational, cross-sectional study.

METHODS

Participants were randomly selected from two district public health centres in Yilan County, Taiwan. Of 162 individuals who met the study criteria, 156 agreed to participate and provided data on demographic information, nutrition self-efficacy (Cardiac Diet Self-Efficacy scale), health locus of control (Multidimensional Health Locus of Control scale) and nutritional status (Mini-Nutritional Assessment and serum albumin levels).

RESULTS

The majority of this sample was healthy men (60.9%) with a mean age of 72.29 years. The results indicated that age, educational level, current chronic diseases and chance health locus of control all affected nutritional status in terms of Mini-Nutritional Assessment scores, but only current chronic diseases explained significant variance in nutritional status in terms of albumin levels.

CONCLUSIONS

The current study integrated self-efficacy theory and Health Locus of Control theory to better understand how background characteristics, nutrition self-efficacy and Health Locus of Control relate to nutritional status in older Taiwanese adults. However, the overall predicted variance accounted for by predictors was small, further research is therefore necessary to gain a deeper understanding of nutritional status and its factors among older Taiwanese adults.

RELEVANCE TO CLINICAL PRACTICE

Nurses can help older persons identify factors that relate to their nutritional status and plan effective interventions to maintain healthy nutrition behaviours with the following risk characteristics: (1) lower level of education, (2) more chronic diseases and (3) external control orientation.

Trajectory of declines in physical activity in community-dwelling older women: social cognitive influences

Studies examining physical activity behavior suggest that activity levels decline with age. Such declines are particularly problematic among older adults in light of the research suggesting a protective effect of physical activity on numerous physical health outcomes associated with independent living. Despite a growing recognition of the importance of a physically active lifestyle, little is known about the role of demographic and psychosocial variables on this trajectory of change. In this study, the roles played by outcome expectations, self-efficacy, and functional limitations on changes in physical activity levels over a 2-year period in older women were assessed using latent growth curve modeling. Data were obtained from 249 community-dwelling older women (M age = 68.12, n = 81 Black, and n = 168 White). Demographic, health status, and psychosocial data were collected via self-report upon entry into the study. Self-reported physical activity was assessed at baseline and again at 12 and 24 months. As expected, physical activity declined over the 2-year period. Self-efficacy demonstrated an indirect association with the trajectory of decline in physical activity through functional limitations. Importantly, the pattern of relationships appears independent of demographic factors and chronic health conditions.

Assessing outcome expectations in older adults: the multidimensional outcome expectations for exercise scale

Outcome expectations, an important element of social cognitive theory, have been associated with physical activity in older adults. Yet, the measurement of this construct has often adopted a unidimensional approach. We examined the validity of a theoretically consistent three-factor (physical, social, and self-evaluative) outcome expectations exercise scale in middle-aged and older adults (N = 320; M age = 63.8). Participants completed questionnaires assessing outcome expectations, physical activity, self-efficacy, and health status. Comparisons of the hypothesized factor structure with competing models indicated that a three-factor model provided the best fit for the data. Construct validity was further demonstrated by significant association with physical activity and self-efficacy and differential associations with age and health status. Further evidence of validity and application to social cognitive models of physical activity is warranted.

Using social cognitive theory to explain consumers' behavioral intentions in response to direct-to-consumer prescription drug advertising

BACKGROUND

Previous research describing consumers' communication behaviors in response to direct-to-consumer advertising (DTCA) suggests a social cognitive rationale to explain DTCA-related communication behavior.

OBJECTIVE

Guided by social cognitive theory, the objective of this study was to explore outcome expectancy and self-efficacy beliefs as predictors of individuals' intentions to communicate with their physicians about an advertised drug.

METHODS

One hundred and seven female college students completed a questionnaire, read an advertisement for an oral contraceptive drug, and completed a second questionnaire. The questionnaires assessed participants' self-efficacy and outcome expectancy beliefs, intended communication behavior, and demographic information.

RESULTS

Pearson product-moment correlation analyses showed that outcome expectancy (r=0.75, P<.01) and self-efficacy (r=0.21, P<.05) beliefs were associated positively with intentions to communicate with physicians in response to DTCA. However, ordinary least squares regression analyses revealed that only outcome expectancy beliefs predicted intended communication behavior (B=1.56, P<.01). Results also showed that participants had a relatively greater likelihood of requesting information about, than requesting a prescription for, the advertised drug [t(106)=14.75, P<.01].

CONCLUSIONS

The results identify cognitive factors that guide consumers' plans for interacting with physicians in response to DTCA. Health care providers can use these results to guide communication with patients regarding DTCA and meet patients' drug-related informational expectations.

Determinants of older rural women's activity and eating

This research examined the relationship of cognitive-perceptual determinants from the Health Promotion Model to physical activity and healthy eating at baseline of a clinical trial among rural women aged 50 to 69. Two multivariate regression analyses with canonical correlation (N = 179) each yielded one interpretable canonical variate that explained similar amounts of variance (21.7% and 22.5%) in sets of activity and eating variables. In both analyses, the determinants set is a linear combination of all four cognitive-perceptual constructs from the model (perceived self-efficacy, benefits, barriers, interpersonal influences). The activity behavior set included caloric expenditure, VO2max, and stretching and strengthening activity, whereas the eating behavior set included daily percentage of calories from fat and servings of fruits and vegetables, meat, and whole grains. As predicted by theory, greater self-efficacy, benefits and interpersonal support, and fewer barriers are associated with desirable healthy lifestyle behaviors.

Social-Cognitive Determinants of Physical Activity Attendance in Older Adults

The present study evaluated whether, and to what extent, the constructs implicated in the theory of planned behavior could predict behavioral intention to exercise and exercise-class attendance of older adults (age 65–90 years) already enrolled in a physical activity program. The study also evaluated whether including self-efficacy judgments might improve the predictive capacity of the model. Participants (N = 1,095) were randomly sampled Italian volunteers from exercise classes for older adults. First, they completed questionnaires assessing the above-mentioned constructs. Then, class attendance was recorded during the following 3 months. Results indicated a substantial correspondence between the model and the data. Perceived behavioral control and self-efficacy were the strongest predictors of behavioral intention, whereas attitudes and subjective norms only partially contributed to its prediction. The inclusion of self-efficacy improved the predictive capacity of the overall model. Finally, results showed a weak relation between behavioral intention and attendance rate in physical activity sessions.

Psychosocial factors influencing the practice of preventive behaviors against the severe acute respiratory syndrome among older Chinese in Hong Kong

OBJECTIVE

This study explored psychosocial factors that influenced the practice of preventive behaviors against the severe acute respiratory syndrome (SARS) among older adults.

METHOD

A total of 354 older Chinese were telephone interviewed during the outbreak of SARS in Hong Kong. They were asked about their perceived health threats, efficacy beliefs, and the practice of SARS preventive behaviors.

RESULTS

Only 40.7% of the elderly participants practiced the recommended SARS preventive behaviors. Elderly participants who perceived greater personal vulnerability to the disease, who possessed greater self-efficacy, who had greater confidence in local health authorities, and who had lower educational attainment were more likely to adopt the suggested SARS preventive behaviors.

DISCUSSION

This study supported the conceptual framework that specified perceived health threats and efficacy beliefs as the two core dimensions of motivating factors in adopting SARS preventive behaviors.

A review of the outcome expectancy construct in physical activity research

BACKGROUND

Outcome expectancy is a central construct in social cognitive models of health behavior widely used as frameworks for physical activity research.

PURPOSE

This article provides a review of the outcome expectancy construct and its application to research on physical activity.

METHODS

Theoretical articles describing definitions and placement of outcome expectancy within social cognitive models, as well as empirical research on outcome expectancy and physical activity, were reviewed.

RESULTS

Self-efficacy theory, the transtheoretical model, the theory of planned behavior, and protection motivation theory differ in their labeling and conceptualization of outcome expectancy but unanimously include expected outcomes of behavior. Preliminary empirical investigation of the role of outcome expectancy in understanding physical activity has yielded mixed results. Positive outcome expectancy appears to be more predictive of physical activity in older adults than in young to middle-aged adults, and personal barriers appear to be the most predictive subtype of negative outcome expectancy. In addition, a small number of studies indicate relations between outcome expectancy and other theoretical variables, including behavioral intention, stage of change, and self-efficacy.

CONCLUSIONS

Further research on the role of outcome expectancy is necessary to design effective physical activity interventions. New directions in outcome expectancy research could involve (a) expanding the conceptualization of outcome expectancy to include expected outcomes of sedentary behavior and affective responses to physical activity, (b) further examination of potential moderators of the relation between outcome expectancy and physical activity (such as outcome value and outcome proximity), (c) distinguishing between the role of outcome expectancy in behavior onset versus behavior maintenance, (d) examining outcome expectancy as a mechanism of change in environmental intervention approaches, and (e) further analysis of interrelations between outcome expectancy and other social cognitive variables.

Diagnostik von Ressourcen im Alter

Zusammenfassung: Als Ergänzung zur psychopathologisch orientierten Diagnostik zieht seit einiger Zeit die Beschäftigung mit Stärken, Kompetenzen und Ressourcen einer Person Aufmerksamkeit auf sich, zuletzt unter den Bemühungen der Positiven Psychologie. Gerade die Alterspsychotherapie kann von einer Ressourcenorientierung profitieren. Dieser Artikel verfolgt zum einen das Ziel, Instrumente zur Diagnostik verschiedener Ressourcen darzustellen, zum anderen Befunde zu positiven Konsequenzen dieser Ressourcen im Alter zusammenzufassen. Berücksichtigt werden emotionale Ressourcen (positiver Affekt, Lebenszufriedenheit, Selbstwerterleben), motivationale Ressourcen (Kontrollüberzeugung, Selbstwirksamkeitserwartung, dispositionaler Optimismus, optimistischer Attributionsstil, Hoffnung, intrinsische Lebensziele), volitionale Ressourcen (Handlungsorientierung, Selbstregulation und Selbstkontrolle, Aufmerksamkeitsregulation, Emotionsregulation), interpersonale Ressourcen (Bindung, Altruismus, soziale Verantwortung, Vergebung, Humor) und soziale Ressourcen (soziales Netzwerk, soziale Unterstützung, Partnerbeziehung). Diskutiert wird die Notwendigkeit einer Diagnostik der Ressourcen in der Psychotherapie, vorgeschlagene Änderungen am DSM-IV und Schlussfolgerungen für geplante Forschungsprojekte.

RCT of a theory-based intervention promoting healthy eating and physical activity amongst out-patients older than 65 years

A randomised controlled trial was used to evaluate a theory-based health promotion intervention. The intervention, a healthy living booklet, was designed to promote healthy eating and physical activity amongst people aged over 65 years attending hospital out-patient clinics. The booklet employed persuasive arguments targeting the most proximal cognitive antecedents of behaviour specified by the theory of planned behaviour, as well as goal setting prompts. Participants (N = 252, average age=82) were randomly allocated to a control (patient satisfaction questionnaire) or intervention (healthy living booklet) group. Cognitions and behaviour were measured pre-intervention and at a two week follow up. The intervention group made significantly higher gains in perceived behavioural control, intention and behaviour for both target behaviours, suggesting that the intervention was successful. Sixty three of those invited to set goals to eat more healthily (e.g., "to eat five portions of fruit and vegetables a day") did so, and 67% of those who set such goals reported 100% success in acting on them. By contrast, only 34% of intervention participants set an activity goal (e.g., "a five minute walk everyday"), and only 51% reported 100% success in enacting these goals. Results suggest that the observed behavioural effects of the healthy eating booklet could be attributed to goal setting as well as changes in perceived behavioural control and intention.

Older women and exercise: explanatory concepts

BACKGROUND

Older women remain predominantly sedentary despite potential health benefits and reduced risks of cardiovascular disease associated with regular exercise. Primary care interventions to increase exercise need to focus on constructs amenable to intervention that predict exercise behavior.

PURPOSE

The study tested an explanatory model of older women's exercise behavior using concepts from social cognitive theory, the transtheoretical model, and the theory of planned behavior (self-efficacy, outcome expectancy, perceived exercise barriers, processes of change, perceived health, and age).

METHODS

Data were collected by interviews with 203 older community-dwelling women physically capable of some exercise. Ordinary least squares regression results were used to determine the direct and indirect effects in a path model.

FINDINGS

All concepts and 13 hypothesized paths were retained in the trimmed model. The constructs accounted for 46% of the variance in exercise behavior. Outcome expectancy had the largest total effect. Processes of change had the largest direct effect on exercise behavior. Exercise self-efficacy and perceived exercise barriers accounted for similar amounts of variance in exercise behavior, whereas age and health had only modest effects.

CONCLUSION

Important constructs for future exercise model testing and intervention research should include outcome expectancy, processes of change, exercise self-efficacy, and perceived barriers to exercise. Primary care interventions designed to increase older women's exercise should focus on these same constructs.

Concepts in health promotion. Perceived self-efficacy and barriers in older adults

Many older adults have reached later life in apparent good health while others' lack of self-care activities has greatly accelerated the process of aging. In this article, self-efficacy and perceived barriers are explored as significant concepts that influence the self-care activities of elderly individuals. A conceptual model is presented depicting perceived self-efficacy and barriers as determinants of self-care activities. This conceptual model differs from earlier health promotion models because it is specific for older adults. Based on empirical studies, this conceptual model demonstrates that the variables of perceived self-efficacy and barriers have a profound effect on an older adult's participation in self-care activities. Testing of this model is needed to provide a knowledge base for designing health promotion strategies, maximizing cost containment strategies, and contributing to Healthy People 2010 objectives of increasing quality of life for all older adults.

Are there different predictors of distinct exercise components?

Rehabilitation nurses often recommend to aging adults that they exercise. Despite the recommendations and the widespread evidence of its benefits, few older adults exercise. This study examined the predictors of distinct components of exercise behavior: exercise intensity, frequency per week, duration of sessions, and months per year. Social cognitive theory predictors of exercise were measured with previously developed instruments. Interviews were conducted with community-dwelling elders (N = 147). The study constructs accounted for modest to moderate amounts of variance (41% of months per year, 35% of frequency, 35% of exercise intensity, and 20% of episode duration). Self-efficacy was the most important predictor of each construct, with Beta weights ranging from .23 to .53. Barriers significantly predicted months' per year, frequency per week, and exercise intensity, but not the duration of individual exercise sessions. Outcome expectancy predicted only exercise intensity. These findings support the importance of self-efficacy and perceived barriers for most components of exercise behavior.

Prediction of coronary heart disease preventive behaviors in women: a test of the health belief model

Coronary heart disease (CHD) risk increases with age, and this increase is more dramatic in women than men. The incidence of CHD is lower in premenopausal women compared with men. After menopause, the risk of mortality from CHD increases in women. The purpose of this study was to test predictors of CHD preventive behaviors using an adapted form of the Health Belief Model (HBM) in a sample of 178 women. The predictor variables were perceptions of susceptibility to CHD, perceptions of seriousness of CHD, general health motivation, social support, and knowledge of risk factors of CHD. Regression results revealed that susceptibility to CHD, seriousness of CHD, knowledge of risk factors of CHD, and general health motivation together explained 76% of the variance of CHD behaviors. Implications for future research and for improving education about consistent adoption of CHD preventive behaviors are discussed.

Influences on older women's adherence to a low-fat diet in the Women's Health Initiative

OBJECTIVE

Most studies of dietary change during aging have focused on maintaining adequate intake by impaired elderly, and little is known about factors affecting dietary change for preventive purposes in older individuals. The purpose of this exploratory study was to determine the major behavioral influences on older women's adherence to a dietary fat reduction intervention.

METHOD

A diverse sample of 92 women aged 55 to 80 was recruited from two East Coast sites of the Women's Health Initiative. All the women were participating in the dietary modification arm of WHI, had received the same dietary instruction, and were in the maintenance phase of the intervention. The women were classified by nutritionists as adherent or nonadherent to a diet limiting fat intake to <20% of total calories. Focus groups and telephone interviews were conducted, and textual data were coded and sorted using content analysis techniques within the four categories of the Stimuli-Organismic Factors-Response Repertoire-Consequences (SORC) behavioral model. Frequencies of responses within categories were tabulated and compared qualitatively.

RESULTS

Adherent women were more likely to report assertiveness, a lifelong commitment to reduced dietary fat, satisfaction with their lifestyle changes, and having applicable knowledge and skills. Nonadherent women reported more difficulty resisting negative emotions and prior food preferences and habits; they were also more concerned about negative responses from others.

CONCLUSIONS

Enhancing adherence of older women to a dietary fat reduction program will require shifting priorities away from conforming to social pressure and using high-fat foods for personal satisfaction and moving toward enhancing motivation and commitment to long-term health.

Temporal relationships of self-efficacy and social support as predictors of adherence in a 6-month strength-training program for older women

The present study investigated how self-efficacy and social support predicted adherence to a strength training program for elderly women over two time periods in the initial 6 mo. of the program. Participants were 30 elderly women volunteers aged 75 to 80 who completed measures of barrier self-efficacy and general social support at baseline and 3 mo. later. Social support from the program was also measured at 3 mo. Adherence to the program was measured by attendance. Hierarchical regression equations were utilized to identify the contributions of self-efficacy and social support for adherence at 0 to 3 mo. and 4 to 6 mo. For prediction of the first 3 mo. of adherence, both self-efficacy and social support contributed significant unique variance towards the total explained variance of 36%. For the 4- to 6-mo. period, self-efficacy explained significant (12%) variance in adherence even when controlling for the previous 3-mo. adherence. Inclusion of general social support and social support from the program, however, did not account for significant variance. Researchers must continue to examine self-efficacy and social support in exercise adherence within various time periods among older adults to develop effective intervention strategies.

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.