Self- Efficacy and Heart Disease . Self- efficacy makes a difference in how people feel, think, and act. In terms of feeling, a low sense of self- efficacy for a particular situation is positively related to depression and anxiety. High self- efficacy for a specific situation allows one to deal better with uncertainty, distress, and conflict.
In terms of thinking, the strong sense of competence resulting from high self- efficacy facilitates enhanced cognitive processes and academic performance. Finally, in terms of action, self- related cognitions are a major ingredient of the motivation process. Self- efficacy levels can enhance or impede motivation. People with high self- efficacy in a particular domain of human functioning choose to perform more challenging tasks. They set higher goals and stick to them. Actions are preshaped in thought, and people anticipate either optimistic or pessimistic expected outcomes of a specific task in line with their level of self- efficacy. Once an action has been taken, high self- efficacious persons invest more effort and persist longer than those low in self- efficacy to accomplish a specific task.
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When setbacks occur, those with high self- efficacy recover more quickly and maintain commitment to their goals (Schwarzer, 1. Self- efficacy levels for specific cardiovascular health- related behaviors may be an important determinant of future cardiovascular health. Dietary self- efficacy, physical activity self- efficacy, and cessation of smoking self- efficacy are among the examples that will be discussed where self- efficacy for specific health- related behaviors likely plays a large role in future cardiovascular risk factor profiles.
The following sections will review the evidence supporting links between self- efficacy of specific cardiovascular health- related behaviors and specific well- established cardiovascular risk factors. Assessing the multiple dimensions of self- efficacy. Bandura (1. 98. 6) argued that self- efficacy expectations consist of three dimensions: magnitude, generality, and strength. Each of these dimensions implies different measurement procedures.
Magnitude refers to the ordering of tasks by difficulty level. Generality concerns the extent to which efficacy expectations about a specific situation can be generalized to other situations. Finally, strength refers to a judgment of how certain one is of being able to succeed at a particular task (Mudde et al., 1. There is no standard measurement for self- efficacy.
Self- efficacy, unlike dimensions of personality, must be considered in terms of a specific situation (Gerin et al., 1. Therefore, different measures are used to assess self- efficacy for each particular health- related behavior studied. In addition, a different measure is often used to assess each of the three dimensions of self- efficacy for a particular health- related behavior. Self- efficacy and Smoking Cessation.
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Cigarette smoking has been identified as a risk factor for cardiovascular disease. Furthermore, studies indicate that patients with coronary artery disease who stop smoking have a lower mortality from all causes of death and a less frequent occurrence of myocardial infarction in particular than those who continue to smoke (Vlieststra et al., 1.
Self- efficacy in the area of smoking cession has been thoroughly studied. Thus, this is an excellent first example of how self- efficacy has been shown to predict behavioral change for an important cardiovascular risk factor.
The consensus of these studies is as follows: pre- treatment self- efficacy was generally not predictive of smoking status after treatment. However, post- treatment self- efficacy of subjects who were abstinent after treatment was significantly higher than self- efficacy of those who were not successful. Post- treatment self- efficacy expectations were significant predictors for short- term maintenance of smoking cession (3- 6 months after treatment) (Pederson et al., 1. Haaga, 1. 98. 9; Coelho, 1.
Mc. Intyre et al., 1. This relationship held true even when post- treatment smoking status was controlled for and only subjects, who were abstinent after the treatment were included (Haaga and Stewart, 1. Bear and Lichtenstein, 1. Diclemente, 1. 98. For self- quitters the predictive power of self- efficacy may be even stronger. Gritz et al., 1. 99.
Mudde et al., 1. 99. A recent prospective study by Mudde et al., 1. Each measure represented different combinations of the three dimensions of self- efficacy. The perceived difficulty scale used (PDS- Strecher et al.,1. The perceived ability scale (PAS- Coletti et al., 1. PAM- Mudde et al., 1. Their results confirmed that perceived self- efficacy for smoking cessation predicts short and long- term smoking cessation.
Results also suggested that the PDS may predict short- term cessation, while the PAS may be a predictor of long- term abstinence. By means of factor analyses, various subscales were found in both of these scales. The negative/affective subscale of the PDS and the negative/moodstates subscale of the PAS appeared to be the most important elements of these two scales. However, it was the PAM measure that showed the greatest predictive power for post- follow- up abstinence from smoking.
Since all three measures included the dimension generality, a conclusion might be that magnitude is the dimension of greatest importance for the prediction of short- term cessation success, while strength may be the dimension that best determines long- term abstinence. Please see Mudde et al., 1. In summary, the predictive ability and consistency of self- efficacy evaluations for smoking behavior have been impressive. Few constructs in the social sciences can boast such a record. In almost every case, efficacy evaluations, particularly abstinence efficacy evaluations, have been the most significant, or among the only significant, predictors of smoking cessation treatment outcome that emerged from studies that included a wide range of other predictors (Di. Clemente, 1. 98. 6; Di.
Clemente et al., 1. Self- efficacy and Weight Loss. Being overweight is a significant risk factor for the development of hypertension and coronary heart disease (see the link for a review of obesity and cardiovascular health by clicking on “overweight” among the listed risk factors our web page: www. Weight control self- efficacy to perform behaviors that lead to weight loss has been examined in a number of ways. In fact, the assessment of self- efficacy varies greatly from study to study and is more diverse than in smoking cessation self- efficacy research.
Due to the great variety in assessment of the construct of weight control self- efficacy, it should be noted that it is difficult to summarize the findings and make generalizable conclusions. The closest thing to a standard assessment in the field of weight control self- efficacy is Glynn and Ruderman’s (1. Eating Self- Efficacy scale (ESES) (Di. Clemente et al., 1. There is a large amount of evidence suggesting that weight control self- efficacy plays an important role in weight loss. Chambliss and Murray (1. However, this effect was only apparent for those with an internal locus of control.
Much stronger evidence comes from numerous prospective studies investigating the predictive powers of weight control self- efficacy on weight control. Expectations that seem more like outcome expectancies than efficacy expectancies (i. Mitchell & Stuart, 1. Weinberger et al., 1. Blair et al., 1. 98.
Most studies that use efficacy to resist the urge to eat or refrain from overeating have found these efficacy evaluations to be predictive of weight loss during the active phase of treatment (Glynn & Ruderman, 1. Forster & Jeffrey, 1. In addition, posttreatment efficacy evaluations have been related positively to maintenance of weight loss (Patsis & Hart, 1. Rodin et al., 1. 98. Di. Clemente et al., 1. Despite all the difficulties and differences in the assessment of self- efficacy related to eating behavior in weight control, the role that self- efficacy appears to play is quite similar to that in smoking cessation, where the assessments have been a bit more uniform. Efficacy evaluations appear to be useful and unique predictors of weight loss.
Few constructs predict weight loss and maintenance of that loss in as consistent a fashion as self- efficacy focused on overeating behaviors (Di. Clemente et al., 1. Self- Efficacy and Low- Fat Diet“There is substantial evidence that reducing saturated fat in the diet decreases the risk of coronary heart disease (CHD) in populations (Kromhout and Lezenne- Coulander, 1. Kushi et al., 1. 98.
Keys et al., 1. 98. Efforts to alter dietary habits through various programs have met with limited effectiveness (Advisory Board – IHHC, 1. One reason for the limited success is the failure to fully understand the cognitive mediators of dietary change (Plotnikoff and Higginbotham, 1. One recent study by Plotnikoff and Higginbotham (1. Future research is needed focusing specifically on dietary self- efficacy to determine whether substantial saturated fat reductions can be obtained by treatment programs developed to increase dietary self- efficacy. Self- efficacy and Recovery from Heart Attack.
Ewart and colleagues have studied the relationship between physical activity self- efficacy and recovery from heart attack. According to Ewart, 1. Self- efficacy theory has improved their ability to identify and alleviate these inappropriate fears. Research reviewed by Ewart(1.
Furthermore, evidence is reviewed that self- efficacy predicts physical over- exertion and has called for the development of scales of self- efficacy to identify individuals who may be at risk of dangerous overexertion due to unrealistically optimistic appraisals of their physical capabilities (Ewart, 1. Self- efficacy and Physical Activity. Of course, physical activity is not only important to recovery from heart attack. Physical activity appears to decrease the risk of coronary artery disease.
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