Testing the health promotion model for adherence and quality of life in individuals with multiple sclerosis

The nature of multiple sclerosis (MS) presents challenges to health-promoting behaviors (e.g. adherence) and quality of life. The Health Promotion Model (HPM) proposes that these outcomes are explained by individual characteristics (i.e. biological, social, psychological) and behavior-specific cognitions (e.g. self-efficacy). The current study sought to test the HPM in explaining self-reported adherence and MS quality of life among 121 MS patients receiving care in an MS clinic in the southeastern United States. Hierarchical regression models partially supported the HPM for adherence (R² = .27) and more fully for quality of life (QoL) (R² = .64). Depression and stigma were among the variables most strongly related to both adherence and QoL; contrary to HPM theory, self-efficacy was not significantly related to adherence but was to QoL. Thus, the HPM may help to guide strategies used to improve QoL among individuals living with MS; however, the model may need further refinement to be used with adherence.     

Two alternative models of health behaviour and recovery from activity limitations due to acute injury: A prospective study

Cognitions influence recovery from activity limitations. In this study we aimed to independently test, compare and combine the common sense self-regulation model (CS-SRM) and social cognitive theory (SCT) in predicting recovery from activity limitations due to acute injury. Measures were gathered at two time points 5–6 weeks apart. The sample consisted of 146 university students (Mean age: 21.86, SD: 4.83, 62% female) with a heterogeneous range of injuries that limited their participation in physical activity. The dependent variable was recovery from activity limitations (Physical Functioning?–?Short Form-36). The predictor variables were measured using the Brief Illness Perception Questionnaire and SCT items designed according to theoretical recommendations. Time-line (TL) and self-efficacy (SE) were significant predictors of recovery in a multivariate analysis, controlling for reported pain at Time 1. A combined model including the best predictors from both models, TL (β = ?0.25, p < 0.05, R ² change = 0.17, p < 0.01) and SE (β =0.31, p < 0.05, R ² change = 0.05, p < 0.05), accounted for a significant amount of the variance in recovery from activity limitations. A combination of key variables from both models may be particularly useful for understanding the cognitive factors that influence recovery from activity limitations.     

Measuring the impact on relatives of caring for people with Alzheimer's disease: Quality of life,burden and well-being

Abstract

This study compared key correlates of caregiver stress in 50 Alzheimer's disease patients and their primary caregivers. in relation to three outcome measures - perceived burden, psychological well-being, and quality of life (QoL). These were evaluated using the Zarit Burden Interview. General Health Questionnaire (GHQ-30), and Schedule for the Evaluation of Individual QoL (SEIQoL-DW) respectively. Informal social support was evaluated on Vaux's Social Support Appraisal Scale. Patients' cognitive. functional, and behavioural status were rated on Mini-Mental State Examination, Blessed-Roth Dementia Scale. and Baumgarten Dementia Behaviour Disturbance Scale respectively. Standardised multiple regression analysis was used to compare the outcome measures. In this model burden was highly related to behaviour disturbance. and also to social support (adjusted R² = 0.45). Well-being was significantly related to behaviour disturbance, and also to functional status (adjusted R² = 0.40). With regard to QoL the model performed poorly as most of the variance in QoL was not accounted for by the model (adjusted R² = 0.14). These findings highlight differences in factors determining caregiver QoL. burden and well-being.     

Black and white adolescent males' perceptions of ideal body size

A stratified random sample of 496 white (n =337) and black (n =159) adolescent males participated in a survey of ideal body size beliefs. Responses to the questionnaire and a series of nine female and male body size drawings were analyzed using the General Linear Model Analysis of Variance and Categorical Modeling. Using SES and race as independent variables and BMI (kg/m ²)as a covariate, black males were found to prefer a significantly heavier ideal female body size than whites (p <.0001) and also perceived that their parents, female friends, and male friends would select as ideal a significantly heavier female body size than white subjects. Black subjects were 1.9 times (O.R. = 1.88, 95% C.I. = 1.44, 2.47) more likely to select a larger ideal female hip/buttocks size and 1.7 times (O.R. = 1.72, 95% C.I. = 1.25, 2.37) more likely to choose a larger ideal female thigh size than white subjects. Our findings seem to point toward a greater approval and social acceptance of a larger body size for black females by black males. This study was conducted by the University of South Carolina School of Public Health and funded in part by ASPH-CDC Cooperative Agreement, Center for Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, Georgia.     

Assessing Approximate Fit in Categorical Data Analysis

A family of Root Mean Square Error of Approximation (RMSEA) statistics is proposed for assessing the goodness of approximation in discrete multivariate analysis with applications to item response theory (IRT) models. The family includes RMSEAs to assess the approximation up to any level of association of the discrete variables. Two members of this family are RMSEA₂, which uses up to bivariate moments, and the full information RMSEA_n. The RMSEA₂ is estimated using the M₂ statistic of Maydeu-Olivares and Joe (2005, 2006), whereas for maximum likelihood estimation, RMSEA_n is estimated using Pearson's X² statistic. Using IRT models, we provide cutoff criteria of adequate, good, and excellent fit using the RMSEA₂. When the data are ordinal, we find a strong linear relationship between the RMSEA₂ and the Standardized Root Mean Squared Residual goodness-of-fit index. We are unable to offer cutoff criteria for the RMSEA_n as its population values decrease as the number of variables and categories increase.     

Repeated measurements analysis of variance when the correlations have a certain pattern

Consider a repeated measurements study in which a single observation is taken at each oft(t > 2) equally spaced time points for each ofn subjects. This paper uses a result of Box to find the appropriate multiplicative correction term for the degrees of freedom in the analysis of variance table for the case when there is equal variability per time point, and when the correlation between observationsu time units apart is equal to ^u . For large values oft, the multiplicative correction has a lower bound approximately equal to 2.5/(t – 1).Dr. Fleiss is also with the Biometrics Research Unit of the New York State Psychiatric Institute. This work was supported in part by grant DE 04068 from the National Institute of Dental Research.     

Statistical guidelines for studies of the theory of reasoned action and the theory of planned behaviour

Abstract

We identify potential problems in the statistical analysis of social cognition model data, with special emphasis on the theories of reasoned action (TRA) and planned behaviour (TPB). Some statistical guidelines are presented for empirical studies of the TRA and the TPB based upon multiple linear regression and structural equation modelling (SEM). If the model is tested using multiple regression, the assumptions of this technique must be considered and variables transformed if necessary. Adjusted R² (not R²) should be used as a measure of explained variance and semipartial correlations are useful in assessing each component's unique contribution to explained variance. R² is not an indicator of model adequacy and residuals should be examined. Expectancy-value variables that are the product of expectancy and value measures represent the interaction term in a multiple regression and should not be used. SEM approaches make explicit the assumptions of unidimensionality of constructs in the TRA/TPB, assumptions that might usefully be challenged by competing models with multidimensional constructs. Finally, statistical power and sample size should be considered for both approaches. Inattention to any of these aspects of analysis threatens the validity of TRA/TPB research.     

The association between religion and self-reported academic honesty among college students

Current research yields inconsistent findings about the association between religious variables and academic cheating among college students. In this study, we investigated possible reasons for this disagreement by examining whether, and to what extent, three particular religious variables: religious identity, affirmation of importance and religious services attendance, are associated with academic honesty among college students. Specifically, we utilised a sample of 2503 American college-aged students from Gallup^® daily tracking survey and used analysis of variance (ANOVA) to address the proposed research question. Research findings indicate that religious service attendance is positively associated with academic honesty among college students. Specifically, students who attend religious services more frequently are less likely to be engaged in academic misconduct than students who attend less frequently. This finding remains consistent when other important factors such as student attitudes toward cheating and gender were included in the analysis.     

Rational Emotive Behavior Therapy (REBT) in the New Millenium: A Cross-Cultural Approach

This paper reviews and discusses the results of five cross-cultural studies in Colombia, Costa Rica, El Salvador, Spain, and USA, using 2 (college students vs. their parents) × 2 (males vs. females) MANOVA match group designs with the Attitudes and Beliefs Inventory subscales as dependent variables, two multicultural studies investigating the relationship between some demographic variables (Pan American Health Organization's Index of Violence, and Acculturation) and people's Irrationality, and two multidisciplinary studies on the relationship between some medical conditions (skin diseases, and severity of symptoms during menopause) and Irrational Beliefs.     

Analysing multitrait–multimethod data with structural equation models for ordinal variables applying the WLSMV estimator: What sample size is needed for valid results?

Convergent and discriminant validity of psychological constructs can best be examined in the framework of multitrait–multimethod (MTMM) analysis. To gain information at the level of single items, MTMM models for categorical variables have to be applied. The CTC(M?1) model is presented as an example of an MTMM model for ordinal variables. Based on an empirical application of the CTC(M?1) model, a complex simulation study was conducted to examine the sample size requirements of the robust weighted least squares mean‐ and variance‐adjusted χ² test of model fit (WLSMV estimator) implemented in Mplus. In particular, the simulation study analysed the χ² approximation, the parameter estimation bias, the standard error bias, and the reliability of the WLSMV estimator depending on the varying number of items per trait–method unit (ranging from 2 to 8) and varying sample sizes (250, 500, 750, and 1000 observations). The results showed that the WLSMV estimator provided a good – albeit slightly liberal – χ² approximation and stable and reliable parameter estimates for models of reasonable complexity (2–4 items) and small sample sizes (at least 250 observations). When more complex models with 5 or more items were analysed, larger sample sizes of at least 500 observations were needed. The most complex model with 9 trait–method units and 8 items (72 observed variables) requires sample sizes of at least 1000 observations.     

Comments on “the measurement of factorial indeterminacy”

Guttman's index of indeterminacy (2² – 1) measures the potential amount of uncertainty in picking the right alternative interpretation for a factor. When alternative solutions for a factor are equally likely to be correct, then the squared multiple correlation ² for predicting the factor from the observed variables is the average correlation _AB between independently selected alternative solutionsA andB, while var ( _AB )=(1 – ²)²/s, wheres is the dimensionality of the space in which unpredicted components of alternative solutions are to be found. When alternative solutions for the factor are not equally likely to be chosen, ² is the lower bound for E( _AB ); however, E( _AB ) need not be a modal value in the distribution of _AB . Guttman's index and E( _AB ) measure different aspects of the same indeterminacy problem.     

Predicting Intention to Save Water: Theory of Planned Behavior,Response Efficacy,Vulnerability, and Perceived Efficiency of Alternative Solutions1

These 2 studies attempted to predict people's intention to save water. Study 1 used a model based on Ajzen's (1991) theory of planned behavior (TPB) and other variables: vulnerability, 2 collective efficacy variables, and subjective effectiveness of alternative solutions (SEAS) to ease drought impact. Study 2 tested a model similar to that of Study 1, but with 2 personal efficacy variables added. Respondents in both studies were residents of Taiwan (Ns= 166 and 210). Analysis indicated that the modified models (R²>.32) were better than the TPB model (R²<.19), and SEAS and response efficacy had crucial effects on people's intentions to retrofit. The studies also found some significant but inconsistent effects of income, dwelling, and education.     

Analgesia and other causes of amnesia that mimic post-traumatic amnesia (PTA): A cohort study

Objective. This study explores the possibility that a post-traumatic amnesia (PTA) like phenomenon is caused by the administration of drugs in hospital following injury and that this may be observed in patients who have not suffered a traumatic brain injury (TBI). This work also explored the possibility for an additional contribution to this phenomenon of demographic and psychological variables. Method. Sixty-three orthopaedic patients with no evidence of brain injury were recruited to a two-phase study. Medication records, demographic, and psychological data were obtained at the phase 1. At follow-up interviews (phase 2), psychological data (mood and post-traumatic stress disorder, PTSD) were again obtained and retrospective assessment of PTA using the Rivermead PTA protocol was carried out in 47 patients. Results. Thirty-eight per cent (N=18) of the total sample (N=47) reported a PTA-like phenomenon despite not having suffered TBI. A logistic regression model including the receipt of opioids, surgery, and anxiety-related variables, was significant in predicting this phenomenon (χ²=22.054, df=4, p≤.01) and accounted for up to 57.5% of variation in the data. Age, either alone or in interaction with opioid use, depression, and PTSD symptoms were not significant predictors. PTA-like phenomenon did not occur without at least one predictive factor. Conclusion. Receiving opioids, undergoing surgery, and suffering clinical levels of anxiety at an early stage following injury, can lead patients who have not suffered a TBI to report a PTA-like phenomenon at follow-up. This suggests that retrospective PTA assessment on actual brain injury patients may also be influenced by these factors.     

Predictors of university students’ willingness in the USA to use clergy as sources of skilled help

This exploratory study investigated U.S. university students’ perceptions (N = 186) and the predictor variables associated with their willingness to use clergy as a source of help. In the final regression analysis using the predicted variable of willingness to use clergy as a source of help (R = 0.816, R ²= 0.665, Adjusted R ²= 0.650), there were seven significant predictor variables: (a) trust of clergy, (b) empathic ability of clergy, (c) having previously sought help from clergy, (d) respondents’ dominant/minority cultural identification, (e) attendance at religious services at least once a year, (f) believing that spiritual counselling is as effective as psychotherapy, and (g) receiving religious/spiritual education as a child. An eighth variable was retained in the final regression model because of its proximity to significance (Friendships between clergy and people, p = 0.051). Accusations against clergy and the belief that clergy are held to a higher standard did not predict willingness to use clergy as a source of help. A general linear model (F = 125.696, df = 10, p < 0.001) revealed that those who self-identified with Protestant Christianity, Catholic/Orthodox Christianity, and Judaism were more likely to consider seeking help from clergy than those who self-identified with another religious tradition (Hinduism, Islam, or Buddhism), or adherence to spiritual not religious belief. Further, those who self-identified as Jewish or Christian were also more like to perceive clergy as trustworthy and empathic. Finally, African American/Caribbean Black respondents were more likely than either Latino/Latino American respondents or European American respondents to seek help from clergy, to perceive clergy as empathic, and to believe that spiritual counselling is as effective as psychotherapy (F = 1495, df = 12, p < 0.001).     

A mixed‐method approach to sense of coherence,health behaviors,self‐efficacy and optimism: Towards the operationalization of positive health attitudes

Posadzki, P., Stockl, A., Musonda, P. & Tsouroufli, M. (2010). A mixed‐method approach to sense of coherence, health behaviors, self‐efficacy and optimism: Towards the operationalization of positive health attitudes. Scandinavian Journal of Psychology, 51, 246–252. This study discusses the results of a cross‐sectional survey of healthy college students in Poland. More specifically, it describes, explores, and explains the relationships between psychological variables/models such as health behaviors (HB), sense of coherence (SOC), level of optimism (LOO), and self‐efficacy (SE) among college students. These separate constructs have also been used to operationalize a positive health attitude (PHA) as a novel construct. The social survey was carried out at three higher education institutions in Poland in January 2006. The random sample of 455 undergraduate students was taken from five different faculties: Physiotherapy, Physical Education, Tourism and Recreation, English Philology and Polish Philology. Four reliable and validated research tools were used to collect the data: Juczynsky’s Health Behaviour Inventory (HBI); Antonovsky’s Sense of Coherence Questionnaire (SOC‐29); Schwarzer & Jerusalem’s Generalized Self‐Efficacy Scale (GSES); and Seligman’s Scale (SS). The results indicate statistically significant differences (p < 0.001) between these four variables: for example, the healthier health behaviors the stronger the sense of coherence, level of optimism and self‐efficacy. It was also demonstrated that LOO, SOC, SE, and HB correlate with one another. Finally, these variables create an explicit empirical‐theoretical pattern. All the research results from REGWQ tests, Pearson’s correlation coefficient and cluster analysis suggest the existence of conceptual similarities between these four variables and/or the existence of some broader scientific construct such as PHA. However, this needs to be examined further. These results could be a good indicator for future research among different faculties or age groups.     

Self-Identity and the Theory of Planned Behavior: A Useful Addition or an Unhelpful Artifice?1

Among the variables proposed as useful additions to the structure of the theory of planned behavior (Ajzen, 1991), there is evidence for the predictive usefulness of a measure of self-identity. In the study reported here, members of the general population in the United Kingdom (n= 235) completed a questionnaire addressing the consumption of a diet low in animal fats. The questionnaire was structured in terms of the TPB and contained additional variables that previous research has indicated to be useful predictors of intentions and behavior. A multiple regression of intentions (R²= .80) showed self-identification as a health-conscious consumer to have a predictive effect independent of the effects of these other variables. This effect was also found in replication studies.     

The Influence of Sex,Gender, Self-Discrepancies,and Self-Awareness on Anger and Verbal Aggressiveness Among U.S. College Students

Abstract

Among a sample of 445 U.S. college students, the authors examined the extent to which individual differences (e.g., sex, gender, self-discrepancies, self-awareness) explained anger tendencies and verbal aggressiveness. Regression analyses showed that (a) the tendency to repress anger (anger-in) was explained by masculinity, desire to be masculine, and public self-awareness, R ² = .19, F(11, 433) = 8.44, p < .001; (b) the tendency to express anger (anger-out) was explained by sex, masculinity, and public self-awareness, R ² = .17, F(11, 433) = 7.38, p < .001; and (c) willingness to be verbally aggressive was explained by sex, femininity, and private self-awareness, R ² = .32, F(11, 433) = 16.94, p < .001. In addition, different types of individual difference variables accounted for anger tendencies and verbal aggressiveness across sex and gender categories, suggesting that anger and verbal aggressiveness may be driven by different psychological processes across types of participants.     

A randomised controlled trial of the Adult Resilience Program: A universal prevention program

A randomised, waitlist controlled, trial was conducted to evaluate the effects of the Adult Resilience Program (ARP), a universal prevention social–emotional programme for adolescents and adults, on self-reported depression, anxiety, stress, resilience, and self-esteem. Seventy-six students from a private university in Singapore were randomised to the ARP group or wait-list control (WLC) group and assessments were conducted at pre-intervention (T1), post-intervention (T2), and 6-month follow-up (T3). A 2 × 3 mixed between-within groups multivariate analysis of variance with the between-group factor of Group (ARP, WLC) and the within-group factor of time (T1, T2, and T3) and the dependent variables of depression, anxiety, stress, resilience and self-esteem, with age and stage of degree as covariates showed a significant decrease over time in depression (ηp² = .20), and anxiety (ηp² = .06). There was a significant decrease in stress for the ARP only from T1 to T2 (ηp² = .16). While there was a significant interaction of Time and Group for resilience (ηp² = .07), there was no significant change in resilience for the ARP group alone. The results provide preliminary support that the ARP can impart essential skills that can have a positive impact on mental health in university students.