The Mediating Role of Self-Efficacy on Personal Coping Style and Exercise Behavioural Intentions in Cardiac Rehabilitation Patients

Abstract

PURPOSE: The purpose was to determine the influence of two levels of psycho-social factors on behavioural intentions (BI) to follow the prescribed exercise in cardiac rehabilitation (CR). Coping style (CS) and self-efficacy for overcoming barriers (BAR-SE) were assessed. CS is regarded as a stable person characteristic whereas self-efficacy is a manipulable variable related to behaviour. Stable person characteristics, such as CS, are thought to be difficult to change. Finding social-cognitive mediators of their effects is one way to develop targets for intervention that are, theoretically, regarded as more conducive to change. Self-efficacy, one's confidence in one's ability to perform behaviours required to produce an outcome (Bandura, 1986) is a manipulable variable. METHODS: A sample of 357 volunteer CR patients was recruited upon entry into a regional CR program. Each participant responded to a questionnaire assessing coping (CHIP, Endler et al., 1998), and self-efficacy for overcoming exercise barriers (BAR-SE) previously solicited from CR patients (Blanchard et al.). The CHIP assesses four forms of CS: instrumental, palliative, distraction, and emotional preoccupation, with each form believed to reflect declining functionality respectively. That is, instrumental coping is most likely to lead to functional outcomes, and emotional preoccupation least likely. RESULTS: Mediation of CS by BAR-SE was assessed according to the recommendations of Baron & Kenney (1986). BAR-SE predicted BI (β = .341, P < .001). Two of the four CS types predicted BI (instrumental, β = .223 P < .001; emotional β= −.121, P < .05). Two CS types predicted BAR-SE (instrumental, β = .211, P < .001; emotional β= −.255, P < .001). Finally, BAR-SE (β = .331, P < .001) mediated the influence of emotional CS (β= −.03) on BI, but instrumental CS remained significant (β = .152, P < .01). These results show the expected positive relationship of instrumental CS to BI and BAR-SE, and negative relationship of emotional preoccupation to BI and BAR-SE. They also show full mediation of the undesirable CS by BAR-SE. CONCLUSION: These results show that a social-cognitive variable effectively mediates the negative influence of a person-level variable: emotional preoccupation CS, on BI to follow the exercise prescription demanded in CR. BAR-SE, however, did not influence the relationship between a positive person-level variable: instrumental CS, and BI. These results are promising because they offer evidence of a possible positive synergy of these two levels of variables in producing positive BI. They also offer a viable target to offset the negative influence of a less functional personal characteristic.