Changes In Self-efficacy Scores Research Articles

Learning Mathematics from Examples and by Doing: Enhancing Learning Engagement and Self-efficacy

Purpose: Numerous empirical studies have confirmed that learning from examples and by doing (LFED) can improve learning efficiency; however, its impact on learning motivation is still unclear. Therefore, this study investigated the effects of LFED on students' mathematics learning performance, academic engagement and academic self-efficacy to explore its effect on Learning motivation. Methods: In a cluster randomized controlled trial, 119 seventh-grade students were randomly assigned to either a four-month LFED group (n=59) or a conventional group (n=60). The interventional group was taught by the LFED method, and the other received a traditional teaching method. Both groups were assessed before and after the intervention to measure academic performance in mathematics, learning engagement, and academic self-efficacy. Results: Repeated-measures ANOVA showed a significant group-by-time effect for academic self-efficacy and learning behavior dimension scores; there were no significant group-by-time effects for math academic performance, learning engagement scores, and related dimension scores. Paired-sample t-tests showed no significant change in self-efficacy scores in the LFED group but a significant decrease in self-efficacy and all related dimensions scores in the conventional group. There was no change in cognitive engagement dimension scores in the LFED group but a substantial decrease in the conventional group. Conclusion: As an adaptive learning method originating from artificial intelligence, LFED had an equal impact on math academic performance as traditional teaching methods. However, LFED was feasible and effective in enhancing students’ academic self-efficacy and cognitive learning engagement.

A Technological Approach to Improved Breastfeeding Rates and Self-Efficacy: A Randomized Controlled Pilot Study.

Breastfeeding confers significant maternal and infant benefits; however, breastfeeding rates remain suboptimal in the United States. A parent's decision to breastfeed is influenced by non-modifiable and modifiable factors, including breastfeeding knowledge and self-efficacy. There is a positive correlation between high maternal self-efficacy and breastfeeding duration. Parents increasingly rely on technology for health information. To determine if a smartphone application affected maternal self-efficacy and breastfeeding exclusivity rates. This study was a randomized, controlled pilot study examining the effect of an educational program, included in a smartphone application, on breastfeeding self-efficacy (assessed in postpartum Week 1 and Weeks 4-6) and breastfeeding rates (assessed in postpartum Weeks 4-6). Forty participants were recruited using block randomization to intervention (17 of 20 completed the study) and usual care (19 of 20 completed the study) groups. To examine the pre-test/post-test difference in the Breastfeeding Self-Efficacy Scale - Short Form total scores, a change in score (post-intervention minus pre-intervention) was calculated for each parent. The intervention group (phone application and usual care) showed greater change in self-efficacy scores (M = 7.6, SD = 7.8) compared to the control group (usual care; M = 1.2, SD = 3.7, p = .001). The rate of exclusive breastfeeding was nearly twice as high in the intervention group as in the control group, but did not reach statistical significance (p = .093). The investigators found enhanced breastfeeding self-efficacy and breastfeeding rates among postpartum women receiving a smartphone educational program in the first 6 weeks postpartum. Further studies on smartphone interventions will develop our understanding of this technology in improving breastfeeding rates.

Effect of family-centered interventions on self-efficacy of family of patients with low consciousness admitted the intensive care units : A randomized controlled trial

Introduction: Families of patients with low consciousness have an important role in supporting them and should acquire the necessary capability for patient care. Objective: This study aimed to examine the effect of family-centered interventions on the self-efficacy of the families of patients admitted to the intensive care units. Materials and Methods: This research was a randomized clinical trial with a pretest-posttest design conducted in intensive care units of hospitals in Khorram abad City, Iran, in 2019-2020. Seventy family members of patients were selected by convenience sampling and were assigned to the intervention (n=28) and control (n=28) groups by stratified random blocks. The study data were collected through the self-efficacy questionnaire and Hospital Anxiety and Depression Scale. The intervention was carried out using a family-centered model. The collected data were analyzed using the statistical tests of the Chi-square, independent t-test, and paired t-test. Also, the generalized linear model was used to compare changes in self-efficacy scores of the two study groups after adjusting demographic, anxiety, and depression variables. Results: Data analysis showed that most samples were male (53.8%) with a mean age of 38.15±8.68 years. The results showed a significant difference in the mean scores of self-efficacy, anxiety, and depression between the intervention and control groups (P=0.001). The intervention significantly increased the Mean±SD of caregivers’ self-efficacy (40.14±14.35, P=0.001) in the intervention group. The results showed that the self-efficacy mean score of the intervention group was 36 scores higher than the caregivers’ self-efficacy of the control group (95% CI; 20.6-51.4, P=0.028). Conclusion: The participation of family members of patients with low consciousness in the care of the patients in the intensive care unit has an effective role in the self-efficacy of caregivers of these patients.

Effectiveness of combined modulated ultrasound and electric current stimulation to treat diabetic foot ulcers.

The use of combined ultrasound and electrostimulation (CUSECS) as an adjunct therapy for diabetic foot ulcers (DFUs) is a relatively new concept. This study aimed to investigate if combined ultrasound and electrostimulation is an effective adjunctive treatment for hard-to-heal DFUs when compared with standard wound care. A randomised controlled pilot study design was used. Patients with hard-to-heal DFUs from two centres were sequentially randomised. For 8 weeks, the experimental group received CUSECS and standard wound care treatment twice a week. The control group received standard wound care treatment once a week. Wound changes were documented using photography, which also facilitated wound size measurement. Self-efficacy, economic cost, quality of life and reoccurrence rates were analysed as secondary objectives. The experimental group (n=6) achieved a higher rate of mean wound healing (mean difference (MD): 0.49) when compared to the control group (n=5, MD: 0.01). Two participants completed full healing in the experimental group and one in the control group. There were no statistically significant findings because of the small sample size. There were no direct adverse reactions to this therapy. Quality of life scores improved in the treatment group. There was no significant change in self-efficacy scores. Costs were higher in the experimental group; however, the healing rate was quicker, which could be extrapolated to cost reductions over time. Results suggest that CUSECS may be a useful adjunctive therapy for treatment of hard-to-heal DFUs. Further large-scale studies are needed to ascertain the effectiveness of CUSECS. The findings here are inconclusive but indicate that CUSECS may offer promise as a treatment.

Using Standardized Patients to Augment Communication Skills and Self-Efficacy in Caring for Transgender Youth.

To examine the impact of standardized patient encounters (SPEs) on gender-affirming communication skills and self-efficacy of pediatrics learners. Fourth-year medical students, pediatrics interns, psychiatry interns, and nurse practitioner trainees on 1-month adolescent medicine blocks completed a curriculum with e-learning activities that was expanded to include SPEs. Following e-learning, learners completed 2 SPEs featuring transgender adolescent cases. Faculty observers and standardized patients completed checklists focused on history-taking, counseling, and interpersonal communication, and provided learner feedback after each case. The curriculum was evaluated by comparing skills checklists scores from case 1 to case 2 via Wilcoxon signed-rank tests. Self-efficacy was assessed precurriculum (Assessment 1), post-e-learning (Assessment 2), and post-SPE (Assessment 3) using a previously developed instrument. Changes in self-efficacy scores were assessed via linear regression models with generalized estimating equations. Forty-three eligible learners participated in the study. The majority were pediatrics interns, and 5 learners had worked in a transgender clinic prior to the curriculum participation. Learners increased median total checklist scores between cases from 22 to 28 (P < .001) (maximum score of 34). Learners' overall self-efficacy scores improved by 3.4 (confidence interval [CI]: 2.9-3.9; P < .001) between Assessments 1 and 2 and by 1.5 (CI: 1.2-1.7; P < .001) from Assessment 2 to 3. Similar improvements in checklist scores and self-efficacy occurred within stratified learner types. The combination of SPEs with e-learning is effective at improving self-efficacy and gender-affirming communication skills for a multidisciplinary pediatrics learners. The comprehensive curriculum allowed learners inexperienced with transgender youth to apply knowledge and practice skills.

Effect of Empowerment Program with and without Telenursing on Self-efficacy and Glycosylated Hemoglobin Index of Patients with Type-2 Diabetes: A Randomized Clinical Trial.

Introduction: Developing new training methods for improving the health of diabetic patients has always been a concern for nurses. The present study aims to investigate the effects of empowerment-based interventions with or without telenursing on self-efficacy and HbA1c level in diabetic patients.Methods: In this randomized clinical trial, 156 patients with type-2 diabetes were randomly assigned into two intervention groups (empowerment with/without telenursing) and one control group. All subjects in the intervention groups participated in two sessions of the empowerment program. However, only the group of empowerment with telenursing received telephone counseling for 12 weeks. The patients in the control group did not receive any intervention programs. Self-efficacy was measured by diabetes-specific self-efficacy scale. The HbA1c level was measured using Bionic kit. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, Ill., USA).Results: After 14 weeks, while the changes in self-efficacy scores of the control group were not statistically significant, they were significant in the two intervention groups. Comparison of the two intervention groups showed that self-efficacy was higher in the group of empowerment with telenursing. It was only in the empowerment with telenursing group that the reduction of HbA1 c was significant.Conclusion: Training based on empowerment models and emphasis on the strengths of clients in solving their own problems can play a major role in increasing self-efficacy and reduction of HbA1c level. In addition, a continuous training program, along with telephone follow-ups can result in higher self-efficacy and lower HbA1c level.

1124. Increasing Student Confidence in Antimicrobial Prescribing with a Novel Teaching Framework

BackgroundPhysicians frequently prescribe antimicrobials inappropriately, increasing rates of resistance and adverse effects. Difficulty with antimicrobial reasoning likely begins during medical school, where many students learn infectious diseases by memorization. Past work has shown that learners benefit from tools such as schema and checklists. We report our experience using an antimicrobial reasoning teaching tool in a pilot medical student workshop.Figure 1: Antimicrobial Selection Tool Figure 2: Usefulness of Session and Tool MethodsWe converted a published antimicrobial reasoning framework into a teaching tool (Fig 1). Students enrolled in the 2020 Internal Medicine Residency Preparation Course participated in one of two identical hour-long antimicrobial reasoning workshops. We started with an interactive didactic introducing the tool. Students used the tool to work through a clinical vignette in small groups, followed by a facilitated discussion. Students filled out pre- and post-surveys assessing their identification of factors impacting antimicrobial selection, and their self-efficacy regarding antimicrobial selection. The number of factors identified was analyzed using a t-test, while the change in self-efficacy scores was analyzed using a paired t-test. Students also rated the utility of the session.Results87% of students (52/60) completed surveys. Prior to the session, only 59% (n=29) of students felt prepared to prescribe antimicrobials and the majority of students (59%, n=30) felt less confident managing infections than other conditions. After the session, there was a significant increase in students’ perception of their preparation to prescribe antimicrobials (t=2.08, p=0.04) and ability to identify factors important to antimicrobial selection (t=2.13, p=0.036). The majority of students found both the session and tool to be useful for future practice (Fig 2).ConclusionAt baseline, medical students feel unprepared to prescribe antimicrobials and are less confident managing infections than other conditions. This workshop assessed the feasibility of using an antimicrobial reasoning tool to teach students. Despite its brevity, students felt more prepared to prescribe antimicrobials after the session and rated it as useful for future practice. They felt a simpler tool and longer session would improve future efforts.Disclosures All Authors: No reported disclosures

TELEMONITORING MULTIDISCIPLINARY PROFESSIONAL GROUPS IMPROVES THEIR SELF-EFFICACY IN THE CARE OF MINERS

SESSION TITLE: Occupational and Environmental Lung Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Given the re-emergence of pneumoconiosis in the U.S., there is a tremendous need to train rural professionals in its multidisciplinary management. The Miners’ Wellness TeleECHO (Extension for Community Health Outcomes) Program in New Mexico, U.S., provides longitudinal multidisciplinary telementoring to professionals taking care of miners. The impact of this approach on the self-efficacy of participants has not been previously evaluated. METHODS: This is a 12-month longitudinal study involving clinical and non-clinical professionals caring for miners. The study outcome was the change in self-efficacy scores, using a customized instrument of 14 measures, grouped into three domains: clinical, medicolegal and soft skills. The primary outcome utilized a retrospective pre–post design that collects “pretest” data at the post-intervention timeframe. RESULTS: Subjects reported significant improvements in nine of 14 items (p<0.05) and a significant decline in one of 14 items (with respect to their ability to interpret pulmonary function test results, p<0.001) since their start dates in the program. Subjects also reported significant improvement with respect to their scores for all three domains and for the 14-item total score (p≤0.01). Existing participants and clinical professional groups demonstrated greater improvement in selected items than fresh participants and non-clinical professional groups respectively. CONCLUSIONS: This study is the first in a stepwise approach to determine the benefit of participating in a multidisciplinary telementoring intervention by improving participant self-efficacy in caring for miners with complex mining-related diseases. Our study finding represents a potential solution to a growing access to care gap for miners with pneumoconiosis. CLINICAL IMPLICATIONS: Although future studies will determine whether improved participant self-efficacy correlates with improvement in patient outcomes, our study finding represents a potential solution to a growing access to care gap for miners with pneumoconiosis. This provides the rationale for utilizing systems that are already in place for rapid scaling of the Miners’ Wellness TeleECHO Program at other institutions nationally and globally. DISCLOSURES: no disclosure on file for Nour Assad; No relevant relationships by Ramni Khattar, source=Web Response No relevant relationships by Kyla LeSuer, source=Web Response No relevant relationships by Orrin Myers, source=Web Response No relevant relationships by Brian Soller, source=Admin input No relevant relationships by Akshay Sood, source=Web Response

Effectiveness of a HealthMessages Peer-to-Peer Program for People With Intellectual and Developmental Disabilities.

Effective strategies to improve health education, food choices, and physical activity are vital for people with intellectual and developmental disabilities (IDD), as their sedentary lifestyles and high fat diets are contributing to poor health, such as cardiovascular disease, osteoporosis, hypertension, Type II diabetes, and obesity. This study examined the effectiveness of a peer-led health promotion program for people with IDD. One group pre/post-test design was used to test the feasibility and effectiveness of the 12-week HealthMessages Program for three groups: peer health coaches (PHCs), mentors, and peer participants. A total of 379 volunteers participated including PHCs people with IDD (n = 33), mentors-staff from community organizations (n = 35), and peer participants-peers with IDD (n = 311). Following the intervention and 12-week HealthMessages Program, PHCs had significant changes in physical activity and hydration knowledge, mentors had significant changes in self-efficacy scores, and peer participants had significant changes in physical activity and hydration knowledge, social supports, and total health behaviors. A dyad approach supported PHCs and mentors to implement a successful HealthMessages Program with their peers.

Effect of TELEmedicine for Inflammatory Bowel Disease on Patient Activation and Self-Efficacy.

Limitations in inflammatory bowel disease (IBD) care necessitate greater patient activation and self-efficacy, measures associated with positive health outcomes. We assessed change in patient activation and general self-efficacy from baseline to 12months through our TELEmedicine for IBD trial, a multicenter, randomized controlled trial consisting of a web-based monitoring system that interacts with participants via text messaging. A total of 222 adults with IBD who had experienced an IBD flare within 2years prior to the trial were randomized into either a control arm that received standard care (SC) or an intervention arm that completed self-testing through the TELE-IBD system every other week (EOW) or weekly (W). Changes in self-efficacy scores were not significantly different between control and experimental groups. Patient activation scores were significantly different between standard care and the TELE-IBD EOW group only (p = 0.03). Use of remote monitoring did not improve self-efficacy or patient activation compared to routine care.

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention.

BackgroundMany patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors.MethodsQuality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008–2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID.Results40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07–0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15).Conclusions and relevanceThis historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further.

Prospective, randomised controlled trial to evaluate the effect of smart glasses on vestibular examination skills

This proof-of-concept trial explored whether using Google Glass to augment instruction of vestibular assessment and treatment skills increased student competence. In 2015, 103 physiotherapy students with no prior vestibular examination...

The Predictive Validity of the Return-to-Work Self-Efficacy Scale for Return-to-Work Outcomes in Claimants with Musculoskeletal Disorders.

Purpose To examine the predictive validity of the Return-to-Work Self-Efficacy (RTWSE) Scale in terms of the scale’s baseline absolute values and of changes in self-efficacy scores, with the outcome of return-to-work (RTW) status in a sample of injured workers with upper extremity and back musculoskeletal disorders. Methods RTWSE was measured with a 10-item scale assessing Overall RTWSE and three self-efficacy subdomains: (1) ability to cope with pain, (2) ability to obtain help from supervisor and (3) ability to obtain help from co-workers. Outcome measures included RTW status (yes/no) measured at 6- and 12-month follow-up. RTWSE improvement was defined as an increase in self-efficacy scores between baseline and 6-month follow-up time points. Logistic regression analyses were performed with RTW status as the dependent variable and adjusted for age, gender, educational level, personal income, pain site, pain severity, functional status, and depressive symptoms, and for baseline RTWSE scores in the improvement score analyses. Results A total of 632 claimants completed the baseline telephone interview 1 month post-injury; 446 subjects completed the 6-month interview (71 %) and 383 subjects completed the 12-month interview (61 %). The baseline Pain RTWSE scores were found to be useful to predict RTW status 6 months post-injury, with a trend for baseline Overall RTWSE. Improvements over time in Overall RTWSE and in Co-worker RTWSE were found to be useful to predict 12-month RTW status, with trends for improvements in Supervisor RTWSE and Pain RTWSE. Conclusion The study found evidence supporting the predictive validity of the RTWSE scale within 12 months after injury. The RTWSE scale may be a potentially valuable scale in research and in managing work disabled claimants with musculoskeletal disorders.

A Randomized, Controlled Trial of Yoga in Pediatric Inflammatory Bowel Disease: Preliminary Findings

Introduction: Twenty-five percent of inflammatory bowel disease (IBD) is diagnosed in pediatrics with peak onset in the pre-adolescent years during a time of great psychosocial growth. IBD adds stressors of a chronic disease with unpredictable symptoms. Health-related quality of Life (HRQOL) may be impaired by pain, school absences, and the chronic nature of IBD. Yoga may be well-suited as an adjunct to conventional IBD therapy to decrease stress and improve HRQOL. There have not been any studies to date looking at the role of yoga in IBD. The aim of this study is to determine if a structured yoga program, in addition to standard medical therapy, improves HRQOL and self-efficacy in pediatric patients recently diagnosed with IBD. Methods: Newly diagnosed patients 11-17 years old were randomized to either the yoga program or a waitlist control group. At 3 months from diagnosis, the study group participated in 12 weeks of yoga in addition to standard medical therapy. The control group continued to receive standard medical therapy and at 6 months from diagnosis was offered yoga participation. At 3 and 6 months from diagnosis, questionnaires were completed by both groups to measure HRQOL (PedsQL total score) and self-efficacy. Patients were required to complete at least 9 of 12 yoga classes. Demographic and disease-specific data included age, gender and disease type (Crohn’s disease, ulcerative colitis). Descriptive statistics were performed for the study sample. Continuous variables were summarized using average and standard deviation and proportions were used for categorical variables. Total PedsQL and self-efficacy scores were compared in the control group and yoga group using the Mann-Whitney U test. Positive differences in scores indicated improvement. Results: A total of 12 patients were included: 6 in the yoga and 6 in the control group. Average age was 13 years (SD1.6), with 67% females, and 67% had Crohn’s disease. Overall median change was 25 for HRQOL and 1.5 for self-efficacy scores. Median change in total PEDSQL scores was 100.0 in the yoga group vs. only 12.5 in the wait list group; despite the trend, this difference was not statistically significant (p=0.52). The change in self-efficacy scores in the 2 groups also was not significantly different between groups (2.5 for yoga vs. 1.5 for wait list; p=0.37). Conclusion: A formal yoga program in newly diagnosed pediatric patients with IBD showed trends toward improvement in HRQOL and self-efficacy, although not reaching statistical significance. Further study with a larger sample size will investigate if disease activity scores will change after yoga participation and determine if yoga will improve quality of life in this population. Disclosure - Madelana Ferrara and Madeline Marchell are paid to to teach the study subjects yoga.

The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients

BackgroundPersonal health records (PHRs) provide patients with access to personal health information (PHI) and targeted education. The use of PHRs has the potential to improve a wide range of outcomes, including empowering patients to be more active participants in their care. There are a number of widespread barriers to adoption, including privacy and security considerations. In addition, there are clinical concerns that patients could become anxious or distressed when accessing complex medical information. This study assesses the implementation of a PHR, and its impact on anxiety levels and perceptions of self-efficacy in a sample of breast cancer patients.MethodsA quasi-experimental pre-test/post-test design was used to collect data from participants to evaluate the use of the PHR. Study participants completed background and pre-assessment questionnaires and were then registered into the portal. By entering an activation key, participants were then able to review their lab results and diagnostic imaging reports. After six weeks, participants completed post-assessment questionnaires and usability heuristics. All data were collected using an online survey tool. Data were cleaned and analyzed using SAS v9.1.ResultsA total of 311 breast cancer patients completed demographic and pre-assessment questionnaires, 250 registered to use the online intervention, and 125 participants completed all required study elements. Matching the pre- and post-anxiety scores demonstrated a decrease in mean anxiety scores (-2.2, p = 0.03); the chemotherapy sub-group had a statistically insignificant mean increase (1.8, p = .14). There was no mean change in self-efficacy scores.ConclusionsParticipants generally found the portal easy to use; however, the perceived value of improved participation was not detected in the self-efficacy scores. Having access to personal health information did not increase anxiety levels. While these results suggest that the use of this PHR may be of benefit for informing patients, further research is required to investigate the impact on the patients experiences, their participation in their care, their relationships with the health care team, and their health outcomes.

Project Shake-It-Up: Using health promotion, capacity building and a disability studies framework to increase self efficacy

Purpose. Project Shake-It-Up provided a health promotion and capacity building program for individuals with spinal cord injury, multiple sclerosis, and related neurological impairments. Major research aims were to evaluate changes in participants' self-efficacy, ability to set/achieve goals, and perceived independent-living status.Methods. Participants completed self-efficacy measures at baseline, program completion, 6- and 12-month follow-up, and set health and/or independent living goals. Progress toward goal attainment was monitored periodically and assessed qualitatively.Results. There was a statistically significant difference in the change in self-efficacy scores for intervention participants compared to non-participants. Participants gained independent-living skills and confidence in their abilities to set and achieve a variety of goals, in the areas of education, employment, housing, transportation, accessing community resources and activities, participation in sports and leisure, and health promotion.Conclusions. Researchers evaluated results using a disability studies framework of empowerment which recognizes the role of environment, gender, race/ethnicity, and social status in the experience of disability. Participants reported increased independence, community access, and participation. They took action in multiple arenas with changes observed and reported in areas of intrapersonal, interpersonal, and behavioral functioning that indicated greater personal empowerment.

Self-Efficacy in Mastery Learning to Apply a Therapeutic Psychomotor Skill

This study assessed changes in Self-efficacy scores produced by each of the four steps of instruction used to teach students a therapeutic psychomotor skill used by osteopathic physicians. Volunteering subjects were an entire class of 83 first-year osteopathic medical students (40 men, 43 women, M age = 25.1 yr.). Self-reported Self-efficacy to perform the skill was sampled: (1) after an instructor's demonstration of the skill during a laboratory session, (2) after paired students practiced during the laboratory session, (3) after independent self-paced practice outside class using an instructional handout and videotape, and (4) after receiving individualized feedback on skill performance from an instructor acting as the "patient." The first two steps, representing typical skill instruction, produced mean Self-efficacy scores of 18% and 30%, respectively. On the last two steps, added to implement mastery learning, mean Self-efficacy scores increased to 75% and 85%, respectively. The instructors confirmed that all students mastered performance of the skill. Mastery learning was effective in developing both the therapeutic skill and high Self-efficacy to utilize the skill.

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. J Am Diet Assoc. 2001;101:1006-1011.

Self-efficacy and in-patient cardiac rehabilitation

Self-efficacy reflects an individual's perceptions or beliefs about how capable he or she is of performing a specific activity or task and measures self-confidence to perform that specific activity or task. This study investigated the effect of in-patient cardiac rehabilitation on self-efficacy scores for 3 categories of activities: routine physical activities, daily living tasks and levels of concentration and ability to cope. On discharge from the intensive or coronary care unit, patients without contraindications to early ambulation were randomized to either a ward ambulation program (n = 26) or a dedicated exercise center program (n = 25) with all patients receiving the same standardized education/counseling. There were no differences between the groups in self-efficacy at baseline, at hospital discharge or 7 days later. Significant improvements in self-efficacy scores were observed by day 28 in both groups for routine physical activities and daily living tasks with no change in self-efficacy scores for concentration or ability to cope. At that time the exercise center patients had higher self-efficacy scores for walking time (p = 0.041) and overall exertion (p = 0.024) than the ward ambulation patients. For the majority of the self-efficacy variables considered, both in-patient exercise rehabilitation programs were equally effective in improving self-efficacy scores for physical activities and daily living tasks over the first 28 days after return to home. The lower cost associated with ward ambulation programs suggests that they are more cost-effective than developing a program in a dedicated in-patient exercise center.