A Dyadic Investigation of Exercise Support Between Cardiac Patients and Their Spouses.

The authors examined married partners' similarity in reported exercise behavior as a moderator of the association between social support for exercise provided and received by extending an actor-partner dyadic effects model. Participants were married cardiac rehabilitation patients and their spouses (N=99 couples). For couples similar in their reported exercise behavior, a significant association was found between both partners' independent reports of providing exercise support to and receiving exercise support from one another (n=49 couples). However, for couples differing in their reported exercise behavior (n=50 couples), no association was found between either partner's provision and receipt of support for exercise. Findings have the potential to inform practitioners of patients who may not be receiving adequate social support for their recommended exercise. Future interventions may consider implementing dyadic educational or motivational strategies with patients and their spouses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process and Outcome in Cardiac Rehabilitation: An Examination of Cross-Lagged Effects.

Cardiac rehabilitation patients improve cardiorespiratory fitness and quality of life, yet therapeutic processes that produce these changes remain unknown. A cross-lagged panel design was used to determine whether early-treatment enhancement of self-efficacy regarding abilities to change diet and exercise habits and the quality of the patient-staff working alliance predicted late-treatment changes in a wide range of outcomes, but not vice versa. Eighty cardiac patients participating in a 12-week program completed measures at early, mid- and late treatment. Early-treatment changes in exercise self-efficacy predicted late-treatment changes in activity level, depression, and working alliance, but not vice versa. Diet self-efficacy changes correlated with concurrent changes in fat intake and body weight. Early-treatment changes in cardiorespiratory fitness and activity level predicted late-treatment changes in working alliance, but not vice versa. Findings suggest that increased exercise self-efficacy represents an important therapeutic mechanism by which rehabilitation gains are realized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of proxy efficacy and reliance to home-based physical activity after cardiac rehabilitation.

Objective: To examine cardiac rehabilitation program (CRP) participants' beliefs about their interventionists (proxy efficacy and reliance), self-efficacy, and exercise behavior during transition to home-based exercise. Participants and Design: Participants were 44 (16 women and 28 men) CRP outpatients (Mage = 59.43 ± 13.53 years). The design was prospective, with proxy efficacy and reliance as well as self-efficacy being used to predict two outcomes: self-regulatory self-efficacy and home-based exercise. Results: After self-regulatory efficacy reported earlier in the program was controlled for, proxy reliance predicted later program self-regulatory efficacy for home-based exercise (adjusted R2 = .10, p = .02). Proxy efficacy for self-regulation predicted home-based exercise frequency (adjusted R2 = .18, p = .01). Greater proxy efficacy for self-regulation was associated with higher exercise frequency. Conclusion: CRP participants' beliefs in the capabilities of their exercise consultants to help them develop self-regulatory skills play a role in how much exercise they do after supervised rehabilitation. Yet, individuals who strongly rely on their interventionists to assist them in exercising report weaker self-efficacy for exercising on their own. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Mediating Role of Self-Efficacy in the Development of Entrepreneurial Intentions.

The purpose of this study was to investigate the mediating role of self-efficacy in the development of students' intentions to become entrepreneurs. The authors used structural equation modeling with a sample of 265 master of business administration students across 5 universities to test their hypotheses. The results showed that the effects of perceived learning from entrepreneurship-related courses, previous entrepreneurial experience, and risk propensity on entrepreneurial intentions were fully mediated by entrepreneurial self-efficacy. Contrary to expectations, gender was not mediated by self-efficacy but had a direct effect such that women reported lower entrepreneurial career intentions. The authors discuss practical implications and directions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responsiveness of Health-Related Quality of Life Outcome Measures in Cardiac Rehabilitation: Comparison of Cardiac Rehabilitation Outcome Measures.

Assessment instruments that are not responsive to change are unsuitable as outcome tools in cardiac rehabilitation because they underestimate the psychosocial benefits of program attendance. Nine questionnaires were assessed for responsiveness with the standardized response mean (SRM). Questionnaires were allocated into 3 batteries, and each battery was completed by cardiac rehabilitation and comparison participants at 2 time points (411 and 375 participants in total, respectively). There was a high degree of variability in the responsiveness of instrument subscales. The positive affect subscale of the Global Mood Scale (J. Denollet, 1993a) was the most responsive (SRM = 0.62). Further information on the comparative responsiveness of psychosocial scales is important to optimize instrument selection for outcome studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiple Dimensions of Organizational Identification and Commitment as Predictors of Turnover Intentions and Psychological Well-Being.

Although it is recognized that identification and commitment are closely related aspects of employees' psychological attachment to the organization, there has been no analysis of the overlap between multiple dimensions of each construct. In this study, three-component models of organizational identification and commitment were investigated as predictors of turnover intentions and psychological well-being (self-esteem, satisfaction with life, and self-efficacy) among employees (N = 60) of a small organization. Highly identified employees tended to be committed ones, but different dimensions of each construct were specifically linked to various criteria. Affective components of both identification and commitment were negatively associated with turnover intentions, and positive in-group affect (i.e., feelings derived from being a member of the organization) predicted perceptions of self-efficacy. Continuance commitment was distinct from the other predictors, and was negatively related to self-esteem and self-efficacy. The results warrant further efforts to integrate the perspectives of social identity theory and organizational psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common and specific process factors in cardiac rehabilitation: Independent and interactive effects of the working alliance and self-efficacy.

Objective: Therapeutic processes in cardiac rehabilitation programs are virtually unexamined. Models were tested by which changes in the working alliance between patient and staff (agreement on goals/tasks; emotional bond) may affect outcomes in conjunction with changes in patient self-efficacy to change their diets and increase exercise. Design: Cardiac patients (n = 79) participated in a 12-week program, and completed assessments at early, mid, and late treatment. Main Outcome Measures: Changes in cardiac depression, physical health, perceived exertion during exercise, rate/pressure product at submaximal exercise tolerance, weight loss, return to work, total fat intake. Results: Early-treatment changes in agreement on goals/tasks were related to changes in psychosocial factors and perceived exertion during exercise independent of effects of changes in self-efficacy. Early-treatment changes in goals/tasks and self-efficacy interacted to predict changes in cardiorespiratory fitness, weight loss, and return to work such that patients high on both goals/tasks and self-efficacy showed the most gains. Conclusion: Sound therapeutic relationships between patients and staff may play an important role in facilitating the achievement of a wide-range of salutary outcomes during cardiac rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice Variability and Transfer of Training: The Role of Self-Efficacy Generality.

Practice variability has been shown to enhance transfer of training. The purpose of the present study was to examine the role of self-efficacy generality as a motivational mechanism in explaining the relationship between practice variability and transfer. Undergraduate students (N = 82) were randomly assigned to 1 of 2 training conditions (constant or variable) for a computer decision-making task. Measures of self-efficacy (intensity and generality) and transfer (near and far) were assessed. The results provided support for some of the hypothesized relationships. Specifically, practice variability led to increased self-efficacy generality. Both self-efficacy intensity and generality influenced far transfer performance, although only self-efficacy generality served as a mediator between practice variability and far transfer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group Leadership: Efficacy and Effectiveness.

A model of leadership effectiveness including leadership efficacy, anxiety, and self- and collective efficacy for the task was hypothesized and tested in 2 laboratory studies. Groups of 3 people, 1 designated as leader, performed distinct employee hiring tasks in both studies. The empirical model from the combined samples indicates that leaders high in leadership efficacy experienced higher levels of self- and collective efficacy for the task and lower levels of anxiety, and lower levels of anxiety were related to higher self-efficacy for the task. Additionally, the model indicates that the leaders' self-efficacy for the task was associated with their collective efficacy, which in turn predicted the followers' collective efficacy. The followers' collective efficacy strongly predicted group performance. The results are discussed in terms of both their practical significance and their theoretical implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Item Response Theory and Computerized Adaptive Testing: Implications for Outcomes Measurement in Rehabilitation.

Objective: To evaluate computerized adaptive testing (CAT) measures of rehabilitation outcomes. Study Design: Physical functioning questions were calibrated via item response theory (IRT) and administered with CAT software. Subjects: 485 adults interviewed during postacute care rehabilitation (simulation study) and 26 adults who completed CAT and personal interviews (CAT pilot study). Main Outcome Measures: Patient acceptance and respondent burden, reliability, and discriminant validity. Results: In the simulation study, CAT-based estimates correlated highly (r=.93 and r=.98) with criteria, minimized ceiling and floor effects, and reduced respondent burden while achieving high reliability. Pilot study patients preferred self-administered CAT surveys, and CAT scores discriminated well across severity levels. Conclusions: CAT software has considerable potential to improve physical functioning measurement in rehabilitation settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Abstinence Self-Efficacy and Abstinence 1 Year After Substance Use Disorder Treatment.

To better understand the relationship between abstinence self-efficacy and treatment outcomes in substance use disorder patients, experts in the field need more information about the levels of abstinence self-efficacy most predictive of treatment outcomes. Participants (N = 2,967) from 15 residential substance use disorder treatment programs were assessed at treatment entry, discharge, and 1-year follow-up. A signal detection analysis compared the ability of different measures of self-efficacy to predict 1-year abstinence and identified the optimal cutoffs for significant predictors. The maximal level of abstinence self-efficacy (i.e., 100% confident) measured at discharge was the strongest predictor of 1-year abstinence. Treatment providers should focus on obtaining high levels of abstinence self-efficacy during treatment with the goal of achieving 100% confidence in abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are goal intentions or implementation intentions better predictors of health behavior? A longitudinal study in orthopedic rehabilitation.

Objective: To compare the predictive power of goal intentions and implementation intentions. Design: Both constructs were expected to explain physical exercise at 3 points in time (with follow-ups at 6 and 12 months) in a sample of 368 persons participating in orthopedic rehabilitation. Results: Goal intentions and implementation intentions predicted exercise during rehabilitation. In contrast, goal intentions failed to predict exercise at later points in time, whereas implementation intentions continued to be associated with exercise 12 months later. Conclusions: Implementation intentions rather than goal intentions predict behavior as it becomes routine. As automatic processes such as behavior elicited by planning are largely age invariant, strengthening those processes might help to overcome volitional problems across all age groups represented in rehabilitation settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond the "Self in Self-Efficacy: Spouse Confidence Predicts Patient Survival Following Heart Failure.

Ratings of patient efficacy to manage illness, made by 191 congestive heart failure patients and their spouses, were examined as predictors of patients' survival over the next 4 years. When considered alone, both the patient's self-efficacy and the spouse's confidence ratings predicted survival, but only spouse confidence remained significant when both partners" efficacy ratings were included in the same Cox regression model. The overlapping prognostic significance of spouse confidence and a global, multicomponent measure of marital quality positioned the former as a proxy for the latter, reflecting a fundamentally social protective factor in patient survival. Successful adaptation to heart failure appears to involve more than the patient's personal agency, and psychosocial data from spouses can improve prediction of patient outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance Measurement, Health Care Policy, and Implications for Rehabilitation Services.

Provision of reliable, valid, and informative data to the public for evaluating the performance of health care services has been inconsistent at best and erroneous at worst. This article examines how private and governmental agencies are addressing this issue by concentrating on a well-defined set of performance indicators for several key diseases. In order to fully consider the implications of these developments for rehabilitation, the author discusses 4 topics: (a) how quality and safety concerns influence health care policy, (b) watershed events over the past half century that have contributed to a quality and safety dilemma in health care, (c) the difference between process and outcome indicators and implications for robust performance measurement, and (d) emerging coordination efforts by accreditation and regulatory agencies that will shape clinical service delivery in rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work-Family Conflict and Job Withdrawal Intentions: The Moderating Effect of Cultural Differences.

This study examined the interactive effects of individual cultural orientation with work-family conflict on employees' job withdrawal intentions. Using a sample of 394 employees from the banking sector in the United States and China, the authors found that work interfering with family (WIF) was more positively related to job withdrawal intentions among individuals scoring high on idiocentrism. It is interesting to note that the authors (unexpectedly) found that family interfering with work (FIW) was more positively related to job withdrawal intentions for those scoring high on allocentrism or low on idiocentrism. Implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of Chronic Pain in Rehabilitation: Outcomes Measures in Clinical Trials and Clinical Practice.

Objective: Chronic pain, or pain that lasts for months or even years, is prevalent among patients in rehabilitation settings, and treatment is costly. People with chronic pain often suffer physical limitations and emotional distress. As new treatments become available and clinical trials are initiated, it is important to measure outcomes in an effort to determine the efficacy of treatment interventions. This article provides a review of the core domains of outcomes assessment among people with chronic pain, including recommendations for outcome measures to be used in clinical trials and clinical practice settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation in prison: The incarcerated retarded.

Incarcerated retarded citizens have extensive needs for rehabilitation intervention. However, barriers to providing rehabilitative experiences within the correctional milieu are very substantial. The authors offer recommendations to improve the effectiveness of rehabilitation programs for retarded offenders. The authors also highlight possible pitfalls in providing such services. These pitfalls include potential negative consequences of “labeling” and the ethical conflict between corrections and rehabilitation professionals related to contrasting value orientations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinants of exercise intention and behavior during and after phase 2 cardiac rehabilitation: An application of the theory of planned behavior.

Objective: To evaluate the theory of planned behavior (TPB) as a framework for understanding exercise motivation during and after Phase 2 cardiac rehabilitation (CR). Design and Participants: Patients (57 men and 24 women) completed a TPB questionnaire that included attitudes, subjective norms, perceived behavioral control, and exercise intentions pre- and post-Phase 2 CR. Results: During Phase 2 CR, regression analyses indicated that attitude, subjective norm, and perceived behavioral control (PBC) explained 38% of the variance in exercise intention while intention explained 23% of the variance in exercise adherence. At postrehabilitation follow-up, attitudes, subjective norm, and PBC explained 51 % of the variance in exercise intention while intention explained 23% of the variance in exercise adherence. Conclusion: The TPB is a useful framework for understanding exercise intentions and behavior both during and after Phase 2 CR. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of Barriers Self-Efficacy and Perceived Behavioral Control for Explaining Physical Activity Across 1 Year Among Adolescent Girls.

The absence of longitudinal data about correlates of physical activity during adolescence has hindered the identification of key mediator variables that can be targeted by interventions. Building on the authors' previous report of a cross-sectional analysis, this study compared barriers self-efficacy and perceived behavioral control as predictors of change in 2 levels of physical activity across a 1-year period among a sample of Black and White adolescent girls (N = 1,038). Self-efficacy did not predict change in either moderate or vigorous physical activity. In contrast, perceived behavioral control exhibited a longitudinal, independent relationship with change in vigorous physical activity. The authors concluded that perceived behavioral control is an independent predictor of change in vigorous physical activity levels across a 1-year period among a sample of Black and White adolescent girls and warrants study as a potential mediator variable in interventions designed to increase or maintain physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)