Self-efficacy and barriers to multiple behavior change in low-income African Americans with hypertension
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Behavioral risk factors are among the preventable causes of health disparities, yet long-term change remains elusive. Many interventions are designed to increase self-efficacy, but little is known about the effect on long-term behavior change in older, low-income African Americans, especially when facing more problematic barriers. A cohort of 185 low-income African–Americans with hypertension reported barriers they encountered while undergoing a multiple behavior change trial from 2002 to 2006. The purpose of the present study was to explore the relationships between self-efficacy, barriers, and multiple behavior change over time. Higher self-efficacy seemed to be partially helpful for smoking reduction and increasing physical activity, but not for following a low-sodium diet. Addiction was indirectly associated with less reduction in smoking through lower self-efficacy. Otherwise, different barriers were associated with behavior change than were associated with self-efficacy: being “too busy” directly interfered with physical activity and “traditions” with low-sodium diet; however, they were neither the most frequently reported barriers, nor associated with lower self-efficacy. This suggests that an emphasis on self-efficacy alone may be insufficient for overcoming the most salient barriers encountered by older African Americans. Additionally, the most common perceived barriers may not necessarily be relevant to long-term behavioral outcomes.
KeywordsAfrican Americans Self-efficacy Behavior change barriers Smoking Physical activity Low sodium diet Hypertension
The study was supported by grant R01 HL69397 from the National Heart, Lung, and Blood Institute. The first author was supported by National Research Service Award T32 HP10031-12, National Institutes of Health (NIH).
Conflict of interest
The authors declare that there are no conflicts of interest.
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