How to Be More Self-Efficient: A Guide for Cardiac Patients

Abstract 

OBJECTIVE: The goal of this study is to understand the relationship that exists among cardiac patients and self-efficacy. 

BACKGROUND: Type A Behaviors are attributed to cardiovascular diseases. Aggression is a major cause of cardiac conditions. Lack of self-efficacy awareness among cardiovascular patients increases the risks associated with their complications. 

METHODS: Cross-sectional qualitative study was used where sixty participants were chosen randomly from three districts in the United States 

RESULTS: The results indicate that GSE and TAB are closely linked. The results also show that interventions directly affect self- efficacy among cardiac patients 

CONCLUSIONS: The findings suggest that patients should be able to balance self-care with other activities. The study also recommends for further studies. 

Introduction 

Human body psychological abnormalities are responsible for heart diseases (also known as cardiovascular diseases (CVD)) among individuals (Maron et al., 2007). These psychological abnormalities are attributed to self-efficacy. Self-efficacy is the "confidence in one's ability to behave in such a way as to produce a desirable outcome" (Bandura, 2010). Individuals with low self-efficacy are more prone to heart-related complications due to depressions and anxieties (Bandura, 2010). 

On the other hand, individuals with high self-efficacy are always prepared to deal with uncertainties in their lives. Low self-efficacy impedes an individual's motivations in their lives while high self-efficacy enhances one's motivation (Bandura, 2010). Self-efficacy comes in multiple dimensions, especially to cardiovascular patients. It is known that there are specific cardiovascular health behaviors (current and future) that are dictated by the levels of self-efficacy (Bandura, 2010). 

Heart-related diseases are spread globally. In 2016, CVD was accounted to have resulted in more than 900,000 deaths in the United States in 2016 (Mozaffarian, 2016). Two types of risk factors, modifiable (health, e.g., Diabetes, high blood pressure) and nonmodifiable (social and economic status), are all associated with cardiovascular mortality rates (Mozaffarian, 2016). The different forms of cardiovascular diseases have very high costs to the economies of the countries in treating and managing them. CVD has a direct relationship with how the heart functionalities. Heart-related complications studies started as early as the 1960s (Mozaffarian, 2016). Most of the reviews came up with similarities among the behaviors of the patients. Most studies were done on self-efficacy, and its relationship with cardiac patients have concentrated on rehabilitation programs (Scholz, Sniehotta, & Schwarzer, 2005). Moreover, self-efficacy theory poses a proposal that the confidence that the cardiac patients have in performing tasks influences how they engage in the actual tasks which results in either positive or negative health outcome (Scholz, Sniehotta, & Schwarzer, 2005). Therefore, cardiac patients must have the ability to change their behaviors to have a positive change in their health status. 

Background 

In self-efficacy study done by Friedman, he documented personality and Type A traits and its relation to cardiovascular diseases (Myrtek, 2001). He was quick to note that individuals with Type A traits as being very competent who always work towards achieving success (Myrtek, 2001). On the other hand, such people were recorded to have very negative attitudes when provoked, and they would get angry very fast. In his research, he found that most people who died of heart attacks were those that used to work extra hard (Myrtek, 2001). This research problem led to further studies by other researchers. 

Two cardiologists incepted the concept of Type A traits (TAB) (Myrtek, 2001). An observation that they had noted in their clinic drove their research. They indicated that their clinic seats would wear up very quickly and in the same place. The carpenter would later give them feedback that the seating posture of the patients at the edge of the benches (an act of nervousness) was the reason behind the tearing out. This is where the cardiologists came up with the idea of how individual impatient and cardiac complications were related (Myrtek, 2001). However, they were careful not to attribute all individuals with this type of behaviors to have fallen ill of cardiac complications (Myrtek, 2001). 

Although Type A persons are very active in their duties, their attitudes are highly likely to bring about body physical damages. It was also noted that such individuals never practiced good health habits. Studies done have also proved that the characteristics of Type A persons are consistent with cardiac complications (Myrtek, 2001). 

It is known that most people who suffer from CVD are those who possess Type A traits. However, each cardiac patient handles their conditions differently (Myrtek, 2001). One thing that brings these differences is different in psychological abnormalities (Myrtek, 2001). During the period of heart complications, the patients experience various degrees of self-efficacy. As Bandura's Theory dictates, high levels of self-efficacy help the individuals in overcoming hard situations in their lives while low self-efficacy increases the cardiac complications with the patients (Bandura, 2010). Researches done previously also indicate that self-efficacy not only does it bring cardiac complications but also, it's associated with physical body illnesses (Myrtek, 2001). These studies reveal that individuals with high self-efficacy are at a better position to react well and move on with their lives as opposed to those individuals with low self-efficacy (Myrtek, 2001). Therefore, the researchers recommended that every individual should learn the basics of what constitutes self-efficacy and practice their skills on having high self-efficacy which would help them in the future when hard times arise. 

Research problems 

Despite the decrease in cardiovascular diseases, there are increased health risks associated with lack of awareness among the patients. Education has not reached the masses on smoking cessation, weight loss programs, social determinants as well as heart attack recoveries. Hardworking individuals with TAB are exposed to cardiac diseases at a higher rate than Type B individuals who are less aggressive. 

Research significance 

This research will be beneficial to the medical practitioners as well as the cardiac patients in understanding the issues associated with heart complications and self-efficacy. 

Research objectives 

This study was meant to define self-efficacy and relation to cardiac patients. 

It was also meant to dig deep in finding the relationship between Type A personal traits and self-efficacy. 

To find out whether interventions had an impact on self-efficacy. 

Hypothesis 

An essential aspect used to measure the patient's success is their ability to carry on with routine jobs while managing their conditions. 

There is a close relationship between GSE and TAB 

GSE and aggression are closely linked 

Interventions (education) has a direct impact on cardiovascular patients' self-efficacy. 

Literature review 

Studies have been undergoing concerning the issues related to cardiac patients. One thing that the researchers have agreed in common is that the cardiac patients care program involves complex as well as challenging treatment mechanisms. That said, self-care by the cardiovascular victims themselves is a significant ingredient in managing their conditions (Myrtek, 2001). These patients are under strict dietary programs that must be followed to the letter. Apart from such dietaries, these patients are also required to make lifestyle adjustments to have improved health care programs. To manage all these, the patients need to have self-efficacy at high degrees. 

Bandura's Social Cognitive Theory differentiated between outcome expectations and efficacy Expectations. Outcome expectations comprise of "individual's belief that a specific behavior will lead to a particular outcome." (Bandura, 2010) On the other hand, efficacy expectation also known as perceived self-efficacy is "the individual's belief in their ability to execute or perform the specific behavior." (Bandura, 2010) Perceived expectations dictate that an individual has the capabilities of controlling their health and the degree of self-efficacy affects the primary outcomes of such controls. Previously done studies have shown that there is a close tie between high self-efficacy and improved self-care among cardiac patients. An example was the research done on dietary behaviors among patients living with diabetes. The researchers based their results on self-efficacy which showed that individuals with high self-efficacy had improved self-care programs. 

Studies have also been conducted regarding patients' adherence to set health behaviors. The first thing that the patients need is getting Enlighted on the importance of self-efficacy. Patients without prior knowledge were found to have difficulties in adhering to these set health behaviors. According to the researchers, this brought for interventions focusing on improved self-efficacy which in turn would help the health practitioners in coming up with healthcare program designs. 

According to Bandura's Theory, self-efficacy expectations comprised of three dimensions, that is, 

Magnitude the tasks were ordered by their difficult in levels 

Generality generalization of a specific situation into other solutions 

Strength the certainty of success for an individual to perform a given task 

All these dimensions implied the use of different measurement procedures. However, since the measurement procedures for self-efficacy are not standardized, they must be applied differently in specific situations in which they appear and especially in behaviors that are related to health. 

smoking cessation 

Another study that has been undergoing is the relationship between cigarette Cessation and self-efficacy. Cigarette smoking has close ties with cardiac diseases (Farajat, Hoving, & De Vries, 2011). Researches over time have shown that patients who cease smoking have lower mortality rates as compared to those who continue smoking (Farajat, Hoving, & De Vries, 2011). Self-efficacy has been used to study behavioral change to patients successfully. The studies in this field have led to the researchers coming into a consensus that one cannot use pre-treatment self-efficacy in predicting the post-treatment smoking status (Farajat, Hoving, & De Vries, 2011). In making their conclusions, the researchers found that the expectations of post-treatment self-efficacy for the patients who had ceased smoking were much higher as opposed to those individuals who were unable to stop smoking. It was also found that individuals who had trained themselves in quitting smoking had a more powerful self-efficacy (Farajat, Hoving, & De Vries, 2011). 

A report done by Zimmerman (2000) cited Mudde et al. (1995) study, who wanted to find out smoking cessation's strongest predictor by making a comparison of measurements of self-efficacy. To do this, they used different scales in answering the self-efficacy dimensions as mentioned above. The first scale that was used was the perceived difficulty scale (PDS) which addressed magnitude and generality dimensions (Zimmerman, 2000). The next two scales that were combined were the perceived ability scale (PAS) and the 1-item perceived ability measure (PAM) which employed generality and strength dimensions at different levels (Zimmerman, 2000). These scales confirmed that self-efficacy for smoking cessation could be used to predict the short and long terms of smoking cessation (Zimmerman, 2000). 

Weight-loss 

Overweight is one of the factors associated with coronary heart diseases as well as hypertension risks (Linde et al., 2006). The examination of self-efficacy in this field has been on the behavior's individuals put in place in reducing their weights (Linde et al., 2006). However, even though researches have been going on, the researchers have not been able to come up with a generalized conclusion. The research study that has been widely used by many individuals is the Eating Self-Efficacy Scale (ESES) (Linde et al., 2006). This research was meant to investigate the predictive powers associated with self-efficacy weight control. They found that the expectations that an individual has concerning reaching the required weight, and the confidence such individuals have in losing weights are significant determinants of their progress in the weight loss exercises (Linde et al., 2006). These studies have found that refraining from eating during treatment is a predictive measurement of weight control efficacy. 

Heart attack recovery 

The self-efficacy of physical activities has been linked to recovery effects from a heart attack (Woodgate, & Brawley, 2008). Studies have revealed that physical activities reduce cardiovascular diseases (Woodgate, & Brawley, 2008). There have been campaigns all over the globe mobilizing people to participate in physical activities that will reduce the risks of falling ill to cardiac conditions. However, "large numbers of heart attack survivors experience unnecessary distress and put themselves at significant medical risk due to excessive fear of physical activity." (Woodgate, & Brawley, 2008). These are myths that self-efficacy theory has helped to disapprove. Such survivors' self-efficacy has been influencing in disregarding those fears, and the results are visible. It has also been found that very few people participate in physical activities to reduce such risks. It has also been found that within the first six months of participation, the rate of attendance by participants is very high; reason being high self-efficacy (Woodgate, & Brawley, 2008). After the sixth month, the number starts to drop when self-efficacy starts to differ from expectations efficacy. This is attributed to the changing beliefs about the importance of exercising. 

Social determinants 

These factors are associated with the growing environments of individuals from their early childhoods (Bandura, 2004). It is believed that people who grew up in hostile environments; including but not limited to hostile parents, economic status, having very demanding parents are all factors that are involved in shaping the personality of an individual (Bandura, 2004). For adults, job-related stress also influences the self-efficacy of an individual. 

In the studies mentioned above, the researchers emphasize on patient's level of self-efficacy in following the stipulated treatments as well as their capabilities in managing their conditions. In these studies, the patients' self-efficacy was measured quantitatively after an intervention the researchers employed baseline values as well as control groups in rating the scores. It was also found that self-efficacy has a hand in risks associated with cardiovascular diseases. These reviews support the researchers' point of view in that the most important aspect used to measure the patient's success is their ability to carry on with routine jobs while managing their conditions. To find out the truth of this claim, cross-sectional qualitative research was necessary. 

Methodology 

Design 

A cross-sectional qualitative study was used. This study was conducted in three districts in the United States. Data were collected in two weeks in March 2019. 

Sample 

Sixty patients were chosen from the districts to participate in the study. This population consisted of 40 males and 20 females. The participants were aged between 20 and 60 years. This population specifically consisted of patients who suffered from heart failure, obesity, diabetes, and high blood pressure. Stratified random sampling was used in the selection of samples. Time and costs constraints restricted this study; therefore, the participants were treated as an adequate representation for both the public and private health sectors. 

Procedure 

In administering the questionnaires, the researchers visited the targeted hospitals in the various districts. The necessary assistance was offered by recruiting three more people. The participants were approached by the researchers and the reasons behind the research were explained to them including their rights to choose whether or not to engage in the study. This was followed by the participants signing informed consent which gave the researcher the go-ahead in carrying out the research. The participants were asked to return the questionnaires sealed in envelopes after a week for data analysis. In minimizing the risks associated with the study, the anonymity of the participants was granted by issuing them with randomly computer-generated numbers. The data collected was also locked in safety cabinets. 

Findings 

In the collection of quantitative data, the researcher used two types of questionnaires, that is, 

AnjumKhalique TAB Pattern Scale 

This questionnaire consisted of 12 items. These items were further categorized into three subscales. This meant that each subscale would be made of four elements. The researcher ensured that each item had two statements and the respondents were two choose one in every item regarding their personality. Of the two accounts, one was made up of Type A (with an associated score of 1), and the other was made up of Type B (with an associated count of 0) behaviors. This gave a total score range of 0 to 12. 

Scores	Category (personality)
1-4	Low Type A (Type B)
5-8	Not Type A or B
9-12	High Type A

GSE Scale (Generalized Self Efficacy) 

The researcher used a self-administered scale with four points and ten items developed by Jerusalem &Schwarzer (Luszczynska, Scholz, & Schwarzer, 2005). The responses were assigned values as follows; 

1=Not true at all 

2=Hardly True 

3=Moderately True 

4=exactly True 

In analyzing the data collected from the research, SPSS software was used. In answering the research questions, the researcher used descriptive statistics (tabular figures) the measures of central tendencies (mean, mode, and median), the measures of dispersion (variance and standard deviations), and the use of inferential statistics (including t-tests and chi-squares). 

Score	Frequency	Percentage %
High	4	6.7
Moderate	24	40
Low	32	53.3
Total	60	100
mean	23.4
Standard Deviation	0.58

Before intervention 

According to these findings, it's clear that before the self-efficacy intervention, cardiac patients with low self-efficacy topped the list with a percentage of 53.3 followed by individuals with moderate self-efficacy at 40%. Individuals with a high level of self-efficacy had the least rate of 6.7%. 

Score	Frequency	Percentage %
High	34	56.7
Moderate	20	33.3
Low	6	10
Total	60	100
mean	48.8
Standard Deviation	2.2

After intervention 

After self-efficacy intervention, the percentages shifted in favoring high self-efficacy with 56.7%. The level of low self-efficacy declined at high rates from 53.3% to 10%. In making a comparison of self-efficacy in the two figures, the researcher used m-paired t-tests. 

	Before	After
Average	23.4	48.8
Standard deviation	0.58	2.2
m-Paired t-test	=5/02t	P<0.001

Based on these results, the researcher accepted the hypothesis that interventions had a direct influence on the self-efficacy of cardiovascular patients. 

In determining the linear relationship between TAB and GSE, product moment correlation coefficient (PMCC) (value between -1 and 1) denoted by r was used, for 1-tailed tests its necessary to note that the level of significance starts at 0.05. In the first case, a nonsignificant r=0.04, a positive value was found to be linking TAB and GSE. This led to the researcher accepting the hypothesis. 

The researcher also went ahead to compare the relationship that existed between cardiovascular diseases and aggression. The PMCC gave a positive r=0.138 which signifies that aggressiveness is directly associated with cardiac complications. 

	Scale	GSE	Level of Significance (2 tailed)
TAB	TAB	0.04	0.557
	GSE	1
Aggression	Aggression	0.138*	0.026
	GSE	1

Discussions 

As with the main objectives of this study, this research was meant to help in answering whether interventions had any impacts on self-efficacy. This paper was also intended to find out the truth regarding claims from previous studies that the most crucial aspect used to measure the patient's success is their ability to carry on with routine jobs while managing their conditions. These study results were based purely on these objectives as well as the claims. The results show that before interventions, cardiovascular patients with low self-efficacy existed at high numbers. These individuals attributed their self-efficacy fears to the failures they faced in their lives such as participating in physical activities. As much as we appreciate the need for physical activities, cardiovascular patients reported fears of participating in them. These participation self-efficacy fears were addressed by interventions, and the respondents responded positively. 

Interventions also helped cardiac patients in their medical adherence schedules. This helped answer our research claim verification that the most crucial aspect used to measure the patient's success is their ability to carry on with routine jobs while managing their conditions. Self-care is essential to cardiovascular patients. Failure to adhere to the prescribed health guidelines increased the risks associated with cardiac diseases. Interventions lowered the levels of medical adherence self-efficacy. 

Limitations of the study 

The main limitation of this study is that there were insufficient funds and time constraints. This study was conducted in two weeks which cannot guarantee a sufficient representative sample for the research. Another limitation of this study is that it was complicated to deal with cardiac patients. Their attitudes and the nature of their complications were hard to comprehend by the researchers. The size of the sample size was small. This increased the risk of biasness in the research. Some respondents did not understand the questionnaires entirely due to their age brackets and also insufficient education hindered the answering of the questionnaires. This also increased biasness chances as well as time consumption since the researchers had to be involved in explaining to such participants in details. 

Implications of this study 

These results are significant for cardiovascular medical practitioners in creating awareness to the public of all the factors that increase the risks of cardiac diseases 

This study provides the basis for cardiologists to give their recommendations as the issues related to TAB and GSE are mentioned. 

The sample size used in this research, no matter its significance, cannot be used as a sufficient representative sample to the larger world. More research is needed involving large sample sizes in addressing the issue. 

Conclusion 

This study gives a clear analysis of the interventions have on cardiac patients' self-efficacy. The study also attributes aggressiveness in TAB as a source of cardiac complications. Moreover, this study helps in settling the claim that the most important aspect used to measure the patient's success is their ability to carry on with routine jobs while managing their conditions. According to the research done on this paper, this claim is valid. 

References 

Bandura, A. (2004). Health promotion by social cognitive means. Health education & behavior , 31 (2), 143-164. 

Bandura, A. (2010). Self ‐ efficacy. The Corsini encyclopedia of psychology , 1-3. 

Farajat, M., Hoving, C., & De Vries, H. (2011). Psychosocial determinants of cigarette smoking among university students in Jordan. Journal of developmental origins of health and disease , 2 (3), 152-161. 

Linde, J. A., Rothman, A. J., Baldwin, A. S., & Jeffery, R. W. (2006). The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychology , 25 (3), 282. 

Luszczynska, A., Scholz, U., & Schwarzer, R. (2005). The general self-efficacy scale: multicultural validation studies. The Journal of Psychology , 139 (5), 439-457. 

Maron, B. J., Thompson, P. D., Ackerman, M. J., Balady, G., Berger, S., Cohen, D., ... & Krauss, M. D. (2007). Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation , 115 (12), 1643-1655. 

Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., ... & Howard, V. J. (2016). Heart disease and stroke statistics-2016 update a report from the American Heart Association. Circulation , 133 (4), e38-e48. 

Myrtek, M. (2001). Meta-analyses of prospective studies on coronary heart disease, type A personality, and hostility. International journal of cardiology , 79 (2-3), 245-251. 

Scholz, U., Sniehotta, F. F., & Schwarzer, R. (2005). Predicting physical exercise in cardiac rehabilitation: The role of phase-specific self-efficacy beliefs. Journal of Sport and Exercise Psychology , 27 (2), 135-151. 

Woodgate, J., & Brawley, L. R. (2008). Self-efficacy for exercise in cardiac rehabilitation: review and recommendations. Journal of Health Psychology , 13 (3), 366-387. 

Zimmerman, B. J. (2000). Self-efficacy: An essential motive to learn. Contemporary educational psychology , 25 (1), 82-91.