Factors influencing change in participants in a self management program for chronic disease in Hong Kong

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Factors influencing change in participants in a self management program for chronic disease in Hong Kong


Author: Chan, Chi-chung Sam
Title: Factors influencing change in participants in a self management program for chronic disease in Hong Kong
Degree: M.Phil.
Year: 2007
Subject: Hong Kong Polytechnic University -- Dissertations.
Chronic diseases -- Treatment.
Self-care, Health.
Department: Dept. of Rehabilitation Sciences
Pages: xii, 218 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2165727
URI: http://theses.lib.polyu.edu.hk/handle/200/1748
Abstract: The Chronic Disease Self-Management Program (CDSMP) has been shown to enhance participants' competence in managing their own physical and psychological conditions. The underlying mechanisms for psychological and behavioral changes during the six-week program and the phenomenon of readiness to change have not been full addressed previously. The purposes of the study were two-fold: (1) to construct an across-time model to capture the relationships among the different psychological (i.e. self-efficacy, social norm and attitude) and behavioral variables throughout the six-week Program; and (2) to explore the extent to which participants' readiness to change accounts for their changes in psychological and behavioral variables in the 6-week CDSMP. This study attempted to build an across-time conceptual model for different types of self-management behaviors based on the components of two social cognitive models, the Theory of Planned Behavior and the Transtheoretical Model. It included self-efficacy, attitude toward behavior, social norm, and readiness to change. It was hypothesized that the readiness-to-change variable would act as a predictor for the across-time relationships among behavior and social cognitive variables included, and self-efficacy would in turn directly influence the behavior via the indirect effect of social norm and attitude toward behavior. Sixty participants with various chronic diseases were recruited to attend the CDSMP. There were 48 women and 12 men with a mean age of 51.0 (standard deviation = 10.7) and an average disease duration as 9.83 years (standard deviation = .71). They were requested to complete a set of questionnaires at the first, fourth and sixth weeks in the CDSMP. The questionnaires administered were: Self-management Behaviors Questionnaire (SMBQ) (including exercise engagement (EE), cognitive symptom management (CSM), tangible help-seeking (TH) and communication with professionals (COM)), Self-efficacy Questionnaire (SEQ), Attitude toward Behavior Questionnaire (ATBQ), Social Norm Questionnaire (SNQ) and Chinese version of the University of Rhode Island Change Assessment (C-URICA) scale. Ward's method of Hierarchical cluster analysis revealed that, in this sample had two stage-of-change profiles, which were also high in contemplation and action subscores of C-URICA. Besides, latent growth curve modeling showed a good model fit for the exercise engagement (RMSEAEE=.001), cognitive symptom management (RESEAcsM =.029) and tangible help-seeking (RMSEATH=.031) and a moderate model fit for the communication with professionals (RMSEACOM=.073). The cross-time modeling discovered different change mechanisms in four self-management behaviors. Self-efficacy was found to be the key parameter to predict exercise engagement (r=.381) whereas social influence did not (p>.05). Although attitude and social norm only exerted indirect effect onto cognitive symptom management behavior through self-efficacy, the change of these two parameters exerted direct effect onto the behavior. The change of the behavior in turns imposed a positive influence onto the change of the self-efficacy. Furthermore, for communication with professionals, it was the change of self-efficacy along with that of social influence that exerted direct effect onto that of the behavior. A different change mechanism was found for tangible help-seeking behavior. Help-seeking self-efficacy exerted both direct and indirect influences (via social norm and attitude) on the behavior itself. The Stage-of-change construct which is constituted by precontemplation, contemplation, action and maintenance, was found to be a better predictive for change of psychological parameters rather than behaviors. The present study had constructed across-time models for various self-management behaviors. The models amalgamated the parameters from both the Theory of Planned Behavior and the Transtheoretical Model. The models revealed the significance of social norm and attitude toward behavior, apart from the commonly focused variable of self-efficacy. Also, the finding suggested the relevance of assessing participants' readiness to change at the beginning of the structured program. It was also found that the relationships among variables appeared to be different for different self-management behaviors.

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