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Health Education & Behavior2014, Vol 41(1) 7–11© 2013 Society for PublicHealth EducationReprints and 10.1177/1090198112473109heb.sagepub.comBrief ReportThe interest in workplace health promotion activities targetingphysical activity and nutrition is high and is motivated bypublic health and productivity concerns (Black, 2008;Pencak, 1991; Wolfe, Ulrich, & Parker, 1987). However,many health promotion initiatives struggle with low participation and have problems achieving optimal effect. Low participation may be because of a multitude of factors related toindividual, institutional, community, and governmental actionsor policies (Linnan, Sorensen, Colditz, Klar, & Emmons,2001). Yet, since many worksite health promotion programsare, for ethical reasons, made voluntary, participation is, in theend, contingent on the individual employee’s motivation andwillingness to participate in a given program.Human behavior can be described as a compromisebetween processes residing within the person and externaland situational circumstances (Bandura, 1978; Blumberg &Pringle, 1982; Buss, 1991). Accordingly, decisions tochange health behaviors may be viewed as the result of aninteraction between behavioral, cognitive, and environmental influences (Bandura, 1978). Notwithstanding theplentiful range of external incentives that may motivateindividuals into action (Cialdini, 2001), a person’s selfefficacy (i.e., the perceived belief about his or her ability toachieve a specific behavior in a particular situation) is oftenconsidered important for understanding changes in healthbehaviors (Bandura, 2004). Indeed, in social cognitive theory, self-efficacy is viewed as a core psychological beliefthat affects basic processes of change, whether this is concerns, contemplations, mobilization of efforts, or dealingwith relapses (Bandura, 2004).In a recent review, it was concluded that self-efficacy wasimportant for adherence to physical activity and exercisetherapy (Rhodes & Fiala, 2009). Although it makes sensethat a certain amount of self-efficacy is needed to engage, orto change behavior, it also seems reasonable to assume thatexaggerated belief in one’s own efficacy could lead to therejection or evasion of offers of help or assistance. Thisaspect of self-efficacy seems, however, to have been poorlyelucidated in research.For this reason, as part of a process evaluation of a multipurpose in-house health promotion service in the Danishpolice (Persson et al., 2013), we decided to address this issuein relation to the use of an in-house wellness service. Thewellness service consisted of six full-time consultants (fivewomen) who served all employees in the Danish NationalPolice and the 12 police districts. Hence, the consultantstravelled a lot with the goal to visit the main stations in thevarious districts at least once every 4 to 6 weeks. The workof the wellness service focused on improving physical wellbeing related to the four major lifestyle factors (i.e., exercise,eating, drinking, and smoking) and was available, free ofcharge, to all employees. The service could be used during473109 HEBXXX10.1177/1090198112473109Health Education & BehaviorPersson et al.20131National Research Centre for the Working Environment, Copenhagen,Denmark2Steno Health Promotion Center, Steno Diabetes Center, Gentofte,DenmarkCorresponding Author:Roger Persson, Lersø Parkallé 105, 2100 Copenhagen, Denmark.Email: [email protected] Relationship BetweenSelf-Efficacy and Help EvasionRoger Persson, PhD1, Bryan Cleal, PhD2, Mette Øllgaard Jakobsen, MSc1,Ebbe Villadsen1, and Lars L. Andersen, PhD1AbstractObjective. To examine the relationship between self-efficacy and not wanting help to change health behaviors. Method.All employees in the Danish police department were invited to respond to an electronic questionnaire. All respondentsexpressing a desire to change health behaviors in relation to smoking (n = 845), alcohol (n = 684), eating (n = 4431), andphysical activity (n = 5179) and who subsequently responded to questions on self-efficacy were included. Results. Boththe bivariate and multiple regression analyses showed that all four specific self-efficacy scores were positively related toreporting that one did not want help. Conclusion. A high belief in one’s own ability to change lifestyle behaviors in relationto smoking, alcohol, eating, and physical activity may lead to avoidance of help offers in a workplace setting.Keywordsbarriers, health promotion, motivation, police, self-effcacy, work8 Health Education & Behavior 41(1)working hours so long as the appointments did not conflictwith daily work tasks. At times the consultation served toincrease the employee’s awareness; on other occasions theconsultation served to support more radical lifestyle changes.Furthermore, the counseling contained elements of primary,secondary, and tertiary prevention. Although most activitieswere directed toward individual employees, other activities,such as group activities, health campaigns, and education,were also occasionally endorsed. In view of the wellness service’s main focus, we decided to explore how well, statistically speaking, self-efficacy could predict the preference fornot receiving help, among participants who had acknowledged that they wanted to change health behaviors in relationto smoking, alcohol, eating, and physical activity.Materials and MethodParticipantsThe research was conducted in accordance with Danish lawand institutional guidelines on ethics in research. All potential users of the wellness service, that is, all administrativeworkers (e.g., lawyers, clerks, and mechanics) and policeofficers, were invited to respond to an electronic questionnaire (n = 15,284). To guarantee anonymity and alleviatepossible concerns about the access that employers wouldhave to the results, participants were required to log on to anexternal server in order to complete the questionnaire. Therewere in total 6,373 respondents (41.8%). Only thoseemployed in the Danish National Police and in the 12 policedistricts and had responded to at least two third of the itemsin the questionnaire were included (N = 6,062; mean age =44 years, SD = 11 years). In the present study, we focus onparticipants who had responded that they perceived a needfor lifestyle changes in relation to the four major life stylefactors. Thus, of the 6,062 eligible participants, 845 wishedto cut down or quit smoking (14 %), 684 wished to reducetheir alcohol consumption (11 %), 4,431 wished to adopthealthier eating habits (73 %), and 5,179 wanted to be morephysically active (85%). Demographic characteristics andlifestyle factors for each of the subgroupings are presentedin Table 1.MeasuresPredictor variables. General self-efficacy was assessed withthree items that read, “I am confident that I can deal efficiently with unexpected events,” “I can solve most problemsif I invest the necessary effort,” and “I can usually handlewhatever comes my way.” All items had five response categories: always, often, sometimes, seldom, and never/hardlyever. The mean score (range 1-5) was used as a continuouspredictor. Higher scores indicated greater self-efficacy.Cronbach’s alpha varied between .71 and .72 when calculated in each of the four study samples.Specific self-efficacy was assessed with one item for eachlifestyle factor: “If you decide to (smoke less/consume lessalcohol/eat healthier/be more physically active), do youbelieve, that you can do it?” All specific self-efficacy itemswere responded to on a scale from 1 to 10, where the respondents were asked to evaluate how easy it would be: 1 = donot believe it is possible at all and 10 = it should be very easyto do that.Table 1. Demographic and Lifestyle Characteristics for Each ofthe Four Subgroupings.SmokersAge in years, mean (SD) 45 (11)Gender, % women 33Proportion wanting to changebehavior, % of the study sample14Number of cigarettes/day, median(25th-75th percentile)12 (7-35)Number of cigars/day, median(25th-75th percentile)0 (0-0)Number of pipe chambers/day,median (25th-75th percentile)1 (0-4)Alcohol consumersAge in years, mean (SD) 47 (10)Gender, % women 20Proportion wanting to changebehavior, % of the study sample11Number of consumed units/week,median (25th-75th percentile)5 (3-7)Proportion consuming alcohol upto 3-4 times/week, %76Proportion consuming alcohol upto 5-7 times/week, %24Healthier dietAge in years, mean (SD) 43 (11)Gender, % women 29Proportion wanting to changebehavior, % of the study sample73Proportion consuming at least 1serving of fruit/day, %43Proportion consuming at least 1serving of vegetables/day, %34Proportion consuming fast foodat least 1 time/week, %16Physical activityaAge in years, mean (SD) 44 (11)Gender, % women 29Proportion wanting to changebehavior, % of the study sample85Proportion physically active atleast 30 minutes 7 days/week, %7Proportion physically active atleast 30 minutes 0-3 day/week, %57aDefined as any activity that increases the respiration rate (e.g., heavygarden work, walking at a fast pace, competitive sports, etc.), at least 30minutes per day (%).Persson et al. 9Outcome. All four outcome variables were binary, andreflected whether the participants had marked “I do not wanthelp” on a list that provided several options for help in relation tosmoking, alcohol consumption, eating, and physical activity.Statistical AnalysesThe statistical computations were made with IBM SPSSVersion 20 for Windows. P values less than .05 were considered statistically significant. Binary logistic regressionanalyses were used to explore bivariate relationships.Multiple binary logistic regression analyses were used toestimate age-adjusted (continuous) and gender-adjusted(categorical) relationships.ResultsThe mean specific self-efficacy scores were as follows: forsmoking 5.9 (SD = 2.4; range = 0-10), alcohol 7.6 (SD = 2.0;range = 1-10), eating 6.9 (SD = 1.8; range = 1-10), andphysical activity 7.0 (SD = 1.8; range 0-10). The mean generalself-efficacy scores in the four subsamples were as follows:smoking 4.2 (SD = 0.5; range = 1.3-5.0), alcohol 4.1 (SD =0.5; range = 1.7-5.0), eating 4.1 (SD = 0.5; range = 1.3-5.0),and physical activity 4.1 (SD = 0.5; range = 1.3-5.0).Bivariate Logistic Regression AnalysesThe results for the unadjusted bivariate analyses are presented in Table 2. All four specific self-efficacy scoreswere positively related to reporting that one did not wanthelp. The general self-efficacy score was related, with statistical significance, to not wanting help in relation tochanging physical activity patterns. Increasing age waspositively related to not wanting help as regards changingeating and physical activity. Women were less likely toreport that they did not want help in relation to eating andphysical activity.Multiple Logistic Regression AnalysesThe results from the age- and gender-adjusted multiplelogistic regression analyses are presented in Table 3. Thefour specific self-efficacy scores were positively related toreporting that one did not want help with changing healthhabits. The general self-efficacy score was positively relatedto reporting that one did not want help with changing healthhabits in relation to physical activity.DiscussionThis study explored how well self-efficacy could statistically predict the preference of not receiving any help amongof participants who had acknowledged that they wanted tochange health behaviors in relation to smoking, alcohol, eating,and physical activity.The results from both the bivariate and multiple regressionanalyses showed that all four specific self-efficacy scoreswere positively related to reporting that one did not want help.The general self-efficacy score was less clearly associatedwith the reports of not wanting help. General self-efficacy wasonly statistically predictive for reporting that one did not needhelp in relation to physical activity. Irrespective of statisticalsignificance, the results suggest that higher self-efficacy seemsto foster feelings of self-reliance. Whether self-reliance in thepresent context represents a wise and accurate decision or apotentially detrimental one is another question, which can notbe reliably answered with the present data. Yet the resultsshow that specific self-efficacy seems to be related to a selfreliant attitude that may affect attitudes toward help initiatives.Hence, our observations underscore the possibility that highself-efficacy might, in certain situations, act as an individualbarrier and hindrance to receiving help.At first glance, our observations seem to contradict bothempirical evidence (Andersen, 2011; Rhodes & Fiala, 2009)and social cognitive theory, where self-efficacy is viewed asa core psychological belief that affects basic processes ofTable 2. Results From Bivariate Unadjusted Logistic Regression Analyses.N %Gender,OR [95% CI]Age,OR [95% CI]General Self-Efficacy,OR [95% CI]Specific Self-Efficacy,OR [95% CI]SmokingI do not want help 243 29 0.96 [0.70, 1.32] 1.00 [0.98, 1.01] 1.05 [0.78, 1.40] 1.40 [1.30, 1.52]AlcoholI do not want help 520 76 0.98 [0.63, 1.52] 1.01 [0.99, 1.02] 1.14 [0.80, 1.62] 1.12 [1.03, 1.22]EatingI do not want help 483 11 0.64 [0.51, 0.80] 1.05 [1.04, 1.06] 1.19 [0.98, 1.44] 1.18 [1.12, 1.25]Physical activityI do not want help 893 17 0.77 [0.64, 0.89] 1.04 [1.03, 1.05] 1.33 [1.15, 1.54] 1.14 [1.09, 1.19]Note. OR = odds ratio; CI = confidence interval. Gender: 0 = male, 1 = female; age (range = 18-65 years; effect per year increase); general self-efficacy wasmeasured as a mean of three items (1-5; effect per unit increase in mean score). Specific self-efficacy was measured with one item (1-10; effect per unitincrease).10 Health Education & Behavior 41(1)change, whether this concerns contemplation to change,mobilization of efforts, or dealing with relapses (Bandura,2004). It is, however, important to state that our observationsdo not necessarily refute previous empirical findings and thatthey are quite compatible with theories of social cognition.Given that every person may, in theory, be ranged somewhere on the self-efficacy continuum, an individual’s degreeof self-efficacy will always be of relevance when attemptingto understand or describe human behavior. As such, theresults serve as a reminder that the impact of self-efficacy isthe outcome of an interaction with environmental influences(Bandura, 1978). In addition, our observations also suggestthat self-efficacy may affect help-seeking behavior and, byextension, that people with high self-efficacy may prefer notto be helped. Hence, it appears important to distinguishbetween what type of behavior self-efficacy facilitates and inwhich situations.Methodological ConsiderationsThe external validity of our findings is strengthened by thefact that the electronic survey was sent to all occupationalpositions and groups in the Danish police and had a nationwide reach. Obviously, the overall response rate of 41 % isa weakness. The response rate inevitably raises questionsabout how well the participants represent all employees.Even so, an analysis of e-mails from participants whoactively declined to participate in our survey indicated thatthe reasons for not partaking were multifold, including bothpositive and negative attribution of causes. Since all information was derived from self-reports, a number of potentialsources of common method bias also need to be considered(Podsakoff, MacKenzie, Lee, & Podsakoff, 2003). The mostcritical source seems to be that all scores have been delivered by the same person (i.e., common rater effects).Alternatively, the trustworthiness of the results is increasedby the fact that the participants had to actively select the nohelp option among the extensive list of alternatives providedfor each lifestyle factor. Another issue that warrants attention is that the participants reported a generally high degreeof self-efficacy. The general self-efficacy score was, in particular, skewed to the right, almost to the point where therewas a risk of a ceiling effect. One potential explanation forthis high degree of self-efficacy could relate to the fact thata large proportion of our participants were police officersthat conceived themselves as fairly resourceful persons.However, since similarly high levels of self-efficacy havebeen found in the Danish Work Environment Cohort Study(Det Nationale Forskningscenter for Arbejdsmiljø, 2005),one cannot exclude the possibility that questionnaire respondents are, in general, more prone to possess higher selfefficacy than nonrespondents. In any event, it is plausiblethat the fairly compressed general self-efficacy scores makeit more difficult to find effects. Finally, it may be noted thatmost smokers wanting to quit indicated that they neededsupport to do so, whereas they selected the no-help optionmost frequently in relation to alcohol.ConclusionA high belief in one’s own ability to change lifestyle behaviorsin relation to smoking, alcohol, eating, and physical activitymay lead to a decision to avoid help offers. Although the resultspresented here cannot be used to provide a reliable answer withregard to whether such a decision is detrimental or beneficialfor the health of an individual, the results suggest that a highself-efficacy may, in certain situations, lead to decisions thataffect help-seeking behavior in a workplace setting.Table 3. Multiple Logistic Regression Analyses: Age- and GenderAdjusted Analyses for Specific Self-Efficacy and General SelfEfficacy.Variable OR 95% CI pSmokingSpecific self-efficacy 1.41 [1.30, 1.52]


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