Bandura's Social Cognitive Concepts and Physical Activity of People with Multiple Sclerosis: A Hierarchical Regression Analysis
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BACKGROUND: Social Cognitive Theory (SCT), developed by Alfred Bandura, is a theory often employed for health promotion. This theory focuses on a set of determinants, examining how each operates, and translating information about the determinants into health practices. The combination and interaction of the primary determinants of SCT (perceived self-efficacy, outcome expectations, goals, and perceived facilitators and barriers) not only determine, but also influence the health behaviors individuals engage in. Through the use of this theory, determinants to change and adoption of a new behavior can be assessed, and individual treatment plans may be developed to effectively focus on the most influential targets for behavioral change. Multiple Sclerosis, a chronic and debilitating health problem estimated to affect hundreds of thousands of individuals in the United States, often leads to individual suffering and an overall decreased quality of life. Currently, there is no cure for MS, so symptom management and a decrease in debility remain a critical area of focus for health professionals working with MS patients. While there is no cure for this disorder, physical activity has been shown to alleviate multiple symptoms of MS such as mobility impairment, fatigue, pain, and depression, which then improves the quality of one’s life. Furthermore, there is strong empirical evidence to support the use of SCT as an efficacious treatment approach for employing health promotion practices. The purpose of this study is to extend previous findings by examining how various SCT concepts relate to physical health, mental health, stage of change for exercise, and action planning and coping planning for exercise. Additionally, the present study examines how disability affects self-efficacy thereby impacting physical activity. SUBJECTS: A total of 214 individuals (185 females [86%] and 29 males [14%] with self-reported MS recruited from the National Multiple Sclerosis Society and a neurology clinic of a university teaching hospital in the Midwest participated in the current study. The average age among participants was 46.97 years (SD = 9.92). Around 36% of participants were retired due to MS, and approximately 72% of participants reported being treated for secondary health problems (e.g., overweight, high blood pressure, and diabetes). METHOD: Participant demographic data were gathered from self-reports and include age, gender, ethnicity, marital status, years since onset of MS, secondary health issues, education level, vocational status, occupation, area of residence, current and past rehabilitation services received, source of income, total income, access to physical exercise in community, and changes in health practice since onset of MS. SCT concepts were assessed using the following measures: Action Self-Efficacy Scale-Physical Exercise (ASES-PE), Outcome Expectancy Scale-Physical Exercise (OES-PE), Health/Safety Risk Perceptions Scale (HRPS), Health/Safety Expected Benefits Scale (HEBS), Barriers to Health Promoting Activities for Disabled Persons Scale (BHADP), the Action Planning and Coping planning Scale-Physical Exercise (APCPS-PE), the Physical Activity Stages of Change Instrument (PASC). Participant disability and health were assessed using the following measures: Minimal Record of Disability (MRD) and the MOS Short form Health Survey (SF-12v2). The present study used a hierarchical regression analysis to examine associations between various domains and a set of social cognitive concepts (self-efficacy, knowledge of health and risk benefits, and outcome expectancy). RESULTS: There were several significant findings when examining the four domains of action planning and coping planning, stage of change, physical health, and mental health. Results indicated action planning and coping planning was predicted by action self-efficacy (R2 = 45%, ß = .45, p < .001), outcome expectancy (R2 = 45%, ß = .20, p < .01), risk perception (R2 = 45%, ß = .14, p < .05), and perceived barriers (R2 = 16%, ß = -.14, p < .05). Results indicated that stage of change was predicted by action planning and coping planning (R2 = 28%, ß = .26, p < .01). When “physical health” was the outcome variable, it was predicted by age (R2 = 8%, ß = -.20, p < .01), severity of disability (R2 = 14%, ß = -.28, p < .01), action self-efficacy (R2 = 22%, ß = -.16, p < .05), and outcome expectancy (R2 = 22%, ß = .27, p < .01). Lastly, when “mental health” was the outcome variable, it was predicted by age (R2 = 6%, ß = .18, p < .05), perceived barriers (R2 = 11%, ß = -.23, p < .01), outcome expectancy (R2 = 18%, ß = -.25, p < .01), and action self-efficacy (R2 = 18%, ß = .22, p < .05). DISCUSSION: The research findings support the applicability of Bandura’s Social Cognitive Theory as a model for exercise or physical activity for people with MS. This study found unique relationships between physical health and action self-efficacy, and mental health and outcome expectancy (with both relationships having a negative correlation). The current study includes a unique subset of the MS population who are well-educated, affluent, and report greater access to services and who expressed the negative correlate between action self-efficacy and physical health. The aforementioned factors are supposed to support physical health. However, the current group has high action self-efficacy to exercise, and given that they likely have good knowledge about exercise benefits to MS and good environmental support to engage in exercise, their motivation has likely surpassed, and is greater than, their experienced physical health, such as suffering pain and fatigue, which decreases physical health. Furthermore, it may be that the participants in the current study have good knowledge about how physical activity benefits their MS symptoms and progress management; consequently, they have high intention to push themselves to engage in exercise even though they may have experienced pain and fatigue, both of which have affected physical health significantly. Additionally, considering that high outcome expectations of a behavior may lead to stress and anxiety, such stress may decrease mental health, particularly if the positive effects of an activity (such as exercise) are not experienced as soon as and as much as expected. Examining the social cognitive, physical health, and mental health domains provides a well-rounded and empirical basis for employing health promotion efforts in clinical work with persons with MS. Rehabilitation professionals may help persons with MS implement physical activity through the use of SCT, which may improve their mobility impairment, pain, fatigue, and depression. The present study’s findings enable clinicians and rehabilitation professionals to better create and customize treatment to best meet individual patients’ needs and improve their overall quality of life.