The relationship between health-specific self-efficacy and five-year change in blood pressure in young adults
Abstract
Hypertension, defined as a persistently elevated blood pressure of 140/90 mmHg (Raymond & Couch, 2017), is one of the leading causes of secondary disease and premature death. This study is a sub-study of the longitudinal African Prospective study on the Early Detection and Identification of Cardiovascular Disease and Hypertension (African-PREDICT) study (Schutte et al., 2019). From the literature, health-specific self-efficacy seems to be a promising departure point for understanding the role psychosocial factors play in health and disease outcomes but has not been previously explored in a South African study on identifying early hypertension risk factors. The research question was therefore formulated as: Is baseline health-specific self-efficacy associated with a change in blood pressure over five years in young adults? To what extent do sex and ethnicity influence the relationship between health self-efficacy and change in blood pressure?
A stratified sample of 384 apparently healthy young adults (mean age 25.07 years at baseline), with a clinic brachial blood pressure of <140 and <90 mmHg took part in the study. Both systolic and diastolic blood pressure was measured at baseline and 5-year follow up in a clinic setting with the CardioXplore® 24-h ambulatory blood pressure monitoring apparatus and the Dinamap Procare 100 Vital Signs monitor. Baseline health-specific self-efficacy was measured with the Health-specific Self-Efficacy Scale (Schwarzer & Renner, 2005). Pearson product moment correlations were calculated to determine associations between changes in blood pressure and health-specific self-efficacy, while a 2 x 2 factorial Analysis of Variance was calculated to determine the effect of sex and ethnicity on changes in blood pressure.
Results show a slight decrease in blood pressure within normal limits for the age group. No significant correlations were found between health-specific self-efficacy and change in blood pressure, most probably due to self-efficacy’s dependence on, and interrelation with other factors like risk perception, motivation, and social support. A significant but practically small main effect was found for sex on change in systolic blood pressure (SBP) (independent of both nutrition- and alcohol self-efficacy) with female participants showing a smaller decrease in SBP than male participants. A significant, but practically small difference was found between the mean increase in diastolic blood pressure (𝑥̅ = 1.36) in black participants with high nutrition self-efficacy (NSE) compared to the mean decrease in diastolic blood pressure ( 𝑥̅ = -1.63) in white participants with high NSE. Some evidence thus emerged
suggesting ethnic differences regarding NSE and how it impacts on change in blood pressure. Overall, the results clearly illustrate the complex interaction between health-specific self-efficacy, sex, ethnicity, and changes in blood pressure. Although health-specific self-efficacy could not convincingly be identified as an early role player in the risk of developing hypertension, further research needs to be done to better understand its role. More specifically, the possible mediating role of risk perception, motivation, social support, and goal implementation should be investigated. Further, the importance of NSE should be explored to determine similar trends in other contexts, as well as the extent to which NSE is influenced by nutritional knowledge and ethnic identity. The Africa-PREDICT study provides this opportunity as there will be further 5-year interval follow-ups that may account for the effect of change over a longer period.
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