Browsing by Subject "Self-efficacy"

The salience, prevalence, and consequences of feedback students receive on their academic performance have led to widespread interest in assessment outcomes. Despite the frequency and high stakes of performance feedback, a clear picture of how it influences students' academic motivation has failed to emerge. The overarching goal of this dissertation study was to better understand the effect of performance feedback on secondary school students' academic motivation following a high-stakes assessment. In particular, this study had three main aims: (1) begin disentangling the influence of performance feedback from its valence on students' self-efficacy, goal orientations, and intrinsic motivation, (2) explore how the stage of an assessment event and performance feedback interact to influence these motivation constructs, and (3) determine whether the influence of performance feedback on academic motivation depends on the evaluation dimension of the classroom goal structure.

To investigate these topical questions, the current study implemented a cluster-randomized experimental design. One hundred sixty-one seventh through ninth grade students in 13 math or science classes from a single, all-female secondary school were randomly assigned by their class to one of the following four feedback conditions: (1) numeric grades, (2) evaluative comments, (3) numeric grades accompanied by evaluative comments, and (4) no feedback. Students' academic motivation was then measured on three occasions to capture its fluctuations during an assessment event: at baseline, immediately after teachers announced what form of feedback students would receive (i.e., anticipation stage), and immediately after students received their assigned form of feedback (i.e., receipt stage).

Results revealed a series of complex interactions between the stage of feedback (i.e., anticipation vs. receipt) and its form (i.e., grades, comments, grades plus comments, or no feedback). Notably, only students in the grades plus comments condition experienced a decline in self-efficacy from anticipation to receipt of this feedback. However, these students also reported an increase in their mastery goal orientation and intrinsic motivation upon the receipt of grades accompanied by comments. Students in the comments condition experienced a similar increase in intrinsic motivation. Finally, students in the no feedback and comments conditions also reported a greater performance-approach goal orientation when they received performance feedback (or lack thereof) compared to when they anticipated it. No evidence was found to support the hypothesis that students' perceptions of the evaluation dimension of their classroom goal structure moderated these interaction effects. Theoretical, methodological, and practical implications of these findings are discussed along with limitations and recommendations for future research.

Background: Cervical cancer is the fourth most common cancer worldwide, despite its highly preventable nature. Cervical cancer disproportionately affects individuals in low- and middle-income countries (LMICs), especially those in sub-Saharan Africa. Kenya experiences the highest cervical cancer incidence rate within the East African region (33.8 per 100,000 women) and is among the highest in the world. Huchko et al. demonstrated that cervical cancer screening via Human Papillomavirus (HPV)-based self-collection, led by community health volunteers (CHVs), is acceptable and well attended. While well received by communities in Western Kenya, researchers highlighted key barriers to the scale and potential effectiveness of this approach, including a need for electronic data collection and a lack of protocol and decision support tools for healthcare providers, who are often lay providers. Based on high reported mobile phone ownership within Kenya generally and past research documenting success with text message-based delivery of screening results within Western Kenya, the introduction of a mobile application-based intervention to address the identified challenges to cervical cancer screening and prevention appears feasible. This study sought to iteratively develop an mhealth intervention with key stakeholders, evaluate the usability of the intervention, and describe factors that limit and build cervical cancer screening self-efficacy among lay providers.

Methods: Between June 2019 and January 2020, we conducted a two-part study in Kisumu, Kenya to develop and pilot a mobile phone application, “mSaada.” In the first part of the study, between June and August 2019, a purposive sample of 18 participants completed in-depth interviews (IDIs) in two waves to provide a detailed review of the mSaada app and its features. Iterative revisions of the app were informed by participant feedback. During the second part, between October 2019 and January 2020, we conducted a small-scale pilot usability study within three healthcare facilities in Kisumu, Kenya. A convenience sample of 10 community health volunteers incorporated the mSaada mobile application into their daily interactions with clients during cervical cancer screening and education sessions. Participants completed usability and self-efficacy surveys throughout the study period as well as an in-depth interview to provide insight into their experience using mSaada.

Results: Iterative development of the mSaada mobile application resulted in major changes to the app’s user interface, aesthetics and organization, as well as the addition and clarification of educational content included within the platform. Overall, mSaada usability ratings increased significantly during the study period (4.54 to 4.84, p<0.001). During qualitative interviews, participants highlighted the app’s ease of use, impact on their workflow, and the comprehensiveness of the included information as strengths of mSaada. Participants did, however, cite concerns about the feasibility of broader implementation of the platform within Kenya. Overall, CHV self-efficacy increased significantly from the beginning to the end of the study period (4.53 to 4.74, p=0.008). When asked about factors limiting self-efficacy, participants discussed language barriers, time constraints, supply shortage, and privacy issues. Reference materials, personal knowledge, and experience and repetition were seen as factors that build self-efficacy.

Conclusions: While mSaada’s usability increased and the platform was observed to improve lay provider self-efficacy, much research is still needed in this area. Specifically, there is a need to engage women eligible for screening in future studies to help tailor mSaada such that it can best benefit the client population. Also, further development of the technological infrastructure within this setting is needed to promote long-term feasibility and sustainability of an mhealth solution like mSaada.

The current study examined the relationships among the neighborhood environment, levels of self-efficacy, health behaviors, and health outcomes among adults in the United States. The goals of the research were as follows: 1. To examine the role that health behaviors play in the relationship between neighborhood and health; 2. To determine whether health-related self-efficacy mediates or moderates the relationship between neighborhood and health behaviors; 3. To investigate potential gender, education, and race differences in the relationships among the constructs.

The study included 5,600 whites and 321 blacks who participated in the first wave of the National Survey of Midlife Development in the Unites States (MIDUS I). The age range of the sample was 20-75 (mean= 47.14 years) and roughly half of the participants were male (47.4%). Data on the neighborhood (including safety, physical conditions, social cohesion, and homeplace), health-related self-efficacy, health behaviors, and the health outcomes of self-rated health, obesity, and cardiovascular disease were collected through telephone interviews and self-report questionnaires.

Structural equation modeling was employed to address the research goals. The results showed that self-efficacy mediated the relationship between neighborhood and physical activity and that health behaviors mediated the path between neighborhood and physical activity. However, self-efficacy did not serve as a moderator in the association between neighborhood and physical activity. Demographic differences were found according to age, gender, race, and education. Specifically, the model was particularly salient for late midlife and older adults, females, and those with some college education. Furthermore, the impact of neighborhood factors on self-efficacy was greater for blacks than whites.

The present findings contribute to the literature by elucidating the interrelations among neighborhood and the individual-level factors of self-efficacy and physical activity in predicting health outcomes. Furthermore, the direct effect of physical activity on health outcomes suggests that physical activity engagement should be a particular area of intervention focus, especially among older adults and women. Future research should include objective measures of neighborhood, physical activity, and health, additional contexts such as the workplace, individuals above the age of 75, and greater representation of minority groups.

Background: Chronic kidney disease (CKD) is a progressive, irreversible condition that affects 15% of the US population, causing poor health outcomes and enormous social and economic burden. Rural and minority populations bear significant disparity in CKD outcome. Self-management of CKD and comorbid conditions is important in slowing the progression of CKD and preventing end stage renal disease.

Methods: This study uses a mixed-methods study design to investigate the association between positive mental health and self-efficacy and to qualitatively explore the dimensions of positive mental health that influence self-efficacy. A cross-sectional study involving 257 individuals was conducted from May to July 2016. Quantitative data collection involved administration of a questionnaire and clinical assessment of kidney function. Participants were asked about their medical history and attitudes on the chronic disease management (self-efficacy for chronic disease management, coping, social support, and perceived stress), and mental health and illness (positive mental health, depression, anxiety, and PTSD). Ordered logistic regression was used to assess the relationship between positive mental health and self-efficacy, controlling for depression, the interaction between positive mental health and depression, and other covariates. Qualitative data collection involved conducting six focus group discussions involving 35 individuals who experience significant life impact due to kidney disease to explore facilitators and barriers of CKD self-management.

Results: Individuals with flourishing positive mental health were significantly more likely to have high self-efficacy compared to individuals with languishing positive mental health (p < 0.001, Figure 10). Overall, in the fully adjusted model, the proportional odds ratio of improved self-efficacy was 2.89 (95% CI 1.29-6.47), all else held constant. For individuals with CKD, the proportional odds ratio of improved self-efficacy was 7.67 (95% CI 2.42-24.29), all else held constant. For individuals without CKD, positive mental health was not a significant predictor of self-efficacy (p-value > 0.05). Qualitative data showed support for the broaden and build theory as a possible mechanism linking positive mental health and CKD self-management. Positive emotions derived from positive mental health allowed individuals to acquire personal and social resources such as resilience, optimism, and social support that encourage self-management of CKD.

Conclusion: These findings suggest that positive mental health should be incorporated into existing CKD self-management programs to fully address the psychosocial needs of patients and effectively encourage sustainable behavioral changes for CKD self-management. Future efforts should focus on identifying positive mental health interventions that builds on the strong familial relationships, and spiritual and religious organizations in the community to improve positive mental health in this population.

Background: Over one million people have HIV infection in the United States (U.S.), where HIV has permeated all regions of the nation and all ethnic and racial groups. HIV transmission occurs through a number of mechanisms, many of which can be exacerbated by substance use. In 2008, nearly one in four of the HIV-positive population was in need of substance use treatment. The lives of HIV-positive substance users can be further complicated by histories of sexual and physical abuse which is related to worse overall health, health behaviors, and health outcomes.

Objective: This study explores the relationship between the age of initiation of abuse, the type of abuse, psychological symptoms that may result from abusive events, and the confidence in one's ability to communicate with a health care provider, get support from family and friends, and manage his or her mood.

Methods: In the current study, 206 HIV-positive patients were recruited from three infectious disease clinics. The participants screened positive for alcohol or substance use and, as part of a larger study, consented to twelve months of integrated HIV-substance use treatment. Using pre-intervention, baseline data, multiple regression analysis was used to examine the relationship between sexual and physical abuse during childhood and adolescence and current self-efficacy among HIV-positive substance users. Mediational analysis was used to test whether psychological symptoms mediated the relationship between abuse and self-efficacy.

Results: Because of the small sample size, individual categories of abuse were reported but interpretations of these results could not be justified. The primary focus of the discussion focused on individuals who experienced any abuse before the age of 19. Any abuse was not directly associated with one's confidence to communicate (p=0.78). In the relationship between any abuse, psychological symptoms, and communication self-efficacy, anxiety and depression trended towards significance (Banxiety=-0.03, p=0.06; Bdepression=-0.02, p=0.10), but was not a mediator of the relationship. Any abuse was not directly associated with one's confidence to seek support from others (p=0.35). When accounting for psychological symptoms, depression was associated with one's confidence to seek support (B=-0.06, p=0.01). Results were inconclusive for determining a mediation relationship. Any abuse trended toward significance of being negatively associated with one's confidence to manage one's mood (B=-0.34, p=0.11). In the relationship between any abuse, psychological symptoms, and mood management self-efficacy, anxiety and depression were associated with one's confidence to manage one's mood (Banxiety=-0.08, p=0.01; Bdepression=-0.06, p=0.01), but were not mediators of the relationship.

Conclusion: The findings suggest that one's confidence to apply positive health behaviors are tied to psychological symptoms and may be tied to histories of abuse. This study suggests that efforts to improve health behaviors should focus on one's self-efficacy in communicating with health care providers, seeking support from others, and managing one's mood. Additional efforts should be made to address symptoms of depression and anxiety and particularly the correlation that abuse may have in aggravating these symptoms.