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Table 2 Summary of cross-sectional studies selected for analysis

From: The association between self-efficacy and self-care in essential hypertension: a systematic review

No Population Intervention Outcome
1 Ahn & Ham, 2016 [22]
Population: 289 adults receiving medical aid across South Korea, recruited from the community
Instrument: General self-efficacy – measured by 17 questions [44] translated into Korean [45]
Comparison made: Independent variable: Self-efficacy; dependent variable: medication adherence
Medication adherence – Modified Morisky Scale [46] In hierarchical multiple regression analysis, self-efficacy was significantly associated with medication adherence (step 2 β = 0.143, step 3 β = 0.146, p = 0.019)
2 Al-Noumani et al. 2018 [23]
Population: 215 Omanis aged 21 years or older from primary healthcare settings around Oman
Instrument used: Self-efficacy for medication adherence – Medication Adherence Self-Efficacy Scale- Revised (MASES-R) translated into Arabic
Comparison made: Independent variable: self-efficacy for medication adherence, dependent variable: medication adherence
Self-care behaviours assessed:
Medication adherence – Morisky Medication Adherence Scale-8 items translated into Arabic
Participants with higher self-efficacy were 2.5 times more likely to have high medication adherence (OR = 2.59, p < 0.01)
3 Bae et al. 2016 [24]
Population: 401 rural community-dwelling elderly (aged 65 and over) in South Korea, recruited from the community
Instrument: Medication adherence self-efficacy scale – revision (MASES-R) [47]
Comparison made: Independent variable: Self-efficacy for medication adherence; dependent variable: medication non-adherence
Medication adherence – 6 yes or no questions to assess intentional and unintentional non-adherence [48] Self-efficacy has a significant direct influence on unintentional nonadherence behaviours (β = −0.433, P < 0.001), significant indirect effect on unintentional adherence
(β = −0.286, P < 0.001) but no significant direct effect on intentional non-adherence (β = − 0.055, P = 0.515)
4 Bahari et al., 2019 [25]
Population: 158 Saudi men aged 18 and above, attending primary health care centres in the Jizan and Al-Sharqia regions of Saudi Arabia
Instrument used: General self-efficacy - Hypertension Self-Care Profile [49] translated into Arabic
Comparison made: Independent variable: Self-efficacy; dependent variable: performance of self-care behaviours
Self-care behaviours assessed: physical activity, adherence to diet, abstention from alcohol and smoking, self-monitoring of BP, weight control, regular doctor visits, stress reduction [49] - Hypertension Self-Care Profile translated into Arabic Self-efficacy is significantly associated with performance of self-care behaviours (β = 0.353, p < 0.05)
Self-efficacy fully mediates the relationship between family social support and hypertension self-care behaviours
5 Breaux-Shropshire et al., 2012 [26]
Population: 149 municipal employees with access to health insurance, recruited from participants of an employee wellness programme in the United States of America
Instrument: Medication adherence self-efficacy – revised Medication Adherence Self-Efficacy Scale (MASES-R) [47]
Comparison made: Independent variable: Self-efficacy for medication adherence; dependent variable: medication adherence
Medication adherence – 8 item Morisky Medication Adherence Scale [50] Significant positive linear relationship between medication adherence and medication adherence self-efficacy (r = 0.549, p < 0.05)
6 Chang & Sok, 2015 [27]
Population: 306 Koreans aged 65 and above, recruited from public health centres in Seoul, Korea
Instrument used: SE for physical activity – Korean translation of the instrument “Exercise Self-efficacy Measure” [51, 52]
Comparison made: Independent variable: Self-efficacy; dependent variable: Sedentary behaviour and performance of physical activity
Sedentary behaviour and physical activity - Korean translation of International Physical Activity Questionnaire-Short Form (IPAQ-SF) [53, 54] Self-efficacy was not one of the predictors of sedentary behaviour. Sedentary behaviour was instead significantly predicted by variables such as empowerment level, perceived health, time since diagnosis of hypertension, vigorous-intensity physical activity, and depression, which explained 42.6% of the variance in sedentary behaviour.
7 Ea et al., 2018 [28]
Population: 163 adult (aged at least 18) first-generation Filipino immigrants in the United States, recruited from the community
Instrument used: Self-efficacy – Hypertension self-care profile self-efficacy scale [49]
Comparison made: Independent variable: Self-efficacy to engage in various aspects of hypertension management, dependent variable: tendency to engage in hypertension self-care behaviours
Self-care behaviours assessed: adherence to appropriate diet, adherence to medications, smoking cessation, regular exercise, stress avoidance and use of relaxation techniques - Medical Outcomes Study Specific Adherence Scale [55] Self-efficacy is positively correlated with hypertension self-care (correlation coefficient = 0.407, p < 0.001), self-efficacy is a significant predictor of hypertension self-care (β = 0.270, p = 0.003)
8 Elder et al., 2012 [29]
Population: 235 Southern African American men aged 18 or over, recruited from a hospital in Alabama, USA
Instrument used: Self-efficacy - Ogedegbe Self-Efficacy Scale [56]
Comparison made: Independent variable: Self-efficacy; dependent variables: Medication adherence
Medication adherence – measured by Morisky Medication Adherence Scale [50] Participants with higher self-efficacy more likely to report better medication adherence (OR = 1.08; 95% CI = 1.02)
9 Gacek, 2014 [30]
Population: 160 women from Małopolska, Poland, aged 45–60
Instrument used: General self-efficacy – General Self-Efficacy Scale (35, as cited in Gacek, 2014)
Comparison made: Independent variable: Self-efficacy; dependent variable: Adherence to recommended diet
Frequency of consumption of food products – measured using a seven-item scale Higher levels of self-efficacy were associated with more frequent consumption of recommended food products
10 Giena, Thongpat & Nitirat, 2018 [31]
Population: 333 adults aged 60 and above from 4 primary health centres in Bengkulu City, Indonesia
Instrument used: Self-efficacy – Self-rated Abilities for Health Practice Scale (54, as cited in Giena et al. 2017)
Comparison made: Independent variable: Self-efficacy; dependent variable: Performance of self-care behaviour
Self-care - Measured by modified version of Health Promoting Lifestyles Profile II (55, as cited in Giena et al. 2017) Self-efficacy (among other factors) significantly affects health-promoting behaviour (β = 0.321. P < 0.001)
11 Heydari et al., 2014 [32]
Population: 671 adults with hypertension aged 30 and above referred to rural health care centres in Ardabil city, Iran in 2013
Instrument: Health belief model questionnaire, which included 6 items on self-efficacy [32]
Comparison made: Independent variable: self-efficacy; dependent variable: medication adherence
Medication adherence – Morisky Medication Adherence Scale-4 Individuals with moderate self-efficacy more likely to be non-adherent than adherent to medication (OR 1.5, P < 0.001), individuals with low self-efficacy more likely to be non-adherent than adherent to medication (OR 5.1, p < 0.001)
12 Hu, Li & Arao, 2015 [33]
Population: 318 residents of a rural community in Beijing aged 35 and above, recruited from the community
Instruments used: Self-efficacy - validated Chinese version of the Self-Efficacy for Managing Chronic Disease six-Item Scale [57]
Comparison made: Independent variable: Self-efficacy; dependent variable: Performance of self-care behaviour
Self-care behaviours assessed: medication adherence, regular BP measurement, physical exercise,
alcohol abstinence, smoking cessation & low salt diet adherence - assessed using face-to-face questionnaires
Higher self-efficacy is associated with engagement in exercise. A 10-unit increase in self-efficacy is related to an increased odds ratio of 1.25 (95% CI 1.04–1.49) for performing regular exercise.
13 Idowu et al., 2013 [34]
Population: 212 adults aged 31 and above receiving treatment from two tertiary health centres in Nigeria
Instruments used:- Self-efficacy for exercise - Exercise Self-Efficacy Scale (43, as cited in Idowu et al., 2012)
Comparison made: Independent variable: Self-efficacy; dependent variable: Engagement in physical activity
Physical activity level - International Physical Activity Questionnaire [58] Significant associations between physical activity levels and self-efficacy (rs = 0.67, p < 0.01)
14 Khalesi, Irwin & Sun, 2017 [35]
Population: 270 adults aged 18 and over in Gold Coast, Australia, recruited from the community
Instrument used: Self-efficacy for diet and exercise- short version of self-efficacy questionnaire developed by Sallis et al. [59]
Comparison made: Independent variable: Self-efficacy for exercise; dependent variable: medication adherence
Self-care behaviours assessed: Adherence to recommended diet – Food Frequency Questionnaire [60],
Adherence to medication – 4 questions, modified and validated for purposes of this study, containing 4 items on medication, compliance and reasons for non-compliance [61]
Exercise self-efficacy was associated with a higher likelihood of good adherence to antihypertensive medication (t = 2.38, p = 0.01), self-efficacy for adherence to diet not significantly associated with good adherence to antihypertensive medication (t = 1.13, p = 0.25)
15 Lee & Park, 2017 [36]
Population: 255 adults aged 65 and over attending hospitals in Kyung-buk province of South Korea
Instrument: SE- measured with 10-item questionnaire with scale from 10 to 100 (43, as cited in Lee & Park, 2017)
Comparison made: Independent variable: self-efficacy; dependent variable: engagement in self-care behaviour
Self-care behaviour – 16 item questionnaire including items regarding management of diet, body weight, alcohol, smoking, stress, coffee, medication and exercise [62] In participants with controlled hypertension, self-efficacy affected SC behaviour (β = 15.41, p = .009), in participants with uncontrolled hypertension, self-efficacy was the strongest factor affecting self-care behaviour (β = 0.45, p < .001) among the factors analysed
16 Lee et al., 2010 [37]
Population: 445 middle-aged (40–64 years) Korean Americans from the community
Instruments used: Hypertension control self-efficacy - Self-efficacy Scale, modified instrument based on the Hypertension Belief Scale [63]
Comparison made: Independent variable: Self-efficacy; dependent variable: Performance of self-care behaviour
Self-care behaviours – measured by 5 items in questionnaire (medication adherence, healthy diet, weight control, & exercise). Self-efficacy positively associated with performance of self-care behaviour (β = 0.246, p < 0.001)
17 Ma, 2018 [38]
Population: 382 adults aged between 18 and 59 attending two tertiary hospitals in Guangzhou, China
Instrument used: Health belief questionnaire for hypertensive patients – 29 items grouped in five dimensions of health beliefs, of which self-efficacy was one (8 items in the questionnaire measured self-efficacy)
Comparison made: Independent variable: Self-efficacy; dependent variable: engagement in self-care behaviours
Hypertension self-care behaviours assessed: BP monitoring, medication, dietary, physical activity, weight management, smoking and alcohol management – Hypertension self-care behaviours questionnaire (11, as cited in Ma, 2018) Self-efficacy is the strongest determinant of self-care behaviours (β = 0.62, p < 0.001)
18 Nafradi et al. 2016 [39]
Population: 109 adults with hypertension aged over 35 years, recruited from medical offices and hospitals
Instrument: Self-efficacy – Medication Adherence Self-Efficacy Scale (MASES) [47]
Comparison made: Independent variable: Self-efficacy for medication adherence; dependent variable: medication non-adherence
Medication adherence – 15 item scale developed based on the Medication Adherence Report Scale [64] (as cited in Nafradi et al. 2016) – included two separate sub-scales for intentional and unintentional non-adherence Lower adherence self-efficacy is a determinant of intentional non-adherence (t = 4.54, p < 0.001) and unintentional non-adherence (t = 3.15, p = 0.002
19 Namwong et al., 2015 [40]
Population: 341 Thais aged 60 and above attending hypertension clinics in a community hospital in northern Thailand
Instrument: Self-efficacy – Hypertensive Self-efficacy Scale [41]
Comparison made: Independent variable: self-efficacy for medication adherence, adherence to diet, weight control, physical exercise; dependent variable: medication adherence
Self-care– adherence to medications, adherence to diet, weight control, smoking cessation, adherence to exercise, limiting alcohol intake, stress management and four attributes of adherence i.e. (i) alignment of individuals’ behaviours and health recommendations (ii) mastery of new behaviours and health knowledge (iii) ongoing collaboration with health care providers on treatment plan (iv) individuals’ perceived ability to meet optimal blood pressure - Hypertensive Adherence to Therapeutic Regimens Scale [41] Perceived self-efficacy had a significant direct effect on medication adherence (structural path coefficient 0.69, p < 0.01)
20 Pinprapapan et al., 2013 [41]
Population: 321 adults in Northern Thailand aged 35–59 recruited from a community hospital
Instruments used: Self-efficacy for managing hypertension –Hypertensive Self-efficacy Scale
Comparison made: Independent variable: Self-efficacy; dependent variables: Performance of self-care behaviours
Self-care behaviours – adherence to medications, adherence to diet, weight control, smoking cessation, adherence to exercise, limiting alcohol intake, stress management and four attributes of adherence i.e. (i) alignment of individuals’ behaviours and health recommendations (ii) mastery of new behaviours and health knowledge (iii) ongoing collaboration with health care providers on treatment plan (iv) individuals’ perceived ability to meet optimal blood pressure - Hypertensive Adherence to Therapeutic Regimens Scale Direct positive influence of perceived self-efficacy on performance of self-care behaviours (structural path coefficient = 0.54, p < 0.01)
21 Son & Won 2017 [42]
Population: 255 adults aged 65 and over at a general hospital in Seoul, Korea
Instrument: Self-efficacy for medication adherence – Korean version of self-efficacy for appropriate medication use scale [65]
Comparison made: Independent variable: Self-efficacy for medication adherence; dependent variable: medication adherence
Medication adherence – Korean version of 8-item MMAS-B [66] Self-efficacy is significantly positively correlated with medication adherence (r = 0.53, p < 0.001), self-efficacy is significantly predictive of medication adherence (β = .55, P < .001)
22 Warren-Findlow et al. 2012 [43]
Population: 190 African-Americans aged 21 years and above, recruited from the community in the greater metropolitan Charlotte area, USA
Instrument: Self-efficacy - five-item scale modified from existing validated measure to assess self-efficacy to manage disease [67]
Comparison made: Independent variable: self-efficacy; dependent variables: engagement in various self-care activities
Self-care activities –medication adherence, adherence to low-salt diet, engagement in physical activity, practising weight management techniques, not smoking - measured by Hypertension Self-Care Activity Level Effects [10] alcohol intake – measured by NIAAA Quantity and Frequency Questionnaire [68] (as cited in Warren-Findlow et al. 2012) Good self-efficacy statistically significantly associated with increased prevalence of adherence to medication (Prevalence ratio (PR) = 1.23), eating a low salt diet (PR = 1.64), engaging in physical activity (PR = 1.27), not smoking (PR = 1.10), practising weight management techniques (PR = 1.63)
  1. Summary of population studied, instruments used, comparison made and outcome reported in each article that was selected for review
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