Original Article
Factors associated with health-promoting behavior of people with or at high risk of metabolic syndrome: Based on the health belief model

https://doi.org/10.1016/j.apnr.2014.11.001Get rights and content

Abstract

Purpose

The purpose of this study is to identify the associations between self-efficacy and the various factors in the Health Belief Model (HBM), and the health-promoting behaviors of people with, or at high risk of, Metabolic Syndrome (MS).

Methods

132 adults with two or more MS components were included in this cross-sectional study. Health-promoting behavior, self-efficacy and the four-constructs of HBM (perceived threat, cues, benefits, and barriers) were measured using validated tools. The contributions of each HBM factor towards the respective behavior were identified using a three-step hierarchical regression approach.

Results

After controlling for age, gender, education level, income and knowledge of MS, HBM factors accounted for 11% of the total variance in health-promoting behaviors. Beliefs about barriers were found to be a significant predictor of exercise (β =  .28, p < .01) and diet management (β =  .24, p = < .01), suggesting that a higher level of perceived barrier was associated with a lower frequency of health-promoting behaviors. In the final model, self-efficacy explained an additional 31% of the variance in exercise behavior and 13% in diet management behavior.

Conclusions

Self-efficacy and perceived barriers made independent contributions to health-promoting behavior among people with, or at high risk of, MS. Community health program targeting this particular group should tailor strategies that can enhance individuals’ self-efficacy and address barriers perceived.

Section snippets

Background

Metabolic syndrome (MS) is characterized by a cluster of metabolic risk factors, which include impaired glucose tolerance, dyslipidemia, elevated blood pressure, and central obesity (Grundy et al., 2005). The prevalence of MS is approximately 23% in United States and 21% in Hong Kong China (Bandura, 1977, Beltrán-Sánchez et al., 2013). While the presence of MS increases risk of cardiovascular events by approximately 2 times, people with MS are also five times more likely than others to develop

Design and data collection

A cross-sectional survey design was used to assess health-promoting behaviors of people with, or at high risk of, MS in a community setting. A health assessment program was run in two large urban areas of Hong Kong China to promote awareness of cardiovascular health for those between the ages of 18 and 65. A registered nurse first conducted basic health assessments, consisting of the measurement of height, weight, body fat composition, waist circumference, blood pressure, and fasting capillary

Characteristics of subjects

Table 2 provides a summary of subjects’ demographic and clinical data. A total of 132 subjects were recruited with a mean age of 49.30 (SD = 9.46) years, of whom 63% were aged 50 or above. One-third of the subjects had their highest education level below secondary school and 46% had a monthly family income less than the local median (Census and Statistics Department HKSAR, 2012). Regarding their health status, 59% were obese and 25% were overweight. Despite the fact that this study did not

Discussion

In this study, health-promoting behaviors of people with, or at high risk of, MS were examined, providing information on the possible influencing factors based on a theoretical framework. The results of this study showed that individuals in their mid-life, despite their high cardiometabolic risk, exhibit only moderate levels of health-promoting behavior. On the other hand, the importance of self-efficacy and reduced barriers in predicting health-promoting behaviors in regard to exercise and

Limitations

Firstly, although predictors in this study were conceptualized according to a well-established theoretical concept, the cross-sectional study design limited the conclusions that could be drawn on the causal relationship between self-efficacy and HBM factors on health-promoting behaviors. Moreover, the use of self-reporting in this study may have resulted in recall bias of the study variables. Future studies may consider the use of objective measurements, such as those provided by accelerometers

Implications

People with, or at high risk of, MS are susceptible to the development of CVD. The present findings highlight the factors of importance for the development of effective strategies for people at a higher risk for CVD. In Hong Kong China, there is so far no reported health promotion program for people with, or at high risk of, MS at the primary care level. Current practice of health promotion had focused on separate disease groups, where strategies to manage the clustering of cardiometabolic risk

Declaration

The authors declare no conflict of interest.

Acknowledgments

This research was supported by the Professional Development Fund of the Association of Hong Kong Nursing Staff.

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