Social differences in health behaviour: the motivational role of perceived control and coping
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Social economic inequalities in health have been documented in most European countries including Norway. While the components of socio-economic status (SES) occupation, income and education may each have a unique effect on health through different mechanisms, there is concern that an increased discrepancy between social economic groups on health-related behaviours will lead to an increased discrepancy in health between social economic groups in the future. In a social cognitive perspective, SES is considered to influence health behaviour through social cognitive processes. The main aim of this thesis was to study the relationship between educational level (as a component of SES) and psychosocial factors such as perceived control and coping in relation to health behaviour. The following five main research questions were addressed: 1. What is the relationship between educational level and perceived control? 2. How does perceived control predict one’s intention to engage in health behaviour (i.e. smoking cessation and consumption of fruit and vegetables)? 3. To what extent does perceived control mediates the relationship between educational level and intention, and educational level and health behaviour (i.e. fruit/vegetable consumption)? 4. Is educational level related to the use of different coping strategies when one is exposed to health related messages? 5. What are the motivational, behavioural and emotional consequences of these coping strategies? Method The thesis is based on data from three different studies carried out in Norway. Study 1 was a cross-sectional survey directed by the Norwegian Council on Tobacco and Health in November 1995 (survey response rate of 71%). The sample consisted of 421 respondents aged 16-79 (49.4% males, 50.6% females) who replied that they smoked daily. Study 2 was a cross-sectional survey carried out as part of a larger project on injury prevention among adolescents from two counties in Western Norway during December 1993 and January 1994 (survey response rate of 63%). The sample consisted of 1576 18-year old adolescents (52.2% females and 47.8% males). Study 3 was a two wave survey carried out among 45-year-old women residing in the city of Bergen in 1999. The sample consisted of 403 women who responded to the first questionnaire (response rate of 50.8 %), with 329 (81.6%) of them (41.5 % of the total sample) also responding to a follow-up questionnaire. Data from study 1 and 2 are presented in paper I, data from study 3 is presented in paper II and III. Main results Women with higher education levels reported higher general self-efficacy (GSE) (study 1 and study 3), and GSE was also positively related to educational aspirations (study 2). Higher educated women also believed less that chance/fate influenced health (study 3). General beliefs of control were related to higher perceived control in regards to specific health behaviours. Hence, GSE was positively related to confidence in quitting smoking (study 1), the belief that one can avoid injury risk (study 2), and the belief that one is capable of consuming fruits/vegetables at least three times daily (study 3). A long the same line, the belief that health is influenced by one’s own behaviour was positively related to the belief that fruit and vegetable consumption can promote health and diminish illness. As well, the belief in chance or fate was negatively related to beliefs about the health benefits of fruit and vegetable consumption (study 3). Behaviour specific control beliefs were more strongly related to specific intentions than were general control beliefs. Women with higher levels of education had stronger intentions of consuming fruits/vegetables at least three times daily, and also reported higher consumption four weeks later. The positive relationship between level of education and subsequent behaviour was mediated by intention, while the effect of educational level upon intention was only partially mediated through control beliefs (study 3). Women with lower levels of education reported more non-adaptive coping when exposed to health messages (denial, mental and behavioural disengagement), while no significant relationship was observed between level of education and adaptive coping. Non-adaptive coping was negatively correlated with behavioural intentions (fruit/vegetable consumption and physical exercise) while adaptive coping was positively correlated. Non-adaptive coping was also positively related to negative emotions. Conclusions The results indicate that there is a tendency for women with lower levels of education to have lower perceived control, weaker self-efficacy beliefs and a stronger belief that fate/chance influences health. These control beliefs partially mediated the relationship between level of education and intention to consume fruits and vegetables. Further research on educational differences should include several health-related behaviours, and should explore the possible mediating effect of other social cognitive variables along with non-cognitive factors. Women with lower education also seemed to engage in more non-adaptive coping with regards to health related messages. This tendency to avoid health related messages should be looked at as this type of coping seems to have both negative emotional and behavioural consequences and could possibly contribute to increasing differences in health related behaviours between social economic groups.
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Paper I: Psychology and Health, 15(1), Leganger, Anette, Kraft, P., & Espen Røysamb, Perceived self-efficacy in health behaviour research: Conceptualization, measurement and correlates, pp. 51-69. Copyright 2000 OPA (Overseas Publishers Association). Published by the Harvard Academic Publisher imprint, part of The Gordon and Breach Publishing Group. Full-text also available from publisher’s website: <a href”=http://dx.doi.org/10.1080/08870440008400288”target=_blank>http://dx.doi.org/10.1080/08870440008400288Paper II: Journal of Health Psychology, 8(3), Leganger, Anette, & Pål Kraft, Control construct: Do they mediate the relationship between educational attainment and health behaviour? pp. 361-372. Copyright 2003 SAGE Publications. Full-text also available from publisher’s website: <a href”=http://dx.doi.org/ 10.1177/13591053030083006”target=_blank>http://dx.doi.org/ 10.1177/13591053030083006Paper III: Iversen, Anette. C. & Pål Kraft, 2004, Coping with health related messages: The role of educational level and health consciousness. Preprint. (submitted)