Unleashing Confidence: How Self-Efficacy Shapes Healthier Lifestyles in Non-communicable Disease Patients – A Comprehensive Review

Introduction

Non-communicable disease (NCD) refers to the chronic nature of ailments such as cardiovascular diseases (stroke and myocardial infarction), cancers, diabetes, and chronic respiratory illnesses (chronic obstructive pulmonary disease and asthma). NCD is responsible for 74% of global mortality (1). The WHO has launched a Global Action Plan for the Prevention and Control of NCDs (2013–2020), which has now been extended to 2030. This strategy aims to lessen premature deaths caused by NCDs by one-third through efficient prevention and treatment methods, corresponding to the Sustainable Development Goals (SDGs), particularly target 3.4, which aims to mitigate NCD-related fatalities by 2030 (2).

The risk factors for NCDs can be classified into non-modifiable and modifiable influences. Non-modifiable factors include age, sex, and family medical history. Modifiable factors are linked to unhealthy lifestyle practices such as physical inactivity, poor diet, smoking, and excessive alcohol consumption (1, 3). Lifestyle encapsulates how an individual lives and signifies the traits representative of a specific time and locale. It encompasses everyday behaviors and roles of individuals regarding work, physical activity, well-being, and nutrition (4). A strategic approach in the prevention and management of NCDs includes promoting initiatives aimed at healthy lifestyle interventions (5), which have shown beneficial effects on health results (6), prevention of NCDs (7–9), reduction of hypertension risks (10), and alleviating the financial burden on healthcare systems (11, 12).

The WHO advocates for a health-enhancing lifestyle by fostering behaviors that mitigate risk factors associated with NCDs (2). A health-enhancing lifestyle is characterized as a multidimensional concept that involves self-initiated actions, diverse levels of behavior, and individuals’ self-perceptions aimed at maintaining or elevating their wellness level, self-actualization, and personal satisfaction (13). This concept leans on behavior, health beliefs (14), and Pender’s health-promotion models (13). A health-enhancing lifestyle fosters health across six dimensions: i) health responsibility, ii) physical activity, iii) nutrition, iv) social interactions, v) spiritual development, and vi) stress management (15, 16). Spiritual development and physical activity reflected the highest and lowest scores, respectively, across health-enhancing lifestyle dimensions (17).

Research has shown that numerous factors are linked to health-enhancing lifestyle practices, such as socio-demographic variables (18, 19), perceptions of illness (20), social support (21), and self-efficacy (9, 22–24). Self-efficacy refers to an individual’s confidence in their capability to carry out behaviors necessary to achieve specific performance objectives (25). Self-efficacy affects patients’ confidence regarding their ability to adopt and sustain healthy lifestyle modifications, which is essential for managing NCDs. It is one of the dimensions of Social Cognitive Theory (SCT). The application of SCT in managing NCDs and community intervention is increasingly acknowledged to enhance health behaviors within the community (26). Elevated self-efficacy is associated with a higher probability of participating and persisting in health-promoting practices.

lifestyle practices, encompassing physical exercise and nutritious diet (27). Therefore, it’s crucial to comprehend the significance of self-efficacy for healthcare practitioners to formulate specific interventions that bolster patients’ belief in their capability to handle NCDs.

Numerous tools exist to assess self-efficacy utilizing both quantitative and qualitative methodologies. Quantitative tools for evaluating self-efficacy include the Self-Rated Abilities Scale for Health Practice (SRAHP) (9), Cancer Survivors’ Self-Efficacy Scale (CSSES) (28), General Self-Efficacy Scale (29), and Perceived Self-Efficacy Scale (PSES) (30). On the other hand, qualitative tools for measuring self-efficacy emphasize examining individuals’ views and interpretations of their self-efficacy beliefs through open-ended inquiries, interviews, or think-aloud methods (31, 32). Numerous investigations have concentrated on self-efficacy related to health-enhancing lifestyles among distinct study cohorts. Consequently, this review sets out to explore the influence of self-efficacy on health-promoting lifestyles in patients with NCDs and consolidate these insights in one article.

Methodology

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines (33). The research question was formulated utilizing the PEO framework (P: population; E: exposure; O: outcome), concentrating on the impact of self-efficacy in fostering a health-promoting lifestyle among individuals with NCDs. The population for this review is limited to those with NCDs. The intervention considered in this research pertains to the self-efficacy of the NCD patients, while the outcome is the health-promoting lifestyle of this cohort.

Eligibility

The preliminary search yielded 308 citations, of which 173 records were discarded based on publication year, language, and article type using an automated tool. Following the removal of seven duplicate records, 128 unique records underwent title and abstract evaluation. During this screening phase, 120 articles were eliminated, resulting in a total of eight articles available for thorough appraisal. Figure 1 illustrates the article selection process in accordance with the PRISMA flow diagram.

Figure 1.

Process of study selection according to the PRISMA flow diagram.

Outcomes

Discussion

Self-efficacy has a significant influence on health-promoting lifestyles among cancer survivors by affecting treatment factors and recovery processes. This comprises coping mechanisms, physical activity, and psychological resilience (25). When considering coping with treatment factors, high self-efficacy relates to improved coping mechanisms among cancer survivors (25). This enables cancer survivors to adopt a health-promoting lifestyle that alleviates anxiety regarding treatment repercussions and adheres more effectively to treatment regimens (25, 38).

Engaging in physical activity is a crucial health-promoting lifestyle aspect for both cancer survivors and patients dealing with diabetes and hypertension. It can mitigate treatment side effects and improve the quality of life for cancer survivors, as well as those with diabetes and hypertension. Regular physical endeavors such as brisk walking, cardiac rehabilitation, and cycling are essential for patients with non-communicable diseases (NCD). Self-efficacy is a potent predictor of physical activity adherence among NCD patients (39). Self-efficacy aids NCD patients in sustaining their levels of physical activity despite obstacles including fatigue and challenges related to cancer treatment (25).

Self-efficacy influences both the short- and long-term maintenance of a health-promoting lifestyle. Studies have shown that patients with NCD who maintain a high level of self-efficacy are more likely to adhere to prescribed medication schedules. This is vital for managing hypertension and diabetes. Individuals with significant self-efficacy tend to take a proactive approach to health-related responsibilities, such as consistently monitoring their blood glucose (40) and blood pressure (41). The nutritional aspect of a health-promoting lifestyle consists of a low-sodium and low-glucose diet, which is crucial for managing blood pressure and glucose levels, respectively. Those with high self-efficacy are more confident in implementing dietary changes and adhering to them (41).

Elevated levels of self-efficacy correlate with improved interpersonal relationships and spiritual development. The expansion of interpersonal connections enhances patients’ confidence in discussing their symptoms and treatment plans. This promotes productive dialogues regarding personalized approaches to pharmacotherapy, rehabilitation, and self-care (42). Crafting tailored treatment plans requires significant spiritual growth to initiate, practice, and sustain behavioral modifications. Such growth encourages patients to feel capable of managing their conditions, leading to participation in empowerment initiatives like cardiac rehabilitation and counseling clinics, ultimately resulting in enhanced disease control (14).

Self-efficacy levels can be augmented through patient empowerment programs, motivational interviewing strategies, support groups, and the involvement of family members in the management of NCD care. Research indicates that further emphasizing supportive familial settings can bolster self-efficacy among those with NCDs (43, 44). Support from family offers emotional, practical aid and enhances patients’ confidence regarding the management of their NCDs (40, 45). These strategies can be implemented in primary and secondary healthcare facilities by integrating family support into NCD management. Personalized management can be adapted to the specific patient to foster improved health-promoting lifestyles.

An additional tailor-made management strategy to elevate self-efficacy among patients

with NCD is facilitated through the motivational interviewing strategy. Motivational interviewing is a client-centered counseling method designed to bolster intrinsic motivation for transformation by investigating and addressing obstacles. This methodology honors the patient’s independence, empowering them to take charge of their behavioral modification journey. The technique aims to elicit the patient’s motivations for transformation instead of imposing outside motivations. This is essential for fostering self-efficacy, as individuals are more inclined to commit to changes they feel personally inspired to undertake.

Strengths and Limitations

All studies included were of cross-sectional nature, which led this systematic review to a significant risk of bias and a limitation in establishing causal relationships. The restriction to English-language publications confines the variety of article inclusion, possibly omitting high-quality articles published in other languages. Utilizing translation tools may increase the risk of instrument bias. However, the search strategy yielded literature sources from diverse countries where English is not the primary language (China, Korea, Iran, and Indonesia).

A key strength of this study is its eligibility criteria that exclusively include a precise definition of self-efficacy related to a health-promoting lifestyle. Furthermore, as far as we are aware, this represents the first systematic review synthesizing research evidence on the role of self-efficacy in health-promoting lifestyles among NCD patients. This systematic review emphasizes the importance of the self-efficacy approach in enhancing health-promoting lifestyles across various population groups.

Conclusion

In summary, self-efficacy serves as a crucial positive predictor of a health-promoting lifestyle, either as a concept or through its dimensions. Levels of self-efficacy can be enhanced through approaches aimed at individuals and communities. These strategies can be applied in primary, secondary, and tertiary healthcare settings by customizing them to the specific population context to alleviate the global burden of NCDs.

Supporting Information

S1 Table. Table 1. The PRISMA 2020 checklist.

S2 Table. Table 2. The PRISMA 2020 Abstract checklist.

S3 Table. Table 3. Studies identified in literature search.

S4 Table. Table 4. A detailed overview of studies included in the systematic literature review.

Fig.1. Figure 1. Process of study selection according to the PRISMA flowchart.

S1 Appendix. Conflict of Interests Statement and Author Contributions