title: Early Empowerment Strategies Boost Self-Efficacy to Improve Cardiovascular Health Behaviors.
abstract: BACKGROUND
  Self-efficacy, defined as confidence in the ability to carry out behavior to achieve a desired goal, is considered to be a prerequisite for behavior change. Self-efficacy correlates with cardiovascular health although optimal timing to incorporate self-efficacy strategies is not well established. We sought to study the effect of an empowerment approach implemented in the introductory phase of a multicomponent lifestyle intervention on cardiovascular health outcomes.
  
  
  METHODS
  Prospective intervention cohort study.
  
  
  METHODS
  Patients in the Integrative Cardiac Health Project Registry, a prospective lifestyle change program for the prevention of cardiovascular disease were analyzed for behavioral changes by survey, at baseline and one year, in the domains of nutrition, exercise, stress management and sleep. Self-efficacy questionnaires were administered at baseline and after the empowerment intervention, at 8 weeks.
  
  
  RESULTS
  Of 119 consecutive registry completers, 60 comprised a high self-efficacy group (scoring at or above the median of 36 points) and 59 the low self-efficacy group (scoring below median).  Self-efficacy scores increased irrespective of baseline self-efficacy but the largest gains in self-efficacy occurred in patients who ranked in the lower half for self-efficacy at baseline. This lower self-efficacy group demonstrated behavioral gains that erased differences between the high and low self-efficacy groups.
  
  
  CONCLUSIONS
  A boost to self-efficacy early in a lifestyle intervention program produces significant improvements in behavioral outcomes.  Employing empowerment in an early phase may be a critical strategy to improve self-efficacy and lower risk in individuals vulnerable to cardiovascular disease.
authors.affiliation: Integrative Cardiac Health Project Walter Reed Military Medical Center. mariamkashani@yahoo.com.
authors.forename: Mariam
authors.initials: M
authors.lastname: Kashani
authors.forename: Arn H
authors.initials: AH
authors.lastname: Eliasson
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Walizer
authors.forename: Clarie E
authors.initials: CE
authors.lastname: Fuller
authors.forename: Renata J
authors.initials: RJ
authors.lastname: Engler
authors.forename: Todd C
authors.initials: TC
authors.lastname: Villines
authors.forename: Marina N
authors.initials: MN
authors.lastname: Vernalis