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British Journal of Healthcare and Medical Research - Vol. 9, No. 2
Publication Date: April, 25, 2022
DOI:10.14738/jbemi.92.12188. Maxwell, K. D., Gerrior, S., Crawford, K. (2022). The Role of Self-Efficacy and Technology Upon the Participation of Men in Healthy
Lifestyle Behavior. British Journal of Healthcare and Medical Research, 9(2). 214-230.
Services for Science and Education – United Kingdom
The Role of Self-Efficacy and Technology Upon the Participation
of Men in Healthy Lifestyle Behavior
Karen Denise Maxwell
J. T. George School of Business
Hampton University, United States
Shirley Gerrior
Walden University, United States
Kermit Crawford
School of Social and Behavioral Sciences
Hampton University, United States
ABSTRACT
Few health interventions are targeted exclusively to men. Limited knowledge exists
regarding the specific components needed to design Internet health applications to
appeal to men. This study examined the relationship between the use of Internet
health applications and the role of self-efficacy in men and the influence upon
participation in health and wellness behaviors, such as diet and physical activity. A
quasi-experimental design was used to analyze data collected from the National
Cancer Institute’s (NCI) Health Information National Trends Survey (HINTS). A
group of men (N=990) who used Internet health applications were compared to a
control group of men who did not use Internet health applications. Results from the
regression analysis indicated that the use of Internet health applications for self- management of health behavior had a significant effect upon participation in health
and wellness behavior t (49) = -2.212, < .05. Self-efficacy was found to have a greater
significant effect upon participation in health and wellness behavior than Internet
health applications t (49) = -2557, p < .05. Self-efficacy mediated the relationship
between Internet health applications and participation in health and wellness
behavior t (48) = -2.744, p < .05. The results of this study offer support for the
efficacy of operationalized applications as an evidence-informed user-driven
resource for men. Consequently, designing Internet health applications which
include the theoretical foundation, self-efficacy could significantly increase the
participation of men in health and wellness behaviors.
Keywords: Internet health applications, Self-efficacy Men, Self-management, Diet,
Physical Activity, Healthy Lifestyle Participation
INTRODUCTION
Background
The mortality gap in longevity for men and women is widely documented (Arias and Jiaquan,
2017). The reasons for this are complex. Men in the United States commonly suffer from
chronic and preventable diseases that are the result of their health behaviors (Danaei et al.,
2010). Although more men than women have been diagnosed with a higher percentage of
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Maxwell, K. D., Gerrior, S., Crawford, K. (2022). The Role of Self-Efficacy and Technology Upon the Participation of Men in Healthy Lifestyle Behavior.
British Journal of Healthcare and Medical Research, 9(2). 214-230.
URL: http://dx.doi.org/10.14738/jbemi.92.12188
chronic diseases such as heart disease, cancer, and diabetes that are linked to poor nutrition
and lack of physical activity (Duncan et al, 2012), health educators have not targeted or
designed many health promotion interventions exclusively for men (George et al., 2012; Sharp
et al. 2018; Robertson and Baker, 2017). In addition, traditional health interventions used by
women do not similarly appeal to men (Duncan et al., 2012). Emerging evidence suggests that
men are more likely to benefit from self-directed user driven resources (Lefkowich et. al. 2017).
Internet health applications are one such resource. Internet health applications are more
appealing to men than traditional health promotion interventions because self-tailored and
self-paced activities allow enhanced self-management (Taylor et al., 2013). Innovative Internet
health applications exclusively targeted to men are needed to improve health behavior, to
reduce chronic diseases endured by men, and to enhance health outcomes for men
(Vandelanotte et al., 2013).
Treatment of chronic diseases such as heart disease, cancer, and diabetes are projected to cost
the U.S. healthcare system approximately $4.2 trillion per year by 2023 (Anderko et al., 2012).
This forecast is a significant increase from total healthcare expenditures in 2013 of $2.9 trillion
(Centers for Medicare & Medicaid Services, 2014). According to the Centers for Disease Control
and Prevention (CDC; 2013b), heart disease, cancer, and diabetes are costly chronic
preventable diseases.
Internet health applications, and other innovative techniques such as telemedicine, have been
associated with significant health behavior changes (Davies, Spence, Vandelanotte,
Caperchione, & Mummery, 2012). This suggests that developing effective Internet health
applications would benefit from studying specific content and theoretical designs to
understand what factors affect participation in healthy lifestyle behavior for men.
The purpose of this study was to examine the relationship between Internet health applications
used for self-management of health behavior upon men in the United States, and their influence
upon men’s participation in healthy lifestyle behaviors. Internet health applications can be used
to manage healthcare appointments, communicate with healthcare providers, fill prescriptions,
monitor nutrition, physical activity, weight management, and calculate body mass index (BMI).
In the context of this study, participation in healthy lifestyle behavior included fruit
consumption, vegetable consumption, and regular physical activity.
Chronic diseases such as heart disease, cancer, and diabetes are among the most widespread
preventable health conditions in the United States; however, successful management of these
chronic diseases are limited (Chaney et al., 2013). Improving health outcomes associated with
heart disease, cancer, and diabetes requires options that provide the opportunity for self- management (Chaney et al., 2013; Lorig et al., 2012; Miron-Shatz & Ratzan, 2011).
Incorporating the self-management and self-efficacy components of the social cognitive theory
into the design of diabetes Internet health applications, for instance, have successfully been
used to significantly improve health behavior (Glasgow et al., 2012). Internet health
applications used for disease prevention, preventing disease complications, or managing
existing chronic diseases such as heart disease, and cancer are less costly, more effective
treatment for chronic diseases (Hyman, 2009). According to the CDC, chronic preventable
diseases are responsible for 75% of U.S. healthcare spending (2013a). Internet health
applications that increase male participation in healthy lifestyle behavior are predicted to
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British Journal of Healthcare and Medical Research (BJHMR) Vol 9, Issue 2, April - 2022
Services for Science and Education – United Kingdom
produce better health outcomes that prevent or minimize the effects of heart disease, cancer,
and diabetes, ultimately reducing healthcare expenses (Kennedy et al., 2012).
The theoretical framework for this study was based on social cognitive theory. According to
Bandura (1997) utilizing self-efficacy and self-regulation skills can heighten outcome
expectations to overcome the challenges of environmental impediments leading to increased
individual motivation, action and sense of well-being. The social cognitive theory model has
been shown to contribute to successful participation in positive health behavior changes that
prevent disease. Internet health applications can be viewed as effective tools to dispense
knowledge and encouragement to increase the participation of men in healthy lifestyle
behavior. Internet health applications also assist with self-management of an individual’s
health behavior, thereby providing individuals the opportunity to employ self-regulation.
According to Statistica (2022), 89% of all males in developed countries use the internet. This
suggests that the internet can be an effective nexus for engagement of men with important
information on health promotion.
This study explores using interactive Internet health applications to influence healthy lifestyle
habits. Lifestyle habits are a major factor in the participation in chronic disease prevention
activities. Because individuals control their lifestyle habits, men can use these habits to have
major impact on their overall health (Bandura, 2005). Self-management provides individuals
with the opportunity to realize the benefits of engaging in healthy lifestyle behavior. The
benefits of positive self-management can be effective in helping men live longer and healthier
lives (Bandura, 2004). Interactive Internet health applications offer methods of motivating
individuals (Glasgow et al., 2012). If structured properly, interactive Internet health
applications have a strong potential to contribute to an individual’s development of enhanced
motivation toward positive health behavior changes (Bandura, 2005).
METHODS
Data Source
This study used the Health Information National Trends Survey (HINTS) data. HINTS data were
collected by the National Cancer Institute as a probability sample of United States adults’ use of
cancer information and trends in access to health information. HINTS is a comprehensive
database on health promotion communication research. This study used data from October
through February 2012 to perform this study. Specifically, HINTS data enabled the measure of
Internet use associated with healthcare, nutrition, physical activity, healthcare access, cancer
risks, in relationship to individual’s health (National Cancer Institute, 2014b).
A sample of addresses was selected from a database of residential addresses in the United
States. High-minority, low-minority, and Central Appalachian strata were created based on
demographic data. Creation of the three strata was performed to increase the accuracy of the
estimates for the high-minority and Central Appalachian subpopulation. The second stage of
the sample design consisted of selection of the adults living in the households that received the
survey. Survey participants within the households were selected by either the “All Adult”
method or the “Next Birthday” method. The “All Adult” method mailed two surveys that
requested every adult in the household to respond. The “Next Birthday” method requested only
the member of the household with the next upcoming birthday respond to the survey (Westat,
2012).