Abstract
The validation of the Heart Healthy Eating Self-Efficacy Scale (HHESES) and its application in 2 different hypercholesterolemic populations are described. Path models based on self-efficacy and outcome beliefs measured by the HHESES predicted 36% to 70% of variance in eating behavior change for participants in a worksite nutrition intervention. Patients screened with the HHESES upon entry to a lipid clinic also showed high levels of confidence for performing low fat/low cholesterol eating behaviors. Women at high risk had significantly lower outcome beliefs than did men, despite higher self-efficacy. These findings are consistent with Bandura's self-efficacy theory.
CORONARY HEART DISEASE (CHD) remains the number one cause of death for Americans today. Reduction of serum cholesterol, particularly low-density-lipoprotein cholesterol (LDL-C), has become the cornerstone of CHD prevention and treatment.1-3
Both diet and drug interventions are effective means of lowering blood cholesterol,1-3 but cost and safety considerations make diet the preferred method.3 The National Choles-terol Education Program (NCEP) identifies dietary intervention as essential to managing this risk, and has outlined patient-based strate-gies to assist individuals with high blood cholesterol levels (>200 mg/dL), and population-based strategies to reach all Americans.
The defining characteristics of the diet to lower serum cholesterol in patient treatment and to promote heart health in the general public are reduced fat, particularly saturated fat, and cholesterol; reduced sodium; and increased fruits, vegetables, and whole grains. This "heart-healthy diet," followed consistently, can reduce serum cholesterol levels by 10% to 20%.4 But long-term change in eating habits is difficult, and adherence to diet recommendations for cardiovascular health varies considerably.5,6
Even though over 40 million Americans have serum cholesterols in the high-risk range,7 a limited number of studies have examined the factors related to successful dietary change among people with hypercholesterolemia. Most of the strategies are derived from cognitive-behavioral models of eating change.8-10 Bandura's Social Cognitive Theory (SCT) provides a framework for explaining complex patterns of behavior change because it considers the triadic interactions of cognition, behavior, and the environment.11-13