Self-efficacy and barriers to multiple behavior change in low-income African Americans with hypertension

Behavioral risk factors are among the preventable causes of health disparities, yet long-term change remains elusive. Many
interventions are designed to increase self-efficacy, but little is known about the effect on long-term behavior change in
older, low-income African Americans, especially when facing more problematic barriers. A cohort of 185 low-income African–Americans
with hypertension reported barriers they encountered while undergoing a multiple behavior change trial from 2002 to 2006.
The purpose of the present study was to explore the relationships between self-efficacy, barriers, and multiple behavior change
over time. Higher self-efficacy seemed to be partially helpful for smoking reduction and increasing physical activity, but
not for following a low-sodium diet. Addiction was indirectly associated with less reduction in smoking through lower self-efficacy.
Otherwise, different barriers were associated with behavior change than were associated with self-efficacy: being “too busy”
directly interfered with physical activity and “traditions” with low-sodium diet; however, they were neither the most frequently
reported barriers, nor associated with lower self-efficacy. This suggests that an emphasis on self-efficacy alone may be insufficient
for overcoming the most salient barriers encountered by older African Americans. Additionally, the most common perceived barriers
may not necessarily be relevant to long-term behavioral outcomes.