General self‐efficacy in various domains of human functioning: Evidence from five countries

Psychosocial adversities in adulthood among individuals raised with family members with disabilities

Despite millions of individuals worldwide growing up with family members who have disabilities, little is known about how this experience is associated with long-term outcomes. We address this gap by examining how growing up with a parent and/or sibling with a disability is associated with individuals' psychosocial situation in adulthood. Using retrospective information from the 2020 wave of the Survey of Health, Impairment and Living Conditions in Denmark (SHILD, N = 15,699), we explore how growing up in a family with disability is associated with loneliness, socialsupport, general self-efficacy, subjective well-being, and feelings of resentment in adulthood. Our results from linear probability models suggest that growing up with a parent and/or sibling with a disability increases the likelihood of experiencing loneliness, low subjective well-being, and reduced self-efficacy. Additionally, we find that individuals who grow up in a family with disability are more likely to report a lack of social support and heightened feelings of resentment. We conclude that growing up with a parent and/or sibling with a disability is associated with a wide range of psychosocial adversities in adulthood. However, having a disability oneself is even more detrimental for psychosocial outcomes. These findings highlight the need for strengthened support for families with disabilities to improve psychosocial outcomes and break cycles of intergenerational disadvantage.

First aid self-efficacy: a scale adaptation and psychometric properties

BACKGROUND

Self-efficacy is a crucial predictor of effective performance in medical emergencies requiring first aid skills. Despite this, there is no standardized instrument for reliably measuring self-efficacy in first aid situations. The aim was to fill this gap by developing a novel first aid self-efficacy scale and validate it through a comprehensive assessment of its psychometric properties.

METHODS

A systematic assessment of the existing first aid self-efficacy scales was conducted. A psychometric analysis process involving 1152 participants was undertaken for the new scale. The analysis utilized factor analysis, non-parametric item response theory, and classical test theory, including validity assessment.

RESULTS

The developed first aid self-efficacy scale demonstrated excellent psychometric properties. The scale exhibited a robust internal structure, high reliability, and strong construct validity. It showed significant positive correlations with related constructs and effectively distinguished between different levels of first aid knowledge and training history.

CONCLUSION

The first aid self-efficacy scale is a novel, reliable, and valid instrument for assessing self-efficacy in first aid contexts. It can be used to measure the impact of first aid training and interventions, thereby promoting more effective layperson responses in emergencies. The scale's robust psychometric properties make it a valuable tool for both research and practical applications in emergency preparedness and first aid training.

Resilience and its associated factors in optometry students from eight institutions across six countries

CLINICAL RELEVANCE

Resilience is a key enabler for healthcare professionals including optometrists, to cope with adversities and practice self-care. Evaluating the levels of resilience and its associated factors in optometry students can lead to the development of appropriate intervention strategies for academic and professional success.

BACKGROUND

The moderately high prevalence of mental health issues and burnout among optometry students suggests a need to equip the next generation of optometrists with the necessary skills to enhance mental health. Resilience has been shown to mitigate burnout among healthcare professionals and offer personal and professional benefits. Additionally, resilience education during healthcare student training can enhance mental health and wellbeing, leading to better patient care. This study aims to evaluate resilience levels and its associated factors (self-efficacy, mindfulness, positive and negative affect, and coping strategies) in optometry students.

METHODS

Students enrolled in optometry schools across eight institutions in six countries were invited to participate in an online survey within the period of April 2023 - January 2024. The survey comprised of demographic data, existing and validated questionnaires on resilience, self-efficacy, mindfulness, positive and negative affect, and coping strategies. Descriptive statistics and linear regressions were used for analysis.

RESULTS

A total of 294 valid responses were collected. There were no significant differences in resilience scores between countries. Greater resilience (p < 0.05) was associated with older age, higher academic grades and having no financial assistance. Additional predictors of greater resilience included higher self-efficacy, mindfulness, positive affect and acceptance scores, and lower behavioural disengagement scores.

CONCLUSION

Identifying factors that affect resilience in optometry students provides information for targeted strategies that enhance resilience. More work is required to understand the generalisability of these results, impact of culture on resilience, and appropriate intervention methods.

Parent empowerment as a buffer between perceived stress and parenting self-efficacy in immigrant parents

U.S. immigrant parents encounter various challenges during the migration and resettlement process, such as acculturative stress and dissonance in parenting practices between the cultures in the U.S. and those in their country of origin. Although studies have established a link between increased perceived stress and reduced parenting self-efficacy in U.S.-born parents, which could be alleviated by levels of parental empowerment, little is known about this pathway in the context of migration. Guided by the Family Adjustment and Adaptation Response Model and with a focus on low-income immigrant parents of young children, we examined (1) the association between perceived stress and parenting self-efficacy, and (2) whether parental empowerment constitutes a buffer between perceived stress and parenting self-efficacy. Participants included foreign-born, low-income parents (n = 680) with preschool-aged children enrolled in Head Start of Greater Boston. Linear regression models were conducted to examine the relationship between perceived stress and parenting self-efficacy. An interaction term between perceived stress and empowerment was included to test the moderating effect of each dimension of parental empowerment (i.e., resource empowerment, critical awareness, and relational empowerment). Results showed higher perceived stress was associated with lower parenting self-efficacy and this relationship was moderated by relational empowerment. Findings suggest that relational empowerment can be an important resource for immigrant parents with high stress and a protective factor to improve self-efficacy in their parenting. These results pose important implications regarding how healthcare professionals and clinicians may support parents, for example, through the development of culturally sensitive parenting interventions and the creation of safe environments for parent-to-parent relationships.

Does anxiety influence the use of complementary or alternative medicine among cancer patients?

PURPOSE

The aim of this study was to investigate the extent to which patients' anxiety due to their cancerous disease has an influence on the use of complementary and alternative medicine (CAM) methods.

METHODS

230 patients completed an anonymous voluntary questionnaire that was sent to outpatient oncological facilities participating in the survey. This questionnaire included standardised tests such as the Allgemeine Selbstwirksamkeit Kurzskala (ASKU, self-efficacy short scale) and the State-Trait-Anxiety-Inventory (STAI) as well as socio-demographic information and a section on CAM use. Statistical analyses and regression models were used to identify correlations.

RESULTS

Female gender, high level of education (high school diploma or university degree) and increased trait anxiety were related to CAM use. All other variables analysed showed no significant results.

CONCLUSION

This study demonstrates that trait anxiety and sociodemographic factors significantly influence CAM usage among cancer patients. Physicians and health care providers should consider this in consultations to guarantee the best possible care for patients.

Uncovering potential interviewer-related biases in self-efficacy assessment: a study among chronic disease patients

BACKGROUND

Self-efficacy refers to an individual's belief in their ability to accomplish specific tasks and achieve goals, and plays an essential role in achieving positive outcomes in a wide range of domains. Central to the measurement of any form of self-efficacy is the assessment without bias, also in case of an interview situation.

METHODS

Outpatients with macular edema, an eye disease, participated in this questionnaire-based cross-sectional study. The study assessed self-efficacy using the General Self-Efficacy Scale (GSE) in German. Interviewers read questionnaires aloud to patients. Differential item functioning (DIF) was investigated using likelihood-ratio χ2 tests for interviewer, sex, age, education, working status, income, diagnosis, and health-status.

RESULTS

The analysis included N = 556 patients. Median age was 68.4 (IQR: 62.0 - 76.0) years and mean overall GSE score 32.8 (SD: 4.81). No DIF was detected for interviewer. However, DIF was found in item 1 for education (uniform DIF, NCDIFno degree vs. degree = 0.042; easier with degree vs. none), in item 1 and 3 for income (item 1: non-uniform DIF, NCDIF<€ 1,125 vs.≥€ 1,125≤€ 1,950 = 0.050 / NCDIF< € 1,125 vs.≥€ 1,950 = 0.099; item 3: uniform DIF, NCDIF<€ 1,125 vs.≥€ 1,125-≤€ 1,950 = 0.024 / NCDIF< € 1,125 vs.≥€ 1,950: 0.095; both easier with higher income), in item 2 for working status (uniform DIF, NCDIFretired vs. other = 0.017; easier if working) and in item 3 for sex (non-uniform DIF, NCDIFmale vs. female = 0.043; easier for women in low ability, harder for them from medium ability on).

CONCLUSIONS

Given that no DIF was detected concerning interviewers, our findings indicate that an objective assessment of self-efficacy in a face-to-face interview may be feasible, provided that interviewers receive appropriate training. Since DIF effects concerning other patients characteristics found were small, the GSE may provide a relatively bias free way to assess self-efficacy in an interview setting.

The Italian Version of the New General Self-Efficacy Scale (NGSES): Structural Validity, Psychometric Properties, and Measurement Invariance

Background/Objectives: General Self-Efficacy (GSE) refers to an individual's belief in their overall ability to perform effectively across various situations. Research shows that GSE is a key predictor of multiple outcomes, including psychological resilience, better health, and improved overall well-being across different populations and environments. Numerous tools have been developed to measure GSE, enhancing our understanding of self-efficacy and its broader implications. This study aimed to evaluate the psychometric properties of the Italian version of the New General Self-Efficacy Scale (NGSES) in a community sample of adults recruited through social media platforms. Methods: The NGSES was adapted into Italian following the back-translation procedure. A total of 811 participants (mean = 43.18; 68.8% females) completed the scale. A confirmatory factor analysis (CFA) was used to examine the factorial structure of the questionnaire. Adjusted item-total correlations and internal consistency were assessed using McDonald's omega. Additionally, multi-group CFA was used to test factorial invariance across gender. Results: The trimmed model exhibited a strong fit to the data: RMSEA = 0.068, CFI = 0.994, SRMR = 0.043. An omega coefficient of 0.872 confirmed the scale's strong reliability. Convergent validity was established by a moderate and significant correlation with the NGSES. Configural, metric, scalar, and latent means invariance across genders were all confirmed. Conclusions: The NGSES was found to be a valid and reliable tool, suitable for both clinical and research applications in the Italian context. It can also inform the development of educational and therapeutic interventions aimed at enhancing GSE in the general population.

Validation of the Self-Efficacy Questionnaire (SE-12-Gr) Assessing the Healthcare Professionals' Self-Reported Communication Skills with Older Healthcare Users in Greece

Patients' satisfaction with their interaction with the healthcare providers has been found to correlate with adherence to therapeutic plans and better health outcomes. Healthcare providers are experiencing barriers when communicating with specific population subgroups, such as people with low health literacy, low education, and older age. Enhancing the communication skills of the healthcare providers working with older adults could facilitate their interaction with the patients. This study presents the validation of the Self-efficacy-12 (SE-12) in Greek. This is an instrument measuring healthcare providers' self-efficacy of communication skills used during their interaction with older patients. A sample of 230 healthcare providers working with older adults participated in the study. The scale showed good psychometric properties (S-CVI=.97, Cronbach a = .95, ICC = .81). A medium to high correlation was found with the generalized self-efficacy questionnaire. Exploratory Factor Analysis (EFA) yielded two factors ("Self-efficacy in communication skills and strategies" and "Self-efficacy of successful interaction") with good psychometric properties. The SE-12-GR is a brief, valid, and reliable tool for assessing self-efficacy of communication skills and it could be integrated as part of the health literacy tools for healthcare providers working with older people in Greece.

Effectiveness of Simulation with a Standardized Patient on Knowledge Acquisition, Knowledge Retention, and Self-Efficacy Among Moroccan Nursing Students: A Quasi-Experimental Study

Background: Simulation is a crucial component in the training of healthcare professionals, offering a safe environment for practical learning without posing risks to patients. Aim: This study aims to evaluate the effect of simulation with a standardized patient on the acquisition and retention of knowledge, as well as on the self-efficacy of nursing students. Methods: A quasi-experimental study with a pre-test and post-test design was conducted with 120 nursing students, who were randomly assigned to two groups. The experimental group (60) received training through simulation with a standardized patient, supplemented by a lecture-based course. The control group (60) received only the same lecture-based course. A pre-test was conducted to assess students' baseline knowledge and self-efficacy before any intervention. Student performance was then assessed with a post-test immediately after the training to measure knowledge acquisition and self-efficacy and a post-test three months after the intervention to measure long-term knowledge retention. Results: The results showed a statistically significant difference in mean scores between the intervention and control groups in terms of knowledge acquisition (14.92 vs. 13.32; p < 0.001; d = 0.99), self-efficacy (33.02 vs. 31.05; p < 0.001; d = 1.03) and knowledge retention three months after training (12.4 vs. 10.6; p < 0.001; d = 0.94). Conclusions: The results of this study confirmed the effectiveness of simulation in knowledge acquisition and retention, as well as in the self-efficacy of nursing students. These findings support the integration of this method into training programs to strengthen the skills of future healthcare professionals.

Meeting Parents' Health Literacy Needs-Designing and Feasibility Testing of a Three-Step Intervention in the Childhood Epilepsy Context

AIMS

(1) To codesign a health literacy intervention within a specialist healthcare setting to help the parents of children with epilepsy access, comprehend, use and communicate information and (2) to assess the intervention's feasibility by exploring stakeholders' perspectives on its usefulness, ease of use of trial methods and contextual factors impacting its execution.

DESIGN

A codesign participatory approach followed by a feasibility approach inspired by the OPtimising HEalth LIteracy and Access to Health Services (Ophelia) process for health literacy intervention development.

METHODS

(1) The codesign approach included workshops with (a) multidisciplinary personnel (n = 9) and (b) parents (n = 12), along with (c) an interview with one regional epilepsy specialist nurse (n = 1). The participants discussed parents' health literacy needs on the basis of vignettes and brainstormed service improvements. A three-step intervention was subsequently designed. (2) The intervention's feasibility was assessed via interviews with six parents (n = 6), a focus group interview with study nurses, a short doctors survey and a log of time spent testing the intervention.

RESULTS

(1) The parents of first-time admitted children to a specialist epilepsy hospital were targeted for the intervention. Nurse-parent consultations were central to the intervention, activating parents in codeveloping and executing a tailored education plan. (2) Feasibility: parents (n = 6) experienced consultations and education plans that were beneficial for enhancing their self-efficacy in managing the child's condition. The study nurses (n = 3) acknowledged positive outcomes in streamlining patient education but felt that their training on the intervention methods was insufficient. Both parents and nurses identified limited personnel resources as a significant barrier to executing the intervention.

CONCLUSION

The codesigned intervention engaged nurses and parents in HL development despite system barriers. The parents experience enhanced self-efficacy in managing their child's condition. However, needs refinements and further feasibility tests are needed before future implementation.

REPORTING METHOD

The Consort Statement 2010 extension for reporting non-randomised pilot and feasibility studies was used to ensure the methodological quality of the study. A Consort Statement 2010 checklist is provided as an additional file.

PATIENT OR PUBLIC CONTRIBUTION

The collaboration of parents within the target group, the providers involved and the project's steering committee was crucial in codesigning and evaluating this three-step intervention. Parents and multidisciplinary providers actively contributed through workshops, interviews and in discussion meetings. The study nurses testing the intervention played a key role in defining the documentation process for the codeveloped education plan.

IMPLICATIONS FOR PROFESSIONAL CARE

This three-step health literacy intervention can positively impact parents' self-efficacy in managing their child's condition. Enhancing nurses' communication skills is essential for improving parents' health literacy, making it crucial to allocate resources for such training. The intervention content and strategies to meet parents' health literacy needs require refinement, with more provider involvement to better adapt it to the context. Future studies should focus on further feasibility testing by considering a more flexible time frame.

TRIAL REGISTRATION

Open Science Framework: https://osf.io/fg9c7/.

Self-efficacy scale for university teaching in virtual environments, SSUTVE

Self-efficacy is relevant in explaining performance and well-being in different domains of human behaviour. Despite this need, there are no instruments that assess self-efficacy in university teaching in virtual environments. Therefore, the objective of this study was to design the Self-Efficacy Scale for University Teaching in Virtual Environments (SSUTVE) and analyse its psychometric properties. Three studies were developed to achieve this. First, based on grounded theory, 31 university professors were interviewed in-depth, and the 10 categories that emerged were grouped into two dimensions of the construct. In the second study, 10 expert judges (university professors) evaluated the clarity, relevance, and pertinence of the items developed. In addition, 10 judges assessed the clarity of the items. Subsequently, 33 items were accepted, and the degree of agreement was acceptable (lower limit of confidence interval in Aiken's V above the expected). The third study analysed the internal structure. A total of 554 Peruvian university professors participated, and the scale presented adequate indexes of adjustment for a structure of nine correlated factors: basic technological skills, safety in virtual classes, ethical-legal aspects, guidance and/or advice in the use of technological resources (related to self-efficacy in digital competences) and planning, didactics, group management, mastery of the subject, and evaluation and feedback (related to self-efficacy in pedagogical competences). Additionally, the degree of reliability of the scores and constructs was acceptable. It was concluded that the SSUTVE presents psychometric evidence of validity and reliability for Peruvian university professors working in virtual environments.

The relationship between self-efficacy, learning burnout, willingness to fulfill the contract and empathy of rural-oriented tuition-waived medical students of China: a cross-sectional study

BACKGROUND

The empathy of rural-oriented tuition-waived medical students (RTMSs) is closely related to the construction of good doctor-patient relationship and the quality of rural medical and health services. The purpose of this study is not only to explore the relationship between self-efficacy, learning burnout, willingness to fulfill the contract and empathy, but also to explore the mediating role of self-efficacy between learning burnout and empathy, and between willingness to fulfill the contract and empathy.

METHODS

Four hundred ninety-five rural-oriented tuition-waived medical students from 3 medical universities in Shandong Province were selected as research subjects, and General self-efficacy scale (GSES), Learning burnout of university student (LBUS), Willingness to fulfill the contract scale and Jefferson Scale of Physician Empathy-student version (JSPE-S) were used to investigate. SPSS 25.0 and AMOS 24.0 were used for statistical analysis and path analysis of the data.

RESULTS

The willingness to fulfill the contract of rural-oriented tuition-waived medical students has a direct positive impact on self-efficacy (β = 0.11, P < 0.05) and empathy (β = 0.27, P < 0.001), and a significant direct negative impact on learning burnout (β = -0.25, P < 0.001). Learning burnout has a significant direct negative impact on self-efficacy (β = -0.34, P < 0.001), while self-efficacy has a significant direct positive impact on empathy (β = 0.22, P < 0.001). Learning burnout has no direct impact on empathy (β = -0.09, P = 0.109). Self-efficacy has a significant mediating effect between willingness to fulfill the contract and empathy (95% CI: 0.02-0.41), and also has a significant mediating effect between learning burnout and empathy [95% CI: -0.41- (-0.11)]. Learning burnout has no mediating effect between willingness to fulfill the contract and empathy (95% CI: -0.02-0.42).

CONCLUSION

This study found that learning burnout and willingness to fulfill the contract are important factors affecting rural-oriented tuition-waived medical students' empathy, both of which can influence empathy through the mediating role of self-efficacy. This provides positive suggestions for medical colleges to improve the empathy of students, which is of great practical significance for continuously improving the service quality of general practitioners and ultimately realizing the development of high-quality rural medical and health undertakings. In addition, it also provides an important theoretical reference for the formulation of empathy intervention measures and broadens the direction of rural-oriented tuition-waived medical students' research in the future.

Parental expectations and adolescents' happiness: the role of self-efficacy and connectedness

BACKGROUND

A happy adolescent may live a healthy and successful life. This study focused on parental expectations in the Chinese cultural context and investigated whether and under what conditions adolescents' perceived parental expectations are associated with their happiness, the affective component of subjective well-being.

SAMPLE AND METHODS

This cross-sectional study included a sample of 1510 Chinese adolescents; the average age of the adolescents was 12.39 years, and 55.40% were boys. A questionnaire including the perceived parental expectations scale, self-efficacy scale, connectedness subscale and one item that measured happiness was administered to the adolescents.

RESULTS

The results reveal that self-efficacy moderates the relationship between perceived parental expectations and happiness. For adolescents who exhibit higher levels of self-efficacy, perceived parental expectations are negatively correlated with happiness; in contrast, for adolescents who exhibit lower levels of self-efficacy, perceived parental expectations are not related to happiness. Moreover, the results reveal that connectedness moderates the relationship between perceived parental expectations and happiness. Among adolescents who exhibit higher levels of connectedness, a nonsignificant relationship is observed between perceived parental expectations and happiness; in contrast, among adolescents who exhibit lower levels of connectedness, perceived parental expectations are negatively related to happiness.

CONCLUSIONS

This study reveals that, under conditions featuring higher levels of self-efficacy or lower levels of connectedness, perceived parental expectations are not conducive to their happiness. These findings have important implications with regard to parenting practices.

Social support and self-efficacy during early adolescence: Dual impact of protective and promotive links to mental health and wellbeing

This study aimed to assess the impact of sources of social support and dimensions of self-efficacy on psychological symptoms and mental wellbeing among early adolescents. A total of 274 adolescents aged 10-14 from Darjeeling, India, participated in the study. The Multidimensional Scale of Perceived Social Support (MSPSS) and Self-Efficacy Questionnaire for Children (SEQ-C) were utilized to assess dimensions of protective/promotive factors. Nested multivariable regression models assessed associations between age, gender, social support, and self-efficacy on psychological symptoms (internalising, externalising, and total difficulties) and mental wellbeing outcomes (mental wellbeing, optimism, and resilience). Results indicated that 13% of early adolescents screened positive for clinical depression and 44% reported poor mental wellbeing. Emotional and academic self-efficacy, along with family support, were significantly associated with reduced psychological symptoms. Conversely, social, and academic self-efficacy, along with support from friends, were linked to higher levels of mental wellbeing. Regression analyses revealed that dimensions of social support and self-efficacy explained a greater proportion of variability in mental wellbeing outcomes (R2 = 0.37-0.64) than in psychological symptom outcomes (R2 = 0.19-0.22), suggesting a stronger promotive effect on mental wellbeing compared to a protective effect on psychological symptoms during early adolescence. Findings suggest the urgent need for early mental health intervention to strengthen systems of social support and support self-efficacy among early adolescents. Multi-level or sequential interventions that target protective and promotive factors are a key strategy to addressing the global youth mental health crisis.

A physiotherapist-led biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana: a mixed-methods feasibility study

BACKGROUND

Low back pain is a common musculoskeletal condition which causes substantial disability globally. The biopsychosocial model of management has been recommended in national and international guidelines for the management of patients with chronic low back pain (CLBP). However, biopsychosocial approaches are predominantly delivered in high income countries (HICs), although the prevalence of LBP is substantially higher in low- and middle-income countries (LMICs) especially in Africa (39%; 95% CI 30-47). Understanding the effectiveness of BPS interventions in LMICs especially in Africa is underexplored, with substantial inequity between research from HICs and LMICs. Ghana is a LMIC where the effectiveness of biopsychosocial interventions has been underexplored. Therefore, the aim of this study was to explore the feasibility of delivering a physiotherapist-led BPS programme for the management of patients with CLBP in Ghana.

METHODS

This was a mixed-methods, sequential, pretest-posttest feasibility study. Participants involved thirty patients with CLBP. The biopsychosocial intervention involved an exercise and patient education programme based on principles of cognitive behavioural strategies with emphasis on self-management. The biopsychosocial intervention was delivered for six weeks for each participant. Feasibility outcomes regarding management and processes were captured pre-intervention, post-intervention, and three-months post intervention. Semi-structured interviews were conducted post-intervention to explore participants' experiences with the biopsychosocial intervention. Patients' demographics were collected at baseline. Patient reported outcome measures such as intensity of pain, disability, pain catastrophising, kinesiophobia, self-efficacy, and general quality of life, were collected pre-intervention, post-intervention and at three-months follow-up. Qualitative analysis explored participants' experiences regarding the acceptability of the biopsychosocial intervention.

RESULTS

The results of this feasibility study demonstrated that the training programme was acceptable to physiotherapists. Recruitment rate (5 patient participants per week - 100% recruitment met), retention rate post-intervention (90%), data completion rate post-intervention (99.8%) and intervention fidelity (83.1%), all met feasibility thresholds. There were no adverse events. Qualitative data also demonstrated that the biopsychosocial intervention was acceptable to participants.

CONCLUSION

This study has established the potential to deliver a biopsychosocial intervention programme in a Ghanaian hospital setting. This biopsychosocial intervention therefore shows promise, and the result of the study provides a platform to develop future clinical studies.

The impact of a coach-guided personalized depression risk communication program on the risk of major depressive episode: study protocol for a randomized controlled trial

BACKGROUND

Depression is a highly prevalent and disabling mental health problem. Self-help has been strongly advocated for dealing with depression. Built upon the research on risk prediction modeling and risk communication, we developed a coach-guided, personalized depression risk communication tool (PDRC) for sharing information about individualized depression risk and evidence-based self-help strategies. The primary objective of this project is to evaluate the impact of the PDRC on the 12-month risk of major depressive episode (MDE) in Canadians who are at high risk of MDE.

METHODS

This is an assessor-blinded randomized controlled trial (RCT) with two arms. We will recruit 500 males and 500 females in the communities across the country. Individuals are eligible, if they: (1) are 18 years or older, (2) have not had a depressive episode in the past two months, (3) are at high risk of MDE based on the sex-specific risk predictive algorithms for MDE (predicted risk of 6.5% + for men and of 11.2% + for women), (4) can communicate in either English or French, and (5) agree to be contacted for follow-up interviews. After screening and baseline assessment, participants will be randomized by sex into intervention and control group in a 1:1 ratio. Participants in the intervention group will receive the coach-guided PDRC. The participants are assessed at baseline, 3 and 12 months via computer assisted telephone interview system, regarding the presence of MDE, depressive and anxiety symptoms, use of self-help strategies, mental health services use and self-efficacy.

DISCUSSION

The coach-guided PDRC may empower users to actively engage in self-management, leading to reduced risk of MDE. If successful, the coach-guided PDRC will lead to a novel selective prevention program that is closely aligned with the tiered mental health services model, contributing to early prevention of depression and better mental health wellbeing.

DATE OF TRIAL REGISTRATION

2024-10-02.

PROTOCOL VERSION AND DATE

December 6, 2024. Version #1.

TRIAL REGISTRATION

NCT06619366.

Longitudinal study of metacognition's role in self-efficacy and hope development

Self-regulation is a critical component of adaptive functioning, and individual differences in traits like metacognitive self-awareness (MCS), general self-efficacy (GSE), and hope play significant roles in influencing this ability. Self-awareness of cognitive biases is particularly relevant as it may enhance one's capacity to manage challenges and pursue goals effectively. Prior research suggests that higher levels of MCS are associated with improved self-regulation, greater self-efficacy, and stronger hope for success. This longitudinal study sought to explore the development of self-regulation across 3 years of college education, with a specific focus on the role of MCS in shaping the trajectories of GSE and hope. Over 400 undergraduates were assessed five times throughout this period. Growth curve and causal mediation analyses were employed to examine the extent to which MCS contributed to changes in GSE and hope. Our findings indicate that self-awareness of cognitive biases (MCS) significantly influences the development of self-efficacy. Participants with higher levels of MCS exhibited a slightly faster increase in coping skills than those with lower levels. Additionally, MCS moderated the development of hope: individuals with above-median MCS scores showed a faster increase in hope, whereas those with below-median scores experienced an irregular decrease. In conclusion, MCS serves as a valuable resource for developing self-efficacy and hope. However, the influence of real-life challenges on hope appears to depend on an individual's metacognitive skills, with better outcomes observed among those with higher MCS.

Enhancing Nurse Practitioners' Emergency Care Competency and Self-Efficacy Through Experiential Learning: A Single-Group Repeated Measures Study

BACKGROUND/OBJECTIVE

Nurse practitioners serve a vital role as first responders in emergencies. This study investigated the effectiveness of experiential learning in enhancing emergency care competency and self-efficacy among nurse practitioners.

METHODS

A single-group repeated measures design was implemented from June to August 2023 at a regional teaching hospital in southern Taiwan, involving 95 nurse practitioners and NP trainees. Participants completed a baseline (T0) three-minute emergency simulation test, followed by one-on-one guidance, an immediate post-test (T1), and a follow-up test one month later (T2). The "Emergency Care Capability Checklist" (ECCC) was used to assess performance after each test, and the "General Self-Efficacy Scale" at T1 and T2.

RESULTS

The mean age of the participants was 42.1 years (SD = 6.7), with 91 out of 95 participants (95.8%) being female. ECCC scores increased significantly from a baseline mean of 34.6 (standard deviation [SD] = 8.8 at T0 to 46.4 (SD = 4.3) at T1 (p < 0.001). Scores remained elevated at T2, with a mean of 44.7 (SD = 4.9), which was significantly higher than T0 (p < 0.001). However, scores at T2 were slightly lower than at T1 (p = 0.018). GSES scores also increased significantly from T1 (mean = 26.2, SD = 0.6) to T2 (mean = 28.0, SD = 0.6) (p = 0.009).

CONCLUSIONS

This study found that experiential learning was able to significantly improve nurse practitioners' emergency care competencies and self-efficacy. Future research should explore the application of experiential learning in diverse clinical settings to further advance emergency preparedness and self-efficacy among nurse practitioners.

Triangulation of Questionnaires, Qualitative Data and Natural Language Processing: A Differential Approach to Religious Bahá'í Fasting in Germany

Approaches to integrating mixed methods into medical research are gaining popularity. To get a holistic understanding of the effects of behavioural interventions, we investigated religious fasting using a triangulation of quantitative, qualitative, and natural language analysis. We analysed an observational study of Bahá'í fasting in Germany using a between-method triangulation that is based on links between qualitative and quantitative analyses. Individual interviews show an increase in the mindfulness and well-being categories. Sentiment scores, extracted from the interviews through natural language processing, positively correlate with questionnaire outcomes on quality of life (WHO-5: Spearman correlation r = 0.486, p = 0.048). Five questionnaires contribute to the first principal component capturing the spectrum of mood states (50.1% explained variance). Integrating the findings of the between-method triangulation enabled us to converge on the underlying effects of this kind of intermittent fasting. TRIAL REGISTRATION: NCT03443739.

Validation of Rosenberg self-esteem scale among Norwegian adolescents - psychometric properties across samples

BACKGROUND

Self-esteem refers to the evaluative and affective dimensions of the self-concept and is important for positive mental health and overall functioning during adolescence. The Rosenberg Self-esteem scale (RSES) is one of the most frequently used and widely accepted instruments assessing self-esteem; however, the psychometric properties of the instrument have not been investigated in a Norwegian adolescent population. The present study's aim is to investigate the factor structure, construct validity and reliability of the RSES among adolescents 14-21 years.

METHODS

The study was based on two cross-sectional samples (n = 1,233/ n = 1,816) of adolescents from rural and urban areas in Mid-Norway. Concerning the dimensionality of the RSES, two measurement models were tested using Principal Component Analysis and Confirmatory Factor Analysis: a one-factor model and a two-factor-model.

RESULTS

The results show that a two-factor solution of positive and negative aspects of self-esteem representing "perceived personal competence" and "self-value" had the best fit across the two adolescent samples. The RSES also showed high reliability and correlated in expected directions with measures of life satisfaction, stress, and self-efficacy, supporting the convergent validity of the instrument.

CONCLUSION

The psychometric properties of the RSES need to be further evaluated in Norwegian adolescent populations based on the dimensionality found in the present study; however overall, the results indicate that the instrument is appropriate for assessing self-esteem among Norwegian adolescents.

Evaluation of a training program using the SBAR communication tool for caregivers managing acute respiratory distress in lung cancer patients: A pilot randomized controlled trial protocol

Background

Family-based caregivers are increasingly important in the management of non-hospitalized lung cancer patients. However, lack of training can negatively impact care including diagnostic errors that can lead to delays in providing appropriate medical treatment. Acute respiratory failure (ARF) is common symptom of lung cancer and requires urgent intervention as well as adequate communication with healthcare professionals (HCPs) to enable appropriate decision-making and improve patient outcomes. Standardized tools such as the Situation, Background, Assessment, Recommendation (SBAR) tool and its French adaptation SAED, standing for Situation, Antécédent, Évaluation et Demande, are designed to facilitate communication among (HCPs).Additionally, digital interventions, such as serious games, are increasingly used to train HCPs though its use for caregivers has not been studied. This pilot study aims to assess an innovative serious game training using the SAED tool combined with standard instructions on self-efficacy for family-based caregivers of lung cancer patients when facing a simulated situation of ARF. The study also aims to examine caregivers' emotional state, quality of life, satisfaction and knowledge about the SBAR tool.

Methods

A monocentric, randomized, controlled, open-label, superiority, parallel-arm trial will be conducted for 18 months with 3 mid-study assessments (NCT05839353). Family caregivers of lung cancer patients will be recruited at the University Hospital Center of Saint Pierre, Reunion Island, France. Participants will be randomized (1:1) into two groups: the experimental group receiving training using the SBAR/SAED tool and standard instructions for managing respiratory distress/dyspnea, and the control group, receiving standard instructions only. The primary outcome will be to determine perceived self-efficacy as measured by the Generalized Self-Efficacy Scale.

Discussion

This study will present a preliminary assessment of training family caregivers in using the SBAR/SAED tool in simulated episodes of ARF in lung cancer patients. Our findings may provide valuable insights into effective training methods for caregivers in critical home care situations and could be widely used for lung cancer management.

Metacognition for hearing in noise: a comparison between younger and older adults

Metacognition entails knowledge of one's own cognitive skills, perceived self-efficacy and locus of control when performing a task, and performance monitoring. Age-related changes in metacognition have been observed in metamemory, whereas their occurrence for hearing remained unknown. We tested 30 older and 30 younger adults with typical hearing, to assess if age reduces metacognition for hearing sentences in noise. Metacognitive monitoring for older and younger adults was overall comparable. In fact, the older group achieved better monitoring for words in the second part of the phrase. Additionally, only older adults showed a correlation between performance and perceived confidence. No age differentiation was found for locus of control, knowledge or self-efficacy. This suggests intact metacognitive skills for hearing in noise in older adults, alongside a somewhat paradoxical overconfidence in younger adults. These findings support exploiting metacognition for older adults dealing with noisy environments, since metacognition is central for implementing self-regulation strategies.

Felt stigma and associated factors in children and adolescents with epilepsy: a multicenter cross-sectional study in China

Objective

Epilepsy-related stigma is a global problem, yet there has been an inadequate focus on children and adolescents. The purpose of this study was to determine the status quo of stigma and its determinants among children and adolescents with epilepsy in China.

Methods

A multicenter cross-sectional study was conducted across nine hospitals in eight cities within six provinces in China from 10 October 2023 to 15 June 2024. Participants included patients aged 8 to 18 years with epilepsy and their caregivers. Felt stigma was assessed with the Kilifi Stigma Scale for Epilepsy (KSSE). Social support and self-efficacy were collected through the Social Support Rating Scale (SSRS) and the Generalized Self-Efficacy Scale (GSES). The data were analyzed using t-tests, analysis of variance (ANOVA), Spearman correlation analysis, and multiple linear regression analysis.

Results

The study enrolled 281 children and adolescents, with a mean age of 12.25 years (SD = 2.56), including 46.6% females. A total of 35.6% participants had self-reported felt stigma. The mean KSSE score is 9.58 (SD = 7.11). Meanwhile, stigma scores correlated strongly with reduced social support (r = -0.55, p < 0.01) and self-efficacy (r = -0.43, p < 0.01). Place of residence (rural vs. non-rural), academic performance (average and above vs. fair or poor), region (western region vs. non-western region), duration of epilepsy (≤5 years vs. >5 years), drug-resistant epilepsy (yes vs. no), comorbidities (yes vs. no), social support and self-efficacy are major influencing factors among the complex factors influencing the felt stigma among children and adolescents.

Conclusion

Medical staff should be more aware of stigma among children and adolescents with epilepsy, especially those who live in rural and western areas, have poor academic performance, have epilepsy duration of more than 5 years, have drug-resistant epilepsy, and have comorbidities, who are at higher risk of stigma. It is recommended that effective measures be taken to alleviate stigma by improving children and adolescents' self-efficacy and providing more social support for them and their families.

Relationships between autistic traits, self-efficacy, and internalizing symptoms in a nonclinical sample of Indian early adolescents

INTRODUCTION

Having more "autistic traits" is associated with an increased risk of mental health conditions. However, few studies have examined autistic traits in nonclinical samples. This study aims to analyze the relationship between autistic traits and internalizing symptoms among early adolescents and to examine the moderating effect of self-efficacy.

METHODS

Survey data were collected from early adolescents ages 10-14 living in Darjeeling, India (n = 274) to assess autistic traits, self-efficacy, and internalizing symptoms.

RESULTS

Higher internalizing symptoms were significantly associated with a higher report of autistic traits. Academic, social, and emotional dimensions of self-efficacy moderated the relationship between autistic traits and internalizing symptoms.

CONCLUSION

The moderation effects between social and emotional self-efficacy among youth with high versus low autism trait scores suggest the need for social-emotional learning interventions designed for and with neurodivergent youth. Such interventions aim to reduce internalizing symptoms during early adolescence and improve future mental health trajectories.

Adherence with oral nutritional supplements and influencing factors in postoperative patients with digestive tract tumors: a cross-sectional study

OBJECTIVE

This study aims to use structural equation modeling to explore the pathways and effect sizes of factors influencing the adherence of postoperative patients with digestive tract tumor to oral nutritional supplements, providing a theoretical basis for future nursing intervention measures.

METHODS

A total of 300 postoperative patients with digestive tract tumor within 30 days after surgery were conveniently sampled. Surveys were conducted using a General Information Questionnaire, Morisky Medication Adherence Scale, Digestive System Tumor Patient Nutrition Knowledge-Attitude-Behavior Questionnaire, Multidimensional Social Perception Scale, Beliefs about Medical Questionnaire, and General Self-Efficacy Scale. Structural equation modeling was employed to analyze the factors and pathways affecting adherence with oral nutritional supplements.

RESULTS

The adherence score of postoperative patients with digestive tract tumor to oral nutritional supplements was 1.61 ± 1.38. The structural equation model had a good fit (χ2/df = 2.685, GFI = 0.930, CFI = 0.913, AGFI = 0.887, IFI = 0.915, and RMSEA = 0.075). Nutrition knowledge, social support, medication beliefs, and self-efficacy were found to be factors influencing adherence with oral nutritional supplements in postoperative patients with digestive tract tumor, with total effects of 0.539, 0.264, 0.215, and 0.180, respectively. Nutrition knowledge indirectly affected adherence through self-efficacy and medication beliefs, while social support indirectly affected adherence through self-efficacy.

CONCLUSION

Adherence with oral nutritional supplements in postoperative patients with digestive tract tumor is at a low level. Improving social support, enhancing patients nutrition knowledge, increasing self-efficacy, and strengthening medication beliefs are effective ways to improve patient adherence.

(Mis)matched direct and moderating relationships among pro-environmental attitudes, environmental efficacy, and pro-environmental behaviors across and within 11 countries

Pro-environmental behaviors are influenced by individuals' pro-environmental attitudes and environmental efficacy, among many other factors. However, attitude-behavior models are inconsistent on whether and how attitudes, efficacy, and behaviors should match in specificity or generality, and on the moderation effect of efficacy. This study first tests a simple model including direct and moderating relationships between pro-environmental attitudes, environmental efficacy, and pro-environmental behaviors. Then it examines relationships among subscales matched or mismatched in their respective specific or general domain of environmental attitudes (concern, values), environmental efficacy (self, collective), and pro-environmental behaviors (private, public). Secondary data come from an overall sample of 11,000 respondents across 11 countries, with n = 1,000 from each country. Pro-environmental attitudes and efficacy have direct relationships with pro-environmental behavior, but efficacy has little moderation effect. Different combinations of (mis)matched measures produce slightly different results, with the most variance explained, counter to hypotheses, by two mismatched models. Results are generally consistent across countries.

Patient activation in adults with visual impairment: a study of related factors

This study aims to analyze variables related to patient activation in 78 individuals with visual impairment. The Patient Activation Measure (PAM) scores of participants showed no differences between males and females. It was found that the individuals living in urban areas, and participants with higher income and education levels had higher PAM scores. Still, the difference between the groups was statistically insignificant (p > 0.05). The PAM scores of the visually impaired individuals reflect taking action level of activation (66.51 ± 18.14-PAM level 3). There was a moderately significant relationship between PAM scores and visually impaired individuals' self-management, self-efficacy, healthy life awareness, social relations, and environment (p < 0.001). We found that the variables included in the regression model (marital status, self-management, self-efficacy, healthy life awareness, social relations, and environment) explained 72.2% of the PAM score. Individuals with visual impairment can be given training on self-management, self-efficacy, healthy life awareness, and quality of life associated with social relations and environment to develop positive health behaviors.

Relationships between Food Insecurity, Self-Efficacy, and Changes in Body Mass Index among the Youth in Taiwan: Analysis from a Longitudinal Cohort Survey

BACKGROUND

Food insecurity is a heightened concern among economically disadvantaged youth, and it may contribute to the atypical body mass index (BMI) patterns frequently observed in this group. Self-efficacy seems to intervene in the negative impacts of contextual restraints. This study investigated the relationship between food insecurity, self-efficacy, and BMI trajectory among economically disadvantaged Taiwanese youth.

METHODS

We utilized three-wave longitudinal data from the Taiwan Database of Children and Youth in Poverty. The Food Insecurity Score (FIS) assessed food insecurity with a 4-item scale measuring reduced meal frequency, hunger, skipping meals, and economic constraints. Moreover, the General Self-Efficacy Scale (GSES) assessed self-efficacy, showcasing the ability to handle stress effectively and envision success scenarios, contributing to positive outcomes. By employing latent growth modeling, we were able to delineate the impacts of baseline food insecurity and self-efficacy on initial BMI and its subsequent growth trajectory.

RESULTS

Elevated baseline FIS significantly predicted higher initial BMI (coefficient = 0.420, p = 0.042). Baseline GSES was negatively associated with initial BMI (coefficient = -0.093, p < 0.001) but positively predicted the BMI growth rate (coefficient = 0.023, p = 0.011).

CONCLUSION

Enhancing self-efficacy may be an effective multidisciplinary intervention to address psychosocial and socioeconomic factors when tackling weight problems in vulnerable youth groups.

Identifying the top predictors of student well-being across cultures using machine learning and conventional statistics

Alongside academic learning, there is increasing recognition that educational systems must also cater to students' well-being. This study examines the key factors that predict adolescent students' subjective well-being, indexed by life satisfaction, positive affect, and negative affect. Data from 522,836 secondary school students from 71 countries/regions across eight different cultural contexts were analyzed. Underpinned by Bronfenbrenner's bioecological theory, both machine learning (i.e., light gradient-boosting machine) and conventional statistics (i.e., hierarchical linear modeling) were used to examine the roles of person, process, and context factors. Among the multiple predictors examined, school belonging and sense of meaning emerged as the common predictors of the various well-being dimensions. Different well-being dimensions also had distinct predictors. Life satisfaction was best predicted by a sense of meaning, school belonging, parental support, fear of failure, and GDP per capita. Positive affect was most strongly predicted by resilience, sense of meaning, school belonging, parental support, and GDP per capita. Negative affect was most strongly predicted by fear of failure, gender, being bullied, school belonging, and sense of meaning. There was a remarkable level of cross-cultural similarity in terms of the top predictors of well-being across the globe. Theoretical and practical implications are discussed.

Post-traumatic growth correlates among parents of children with chronic illnesses: A systematic review and meta-analysis

Parenting a child with a chronic illness presents a complex journey marked by various challenges, along with possible personal growth following these challenges. In this systematic review we present three meta-analyses, in order to examine the associations of post-traumatic growth (PTG) among parents of children with diverse chronic illnesses, and psychological distress, social support, and resilience. Analyzing 34 studies encompassing a total of 5328 parents, the results reveal several key findings. First, PTG was found to be prevalent among the parents. Second, there was no significant correlation between PTG and psychological distress, suggesting that these two processes may exist independently. Third, a positive correlation was observed between PTG and both social support and resilience-related factors, underscoring the role of these factors in fostering growth among parents of children with chronic illnesses. Additionally, illness type emerged as a moderator, affecting the strength of the above-mentioned correlations with PTG. Specifically, in the case of psychiatric illnesses, correlations of PTG with social support and resilience were stronger than in the context of other illnesses. Overall, this review emphasizes the significance of recognizing and addressing PTG correlates among parents of children with chronic illnesses, offering insights for clinical practice.

Bidirectional reduction effects of perceived stress and general self-efficacy among college students: a cross-lagged study

Perceived stress and general self-efficacy are important issues closely related to the mental health and academic performance of college students. Previous studies have explored the correlation between perceived stress and general self-efficacy, but the understanding of the reciprocal effects of these two factors is still limited. Based on two-wave longitudinal data, this study investigated the bidirectional relationship between perceived stress and general self-efficacy in a sample of Chinese college students. The correlation results showed that perceived stress was significantly negatively correlated with general self-efficacy. Furthermore, by cross-lagged analysis, it was found that perceived stress can significantly negatively predict subsequent general self-efficacy and that general self-efficacy can significantly negatively predict subsequent perceived stress. Bidirectional reduction effects between perceived stress and general self-efficacy are observed among Chinese college students. The results emphasize the necessity of timely stress intervention for college students and the establishment of measures to enhance general self-efficacy.

Factor structure of academic resilience among Polish and Ukrainian students involved in remote education caused by Covid-19 and military aggression

Academic resilience explains how students overcome various challenges or negative experiences that can hinder the learning process. The COVID pandemic as well as war conflicts might be significant factors affecting the structure of the academic resilience of students. This study attempted to assess the extent to which the Cassidy's construct of resilience can be used to interpret the behavior of other-Polish and Ukrainian samples, under remote education caused by the COVID-19 pandemic and Russian military aggression against the Ukrainian civils. Second, the relationships between resilience and students' self-efficacy were estimated. To test the factor structure of the resilience exploratory and confirmatory factor analyses were conducted. Assumed structure reproduced to a greater extent among Polish (83.4% similarity) than in Ukrainian respondents (from 27 to 40%) and it was three or two factors for Polish and Ukrainian students, respectively. General self-efficacy positively correlated with resilience both among Polish and Ukrainian respondents confirming the concurrent validity of the scale. The discovered differences were explained by differences in the historical and sociocultural experiences of the two nations. If among Ukrainian students historical and social experiences actually lead to the formation of a pattern of Perseverance in Overcoming Problems, then in the factor analysis, this pattern should be reproduced in the form of a single factor. At the same time, experiences with negative emotions should give a second-factor Negative affect and emotional response. The results obtained confirmed this assumption.

General self-efficacy as a mediator of the association between adverse childhood experiences and psychological distress in gender-minority individuals

PURPOSE

To investigate the mediating role of general self-efficacy (i.e., belief in one's competence to cope with a broad range of stressful or challenging demands) in the relationship between adverse childhood experiences (ACEs) and psychological distress (i.e., symptoms of stress, anxiety and depression) in gender minority individuals, which include people with a gender identity that is not aligned with their sex assigned at birth.

DESIGN AND METHODS

The study sample included gender minority participants who participated in Waves 4 and 5 of Project AFFIRM, a multi-site longitudinal study of gender minority health. ACEs, general self-efficacy, and psychological distress were measured using the Behavior Risk Factor Surveillance System ACE Module at Wave 4, the PROMIS General self-efficacy measure at Wave 4, and the Brief Symptoms Inventory Global Severity Index (GSI) at Wave 5, respectively. After adjustment for covariates, including age, race, sex assigned at birth, and income, multivariable linear regression analyses were conducted to assess each component of the proposed mediation model. Next, mediation analyses were used to determine whether general self-efficacy mediated the association between ACEs and psychological distress.

FINDINGS

The sample for this study consisted of 166 gender minority adults with a mean age of 38.6 ± 12.2 years. Most were non-Hispanic White (46.4%) and female assigned at birth (59.6%). Mean ACEs score was 3.2 ± 2.1 (range 0-8), mean general self-efficacy score was 13.9 ± 3.6 (range 4-20), and mean raw-score GSI was 17.3 ± 13.7 (range 0-64). Participants who reported experiencing more ACEs had greater psychological distress (B 1.60; 95% CI = 0.66, 2.54) and lower general self-efficacy (B -0.41; 95% CI = -0.67, -0.15). In addition, lower general self-efficacy was associated with higher psychological distress (B -1.06; 95% CI = -1.61, -0.51). Bootstrap estimation of the indirect effect was significant (95% CI = 0.14, 0.90) and explained 27.1% (95% CI = 7.76, 69.76) of the total effect of ACEs on psychological distress in gender minority adults.

CONCLUSIONS

Our findings suggest that general self-efficacy partially mediated the positive association between ACEs and psychological distress in gender minority adults. Interventions that aim to improve general self-efficacy may be beneficial in alleviating psychological distress in gender minority adults.

CLINICAL RELEVANCE

Nurses can play an important role in reducing the health risks associated with ACEs by screening gender minority individuals using a trauma-informed approach to care and offering resources and referrals, as appropriate.

The relationship between student interaction with generative artificial intelligence and learning achievement: serial mediating roles of self-efficacy and cognitive engagement

Generative artificial intelligence (GAI) shocked the world with its unprecedented ability and raised significant tensions in the education field. Educators inevitably transition to an educational future that embraces GAI rather than shuns it. Understanding the mechanism between students interacting with GAI tools and their achievement is important for educators and schools, but relevant empirical evidence is relatively lacking. Due to the characteristics of personalization and real-time interactivity of GAI tools, we propose that the students-GAI interaction would affect their learning achievement through serial mediators of self-efficacy and cognitive engagement. Based on questionnaire surveys that include 389 participants as the objective, this study finds that: (1) in total, there is a significantly positive relationship between student-GAI interaction and learning achievement. (2) This positive relationship is mediated by self-efficacy, with a significant mediation effect value of 0.015. (3) Cognitive engagement also acts as a mediator in the mechanism between the student-GAI interaction and learning achievement, evidenced by a significant and relatively strong mediating effect value of 0.046. (4) Self-efficacy and cognitive engagement in series mediate this positive association, with a serial mediating effect value of 0.011, which is relatively small in comparison but also shows significance. In addition, the propensity score matching (PSM) method is applied to alleviate self-selection bias, reinforcing the validity of the results. The findings offer empirical evidence for the incorporation of GAI in teaching and learning.

The effects of causal and self-efficacy beliefs on help-seeking for people with depressive complaints: a quasi-experimental online study

Background

Only approximately a third of people with depressive symptoms seek professional health care. Furthermore, people labelled as mentally ill may experience stigmatisation, which can impede help-seeking behaviour.

Aim

To examine the effects of three vignette-based interventions endorsing biopsychosocial causal beliefs and strengthening self-efficacy on help-seeking intention and behaviour, as well as the predictive values of these variables and previous treatment experience.

Method

A quasi-experimental online study utilising a fractioned factorial design was carried out. People were screened for depressive symptoms and their current treatment status. After baseline assessment, they were randomly allocated into one of 24 groups receiving a combination of interventional messages. Actual help-seeking behaviour was measured at follow-ups 3 and 6 months after baseline.

Results

Altogether, N = 1,368 participants were included in the final analyses and N = 983 provided data on their help-seeking behaviour within 3 to 6 months after the baseline assessment. The intention to seek help from a general practitioner or a mental health professional was significantly influenced by the interventions. However, help-seeking behaviour was not influenced by the interventions. On a conceptual level, biopsychosocial causal beliefs (β = 0.09-0.23) and self-efficacy to seek help (β = 0.16-0.25) predicted help-seeking intention. There was a negative interaction effect of both self-efficacy beliefs on intention and behaviour, which changed depending on depression severity. In all models, the intention was the main predictor of actual behaviour. Treatment experience predicted both help-seeking intention and behaviour.

Conclusion

Biopsychosocial causal beliefs and self-efficacy have a direct effect on help-seeking intention. Interventions should include information on how to actually seek help as a means to strengthen self-efficacy beliefs and simulate previous treatment experience. Further research is needed to investigate the respective interaction effects on intention and behaviour.

Clinical Trial Registration

https://drks.de/search/de/trial/DRKS00023557, German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111-1264-9954. Registered 16 February 2021.

Being Virtual in Real Interpersonal Interaction: What Makes People Prone to Phubbing?

This study examines the relationship between phubbing, body image, and general self-efficacy. The study group consists of 282 adults over the age of 18. Phubbing Scale, Body Image Scale, and General Self-Efficacy Scale were used to collect data in the study. The collected data were analyzed by independent sample t-test, Pearson correlation coefficient, and regression analysis. As a result of the research, it was found that there was a statistically significant and negative relationship between phubbing and general self-efficacy and body image. As a result of the regression analysis, it was seen that general self-efficacy and body image predicted phubbing. In addition, it was concluded that phubbing differed significantly according to marital status. According to this finding, it has been determined that singles' phubbing level is higher than married individuals. On the other hand, it was determined that the level of phubbing did not differ significantly according to gender.

The Relationship between Wellbeing, Self-Determination, and Resettlement Stress for Asylum-Seeking Mothers Attending an Ecosocial Community-Based Intervention: A Mixed-Methods Study

Psychosocial support programs have been increasingly implemented to protect asylum seekers' wellbeing, though how and why these interventions work is not yet fully understood. This study first uses questionnaires to examine how self-efficacy, satisfaction of basic psychological needs, and adaptive stress may influence wellbeing for a group of asylum-seeking mothers attending a community-based psychosocial program called Welcome Haven. Second, we explore mothers' experiences attending the Welcome Haven program through qualitative interviews. Analysis reveals the importance of relatedness as a predictor of wellbeing as well as the mediating role of adaptive stress between need satisfaction and wellbeing. Further, attending Welcome Haven is associated with reduced adaptive stress and increased wellbeing, which correspond with the thematic analysis showing that attendance at the workshops fostered a sense of belonging through connection with other asylum seekers and service providers as well as empowerment through access to information and self-expression. The results point to the importance of community-based support that addresses adaptive stress and the promotion of social connection as key determinants of wellbeing. Nonetheless, the centrality of pervasive structural stressors asylum seekers experience during resettlement also cautions that relief offered by interventions may be insufficient in the face of ongoing systemic inequality and marginalization.

Pragmatic randomised controlled trial of guided self-help versus individual cognitive behavioural therapy with a trauma focus for post-traumatic stress disorder (RAPID)

Background

Guided self-help has been shown to be effective for other mental conditions and, if effective for post-traumatic stress disorder, would offer a time-efficient and accessible treatment option, with the potential to reduce waiting times and costs.

Objective

To determine if trauma-focused guided self-help is non-inferior to individual, face-to-face cognitive-behavioural therapy with a trauma focus for mild to moderate post-traumatic stress disorder to a single traumatic event.

Design

Multicentre pragmatic randomised controlled non-inferiority trial with economic evaluation to determine cost-effectiveness and nested process evaluation to assess fidelity and adherence, dose and factors that influence outcome (including context, acceptability, facilitators and barriers, measured qualitatively). Participants were randomised in a 1 : 1 ratio. The primary analysis was intention to treat using multilevel analysis of covariance.

Setting

Primary and secondary mental health settings across the United Kingdom's National Health Service.

Participants

One hundred and ninety-six adults with a primary diagnosis of mild to moderate post-traumatic stress disorder were randomised with 82% retention at 16 weeks and 71% at 52 weeks. Nineteen participants and ten therapists were interviewed for the process evaluation.

Interventions

Up to 12 face-to-face, manualised, individual cognitive-behavioural therapy with a trauma focus sessions, each lasting 60-90 minutes, or to guided self-help using Spring, an eight-step online guided self-help programme based on cognitive-behavioural therapy with a trauma focus, with up to five face-to-face meetings of up to 3 hours in total and four brief telephone calls or e-mail contacts between sessions.

Main outcome measures

Primary outcome: the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, at 16 weeks post-randomisation. Secondary outcomes: included severity of post-traumatic stress disorder symptoms at 52 weeks, and functioning, symptoms of depression, symptoms of anxiety, alcohol use and perceived social support at both 16 and 52 weeks post-randomisation. Those assessing outcomes were blinded to group assignment.

Results

Non-inferiority was demonstrated at the primary end point of 16 weeks on the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [mean difference 1.01 (one-sided 95% CI -∞ to 3.90, non-inferiority p = 0.012)]. Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, score improvements of over 60% in both groups were maintained at 52 weeks but the non-inferiority results were inconclusive in favour of cognitive-behavioural therapy with a trauma focus at this timepoint [mean difference 3.20 (one-sided 95% confidence interval -∞ to 6.00, non-inferiority p = 0.15)]. Guided self-help using Spring was not shown to be more cost-effective than face-to-face cognitive-behavioural therapy with a trauma focus although there was no significant difference in accruing quality-adjusted life-years, incremental quality-adjusted life-years -0.04 (95% confidence interval -0.10 to 0.01) and guided self-help using Spring was significantly cheaper to deliver [£277 (95% confidence interval £253 to £301) vs. £729 (95% CI £671 to £788)]. Guided self-help using Spring appeared to be acceptable and well tolerated by participants. No important adverse events or side effects were identified.

Limitations

The results are not generalisable to people with post-traumatic stress disorder to more than one traumatic event.

Conclusions

Guided self-help using Spring for mild to moderate post-traumatic stress disorder to a single traumatic event appears to be non-inferior to individual face-to-face cognitive-behavioural therapy with a trauma focus and the results suggest it should be considered a first-line treatment for people with this condition.

Future work

Work is now needed to determine how best to effectively disseminate and implement guided self-help using Spring at scale.

Trial registration

This trial is registered as ISRCTN13697710.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/97) and is published in full in Health Technology Assessment; Vol. 27, No. 26. See the NIHR Funding and Awards website for further award information.

Refining the Analysis of Mechanism-Outcome Relationships for Anxiety Treatment: A Preliminary Investigation Using Mixed Models

Although efficacious treatments exist for anxiety disorders, issues remain regarding how best to conceptualize and measure purported change processes in clinical research. In the current study, we examined the relationship between treatment-specific (exposure therapy, attention bias modification [ABM]) as well as more general change processes with symptoms within a transdiagnostic sample using mixed models. Results indicated that slope of self-efficacy across treatment and between-session habituation across identical exposures was associated with slope of symptom change. Although slope of anxiety ratings within session was not associated with slope of symptom change, it did interact with other candidate exposure processes to predict symptoms. Purported ABM change processes were not associated with outcome. Our use of mixed models exemplifies an emerging trend in this research aimed at minimizing loss of data through aggregation, and our results highlight the utility of integrating treatment-specific as well as more general change processes in mechanistic research.

Process-Based psychotherapy personalization: considering causality with continuous-time dynamic modeling

Psychotherapy can be improved by integrating the study of mediators (how it works) and moderators (for whom it works). To demonstrate this integration, we studied the relationship between resource activation, problem-coping experiences and symptoms in cognitive-behavior therapy (CBT) for depression, to obtain preliminary insights on causal inference (which process leads to symptom improvement?) and prediction (which one for whom?).

A sample of 715 patients with depression who received CBT was analyzed. Hierarchical Bayesian continuous time dynamic modeling was used to study the temporal dynamics between the variables analyzed within the first ten sessions. Depression and self-efficacy at baseline were examined as predictors of these dynamics.

There were significant cross-effects between the processes studied. Under typical assumptions, resource activation had a significant effect on symptom improvement. Problem-coping experience had a significant effect on resource activation. Depression and self-efficacy moderated these effects. However, when system noise was considered, these effects may be affected by other processes.

Resource activation was strongly associated with symptom improvement. To the extent of inferring causality, for patients with mild-moderate depression and high self-efficacy, promoting resource activation can be recommended. For patients with severe depression and low self-efficacy, promoting problem-coping experiences can be recommended.

Impact of training in the supervision of clinical reasoning in the pediatric emergency department on residents' perception of the on-call experience

BACKGROUND

In 2021, the prevalence of signs of burnout among medical residents was reported to be 67%. Being on call is particularly stressful for residents, notably due to their lack of medical experience. When they are on call, several factors contribute to a mismatch between the residents' theoretical knowledge and the operationalization of that knowledge in a clinical reasoning process. Using the script and cognitive load theories as a basis, we hypothesized that training clinician-teachers in the supervision of clinical reasoning could improve residents' perception of the experience of being on call.

METHODS

We performed a longitudinal, exploratory, controlled study with a cohort of medical residents who were on call in the pediatric emergency department during the semester from 1 November 2021 to 30 April 2022. During the night, the residents on call in the pediatric emergency department completed validated questionnaires investigating (1) mental effort, (2) cognitive weariness, (3) state anxiety, (4) feeling of self-efficacy, and (5) well-being. We compared the questionnaires of residents supervised by pediatricians trained in the supervision of clinical reasoning (supervision group) with those of residents in a control group, supervised by pediatricians with no specific pedagogical training.

RESULTS

A total of 284 questionnaires (174 supervision group, 110 controls) were collected from 38 residents in three pediatric emergency departments. The results confirm that being on call is difficult for residents. Compared to the control group, residents in the supervision group had lower cognitive weariness scores (mean 3.0 ± 1.1 vs. 3.5 ± 1.3). There was no significant difference between groups for any of the other dimensions of the on-call experience. In the supervision group, mental effort was significantly lower at the end of the study semester (5 [5-6] when on call in month 6 of the semester vs. 6 [5-7] when on call in months 1-5 of the semester; p = 0.01) and was greater for more senior residents (7 [6-8] for those in the 4th or higher semester of residency vs. 6 [5-7] for residents in their 1st, 2nd, or 3rd semester of residency; β = 0.92 ± 0.40; p = 0.02).

CONCLUSION

Beyond the positive effects for residents, this study illustrates the feasibility of implementing training for clinicians in the supervision of clinical reasoning.

Physicians' Turnover Intention During the "Post-COVID-19" Era: Risk and Protective Factors

PURPOSE

This research investigates risk and protective factors affecting physicians' turnover intention during the post-COVID-19 era.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional online survey study of 958 physicians working in Lombardy (Northern Italy) hospitals was conducted.

FINDINGS

In the post-COVID-19 era, burnout significantly increases physicians' turnover intention. The same is true for fear of being infected by COVID-19 (FIC), which indirectly affects turnover intention via burnout. The higher FIC and burnout, the higher intention to leave the job or working unity. Self-efficacy significantly decreases turnover intention by reducing FIC and burnout.

ORIGINALITY/VALUE

Implementing turnover preventive programs in healthcare professionals is essential, mainly reducing BO and promoting physicians' personal resources, such as self-efficacy.

Investigating two mobile just-in-time adaptive interventions to foster psychological resilience: research protocol of the DynaM-INT study

BACKGROUND

Stress-related disorders such as anxiety and depression are highly prevalent and cause a tremendous burden for affected individuals and society. In order to improve prevention strategies, knowledge regarding resilience mechanisms and ways to boost them is highly needed. In the Dynamic Modelling of Resilience - interventional multicenter study (DynaM-INT), we will conduct a large-scale feasibility and preliminary efficacy test for two mobile- and wearable-based just-in-time adaptive interventions (JITAIs), designed to target putative resilience mechanisms. Deep participant phenotyping at baseline serves to identify individual predictors for intervention success in terms of target engagement and stress resilience.

METHODS

DynaM-INT aims to recruit N = 250 healthy but vulnerable young adults in the transition phase between adolescence and adulthood (18-27 years) across five research sites (Berlin, Mainz, Nijmegen, Tel Aviv, and Warsaw). Participants are included if they report at least three negative burdensome past life events and show increased levels of internalizing symptoms while not being affected by any major mental disorder. Participants are characterized in a multimodal baseline phase, which includes neuropsychological tests, neuroimaging, bio-samples, sociodemographic and psychological questionnaires, a video-recorded interview, as well as ecological momentary assessments (EMA) and ecological physiological assessments (EPA). Subsequently, participants are randomly assigned to one of two ecological momentary interventions (EMIs), targeting either positive cognitive reappraisal or reward sensitivity. During the following intervention phase, participants' stress responses are tracked using EMA and EPA, and JITAIs are triggered if an individually calibrated stress threshold is crossed. In a three-month-long follow-up phase, parts of the baseline characterization phase are repeated. Throughout the entire study, stressor exposure and mental health are regularly monitored to calculate stressor reactivity as a proxy for outcome resilience. The online monitoring questionnaires and the repetition of the baseline questionnaires also serve to assess target engagement.

DISCUSSION

The DynaM-INT study intends to advance the field of resilience research by feasibility-testing two new mechanistically targeted JITAIs that aim at increasing individual stress resilience and identifying predictors for successful intervention response. Determining these predictors is an important step toward future randomized controlled trials to establish the efficacy of these interventions.

The Role of Emotion Regulation for General Self-Efficacy in Adolescents Assessed Through Both Neurophysiological and Self-Reported Measures

Background

Self-efficacy, the belief in one's ability and capacity to organize and execute actions required to achieve desired results, is associated with adolescent academic achievement and reduced risk for psychopathology. Adolescent emotion regulation represents an important component in the relationship between self-efficacy and developmental outcomes, but the underlying neurophysiological mechanisms are poorly understood. It is unclear how emotion regulation strategies, which change with experience, and emotion regulation capacity, which is largely determined by genetics, contribute to the development of self-efficacy.

Aim

The present study aims to explore the relationship between emotion regulation and self-efficacy in adolescents. We hypothesize that neurophysiological emotion regulation capacity moderates the relationship between emotion regulation strategies and self-efficacy.

Methods

The present study applied a cross-sectional design. A sample of high-school students (N = 45, nfemale = 31, age = 17-18) provided answers on the General Self-Efficacy Questionnaire and the Emotion Regulation Questionnaire. Vagal tone was used as an indicator for emotion regulation capacity.

Results

In the initial correlational analysis, reappraisal, but not expressive suppression nor vagal tone was associated with self-efficacy. Vagal tone was not associated with any self-report measures of emotion regulation or self-efficacy. Contrary to our hypothesis, vagal tone did not moderate the relationship between emotion regulation and self-efficacy.

Conclusion

This is the first study assessing the relationship between neurophysiological indicators of emotion regulation and self-efficacy. Our results do not indicate that vagal tone moderates the relationship between emotion regulation strategies and general self-efficacy. Future studies should also assess the possible influence of metacognition and interoception on relationships.

Effectiveness of an Internet-Based Self-Guided Program to Treat Depression in a Sample of Brazilian Users: Randomized Controlled Trial

BACKGROUND

Depression is undertreated in Brazil. Deprexis is a self-guided internet-based program used to treat depressive symptoms based on empirically supported integrative and cognitive behavioral therapy. Evidence from a meta-analysis supports Deprexis' efficacy in German-speaking countries and the United States, but no study has been conducted using this program in countries with low literacy rates and large social disparities. Furthermore, few studies have investigated whether internet-based interventions ameliorate the psychological processes that might underlie depressive symptomatology, such as low perceived self-efficacy.

OBJECTIVE

The main objective of this study was to replicate in Brazil previously reported effects of Deprexis on depressive symptom reduction. Therefore, the main research question was whether Deprexis is effective in reducing depressive symptoms and the general psychological state in Brazilian users with moderate and severe depression in comparison with a control group that does not receive access to Deprexis. A secondary research question was whether the use of Deprexis affects perceptions of self-efficacy.

METHODS

We interviewed 312 participants recruited over the internet and randomized 189 participants with moderate to severe depression (according to the Patient Health Questionnaire-9 and a semistructured interview) to an intervention condition (treatment as usual plus immediate access to Deprexis for 90 days, n=94) or to a control condition (treatment as usual and delayed access to Deprexis, after 8 weeks, n=95).

RESULTS

Participants from the immediate access group logged in at Deprexis an average of 14.81 (SD 12.16) times. The intention-to-treat analysis using a linear mixed model showed that participants who received Deprexis improved significantly more than participants assigned to the delayed access control group on the primary depression self-assessment measure (Patient Health Questionnaire-9; Cohen d=0.80; P<.001) and secondary outcomes, such as general psychological state measure (Clinical Outcome in Routine Evaluation-Outcome Measurement; Cohen d=0.82; P<.001) and the perceived self-efficacy measure (Cohen d=0.63; P<.001). The intention-to-treat analyses showed that 21% (20/94) of the participants achieved remission compared with 7% (7/95) in the control group (P<.001). The deterioration rates were lower in the immediate access control group. The dropout rate was high, but no differences in demographic and clinical variables were found. Participants reported a medium to high level of satisfaction with Deprexis.

CONCLUSIONS

These results replicate previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months in depressed samples of Brazilian users. From a public health perspective, this is important information to expand the reach of internet-based interventions for those who really need them, especially in countries with less access to mental health care. This extends previous research by showing significant effects on perceived self-efficacy.

TRIAL REGISTRATION

Registro Brasileiro de Ensaios Clíncos (ReBec) RBR-6kk3bx UTN U1111-1212-8998; https://ensaiosclinicos.gov.br/rg/RBR-6kk3bx/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1590/1516-4446-2019-0582.

Resilience and stress as predictors of work engagement: the mediating role of self-efficacy in nurses

Background

Nurses face high levels of stress and work demands, which can affect their work engagement and psychological well-being. Resilience and self-efficacy have been identified as important resources to improve nurses' adaptation and work engagement.

Objective

This study aimed to evaluate the mediating role of self-efficacy in the relationship between resilience and stress on work engagement in Peruvian nurses.

Methods

A cross-sectional design was used, and data were collected from a sample of 459 nurses. Self-report questionnaires were administered to measure self-efficacy, resilience, stress, and work engagement. SEM analyses were performed to examine the relationship between these variables, and a mediation analysis was conducted to evaluate the role of self-efficacy as a mediator in the relationship between resilience, stress, and work engagement.

Results

The results indicated a positive relationship between resilience, self-efficacy, and work engagement, as well as a negative relationship between stress and work engagement. Additionally, self-efficacy mediated the relationship between resilience and work engagement, as well as the relationship between stress and work engagement in nurses.

Conclusion

Personal resources such as self-efficacy are a key factor in the relationship between resilience (work resources), stress (work demands), and work engagement of Peruvian nurses. Strengthening self-efficacy and resilience can improve work engagement and personal satisfaction of nurses. Hospital administrators and nursing managers should consider the importance of resilience, stress, work engagement, and self-efficacy in registered nurses and develop effective strategies to improve them. This can have a positive impact on the quality of care provided to patients and on the job satisfaction of nurses.

Rethinking Learning Experience: How Generally Perceived Life Stress Influences Students' Course Perceptions in Different Learning Environments

Previous research work has already demonstrated that both the form of teaching as well as different teaching methods directly influence students' learning experience along with their psychobiological responses at the endocrine and autonomic level. Aiming to gain deeper insights into the constitution of the learning experience, this study examined the influence of external factors such as generally perceived life stress and self-efficacy on the immediate learning experience in different learning environments. Therefore, a randomized experimental field study was conducted in which both psychological constructs and physiological data (heart rate variability) were collected from healthy first-year medical students (n = 101) during the COVID-19 pandemic. In an effort to determine the consistency of the effects across various teaching formats, the same content of a practical histology course was carried out in a face-to-face setting as well as in passive and active online teaching. While self-efficacy was a strong predictor for positive course perceptions in all learning conditions (Pearson's r = 0.41-0.58), generally perceived worries correlated with higher anxiety during passive online learning and face-to-face learning (Pearson's r = 0.21-0.44), a finding supported by the negative correlation between the level of perceived life demands and enjoyment during the learning unit (Pearson's r = -0.40--0.43). Here, we additionally report initial evidence pointing towards the role of reduced general life stress as a resilience factor for the expression of physiological stress parameters in an academic context (small-sized effect; Pearson's r = 0.18). The data gathered in this study illustrate the relevance of emerging emotional manifestations-either aversive; negative effect or positive; protective effect-for the immediate learning process and thus establish a connection between medical education and the importance of mental health and wellbeing-especially discussed against the background of current social and political challenges in increasingly complex societal structures.

Stressors in university life and anxiety symptoms among international students: a sequential mediation model

BACKGROUND

Anxiety is a common mental health problem among university students, and identification of its risk or associated factors and revelation of the underlying mechanism will be useful for making proper intervention strategies. The aim of our study is to test the sequential mediation of self-efficacy and perceived stress in the association between stressors in university life and anxiety symptoms.

METHODS

A cross-sectional study design was adopted and a sample of 512 international students from a medical university of China completed the survey with measurements of stressors in university life, self-efficacy, perceived stress and anxiety symptoms.

RESULTS

We found that 28.71% of the international students had anxiety symptoms, and stressors in university life were positively associated with anxiety symptoms (β = 0.23, t = 5.83, p < 0.01). Moreover, sequential mediating role of self-efficacy and perceived stress in the association between the stressors and anxiety symptoms was revealed.

CONCLUSIONS

Our study provided a new perspective on how to maintain the mental health, which suggested that self-efficacy improvement and stress reduction strategies should be incorporated in the training programs to support students.

Enhancing a Willingness to Respond to Disasters and Public Health Emergencies Among Health Care Workers, Using mHealth Intervention: A Multidisciplinary Approach

Health care workers (HCWs) are increasingly faced with the continuous threat of confronting acute disasters, extreme weather-related events, and protracted public health emergencies. One of the major factors that determines emergency-department-based HCWs' willingness to respond during public health emergencies and disasters is self-efficacy. Despite increased public awareness of the threat of disasters and heightened possibility of future public health emergencies, the emphasis on preparing the health care workforce for such disasters is inadequate in low-and-middle-income countries (LMICs). Interventions for boosting self-efficacy and response willingness in public health emergencies and disasters have yet to be implemented or examined among emergency HCWs in LMICs. Mobile health (mHealth) technology seems to be a promising platform for such interventions, especially in a resource-constrained setting. This paper introduces an mHealth-focused project that demonstrates a model of multi-institutional and multidisciplinary collaboration for research and training to enhance disaster response willingness among emergency department workers in Pakistan.

Cultural determinants of the gap between self-estimated navigation ability and wayfinding performance: evidence from 46 countries

Cognitive abilities can vary widely. Some people excel in certain skills, others struggle. However, not all those who describe themselves as gifted are. One possible influence on self-estimates is the surrounding culture. Some cultures may amplify self-assurance and others cultivate humility. Past research has shown that people in different countries can be grouped into a set of consistent cultural clusters with similar values and tendencies, such as attitudes to masculinity or individualism. Here we explored whether such cultural dimensions might relate to the extent to which populations in 46 countries overestimate or underestimate their cognitive abilities in the domain of spatial navigation. Using the Sea Hero Quest navigation test and a large sample (N = 383,187) we found cultural clusters of countries tend to be similar in how they self-rate ability relative to their actual performance. Across the world population sampled, higher self-ratings were associated with better performance. However, at the national level, higher self-ratings as a nation were not associated with better performance as a nation. Germanic and Near East countries were found to be most overconfident in their abilities and Nordic countries to be most under-confident in their abilities. Gender stereotypes may play a role in mediating this pattern, with larger national positive attitudes to male stereotyped roles (Hofstede's masculinity dimension) associated with a greater overconfidence in performance at the national level. We also replicate, with higher precision than prior studies, evidence that older men tend to overestimate their navigation skill more than other groups. These findings give insight into how culture and demographics may impact self-estimates of our abilities.