Mediators and moderators of behavior change in patients with chronic cardiopulmonary disease: the impact of positive affect and self-affirmation

Abstract

Among patients with chronic cardiopulmonary disease, increasing healthy behaviors improves outcomes, but such behavior changes are difficult for patients to make and sustain over time. This study aims to demonstrate how positive affect and self-affirmation improve health behaviors compared with a patient education control group. The patient education (PE control) patients completed a behavioral contract, promising to increase their physical activity or their medication adherence and received an educational guide. In addition to the contract and guide, the positive affect/self-affirmation intervention (PA intervention) patients also learned to use positive affect and self-affirmation to facilitate behavior change. Follow-up was identical. In 756 patients, enrolled in three randomized trials, the PA intervention resulted in increased positive affect and more success in behavior change than the PE control (p < .01). Behavior-specific self-efficacy also predicted success (p < .01). Induction of positive affect played a critical role in buffering against the adverse behavioral consequences of stress. Patients who experienced either negative psychosocial changes (p < .05) or interval negative life events (p < .05) fared better with the PA intervention than without it. The PA intervention increased self-efficacy and promoted success in behavior change by buffering stress.

Keywords: Behavior change; Positive affect; Self-affirmation; Self-efficacy; Stress.

Fig 1

CONSORT Consolidated Standards of Reporting Trials diagram. Flow of participants from enrollment to completion of the final follow-up assessment

Fig 2

A PATH model: simultaneous mediation and moderation of the positive affect–self-affirmation intervention. Controls for age, BMI, disease severity, gender, race, and trial clustering. Asterisks indicate strength of association: *P < .01, **P < .05. Plus signs indicate direct relationship: + Increased depression leads to increased stress; decreased depression leads to decreased stress. + Increased positive affect leads to increased self-efficacy; decreased positive affect leads to decreased self-efficacy. + Increased self-efficacy leads to increased behavior change; decreased self-efficacy leads to decreased behavior change. Minus signs indicate inverse relationship: − Increased social support leads to decreased stress; decreased social support leads to increased stress. − Increased positive affect leads to decreased stress; decreased positive affect leads to increased stress. − Increased stress leads to decreased self-efficacy; decreased stress leads to increased self-efficacy. Numbers indicate the following: 1 Increased interval medical events leads to decreased self-efficacy. 2 Increased positive affect intervention leads to increased behavior change. 2 Increased positive affect intervention leads to increased self-efficacy. 3 Increased positive affect intervention leads to decreased stress