Purpose To explain and predict racial or ethnic disparities in advance care planning (ACP) behaviors among American adults by using the Integrated Behavioral Model (IBM) and the Precaution Adoption Process Model. Methods A randomized, observational, nonexperimental, cross-sectional study design was used to survey American adults between 40 and 80 years of age ( n = 386). Results The majority of respondents (75%) had not completed ACP. Significant differences were found by race or ethnicity: 33% of Whites had completed ACP versus Hispanics (18%) and Blacks (8%). Whites had statistically significantly higher levels of most IBM constructs compared with Blacks and Hispanics. The IBM predicted 28% of the variance in behavioral intention. After controlling for sociodemographic variables, direct attitudes, indirect attitudes, and indirect perceived norms were significant predictors of behavioral intention. Conclusion The IBM and the Precaution Adoption Process Model are useful frameworks for interventions designed to increase ACP among racial or ethnic minorities in the United States.
The objective of this study was to assess relationships of the stages of smoking acquisition with self-efficacy and decisional balance in young Taiwanese adolescents. A random sample of 401 students was recruited. Students who were at the precontemplation stage had higher self-efficacy to resist smoking initiation than those who were at the decision-making or maintenance stages. Ratings of benefits of smoking were significantly higher for those in the maintenance stage than in the precontemplation or decision-making stages. In a discriminant function analysis, self-efficacy and decisional balance correctly predicted 77.4% of membership in the three stages. Health educators could use stage-specific skills and strategies based on self-efficacy and decision balance constructs to develop smoking prevention programs.
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