Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients

Abstract

AIMTo describe the relationships between non-alcoholic fatty-liver disease (NAFLD) patient’s disease consequences and treatment perceptions, self-efficacy, and healthy lifestyle maintenance.METHODSA cross-sectional study among 146 ultrasound diagnosed NAFLD patients who visited the fatty liver clinic at the Tel-Aviv Medical Center. Eighty-seven of these individuals, participated in a clinical trial of physical activity and underwent fasting blood tests, analyzed at the same lab. Exclusion criteria included positivity for serum HBsAg or anti-HCV antibodies; fatty liver suspected to be secondary to hepatotoxic drugs; excessive alcohol consumption (≥ 30 g/d in men or ≥ 20 g/d in women) and positive markers of genetic or immune-mediated liver diseases. Patients were asked to complete a self-report structured questionnaire, assembled by the Israeli Center for Disease Control. Nutrition habits were measured using six yes/no questions (0 = no, 1 = yes) adopted from the national survey questionnaire. Participants in the clinical trial completed a detailed semi-quantitative food frequency questionnaire (FFQ) reporting their habitual nutritional intake during the past year. Self-efficacy was assessed by the Self-Efficacy Scale questionnaire, emotional representation, degree of illness understanding, timeline perception, treatment perception and symptoms were measured by the Brief Illness Perception questionnaire. Illness consequences were measured by the Personal Models of Diabetes Interview questionnaire. A path analysis was performed to describe the interrelationships between the patients’ illness perceptions, and assess the extent to which the data fit a prediction of nutritional habits.RESULTSThe study sample included 54.1% men, with a mean age of 47.76 ± 11.68 years (range: 20-60) and mean body mass index of 31.56 ± 4.6. The average perceived nutrition habits score was 4.73 ± 1.45 on a scale between 0-6, where 6 represents the healthiest eating habits. Most of the study participants (57.2%) did not feel they fully understood what NAFLD is. Better nutritional habits were positively predicted by the degree of illness understanding (β = 0.26; P = 0.002) and self-efficacy (β = 0.25; P = 0.003). Perceptions of more severe illness consequences were related with higher emotional representation (β = 0.55; P < 0.001), which was related with lower self-efficacy (β = -0.17; P = 0.034). The perception of treatment effectiveness was positively related with self-efficacy (β = 0.32; P < 0.001). In accordance with the correlation between self-efficacy and the perceived nutrition habits score, self-efficacy was also correlated with nutrient intake evaluated by the FFQ; negatively with saturated fat (percent of saturated fat calories from total calories) (r = -0.28, P = 0.010) and positively with fiber (r = 0.22, P = 0.047) and vitamin C intake (r = 0.34, P = 0.002). In a sub analysis of the clinical trial participants, objectively measured compliance to physical activity regimen was positively correlated with the self-efficacy level (...

Self‐efficacy in patients with chronic musculoskeletal conditions discharged from physical therapy service: A cross‐sectional study

“…This is the first study to explore this relationship between self-efficacy and clinical improvement in patients with chronic musculoskeletal conditions at discharge. Similar results were found in patients with nonalcoholic liver disease; those who reported high levels of self-efficacy had greater confidence in the effectiveness of their treatment (Zelber-Sagi et al, 2017).…”

Treatment of NAFLD with diet, physical activity and exercise

“…168 In a recent cross-sectional study among 146 patients with NAFLD, a better nutritional behaviour was associated with higher patient's perceptions of understanding what NAFLD is, believing in treatment effectiveness and a higher self-efficacy. 169 The 5 A's model (ask, advise, assess, assist, and arrange) may be useful as a tool to assist clinicians advising patients with NAFLD to modify their behaviour, assessing their interest in doing so, assisting in their efforts to change, and arranging appropriate follow-up meetings. 170 A practical guide for behavioural therapy in the lifestyle treatment of NASH NAFLD patients rarely receive support to encourage meaningful and sustainable changes to diet and physical activity behaviour.…”

Barriers and Facilitators to Mediterranean Diet Adoption by Patients With Nonalcoholic Fatty Liver Disease in Northern Europe

“…Poor health service utilization may be attributed in part to lack of symptoms, and viewing long-term diseases and their outcomes as inevitable. 22,23 Therefore, clinicians should stress that NAFLD is treatable and even reversible if diet improvements are sustained. 6 The perceived stigma in obesity and liver disease poses a psychological burden.…”