Aim and objectives: The study aimed to investigate whether the patients' education level affected the mediation effect of self-efficacy on the relationship between the autonomy-supportive healthcare climate and health behaviour among patients with cardiovascular risk factors.
Background: Autonomy and self-efficacy are identified as influential factors related to the behaviours of individuals with health problems. However, it is unclear whether autonomy support from healthcare providers affects health behaviour through self-efficacy and if patients' education level affects the association.
Design: A cross-sectional study.
Methods: A convenience sample of 207 individuals with one or more cardiovascular diseases completed self-administered surveys including the healthcare climate questionnaire, self-efficacy scale and the engagement in health behaviour scale. Data were analysed using descriptive statistics, t test, Pearson's correlation coefficients and hierarchical regression analysis. All procedures of the study adhered to the STROBE guidelines.
Results: The influence of autonomy support from healthcare providers on self-efficacy differed by individuals' education level. Self-efficacy in less educated, but not highly educated individuals, tended to depend on the autonomy-supportive climate. Additionally, the autonomy-supportive healthcare climate affected health behaviour through self-efficacy only in less educated individuals.
Conclusion: The relationship between autonomy support from healthcare providers and self-efficacy was more evident in the relatively less educated individuals. The associations among autonomy support, self-efficacy and health behaviour differed by patient education level, and the mediating role of self-efficacy on the relationship between autonomy-supportive climate and health behaviour was found only in those less educated.
Relevance to clinical practice: Healthcare providers should recognise the importance of supporting patients' need for autonomy to improve self-efficacy and healthy behaviour, particularly in less educated patients. Additionally, healthcare providers' support tailored to patients' needs and educational status should be highlighted.
Keywords: chronic disease; health behaviour; health personnel; nurse-patient relations; personal autonomy; self-efficacy.
© 2021 John Wiley & Sons Ltd.