Self-efficacy as a Predictor of Weight Change and Behavior Change in the PREMIER Trial

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Determine whether self-efficacy independently predicted weight loss in a behavioral intervention and explore factors that influence the path between self-efficacy and weight change.


Secondary analysis of the PREMIER trial, a randomized controlled trial testing effects of lifestyle interventions on blood pressure.


Four academic medical centers.


PREMIER recruited adults (n = 810) with pre-hypertension/stage 1 hypertension, not currently receiving medication. This analysis excluded participants in the control arm, resulting in n = 537.


Participants were randomly assigned to 1 of 3 groups: advice only, established lifestyle recommendations, or established lifestyle recommendations plus Dietary Approaches to Stop Hypertension dietary pattern.

Main Outcome Measures:

Self-efficacy (dietary self-efficacy [DSE], exercise self-efficacy [ESE]), dietary intake, fitness.


Pearson correlations, 1-way analysis of variance, mediation analyses.


Despite an overall decrease in DSE/ESE, change in DSE/ESE significantly predicted weight change at 6 (β = –.21, P < .01; β = –.19, P < .01, respectively) and 18 months (β = –.19, P < .01; β = –.35, P < .01). Change in percent calories from fat partially mediated the DSE/weight change relationship at 6 months. Change in fitness partially mediated the ESE/weight change relationship at 18 months.

Conclusions and Implications:

Changes in DSE/ESE were not associated with behavior change as hypothesized. Additional research is needed to identify mediators between self-efficacy and adoption of behaviors that influence weight loss.

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