effects of perceived self-efficacy, social support and adjustment to college on chinese/taiwanese

184 Pages·2010·5.44 MB·English

EFFECTS OF PERCEIVED SELF-EFFICACY, SOCIAL SUPPORT AND
ADJUSTMENT TO COLLEGE ON THE HEALTH-PROMOTING BEHAVIORS
OF CHINESE/TAIWANESE INTERNATIONAL STUDENTS

A dissertation submitted to the
Kent State University College of Nursing
in partial fulfillment of the requirements
for the degree of Doctor of Philosophy

By
Yun Ying K. Hung
December 2010

Hung, Yun Ying K., Ph.D., December 2010 NURSING

EFFECTS OF PERCEIVED SELF-EFFICACY, SOCIAL SUPPORT AND
ADJUSTMENT TO COLLEGE ON THE HEALTH-PROMOTING BEHAVIORS OF
CHINESE/TAIWANESE INTERNATIONAL STUDENTS

Director of Dissertation: Ann F. Jacobson, Ph.D., RN, ACNS-BC

Most chronic diseases originate in early life and young adulthood and can be
qualified as lifestyle diseases. The health-promoting behaviors of young adults are
critically linked to the health status they can expect to have as older adults.
Of the rapidly growing numbers of international students in the United States, Asian
students comprise the largest proportion, with the majority of this group coming from
China or Taiwan. This study aims to investigate the health-promoting behaviors and
health needs of this specific group of international students. Even as they work to adjust
to a foreign culture, society, and language, these students must also face the challenges of
undertaking a new academic program. It is essential that they develop and practice
health-promoting behaviors to promote and enhance their well-being, as well as to
prevent the risks of developing a chronic illness.
Perceived self-efficacy and social support are central predictors for adjustment to
college and for health-promoting behaviors in college student populations. Although the
influence of adjustment to college on students’ academic performance and psychological
health has been demonstrated, little is known regarding the relationship between
adjustment to college and health-promoting behaviors in Chinese/Taiwanese international
students. Therefore, this study sought to examine the effects of perceived self-efficacy
and social support on health-promoting behaviors in Chinese/Taiwanese international
students as mediated by their adjustment to college.
A cross-sectional, descriptive correlational research design was used to test the study
hypotheses. A convenience sample of 103 Chinese/Taiwanese students at a large public
university in the Midwest completed questionnaires containing: the Generalized
Self-efficacy Scale, the Multidimensional Scale of Perceived Social Support, the Student
Adaptation to College Questionnaire, the Health-Promoting Lifestyle Profile II, and the
Demographic Data Questionnaire. The study model was tested using Baron and Kenney’s
procedures for mediation testing. The results from the study revealed that the effects of
perceived self-efficacy and perceived social support on health-promoting behaviors were
partially mediated through the level of adjustment to college. The mediator variable,
adjustment to college, revealed a statistically significant ability to predict the students’
health-promoting behaviors (Sobel = 3.0, p = 0.003; Sobel = 2.8, p = 0.005).
These findings suggest that the effects of self-efficacy and social support on
health-promoting behaviors in Chinese/Taiwanese international students may be mediated
through their adjustment to college. Further research on larger and more diverse samples
of international students is needed. However, if supported by future studies, these
findings suggest that international students’ level of adjustment to college plays a very
important role in their health-promoting behaviors.
ACKNOWLEDGMENTS
Becoming the recipient of a PhD is a true milestone in my life. At this final stage of
the dissertation process, it is with celebration and gratefulness that I would like to
recognize the people who accompanied me along the way. I could not have achieved this
grand goal without the support of my family, friends, and dedicated professors.
First of all, I would like to thank my parents, Yen-Mei Hung Chiang and Yu-Chuan
Hung, who inspired me from a very early age to pursue a good education and therefore
obtain the key to a successful and happy life. Without the support of my three brothers
and their families, however, I would never have even contemplated the idea of a PhD.
While I have been in the U.S. studying, they have been taking care of my parents back
home in Taiwan, and I thank them.
I offer a special word of thanks to Dr. Karen Budd, who brought me into this
doctoral journey at Kent State University and the University of Akron Joint PhD in
Nursing (JPDN) program. Her wisdom and endless encouragement meant the world to
me. My heartfelt appreciation and thanks also go out to my extraordinary dissertation
chair, Dr. Ann Jacobson, whose insightful comments helped me to more clearly articulate
my ideas. It was her patience, tolerance, and guidance which ultimately brought me
through this process to reach my goal. I would also like to extend a thank you to my
committee members, Dr. Lenny Chiang-Hanisko, Dr. Christine Heifner-Graor, Dr.
Martin J. Jencius and Dr. Jay Lee, for their invaluable time, effort, commitment,
understanding and expertise.
My work as a graduate assistant at the College of Nursing at Kent State University
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has been a source of joy in my life as I have moved along my PhD study path. I wish to
thank all the professors in the JPDN program and at the College of Nursing, each of
whom, in their own way, provided such support for my educational experience: Donna
Martsolf, Claire Draucker, Patrice McCarthy, Patricia Galon, Tracy Riley, Rose Beeson,
Mary Anthony, Carol Sedlak, Ruth Ludwick, Peggy Doheny, and Ratchneewan Ross. I
thank Alison, Debby and Carol for their kindness, encouragement, and comforting smiles
and I am grateful to Martha, Brian and Sue for their professional editorial assistance.
I am ever grateful to my PhD classmates who understood the doctoral “process” and
who gave me a shoulder to lean on and cheered me up when the goal seemed beyond my
reach. I would especially like to thank Lori Huber for having adopted me into her lovely
family, for keeping me safe and warm, and for being with me through the tough times.
I gratefully acknowledge my friends from around the world and my colleagues from
Chung Hwa University of Medical Technology in Taiwan. They are too many to name,
but I thank them for listening, supporting and accompanying me through all the
difficulties along the way. They made my stay in the U.S. very special, and I am grateful.
To David Alvarez Cineira, my special friend, I extend an especially heartfelt thanks for
his encouragement, calming reassurance, and patience which helped me to appreciate this
journey of learning.
Last but not least, I am grateful to the presidents of the Taiwan Students Association
and the Chinese Students and Scholars Association, Yi-Yin Chiang and Liwei Li, for their
support and collaboration. My thanks go out to all those special Chinese/Taiwanese
international students who willingly participated in my research.
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TABLE OF CONTENTS

Page
ACKNOWLEDGEMENTS…………………………………………………………... iii

LIST OF FIGURES ……………………………………………………………..……. viii

LIST OF TABLES ……………………………………………………………………. ix

CHAPTER

I INTRODUCTION…………………………………………………………………... 1
Background ……………………………………………………………............... 1
Factor Affecting Health-Promoting Behaviors……………………………........... 3
College Students…………………………………………………………………. 4
International Students……………………………………………......................... 6
Chinese/Taiwanese International Students…………………………………. 7
Statement of the Problem…………………………………………………........... 8
Purpose of the Study………………………………………………………........... 9
Conceptual Framework…………………………………………………….......... 9
Concepts in Conceptual Framework…………………………………………….. 10
Health-Promoting Behaviors…………………………………….……......... 10
Perceived Self-Efficacy…………………………………………….............. 11
Perceived Social Support…………………………………………………... 12
Adjustment to College……………………………………………................ 12
Significance of the Study…………………………………………………........... 13
Summary…………………………………………………………………............ 15

II. REVIEW OF LITERATURE……………………………………………………… 16
Chinese/Taiwanese International College Students……………………............... 16
Health-Promoting Behaviors…………………………………………….............. 17
Health-Promoting Behavior in College Student Populations…………......... 21
Perceived Self-Efficacy………………………………………………….............. 24
Perceived Self-Efficacy and Health-Promoting Behaviors…………............ 26
Perceived Self-Efficacy and Adjustment to College……………….............. 27
Perceived Social Support………………………………………………............... 28
Perceived Social Support and Health-Promoting Behaviors……..…............ 31
Perceived Social Support and Adjustment to College………...….…............ 32
Adjustment to College…………………………………………………................ 33
Adjustment to College in International Students …………………….......... 36
Adjustment to College and Health-Promoting Behaviors………….............. 37
Summary………………………………………………………………..….......... 38
Hypotheses……………………………………………………………..…........... 39

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III. METHOD …………………………………………………..……………….......... 40
Study Design…………………………………………………………..…............ 40
Study Setting ………………………………………………………..…............... 41
The Setting for Data Collection……………………………………............. 43
Sample……………………………………………………………….…............... 43
Sampling Criteria……………………………………………………........... 44
Sample Size…………………………………………………………........... 44
Instruments…………………………………………………………….…............ 46
Generalized Self-Efficacy Scale……………………………………............. 47
Multidimensional Scale of Perceived Social Support………………............ 48
Student Adaptation to College Questionnaire ……...…..………….............. 50
Health-Promoting Lifestyle Profile II (HPLP II)……………………........... 54
Demographic Data Questionnaire………………………………….............. 58
Protection of Human Subjects…………………………………...………............. 58
Study Procedure…………………………………………………………............. 58
Participants Recruitment………..……………………………..……............ 58
Investigator-Initiated Recruitment………………………………......... 59
Chain-Referral Recruitment …………………………………….......... 60
Collection of Data……………………..……………………………............ 60
Data Analysis………………………………………………………....….............. 62
Data Analysis Preparation…………………………………………….......... 63
Reliability of Study Instruments……………………………………............. 64
Summary………………………………………………………….……............... 65

IV. RESULTS................................................................................................................. 67
Introduction …………………………………………………….……….............. 67
Sample Characteristics…………………………………….…………..……........ 68
Descriptive Statistics of Study Variables ………………………………............... 71
Health-Promoting Behaviors……………………………...…………........... 71
Perceived Self-Efficacy…………..…………………………………............ 73
Perceived Social Support……………..……………………….………........ 73
Adjustment to College………………………………………………............ 73
Preliminary Data Evaluation……………………………………....…….............. 74
Multivariate Regression Models……………………………………………........ 76
Hypotheses Testing…………………………………………………….…........... 78
Study Hypothesis 1…..………………………………………………........... 79
Baron and Kenny Test of Mediation………………………………...... 80
Sobel Test of Mediation………………………………………............. 81
Study Hypothesis 2…..………………………………………………........... 82
Baron and Kenny Test of Mediation…………………………….......... 83
Sobel Test of Mediation………………………………………............. 84
Additional Findings……………………………………….………………........... 85
Sample Characteristics and Health-Promoting Behaviors………................. 85
Correlations of Variable Aspects……………...……...…………………...... 88
Summary……………………………………………………………..…….......... 90
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V. DISCUSSION……………………………………………………………………… 92
Discussion of Findings………………..…………………………………………. 93
Discussion of the Study Variables…………………………..……………… 94
Health-Promoting Behaviors………………………………………….. 94
Adjustment to College………………………………………………… 96
Predictors of Health-Promoting Behaviors and Adjustment to College…… 98
Interpretation of the Hypotheses Testing ……………………….………….. 99
Discussion of Additional Findings…………..……………………............... 102
Sample Characteristics and Health-Promoting Behaviors……............. 102
Correlations of Variable Aspects……………………………………… 102
Implication…………………………………………….……………..………….. 103
Nursing Knowledge, Research, and Practice………………….…………… 103
Health Promotion Model………………………………………..….............. 105
Other Related Disciplines and Organization…………………………….…. 106
American College Health Association………………………………... 107
Limitations………………………………………………….………..………...... 108
Future Studies……………...………………………………….…..…………….. 110
Conclusion…………………………………………………..….………………... 111

APPENDICES………………………………………………………………………… 113

REFERENCES………………………………………………………………………... 154

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LIST OF FIGURES

Figure Page
1. Proposed model of HPB of Chinese/Taiwanese international students….……... 10

2. Mediating role of adjustment to college (Model 1).…………………...……….. 79

3. Results of mediation model 1.………………………………………………….. 81

4. Mediating role of adjustment to college (Model 2).………………………......... 82

5. Results of mediation model 2.…………………………………………………... 84

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