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Medicine and Health Sciences

Attitude

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Full-Text Articles in Social and Behavioral Sciences

Attitudes Toward Caring For Older Adults Among Undergraduate Nursing Students At A Public University In Kuala Lumpur, Malaysia, Azera Hasra Ismail, Siti Zuhaida Hussein, Aslina Mohamed Yasi, Nurul Izzati Ishak, Nurul Nazira Mohd Yazar, Nur Syafiqah Sabri Dec 2023

Attitudes Toward Caring For Older Adults Among Undergraduate Nursing Students At A Public University In Kuala Lumpur, Malaysia, Azera Hasra Ismail, Siti Zuhaida Hussein, Aslina Mohamed Yasi, Nurul Izzati Ishak, Nurul Nazira Mohd Yazar, Nur Syafiqah Sabri

Makara Journal of Health Research

Background: The growing number of elderly members of the population is expected to increase the demand for more dedicated nursing students committed to providing excellent care. This study aims to determine prevailing attitudes toward the care of older adults among undergraduate nursing students at a public university in Kuala Lumpur, Malaysia.

Methods: This is a quantitative cross-sectional survey of 107 undergraduate nursing students enrolled at a public university in Kuala Lumpur, Malaysia. The students were recruited using stratified random sampling. The respondents’ attitudes toward caring for older adults were measured using 14 items from the Geriatrics Attitudes Scale …


Assessment Of The Knowledge, Attitude, And Practice Towards Expired Drug Disposal Among The Community In Beirut City, Lebanon, Nada Khansa, Azza A. K. Gazy, Abdalla El-Lakany, Souraya Domiati Apr 2023

Assessment Of The Knowledge, Attitude, And Practice Towards Expired Drug Disposal Among The Community In Beirut City, Lebanon, Nada Khansa, Azza A. K. Gazy, Abdalla El-Lakany, Souraya Domiati

BAU Journal - Health and Wellbeing

The global increase in pharmaceutical spending has led to enhanced international awareness of the unused and expired drug issues due to improper drug disposal's harmful economic, environmental, and health effects. Consequently, the study was conducted to assess the knowledge, attitude, and practice toward expired drug disposal among the community in Beirut City, Lebanon. A cross-sectional, observational, questionnaire-based study was conducted. Data were analyzed using SPSS version 23. The fact that improper disposal of expired medicine affects the environment and health was acknowledged by 70.7% of the 450 participants. Even though 72.2% of the participants knew that the best method for …


Undergraduate Student Nurses’ Attitude Toward Mental Health Education: A Cross-Sectional Analysis, Abdulellah Modhi Alsolais, Benito Jr Nillo Areola, Amal Alfouzan, Marie Grace Mejia Nones, Talal Ali Alharbi Apr 2023

Undergraduate Student Nurses’ Attitude Toward Mental Health Education: A Cross-Sectional Analysis, Abdulellah Modhi Alsolais, Benito Jr Nillo Areola, Amal Alfouzan, Marie Grace Mejia Nones, Talal Ali Alharbi

Makara Journal of Health Research

Background: Reportedly, there has been a long-standing nursing shortage in Saudi Arabia. This study explored the attitudes of undergraduate student nurses considering them to be a factor contributing to this shortage. This study also investigated the association among gender, hospital exposures, and campus enrollment concerning mental health education.

Methods: Quantitative correlational analysis was used on 124 student nurses in mental health nursing. Using Point Binary, Spearman's rank and one-way ANOVA, significant determinants were correlated to the domains of mental health nursing.

Results: Student nurses have a positive attitude toward mental health education. Gender is significantly related to …


Study On The Influencing Factors Of College Students' Physical Health, Yuan Shang, Zhendong Zhang, Ying Zhang, Yonghuan Chen, Hangqi Zhang Feb 2023

Study On The Influencing Factors Of College Students' Physical Health, Yuan Shang, Zhendong Zhang, Ying Zhang, Yonghuan Chen, Hangqi Zhang

International Journal of Physical Activity and Health

The purpose of this paper was to analyze the changes of college students' physical health and the relevant influencing factors, and provide the basis for the school to formulate reasonable measures to improve students' physical health. A total of 13052 undergraduate students (including 6852 male and 6173 female) from the city of Zhengzhou in Henan province were recruited for the purpose of the study. Mathematical statistics, literature review, questionnaire investigation, and logic analysis were adopted. In terms of body shape, BMI index of both male and female undergraduates increased, and the T test of BMI index showed significant difference (P …


Tattoos In Medicine, Marcus Ibrahim Jun 2022

Tattoos In Medicine, Marcus Ibrahim

HCA Healthcare Journal of Medicine

I am a second-year family medicine resident with a rather large arm-sleeve tattoo. As you can probably deduce by reading the title of this editorial, it will focus on how tattoos in healthcare may be perceived by others. My goal is to illustrate some of my perspectives, opinions, and experiences regarding making my tattoos visible in the clinical setting.


Students’ Attitude To And Motivation For Outdoor Life, Inga Liepina, Daina Krausta Mar 2022

Students’ Attitude To And Motivation For Outdoor Life, Inga Liepina, Daina Krausta

Baltic Journal of Health and Physical Activity

Background: The aim of the research was to find out how the process of the study course Tourism at the Latvian Academy of Sport Education affects the formation of the students’ attitude towards outdoor life education. Material/Methods: In order to find it out, first of all, we clarified the students’ previous knowledge, understanding of outdoor education, as well as their previous outdoor life experience. The total number of participants was 97 students. Both theoretical and practical classes, as well as a five-day outdoor camp with various outdoor activities were included in the study course Tourism. The method of inquiry was …


Adaptive And Maladaptive Perfectionism And Athletes’ Attitudes Toward Doping And Anti-Doping Policy In Sport, Krzysztof Sas-Nowosielski, Aleksandra Budzisz Mar 2022

Adaptive And Maladaptive Perfectionism And Athletes’ Attitudes Toward Doping And Anti-Doping Policy In Sport, Krzysztof Sas-Nowosielski, Aleksandra Budzisz

Baltic Journal of Health and Physical Activity

The article explores two issues – perfectionism and attitudes toward doping in sport. The study was aimed at verifying the thesis that perfectionism in its adaptive and maladaptive forms may have an effect on athletes’ attitudes toward doping. The study sample consisted of 110 athletes (43 females and 67 males). To test perfectionism the Adaptive and Maladaptive Perfectionism Questionnaire developed by Szczucka was used and to measure attitudes toward doping-free sport and anti-doping policies a questionnaire worked out by one of the authors. The effect of perfectionism on doping attitudes was measured. There were significant differences in attitudes toward controls …


The Effect Of Grit On Leisure Time Physical Activity. An Application Of The Theory Of Planned Behaviour, Vello Hein, Andre Koka, Hanna Kalajas-Tilga, Henri Tilga, Lennart Raudsepp Mar 2022

The Effect Of Grit On Leisure Time Physical Activity. An Application Of The Theory Of Planned Behaviour, Vello Hein, Andre Koka, Hanna Kalajas-Tilga, Henri Tilga, Lennart Raudsepp

Baltic Journal of Health and Physical Activity

Background: Grit as a personal trait has an important role in achieving different behavioural outcomes. The present study aimed to test the validity of an extended model of the Theory of Planned Behaviour, in which domains of grit, such as perseverance of effort and consistence of interest are mediators between the attitude and intention, and between attitude and self-reported leisure time physical activity behaviour. Material and methods: The participants were school children: 106 boys (M age = 13.00, SD = 0.98) and 240 girls (M age = 13.13, SD = 0.95) Structural equation modelling (SEM) was used to test the …


An Investigation Into Caffeine Consumption And Self-Reported Dependency In The Republic Of Ireland, Gavin Buckley, Ciara Murphy, Nora O'Sullivan, Róisín Spriggs Dec 2021

An Investigation Into Caffeine Consumption And Self-Reported Dependency In The Republic Of Ireland, Gavin Buckley, Ciara Murphy, Nora O'Sullivan, Róisín Spriggs

International Undergraduate Journal of Health Sciences

Objectives: To explore the consumption of caffeine containing beverages by the Irish population and to investigate their self-perceived dependency on such products.

Methodology: An online survey was distributed with national access to Irish adults which was open to responses from 25th February to 7th March 2021 inclusive. A total of 417 responses from participants over 18 years of age were validated and analysed using Microsoft Excel.

Results: Tea was the most commonly consumed caffeinated product among the Irish population, with the majority of respondents stating their consumption began before 10 years old. The majority of respondents did not …


Putative Factors Influencing Knowledge And Behavioural Practices Of Health Science Undergraduate Students Towards Covid-19 Infection Ahead Of Re-Opening Universities In Ghana, Emmanuel Acheampong, Evans Asamoah Adu, Enoch O. Anto, Yaa Obirikorang, Eric Adua, Sylvester Yao Lopko, Emmanuella Nsenbah Acheampong, Agartha Odame Anto, Vivian Baah, Christian Obirikorang Jan 2021

Putative Factors Influencing Knowledge And Behavioural Practices Of Health Science Undergraduate Students Towards Covid-19 Infection Ahead Of Re-Opening Universities In Ghana, Emmanuel Acheampong, Evans Asamoah Adu, Enoch O. Anto, Yaa Obirikorang, Eric Adua, Sylvester Yao Lopko, Emmanuella Nsenbah Acheampong, Agartha Odame Anto, Vivian Baah, Christian Obirikorang

Research outputs 2014 to 2021

Background: The coronavirus disease 2019 (COVID-19) virus is a global pandemic affecting daily activities and delaying the reopening of several institutions such as universities. As a result, precautionary and preventive measures are being implemented to curtail the spread of the virus. However, knowledge and compliance measures are essential for adequate preparedness to reopen the universities amidst the pandemic. Methods: This cross-sectional study evaluated knowledge, attitudes, and practices (KAP) along with factors influencing Health Science undergraduate students toward the COVID-19 infection pandemic in Ghana. A total of 606 students provided information regarding KAP of COVID-19 infection using an online questionnaire designed …


An Assessment Of Knowledge, Attitude, And Practice Of The Kuantan Community On The Effects Of Monosaccharides On Cancer, Muhammad Alif Mazlan, Muhammad Kamil Che Hasan, Afzan Mat Yusof, Muhammad Lokman Md Isa Dec 2020

An Assessment Of Knowledge, Attitude, And Practice Of The Kuantan Community On The Effects Of Monosaccharides On Cancer, Muhammad Alif Mazlan, Muhammad Kamil Che Hasan, Afzan Mat Yusof, Muhammad Lokman Md Isa

Makara Journal of Health Research

Background: Cancer knowledge, attitude, and practice (KAP) levels of communities are essential to be assessed to enhance cancer educational programs. This study aimed to determine the KAP level of the Kuantan community on the effects of monosaccharides on cancer. The association between the sociodemographic data and KAP level of the community has also been evaluated.

Methods: A cross-sectional survey was performed among residents living in the Kuantan community. Only 303 of 380 responses were included in the data analysis using the chi-square test.

Results: The knowledge and practice levels were moderate, whereas the attitude was at a …


A Study On Knowledge, Attitudes, And Practices On Rabies In The Philippines, Reynaldo Jr Bundalian, Monalisa Lacson, Catherine Bacani, Dinah Rose Soriano, Agnes Garing, Artemio Jr Aquino, Archie Policarpio, Joey Kyle Mallari, Remedios San Jose, Maria Fe Bulao, Neil Tanquilut, Patricia Joy Magsino Nov 2020

A Study On Knowledge, Attitudes, And Practices On Rabies In The Philippines, Reynaldo Jr Bundalian, Monalisa Lacson, Catherine Bacani, Dinah Rose Soriano, Agnes Garing, Artemio Jr Aquino, Archie Policarpio, Joey Kyle Mallari, Remedios San Jose, Maria Fe Bulao, Neil Tanquilut, Patricia Joy Magsino

Kesmas

In 2007, the Philippine government passed the Anti-Rabies Act to address rabies in the country. However, rabies is still a major public health concern in many provinces. This study aimed to evaluate the knowledge, attitude, and practices (KAP) of residents on rabies, the Anti Rabies Act, and responsible pet ownership (RPO) in Pampanga, Philippines. A cross-sectional survey was done from October 2017 to February 2018 in 92 randomly selected barangays in the province. Questionnaires were adapted from similar studies. Logistic regression was used to identify factors associated with KAP. Results showed that most people have good knowledge of the Anti-Rabies …


A Multifactorial Intervention To Reduce Weight Bias In Healthcare Providers, Rose M. Flinchum May 2020

A Multifactorial Intervention To Reduce Weight Bias In Healthcare Providers, Rose M. Flinchum

Evidence-Based Practice Project Reports

No abstract provided.


Knowledge, Attitude, Practices, And Health Beliefs Of Pregnant Women About Urinary Tract Infection And Its Associated Risk Factors: A Local Filipino Community Experience, Annalyn Navarro, Raphael Enrique Tiongco, Reynaldo Bundalian Jr. Nov 2019

Knowledge, Attitude, Practices, And Health Beliefs Of Pregnant Women About Urinary Tract Infection And Its Associated Risk Factors: A Local Filipino Community Experience, Annalyn Navarro, Raphael Enrique Tiongco, Reynaldo Bundalian Jr.

Kesmas

Urinary tract infection (UTI) during pregnancy is assumed to be associated with increased maternal and fetal morbidity and mortality; hence, a proper assessment of knowledge and practices is crucial to formulate preventive strategies to ensure the health of both the mother and the baby. The study determined the knowledge, attitude, practices (KAP), and the beliefs of pregnant women about UTI based on the Health Belief Model. A survey questionnaire was used to gather data from pregnant women with and without UTI. The association of the pregnant women’s sociodemographic characteristics with their KAP and health beliefs was determined using Pearson’s chi-square …


Epidemiology Of Chronic Pain In Ukraine: Findings From The World Mental Health Survey, Anna Xu, Elizabeth Hilton, Riley Arkema, Nathan L. Tintle, Luralyn M. Helming Oct 2019

Epidemiology Of Chronic Pain In Ukraine: Findings From The World Mental Health Survey, Anna Xu, Elizabeth Hilton, Riley Arkema, Nathan L. Tintle, Luralyn M. Helming

Faculty Work Comprehensive List

Chronic pain can pose a serious challenge in everyday life for many individuals globally, especially in developing countries, but studies explicitly exploring risk factors of chronic pain beyond demographic characteristics using survey data have been scarce. To address this problem, this study analyzed World Health Organization data on chronic pain in Ukraine to explore demographic, psychological, and treatment perception-related risk factors to chronic pain. We replicated previous reports of older age, female sex, married status, inadequate financial resources, and comorbidity of other physical conditions as significant demographic risk factors for chronic pain diagnosis but not necessarily for severe pain. We …


Adolescents' Attitude Toward Hiv/Aids Prevention In Yogyakarta, Meysa Tiranda, Nanik Setiyawati, Anita Rahmawati Nov 2018

Adolescents' Attitude Toward Hiv/Aids Prevention In Yogyakarta, Meysa Tiranda, Nanik Setiyawati, Anita Rahmawati

Kesmas

Acquired immunodeficiency syndrome (AIDS) is the second leading cause of death in adolescent groups in the world. In Indonesia, the rate of human immunodeficiency virus (HIV)-infected adolescents increases annually. Yogyakarta, well-known as the education city, has the highest number of HIV/AIDS cases in the productive age group of 20–29 years old, which means that they have been already infected with HIV since teen age. This study aimed to determine influential factors that affect adolescents' attitude toward HIV/AIDS prevention. The study was an analytic survey research with a cross-sectional design. Stratified random sampling was applied to select a sample size of …


Examining Jordanians' Attitudes Towards Five Types Of Developmental Disabilities, Najah Zaaeed Drph, Mohammad M. Mohammad, Peter Gleason, Khaled A. Bahjri Md, Naomi Modeste Apr 2018

Examining Jordanians' Attitudes Towards Five Types Of Developmental Disabilities, Najah Zaaeed Drph, Mohammad M. Mohammad, Peter Gleason, Khaled A. Bahjri Md, Naomi Modeste

Journal of Refugee & Global Health

Background: The diagnosis and reported rates of persons with developmental disabilities (PWDDs) in Jordan is steadily increasing. Although initiatives have been implemented to improve the lives of PWDDs, attitudes towards PWDDs hinder successful inclusion in the Jordanian society.

Objectives: To examine the relationship between Jordanians socio-economic status and attitudes towards persons with developmental disabilities: autism, blindness, cerebral palsy, Down syndrome and muscular dystrophy.

Methods: Jordanians (N=259), ages 18-65 were recruited for this convergent parallel, mixed-methods study. Participants completed the modified 40-item Community Living Attitude Scale-developmental disability (CLAS-DD) and the modified Intellectual Disability Literacy Scale consisting of five vignettes, representing each …


Examining The Protective Effect Of Ethnic Identity On Drug Attitudes And Use Among A Diverse Youth Population, Tamika C. B. Zapolski, Sycarah Fisher, Devin E. Banks, Devon J. Hensel, Jessica Barnes-Najor Aug 2017

Examining The Protective Effect Of Ethnic Identity On Drug Attitudes And Use Among A Diverse Youth Population, Tamika C. B. Zapolski, Sycarah Fisher, Devin E. Banks, Devon J. Hensel, Jessica Barnes-Najor

Educational, School, and Counseling Psychology Faculty Publications

Ethnic identity is an important buffer against drug use among minority youth. However, limited work has examined pathways through which ethnic identity mitigates risk. School-aged youth (N = 34,708; 52 % female) of diverse backgrounds (i.e., African American (n = 5333), Asian (n = 392), Hispanic (n = 662), Multiracial (n = 2129), Native American (n = 474), and White (n = 25718) in grades 4–12 provided data on ethnic identity, drug attitudes, and drug use. After controlling for gender and grade, higher ethnic identity was associated with lower past month drug use …


Beyond The Millennium Development Goals: An Evaluation Of The War On Hiv / Aids In Kenya, Robert G. Nyaga Apr 2016

Beyond The Millennium Development Goals: An Evaluation Of The War On Hiv / Aids In Kenya, Robert G. Nyaga

Theses and Dissertations

HIV/AIDS remains a threat to Kenya and other developing nations. This thesis aimed at assessing the HIV/AIDS situation in Kenya by examining the knowledge of Kenyans towards infection and spread HIV/AIDS, attitudes towards people living with HIV/AIDS, involvement of community opinion leaders in the HIV/AIDS campaigns, sharing of HIV/AIDS information, and government efforts to control HIV/AIDS. A sample of Kenyans (N= 103) was surveyed and asked to respond to several scales assessing each of the above items. Quantitative and qualitative methods reveal the knowledge and attitudes portrayed by Kenyans and show that, although much has been achieved, there is need …


Medical Interns', Residents' And Attending Physicians' Attitudes Towards Integrative Medicine And Recommended Treatments For Patients With Psoriasis, Jennifer L. Pacyon Jan 2016

Medical Interns', Residents' And Attending Physicians' Attitudes Towards Integrative Medicine And Recommended Treatments For Patients With Psoriasis, Jennifer L. Pacyon

PCOM Psychology Dissertations

Background: Psoriasis is a multifactorial disease that effect approximately 7.5 million Americans. There are a variety of traditional treatments for psoriasis (e.g. topical medications, biologics) that for many, are effective in combating the disease. However, traditional treatments often have aversive side effects and may not be appropriate for every patient (e.g. pregnant women). Additionally, the efficacy of these medications are variable leaving some looking for adjunctive treatment options. There is increasing evidence to support the use of adjunctive treatments for psoriatic patients (e.g. psychotherapy, mindfulness). However, research is variable in regards to medical professionals’ attitudes towards integrative medicine (IM) as …


Do Zoos And Aquariums Promote Attitude Change In Visitors? A Critical Evaluation Of The American Zoo And Aquarium Study, Lori Marino, Scott O. Lilienfeld, Randy Malamud, Nathan Nobis, Ron Broglio Apr 2015

Do Zoos And Aquariums Promote Attitude Change In Visitors? A Critical Evaluation Of The American Zoo And Aquarium Study, Lori Marino, Scott O. Lilienfeld, Randy Malamud, Nathan Nobis, Ron Broglio

Lori Marino, PhD

Modern-day zoos and aquariums market themselves as places of education and conservation. A recent study conducted by the American Zoo and Aquarium Association (AZA) (Falk et al., 2007) is being widely heralded as the first direct evidence that visits to zoos and aquariums produce long-term positive effects on people’s attitudes toward other animals. In this paper, we address whether this conclusion is warranted by analyzing the study’s methodological soundness. We conclude that Falk et al. (2007) contains at least six major threats to methodological validity that undermine the authors’ conclusions. There remains no compelling evidence for the claim that zoos …


Do Zoos And Aquariums Promote Attitude Change In Visitors? A Critical Evaluation Of The American Zoo And Aquarium Study, Lori Marino, Scott O. Lilienfeld, Randy Malamud, Nathan Nobis, Ron Broglio Mar 2015

Do Zoos And Aquariums Promote Attitude Change In Visitors? A Critical Evaluation Of The American Zoo And Aquarium Study, Lori Marino, Scott O. Lilienfeld, Randy Malamud, Nathan Nobis, Ron Broglio

Nathan M. Nobis, PhD

Modern-day zoos and aquariums market themselves as places of education and conservation. A recent study conducted by the American Zoo and Aquarium Association (AZA) (Falk et al., 2007) is being widely heralded as the first direct evidence that visits to zoos and aquariums produce long-term positive effects on people’s attitudes toward other animals. In this paper, we address whether this conclusion is warranted by analyzing the study’s methodological soundness. We conclude that Falk et al. (2007) contains at least six major threats to methodological validity that undermine the authors’ conclusions. There remains no compelling evidence for the claim that zoos …


Complementary And Alternative Medicine In Oncology Nursing, Tazeen S. Ali Dr, Salima Somani Dr, Fauziya Ali Dr, Nasreen Sulaiman Lalani Dr Jan 2014

Complementary And Alternative Medicine In Oncology Nursing, Tazeen S. Ali Dr, Salima Somani Dr, Fauziya Ali Dr, Nasreen Sulaiman Lalani Dr

Tazeen S Ali Dr

Use of complementary and alternative medicine (CAM) has increased globally, particularly among oncology patients. This study investigated the knowledge, experience and attitudes of oncology nurses towards CAM. A quantitative study was conducted in tertiary care hospitals in Karachi, Pakistan, where 132 oncology nurses were surveyed. The survey revealed that more than 50% of nurses had never heard about many of the CAM therapies used in Pakistan. Approximately 65% of the nurses had knowledge about prayer and less than 30% had experience of CAM education or training. In addition, the majority of nurses had seen patients using CAM and felt that …


Reassessment Of The Knowledge/Attitude/Behavior Triad, Donald Iverson, Barry Portnoy Jun 2012

Reassessment Of The Knowledge/Attitude/Behavior Triad, Donald Iverson, Barry Portnoy

Don C. Iverson

No abstract provided.


Assessment Of Knowledge, Skill And Attitude Of Oncology Nurses In Chemotherapy Administration In Tertiary Hospital Pakistan, Tazeen S. Ali Dr, Najma Khan Dr, Khurshid Zulfiqar Ali Khowaja Dr Jun 2012

Assessment Of Knowledge, Skill And Attitude Of Oncology Nurses In Chemotherapy Administration In Tertiary Hospital Pakistan, Tazeen S. Ali Dr, Najma Khan Dr, Khurshid Zulfiqar Ali Khowaja Dr

Tazeen S Ali Dr

Objective: To measure the levels of nurse’s know- ledge and attitude after the conduct of education session regarding chemotherapy administration and management. Methodology: This research study was conducted at two oncology units of tertiary Hospital Rawalpindi. A pre-post test intervention study design was used on 35 nurses by using Verity’s tools. Results: The mean scores of knowledge were calculated by Cochran’s Q test showed that knowledge scores have significantly increased with “educational training” (p value < 0.001). The difference in the attitude of the nurses was not found to be statistically significant in repeated measure of ANOVA. Conclusion: The results show that knowledge is the weakest component and attitude is strongest component of oncology nurses competencies in chemotherapy administration.


Evidence Based Practice Implementation: Perceptions And Expectations Of Master Of Social Work Students, Mholi Kent Vimba May 2012

Evidence Based Practice Implementation: Perceptions And Expectations Of Master Of Social Work Students, Mholi Kent Vimba

Doctoral Dissertations

Abstract

Efforts to develop sustainable Evidence-Based Practice (EBP) implementation strategies in work settings have been generally unsuccessful. Scholars have focused on perceptions of workers already in work settings to identify implementation barriers and facilitators. None have focused on perceptions of social workers in training. This nationwide non-probability correlational study assessed Master of Social Work (MSW) students’ perceptions of EBP using a self-administered online survey. A total of 212 (57%) completed this survey with 164 (43%) timed out.

Perceptions were assessed using three sets of questions corresponding to the independent variables: EBP knowledge, attitude toward EBP and EBP self-efficacy. A …