Understanding the development of self-efficacy for physical activity engagement in men after myocardial infarction: A preliminary qualitative study

  • Harlinna binti Abu
    Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Pahang, Malaysia.
  • Salizar binti Mohamed Ludin
    Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Pahang, Malaysia.
  • Siti Noorkhairina binti Sowtali
    Department of Professional Nursing Studies, Kulliyyah of Nursing, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Pahang, Malaysia.


Background: This preliminary finding from a qualitative study examined the process of self-efficacy for the development of physical activity during myocardial infarction (MI) after recovery. A combination of healthy behaviors, including physical activity is the secondary prevention recommended to reduce the risk of recurrent MI. This study aims to understand how self-efficacy for physical activity is developed in a patient after MI by examining their perceptions and personal adherence to physical activity.
Design and Methods: This was a qualitative study and data was collected through semi-structured in-depth recorded phone interviews with eight Malay male participants. They were screened using a questionnaire and participants that met the inclusion criteria were interviewed, and were admitted to National Heart Centre, Malaysia between January to June 2019 diagnosed with MI. The data collected were analysed using NVivo 12 software and thematic analysis was applied.
Results: Four preliminary themes emerged from the study: 1) beliefs in physical activity; 2) healthy lifestyle: new normal or same old habit; 3) factors determining participation in pa; and 4) physical activity adherence strategies.
Conclusions: The results of the studies showed that participants understand the need to maintain physical activity, which helps to maintain a healthy life after MI and prevent recurrent infarction. Strategies for developing self-efficacy for physical activity were also discussed. The need to understand that maintaining physical activity as well as adopting a new normal of healthy habit after MI is crucial in order to maintain the health and prevent recurrence of MI.


Malaysian Ministry of Health [Internet]. Primary & Secondary Prevention of Cardiovascular Disease 2017. Accessed: 2020 Nov 12. Available from: https://www.malaysianheart.org/?p=cpg&a=1171

WHO. Physical activity. 2018 Accessed: 2020 Nov 12. Available from: https://www.who.int/news-room/fact-sheets/detail/physical-activity

Bandura A. Self-efficacy: Toward a unifying theory of behavioural change. Adv Behav Res Ther 1978;1:139–61. DOI: https://doi.org/10.1016/0146-6402(78)90002-4

McAuley E, Morris KS, Motl RW, et al. Long-term follow-up of physical activity behaviour in older adults. Heal Psychol 2007;26:375–80. DOI: https://doi.org/10.1037/0278-6133.26.3.375

Perkins JM, Multhaup KS, Perkins HW, et al. Self-efficacy and participation in physical and social activity among older adults in Spain and the United States. Gerontologist 2008;48:51–8. DOI: https://doi.org/10.1093/geront/48.1.51

Alsaleh E, Windle R, Blake H. Behavioural intervention to increase physical activity in adults with coronary heart disease in Jordan. BMC Public Health 2016;16:643. DOI: https://doi.org/10.1186/s12889-016-3313-5

Houle J, Doyon O, Vadeboncoeur N, et al. Innovative program to increase physical activity following an acute coronary syndrome: Randomized controlled trial. Patient Educ Couns 2011;85:e237–44. DOI: https://doi.org/10.1016/j.pec.2011.03.018

Howarter AD, Bennett KK, Barber CE, et al. Exercise self-efficacy and symptoms of depression after cardiac rehabilitation. J Cardiovasc Nurs 2014;29:168-77. DOI: https://doi.org/10.1097/JCN.0b013e318282c8d6

Izawa KP, Watanabe S, Omiya K, et al. Effect of the self-monitoring approach on exercise maintenance during cardiac rehabilitation: A randomized, controlled trial. Am J Phys Med Rehabil 2005;84:313-21. DOI: https://doi.org/10.1097/01.PHM.0000156901.95289.09

Luszczynska A, Sutton S. Physical activity after cardiac rehabilitation: Evidence that different types of self-efficacy are important in maintainers and relapsers. Rehabl Psychol 2006;51:314-21. DOI: https://doi.org/10.1037/0090-5550.51.4.314

Reid RD, Morrin LI, Pipe AL, et al. Determinants of physical activity after hospitalization for coronary artery disease: the Tracking Exercise After Cardiac Hospitalization (TEACH) Study. Eur J Cardiovasc Prev Rehabil 2006;13:529-37. DOI: https://doi.org/10.1097/01.hjr.0000201513.13343.97

Van Sluijs EMF, Van Poppel MNM, Twisk JWR, et al. Physical activity measurements affected participants’ behaviour in a randomized controlled trial. J Clin Epidemiol 2006;59:404-11. DOI: https://doi.org/10.1016/j.jclinepi.2005.08.016

Shajrawi A, Granat M, Jones I, et al. Physical activity and cardiac self-efficacy levels during early recovery after acute myocardial infarction: A Jordanian study. J Nurs Res 2020;29:e131. DOI: https://doi.org/10.1097/JNR.0000000000000408

Ashford S, Edmunds J, French DP. What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis. Br J Health Psychol 2010;15:265-88. DOI: https://doi.org/10.1348/135910709X461752

Bandura A. Personal and collective efficacy in human adaptation and change. Adv Psychol Sci 1998;1:51–71.

Anselm Strauss JMC. Basics of qualitative research. Thousand Oaks: Sage Publications, Inc.; 1998.

Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour – And are they the same? Health Educ Res 2011;26:308-22. DOI: https://doi.org/10.1093/her/cyr005

Ferrier S, Dunlop N, Blanchard C. The role of outcome expectations and self-efficacy in explaining physical activity behaviours of individuals with multiple sclerosis. Behav Med 2010;36:7–11. DOI: https://doi.org/10.1080/08964280903521354

Bandura A. Social foundations of thought and action. Englewood Cliffs: Prentice Hall; 1986.

Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al. Exercise and physical activity for older adults. Med Sci Sports Exerc 2009;41:1510-30. DOI: https://doi.org/10.1249/MSS.0b013e3181a0c95c

Pickett K, Kendrick T, Yardley L. “A forward movement into life”: A qualitative study of how, why and when physical activity may benefit depression. Ment Health Phys Act 2017;12:100–9. DOI: https://doi.org/10.1016/j.mhpa.2017.03.004

Irmak Z, Fesci H. Effects of nurse-managed secondary prevention program on lifestyle and risk factors of patients who had experienced myocardial infarction. Appl Nurs Res 2010;23:147-52. DOI: https://doi.org/10.1016/j.apnr.2008.07.004

Uysal H, Özcan Ş. The effect of individual training and counselling programme for patients with myocardial infarction over patients’ quality of life. Int J Nurs Pract 2012;18:445–53. DOI: https://doi.org/10.1111/j.1440-172X.2012.02058.x

Harbman P. The development and testing of a nurse practitioner secondary prevention intervention for patients after acute myocardial infarction: A prospective cohort study. Int J Nurs Stud 2014;51:1542–56. DOI: https://doi.org/10.1016/j.ijnurstu.2014.04.004

Lau-Walker M, Landy A, Murrells T. Personalised discharge care planning for postmyocardial infarction patients through the use of the Personalised Patient Education Protocol – implementing theory into practice. J Clin Nurs 2016;25:1292-300. DOI: https://doi.org/10.1111/jocn.13177

Vibulchai N, Thanasilp S, Preechawong S. Randomized controlled trial of a self-efficacy enhancement program for the cardiac rehabilitation of Thai patients with myocardial infarction. Nurs Health Sci 2016;18:188–95. DOI: https://doi.org/10.1111/nhs.12243