I think I can, I think I can: Self-efficacy in the context of pediatric magnetic resonance imaging
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Procedural distress is common among children and has been shown to interfere with cooperation and response during medical procedures. Predictors of procedural distress have been widely studied in an effort to inform identification of children who are at higher risk for procedural distress and those who may benefit from intervention in the form of preparation or support during the procedure. However, many of the predictors identified in previous research do not inform what should be the target of efforts to reduce procedural distress, nor whether such efforts are successful. While not yet studied in the context of pediatric medical procedures, self-efficacy theory suggests that self-efficacy is a reliable predictor of behaviour, that is also measurable and modifiable. Self-efficacy may be useful in the area of pediatric medical procedures as it could provide a target for intervention with direct impacts on procedural distress. The current dissertation sought to examine the role of self-efficacy in the context of pediatric medical procedures, using magnetic resonance imaging (MRI) as a model procedure. Study 1 focused on the development of the MRI Self-Efficacy Scale for Children (MRI-SEC), including both child and parent forms, followed by an assessment of the preliminary psychometric properties. An iterative approach to measure development was followed, in which feedback was incorporated from experts in pediatric MRI, in addition to children and parents with and without prior MRI experience. Subsequently, 127 child-parent dyads completed the MRI-SEC, in which acceptable internal consistency, test-retest reliability, and convergent validity were demonstrated. Study 2 consisted of a randomized-controlled trial, examining the modifiability of MRI self-efficacy when targeted with preparation, and MRI self-efficacy as a mediator of the beneficial effects of preparation on procedural distress. Among a sample of 104 child-parent dyads, children in the preparation condition self-reported higher MRI self-efficacy and lower anticipated fear toward MRI, as compared to children in the control condition. An increase in MRI self-efficacy through preparation was shown to mediate the reduction in anticipated fear. Group differences were not observed for parent measures, with the exception of anticipated child response toward MRI. Lastly, Study 3 investigated MRI self-efficacy and parent-reported confidence in their child’s ability to complete MRI, as predictors of procedural distress and procedural outcomes, among 139 children scheduled for a clinical MRI scan. Child-reported MRI self-efficacy was shown to be a significant predictor of observed procedural anxiety and cooperation at the beginning of the scan, and the need for general anesthesia. Parent confidence in their child’s ability to complete MRI significantly predicted image quality and the need for general anesthesia. Taken together, the findings of this dissertation provide evidence that self-efficacy is a measurable and modifiable predictor in the context of pediatric MRI. A number of theoretical and clinical implications are derived from this research that directly inform how to best support children through potentially stressful medical procedures, like MRI.