Fenotipificación molecular del sistema Duffy

Control is also a key aspect of another social-psychological construct, called self-efficacy (Bandura, 1972a; 1982). It is gaining in significance in health-psychological questions. In his self-efficacy theory, Bandura contended that the behaviour of a person is deter- mined by expectations concerning his or her own efficacy (efficacy expectancy) and the outcome of a behaviour (outcome expectancy). Merely the anticipation of a positive re- sult does not suffice to induce a change in behaviour. Indeed, the conviction that one can actually exercise a particular behaviour or successfully perform this behaviour is decisive. Self-efficacy is built up through the experiences an individual makes in situations that have been successfully mastered. This, in turn, leads to the establishment of suitable coping strategies.

Self-efficacy appears to be fundamental to the motivation of behavioural change. (For an overview of the relationship between self-efficacy and health-related behaviour, see Schwarzer, 1992; Strecher, McEvos Develis, Becker & Rosenstock, 1986). Self-efficacy is a component of the individual appraisal of one’s own coping possibilities and thus contrib- utes to coping with crises and to the construction of the individual’s personal environment (Rippetoe & Rogers, 1987). The empirically established relationship between the willing- ness to adopt preventive behaviours (for a summary, see O’Leary, 1985; Bandura, 1986), to maintain these behaviours in the face of temptation (DiClemente, 1981), and to implement situationally adequate coping strategies (Rippetoe & Rogers, 1987) indicates that self-efficacy influences health-related behaviours and in this indirect manner repre- sents an important factor for health protection.

Bandura originally conceived self-efficacy as situational beliefs and not as a stable personality trait. His theory differs from Antonovsky’s approach in this point. More recent ideas tend to consider self-efficacy both as a trait and as specific cognitions that are only valid for clearly defined situations (Schwarzer, 1992; 1994).

Antonovsky did not distinguish between outcome and efficacy expectations. However, both aspects are implicit in the component of manageability – the confidence that one has the resources available that one needs to cope with events. When one compares the corre- sponding questionnaires, the similarity in the composition of the component of manageability and the construct of self-efficacy is obvious. For example, a question in the SOC-scale asks: “Do you have the feeling that you are in an unfamiliar situation and

don’t know what to do?” In the scale for generalised self-efficacy, the question is: “In

unexpected situations, I always/never know how to act.”

Similar to the HLOC and the stress-coping theories, the self-efficacy theory is characterised by strong action orientation. Subjective assessments influence health-related behaviours and are thus buffers or mediators of health, or rather, of disease and risk factors.

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Hardiness

Kobasa (1979; Kobasa, Maddi & Kahn, 1982) presented the construct of “hardiness” at the same time as Antonovsky coined the term “sense of coherence”. It is important to point out that Kobasa, too, was interested in the question of invulnerability and health resour- ces, that is, she was a proponent of a salutogenic approach from the beginning, even though she did not use this term. In her opinion, it is the personality trait of hardiness which leads people to react differently to objectively identical stressors and stressful situations. Hardiness refers to the fact that individuals are resistant to the negative effects of stress and as a result do not develop any negative consequences. In contrast to Anto- novsky, Kobasa does not view this trait as a static personal characteristic, whose development is completed early and is virtually fixed by adulthood. In her opinion, personality characteristics are personal styles that can develop dynamically as the indi- vidual interacts with the environment. Her standpoint allows for change and is thus not quite as pessimistic as that of Antonovsky.

Hardiness contains three components that not only overlap with each other, but also show some very close parallels to the three components of the SOC: commitment, control and challenge. People having pronounced hardiness are curious about and active in all areas of their lives (commitment). On the one hand, this requires the individual to be convinced of his or her own importance, actions and good judgement. On the other hand, this characteristic also includes social action and engagement. Antonovsky felt that when Kobasa uses the term “commitment”, she means “exactly the same thing” as his term “meaningfulness” (Antonovsky, 1987a, p. 49).

”Control” is meant to be the opposite of “helplessness”. In other words, people with more pronounced hardiness are convinced that they can control and have influence on their surroundings. These persons emphasise the individual responsibility of their actions and the possibility of reducing the negative effects of stressors through self-determined activities. Kobasa distinguished between external control, where the source is outside the self, and internal, self-determined control.

Internal control is meant to be synonymous with self-responsibility and active behaviour. As Antonovsky wrote: “Kobasa’s use of Rotter’s Internal-External Locus of Control Scale

(...) is explicitly at variance with my approach. This culturally narrow scale posits only two alternatives: either I control matters or someone or something ‘out there’ does. It posits a fundamental mistrust in power being in the hands of anyone else”

(Antonovsky, 1987a, p. 52).

Furthermore, persons with high hardiness feel challenged by changes in life. They expe- rience changes as normal and exciting, and as an opportunity for inner growth rather than as a threat. They actively seek new experiences and, in dealing with unexpected situations, show openness and cognitive flexibility. The last component bears a basic dif-

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