Patient Education: Self-efficacy

Self-efficacy refers to the extent of an individual’s belief in his or her abilities. Because self-efficacy is based on feelings of self-confidence and control, it is a good predictor of motivation and behavior. Research has shown that health care professionals can have an impact on self-efficacy and that changes in self-efficacy are associated with changes in behavior. Some examples of ways to enhance a patient’s self-efficacy include:

  • Skills mastery
  • Modeling
  • Social persuasion

Skills mastery refers to the technique of breaking down skills to be learned into very small, manageable tasks so that it is likely the task will be done successfully. People are more likely to adopt a health behavior if they think they will be successful in doing it. Thus, interventions should increase confidence by giving patients many little “successes” in the process of behavior change.3 Alcoholic Anonymous programs take advantage of self-efficacy principles when they encourage participants to take one small step “to promise not to drink today.”

Modeling is a self-efficacy technique by which the patient becomes aware of seeing someone else with a similar problem. Support groups and patient groups such as the Arthritis Foundation’s self-help course and the American Cancer Society’s Reach to Recovery Program are based on modeling. When using modeling, try to match patients with models who are as much like them as possible in terms of age, sex, ethnic origin, and socioeconomic status. It’s important to avoid using superacheiving people who have overcome problems in a dramatic manner. Although such people are inspiring, they are not always the best models if the patient perceives their achievements as unrealistic.

Social persuasion refers to individual efforts to influence behavior. One aspect of persuasion that is particularly effective is to urge and encourage the patient to do slightly more than he or she is now doing. When using this strategy, strive to make teaching goals short-term and realistic, and not much beyond what the patient believes he or she can realistically accomplish.

The way the health care professional presents teaching content can have a major impact on increasing self-efficacy. If the patient feels overwhelmed by the amount of material to be learned or the complexity of tasks involved, he or she will be less likely to be willing to try new skills.

In addition to breaking down information into realistic segments, it’s helpful to emphasize the similarity of the new task to be learned to something the patient is already successful at doing by explaining and reinforcing that the task can be learned one step at a time or by having other patients who have learned the new skills meet with the patient. To build self-efficacy, the first step is to divide a complex task or complex into subtasks that appear easy to the patient. The second step is to offer feedback/reinforcement after each step. Providing enough time for the patient to practice new skills helps build self-efficacy. Examples of repetitions that build self-confidence are practicing insulin injections, demonstrating how to use adaptive equipment, or showing how to select low-sodium foods from a menu. Recognizing and rewarding the patient for accomplishing subtasks are important to help build the esteem that is the basis of self-efficacy. Recognition is particularly important for patients without much education or who have literacy problems. Over their lifetimes, these individuals have often “guessed wrong” and are therefore more likely to have low self-confidence that they can perform the tasks you are asking of them. A sincere statement such as “Good, you’re beginning to get the idea,” or “You’re doing well” from a nurse or other healthcare professional or even a positive response from a computer-aided instruction can help immensely.

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