Self Efficiency in Healthcare What is Self-Efficacy?
Self-efficacy is a core concept within social cognitive theory, which also includes outcome expectations, goals, and impediments (Bandura, 1997). It refers to an individual’s belief in their ability to successfully execute a specific behavior required to achieve desired outcomes. Bandura identifies four mechanisms through which individuals develop self-efficacy: enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states.
Bandura makes a clear distinction between efficacy beliefs and outcome expectancies. An efficacy belief is the conviction that one can successfully perform the behavior necessary to produce a desired outcome. In contrast, outcome expectancy is the estimation that a specific behavior will lead to certain results, which can be physical, social, or self-evaluative. Self-efficacy instruments assess the level, strength, and generality of these beliefs.
Nurse scientists have contributed significantly to the study of self-efficacy in healthcare, though many studies, such as those by Gortner, Harvey, Jensen, Laschinger, Lin, and Ruiz, remain unavailable (Bandura, 1997).
Nursing Research on Self-Efficacy
Nursing research on self-efficacy spans various domains, including cardiac recovery and rehabilitation, chronic disease self-management, memory function, and parent and behavior training. This research demonstrates that self-efficacy can predict better health outcomes across different contexts. For example, self-efficacy for activity and exercise after cardiac events has been found to predict improved health outcomes in hospitalized patients and community-dwelling adults.
Studies have explored the role of efficacy expectations in outcomes related to coronary bypass surgery, valve replacement, implantable cardioverter-defibrillators (ICDs), and participation in cardiac rehabilitation (Jenkins & Gorter, 1998; Moore et al., 2003). Findings suggest that removing barriers and enhancing social support can build self-efficacy in patients who must maintain their efforts for extended periods.
Empowering Individuals
Lorig and colleagues (2001) developed a program of self-efficacy-based interventions to empower individuals in self-managing chronic diseases. The Chronic Disease Self-Management Program (CDSMP) incorporates three self-management tasks—medical management, role management, and emotional management—and six self-management skills: problem-solving, decision-making, resource utilization, patient-provider partnerships, action planning, and self-tailoring.
More than 800 participants with heart disease, lung disease, stroke, or arthritis have participated in the CDSMP. The program’s longitudinal outcomes include reduced emergency room visits, fewer hospitalizations, and decreased health distress. Additionally, this low-cost program significantly improved self-efficacy in diverse populations, highlighting the potential of self-efficacy-based interventions in chronic disease management.
Memory in Relation to Self-Confidence
Adults tend to lose confidence in their memory abilities after age 40, and this decline in confidence becomes more pronounced in individuals over 60, regardless of their functional ability or living arrangements. Traditionally, cognitive aging research focused on a decremental model of cognitive function; however, there is a shift towards a health promotion orientation that recognizes the potential for improving cognitive abilities through training or mental discipline.
Short-term memory performance can be improved with training, but the ability to sustain these gains may be influenced by an individual’s memory self-efficacy. McDougall (2004) found that in community-dwelling older adults over 70, memory self-efficacy predicted everyday memory performance in both Black and White elders. Participants in this study exhibited lowered correlates of perceived inefficiency, which negatively influenced their everyday memory performance. This finding emphasizes the need for continued research into the subjective aspects of memory function, as memory self-efficacy is closely associated with actual memory performance.
Change in Behavior and Children’s Confidence
Problematic behaviors in young children can lead to decreased parental confidence in their parenting abilities, particularly when parents believe they cannot effectively manage these behaviors. This lack of confidence can have adverse effects on the child’s emotional and intellectual development.
Using self-efficacy-derived psychosocial interventions, Gross and colleagues (2003) developed behavioral parent-training interventions for families with toddlers in various settings, including day care centers and low-income urban communities. By boosting parents’ self-efficacy through behavioral parent training, these interventions promote long-term health outcomes in high-risk preschool-age children. This approach demonstrates the importance of enhancing self-efficacy in parents to positively impact children’s behavior and development.
Research Methodology While Evaluating Memory and Cognitive Functions
Evaluating memory and cognitive functions in relation to self-efficacy often involves both qualitative and quantitative research methodologies. Bandura (2001) suggested that studies emphasizing outcome expectations should consider qualitative methods to capture the nuances of cognitive function more effectively.
The Seattle Midlife Women’s Health Study (SMWHS) serves as an example of qualitative research in this area. In the study, 230 women, with an average age of 47, were asked to describe their experiences of memory changes, the causes they attributed to these changes, and how these changes affected their life roles and stress levels (Sullivan, Mitchell, & Woods, 2001). The study identified five categories of memory changes and problems: recalling words or numbers, everyday forgetting, concentration problems, and the need for memory aids. Participants attributed memory changes to factors like role burden and stress, aging, health, menstrual cycle changes, and emotional factors. Notably, memory changes were not attributed to the menstrual cycle or hormone use.
Another study by McDougall and colleagues (2003) evaluated subjective memory evaluations among 169 healthy older adults, with an average age of 68. The study gathered unsolicited comments from 26 participants and identified five qualitative themes: memory management, rationalization, information seeking, reflection, and correlation establishment. In addition to these qualitative themes, the study included two quantitative measures of memory self-efficacy: a 4-item measure and a 50-item measure. The study found no significant age-group differences on the 4-item measure but observed significant differences on the 50-item measure.
These studies highlight the importance of combining qualitative and quantitative methods to understand memory phenomena and develop domain-specific measures of self-efficacy. Both studies provide preliminary evidence supporting the theoretical distinction between efficacy beliefs and outcome expectancies, reinforcing the idea that individuals believe in achieving goals through self-efficacy.
Conclusion
Self-efficacy is a critical concept in healthcare, particularly in relation to cognitive functioning and health behavior change. It involves an individual’s belief in their ability to perform a specific behavior that leads to desired outcomes. The research reviewed in this essay highlights the importance of self-efficacy in various healthcare contexts, including chronic disease management, cardiac rehabilitation, memory performance, and behavioral interventions for children.
Empowering individuals through self-efficacy-based interventions can lead to improved health outcomes, reduced healthcare utilization, and enhanced quality of life. Memory self-efficacy, in particular, plays a significant role in determining cognitive performance and can be influenced by factors such as age, stress, and perceived cognitive abilities.
Research methodologies that combine qualitative and quantitative approaches are crucial for evaluating self-efficacy and its impact on cognitive function and health behavior change. These studies provide valuable insights into how individuals perceive their abilities and how these perceptions affect their health outcomes. Future research should continue to explore the subjective aspects of self-efficacy and develop targeted interventions to enhance confidence and promote health and well-being across diverse populations.
By understanding and promoting self-efficacy, healthcare providers can better support individuals in achieving their health goals and improving their overall quality of life.