Chronis Disease Management - Self-efficacy

Transcript

1. Self-efficacy PHE2 LCI Semester 2 2010 Week 6 Jon Willis
2. Why self-efficacy? • A central concept in self-management is self-efficacy— confidence to carry out a behaviour necessary to reach a desired goal. • Self-efficacy is enhanced when patients succeed in solving patient- identified problems. • Evidence from controlled clinical trials suggests that – (1) programs teaching self-management skills are more effective than information-only patient education in improving clinical outcomes; – (2) in some circumstances, self-management education improves outcomes and can reduce costs for arthritis and probably for adult asthma patients; and – (3) in initial studies, a self-management education program bringing together patients with a variety of chronic conditions may improve outcomes and reduce costs. Bodenheimer T, Lorig K, Holman H, & Grumbach K. 2002. Patient Self-management of Chronic Disease in Primary Care. JAMA, 288:2469-2475
3. Paulette in Legally Blonde Elle: Did you see him? He's probably still scratching his head. Paulette: Yeah, which must be a nice vacation for his balls.
4. What is Self-Efficacy? • It is the expectation that one can master a situation, and produce a positive outcome • Bandura’s Social Cognitive Model says that there are 3 factors that influence self- efficacy: Behaviors, Environment, and personal/cognitive factors. • They all affect each other, but the cognitive factors are important. Bandura believed that there is more to learning than just ‘behaviorism’, what you believe about a situation is important too. Behaviours Personal/cognitive factors Environment
5. Major Depression • DSM IV-TR: one feature of a major depressive episode is a sense of worthlessness, or ruminations over past failures.
6. Social Cognition • Bandura’s basic position is that – “People's level of motivation, affective states, and actions are based more on what they believe than on what is objectively the case.”
7. Social Cognition • Bandura proposed two factors as the major components of relatively permanent change: – Context – Beliefs • There is a similar relationship between: – Piaget and Information Processing – Vygotsky and Social Cognition
8. Social Cognition Overt Behaviour Environment Personal Factors Bandura developed the concept of reciprocal determinism to account for human behaviour
9. • Bandura believed that human beings have specific abilities and that only reciprocal determinism can explain their operation and interaction: – Model and imitate – Self-reflect – Regulate own behavior
10. 1. Model and imitate • Observational Learning – Bandura hypothesized a four-step pattern that combined a cognitive and operant view of learning. Attention notices something in the environment Retention remembers what was noticed Reproduction produces an action that is a copy of what was noticed Motivation consequence changes the probability the behavior will be emitted again
11. 2. Self-Efficacy • Self-reflection is a second human quality and is expressed in the concept of self-efficacy. – “Self-efficacy is the belief in one’s capabilities to organize and execute the sources of action required to manage prospective situations.” (Bandura, 1986)
12. Self-efficacy impacts: • The choices we make • The effort we put forth • How long we persist when we confront obstacles (especially in the face of failure) • How we feel about ourselves, others, the task, etc.
13. Self-efficacy is influenced by: • Mastery experiences • Vicarious experiences • Social persuasions • Physiological states
14. Mastery experiences: Sources of efficacy information • Performance attainment: – most effective source – what you can do...what you need help with – “...if I did it once, I can do it again.”
15. • Vicarious experience: – Learning done by observation of others’ actions – Modelling – “...if I’ve seen it done by someone else, I can do it.”
16. • Social persuasion: – people telling you what you must do – people telling you that you can do it – may not be enough – tied to performance attainment & vicarious experience – can I do this...have I done it before...have I seen it done?
17. • Physiological state: – how your body feels before/during/after a behaviour takes place – pain after exercise vs. training effect – withdrawal after smoking vs. disappearance of withdrawal • Concept of Mastery Experiences: if you master one task, there is a better chance of being successful at other similar tasks. (It is important to note here that the mastery experience must be attributed to themselves… not luck, or chance, or others help.)
18. 3. Self-Regulation • Self-regulation is a third human capability and has several subfunctions: – Goal-setting – Self-observation and monitoring – Performance judgment and evaluation – Self-reaction (e.g., self-satisfaction, self-worth, distress)
19. Recalling locus of control • Generalized expectancy/concept of person’s self • Based on assumptions of self-regulation/social learning • Internal: regulation from inside sources • External: regulation from outside sources • Self-efficacy/locus of control are related
20. Self-efficacy/locus of control matrix A B C D Locus of Control Internal External High Low Self Efficacy
21. Analysing the matrix: • Box A: high self-efficacy/internal LOC – I believe I can do this ... myself! • Box B: high self-efficacy/external LOC – I believe I can do this ... the doctor said I can! • Box C: low self-efficacy/internal LOC – I don’t think I can do this, but I’m in control here! • Box D: low self-efficacy/external LOC – I don’t think I can do this...no matter what the doctor says!
22. Odds of participation • How many of you – Know how to tie your shoes? – Know how to speak French? – Know how to mix chemicals? • Now how many of you: – Would be interested in taking a 2 hour seminar in how to tie your shoes in 12 different ways? – Would be interested in 2 semesters of French? – Would be interested in taking 8 years of university to become an expert chemist, or to learn how to create liquid crystal inventions? • Level of Self-Efficacy + interest = odds of participation?
23. The emotion of interest • Four variable directly influence interest: – Conflict – Complexity – Novelty – Uncertainty • Self-efficacy is directly related to all four of these, so self-efficacy indirectly influences interest through 4 variables… quadratically. • Uncertainty plays the biggest role in interest. • Self-efficacy affects uncertainty: “How will the activity end up?”
24. What research says… Fuzzy dart test – skill test, try to hit target with dart at various distances – distance was adjusted at varying length for different groups, as well as varying the lengths for another group – interest decreased when it got too easy – those put in the moderate difficulty condition were most interested in repeating the task – those who were placed farthest from the target agreed that it would be more interesting if the line was moved closer to the target
25. What research says… difficulty confidence interest low moderate high 1 2 3 4 5 6 7
26. How can I use this information?! 5 strategies for Enhancing Self-Efficacy  Emotional and Physiological arousal  Relaxation techniques, calming fears  Verbal Persuasion  encouragement, convince them success is result of self.  Vicarious Experiences  observation of modeled behaviors  Imagined Experience  imagining yourself in the experience  Performance Experience  actual practice of the activity, “Practice makes perfect!” Maddux (1995)
27. Building self-efficacy in your clients • A 1,000-mile journey begins with a single step – build self-efficacy step-by-step – small tasks in behaviour change lead to a subsequent task related to the larger goals you’ve set – e.g. you lose 20 kgs one-at-a-time
28. • Efficacy expectations... – person’s perceived knowledge of his/her abilities – the client asks: can I do this? • Outcome expectations... – person’s beliefs about whether a given behaviour will lead to • Specific outcomes – the client asks: will I get the results I’m after?
29. Self-Esteem...Self-Efficacy...LOC • Some important points to remember... – It’s not about you...it’s about the client! – The client decides... – You can help!
30. References • Bandura A. (1977). Self efficacy: Toward a unifying theory of behavior change. Psychological Reviews, 84: 191-215 • Bendura A. (1997). Self-efficacy: The exercise of control. New York: Freeman. • Maddux JE. (Ed). (1995). Self-Efficacy, Adaptation, and Adjustment: Theory, Research, and Application. New York: Plenum. • Marks R, Allegrante JP & Lorig K. 2005. A review and synthesis of research evidence for self-efficacy: Enhancing interventions for reducing chronic disability. Implications for Health Education Practice Part I. Health Promotion Practice. 6: 37-43 • Marks R & Allegrante JP. 2005. A review and synthesis of research evidence for self-efficacy: Enhancing interventions for reducing chronic disability. Implications for Health Education Practice Part II. Health Promotion Practice. 6: 148-156