Self-efficacy is a very important concept in health care. It is nearly the same thing as self-confidence, or a belief that you can do something, like monitor mood, change eating habits and start being more physically active. It turns out that self-efficacy is linked to hospital utilization (low confidence = increased ER visits and days in hospital), to blood sugar control (low confidence = worse blood sugar control) and to changes in behavior.
I was first introduced to self-efficacy when I was preparing to be the nurse practitioner interventionist in a randomized, controlled trial of an intervention to reduce disability in older, community dwelling adults. I read the work of Kate Lorig, RN, DrPH, who was developing self-management education programs to help people develop confidence to live with their chronic conditions. I later met Kate and became a T-trainer for one of the many evidence-based programs she and her colleagues at the Stanford Patient Education Research Center have developed. I learned that my job wasn't to fill patient's heads with facts (because information alone is unlikely to change behavior) but was instead to help them build confidence that change was possible by taking small steps toward patient-determined goals.
This new knowledge and approach was a career-changer. No longer frustrated, puzzled or alarmed by what I saw patients doing, I understood the ups and downs of everyone's journey and what part I could play in helping people improve their situations in a way that made sense to them. I was introduced to Motivational Interviewing by Karen Artz, who taught me to be 'The guide on the side, not the sage on the stage.'' I learned with my social worker colleague, Susy Favaro, who taught me many things, including how to say, I wonder what would happen if...'' Susy and I worked together on the disability prevention study, and watched as the phone calls, face-to-face meetings, peer mentoring, and availability of exercise programs, social contact and self-management education slowly helped the intervention group improve their lives.
Dr Lorig and her colleagues have built their programs on some key ideas, including that self-management education is about problems that patient identify, not what health care professionals think they should know. The programs feature techniques known to improve self-efficacy, such as modeling (seeing someone do a behavior, preferable someone like you), social persuasion (most effective from peers), reinterpreting symptoms (maybe the fatigue isn't solely from the illness but is also from de-conditioning), and skills mastery (actually learning and having success with new approaches.) These four techniques could be built into every program that interacts with patients, yet I am surprised how few health care professionals learn about them and about self-efficacy. Just imagine if every cardiac rehabilitation, every health class for junior high students and every physical therapy program built these ideas into their work.
I'll write more in my next post about other tips on increasing self-efficacy.