As a basis for informing the development of interventions to enhance self-efficacy, the following strategies to enhance or provide sources of self-efficacy, as identified by (Bandura, 1997), are summarised:
- Personal accomplishment
- Vicarious experience (learning through the experience of others; this may be powerfully modelled by patients or carers in a similar situation or health professionals)
- Verbal persuasion
- Regulate emotional behaviour (primarily, the management of stress and anxiety which may impair learning)
Their practical application will now be illustrated within the context of a dermatology consultation.
- Personal accomplishment and verbal persuasion: Personal accomplishment can lead to stronger efficacy beliefs than other strategies of influence. This involves reinforcing (acknowledging and encouraging) instances when patients effectively engage in successful health behaviour, such as managing to apply topical medications in the correct order. It is important to assess the patient’s self- management ability and to give them performance feedback, including verbal persuasion to encourage them to build on what they are already doing well.
- Vicarious experience: This refers to social modelling, where opportunities are provided to help the patient learn from others. This may include health professionals demonstrating effective practices, such as a wet-wrapping technique by a parent, or creating group-learning opportunities where there is sharing of good practice by a patient or parental carer with others in a similar social learning situation. Group learning also provides a resource-efficient opportunity for patient or parental carer education; this may include exposure to well-organised patient support groups such as the Psoriasis Association or the National Eczema Society.
- Regulation of emotional behaviour: Bandura (1997) highlights how emotional and physical arousal may interfere with the performance of a desired behaviour. Supporting the patient to regulate such emotions involves examining the patient’s mood state and emotional responses to their condition and exploring coping strategies that suit them. This may involve, for example, triggering an opportunity to raise awareness for discussion, such as using a quality-of-life questionnaire as a basis for discussing the psychosocial impact of their condition or of their usual coping methods, adaptive and maladaptive, such as exercise or excessive alcohol intake, respectively. The patient can be directed to strategies to help them manage stress and anxiety more effectively through pursuing relaxation opportunities, such as returning to social hobbies which have been curtailed due to a lack of self-esteem or engaging them in the use of relaxation methods such as progressive relaxation, yoga or mindfulness-based stress reduction techniques (a training technique to focus attention in the present moment) (Kabat-Zinn et al., 1998).
There is a need to promote active engagement with health promotion materials reflection, clarification and interpretation of the person’s knowledge, attitudes and beliefs as well as their involvement in health-related decisionmaking (Kettunen
et al., 2001). In practice, this will require exploration at follow-up clinics any questions regarding the information supplied or discussion of priority issues highlighted, such as the sequencing of topical treatments.
Increasingly, interventions are being developed to help improve chronic illness management and treatment adherence, which incorporates a range of educational measures based on theory. This is well illustrated in the asthma field, with studies such as that by Schaffer and Tian (2004) utilising an audio tape and booklet alone and combined, with the tape based on Protection Motivation Theory (Rogers and Prentice-Dunn, 1997). Others include the use of individual action planning based on Bandura’s self-cognitive theory (van der Palen
et al., 2001). Wangberg (2008) study utilised an internet-based diabetes self-care intervention tailored to enhance self-efficacy. This highlights the scope to devise systematic interventions, based on theory related to motivation or self-efficacy or coping, that may enhance the likelihood of effective learning and behavioural change related to self-management.
