Barbara Resnicks Theory of Self-Efficacy in the Care of Patient Diagnosed with Congestive Heart Failure

PURPOSE OF THE THEORY The Theory of Self-Efficacy is based on the social cognitive theory and conceptualizes person behaviorenvironment interaction as triadic reciprocality, the foundation for reciprocal determinism. Triadic reciprocality is the interrelationship among person, behavior, and environment; reciprocal determinism is the belief that behavior, cognitive, and other personal factors as well as environmental influences operate interactively as determinants of each other. Cognitive thoughtwhich is a critical dimension of the personbehaviorenvironment interactiondoes not arise in a vacuum. Bandura (1977, 1986) suggested that individuals thoughts about themselves are developed and verified through four different processes: (1) direct experience of the effects produced by their actions, (2) vicarious experience, (3) judgments voiced by others, and (4) derivation of further knowledge of what they already know by using rules of inference. Human functioning is viewed as a dynamic interplay of personal, behavioral, and environmental influences.

CONCEPTS OF THE THEORY Bandura, a social scientist, differentiated two components of self-efficacy theory: self-efficacy expectations and outcome expectations. These two components are the major ideas of the theory. Self-efficacy expectations are judgments about personal ability to accomplish a given task, whereas outcome expectations are judgments about what will happen if a given task is successfully accomplished. Both were differentiated because individuals can believe that a certain behavior will result in a specific outcome; however, they may not believe that they are capable of performing the behavior required for the outcome to occur. Sources of Self-Efficacy Judgment A. Enactive Attainment Enactive attainment has been described as the most influential source of self-efficacy information, and it is the most common intervention that is used to strengthen efficacy expectations in older adults. There has been repeated empirical verification that actually performing an activity strengthens self-efficacy beliefs. Enactive attainment generally results in greater strengthening of self-efficacy expectations compared to informational sources. B. Vicarious Experience Self-efficacy expectations are also influenced by vicarious experiences or seeing other similar people successfully performing the same activity. However, there are some conditions that impact the influence of vicarious experience. If the individual has not been exposed to the behavior of interest or has had little experience with it, vicarious experience is likely to have a greater impact. Additionally, when clear guidelines for performance are not explicated, self-efficacy will be more likely to be impacted by the performance of others. C. Verbal Persuasion Verbal persuasion involves telling an individual that he or she has the capabilities to master the given behavior. Verbal encouragement from a trusted, credible source in the form of counseling and education has been used alone and with performance behavior to strengthen efficacy expectations. D. Physiological Feedback

Individuals rely in part on information from their physiological state to judge their abilities. Physiological indicators are especially important in relation to coping with stressors, physical accomplishments, and health functioning. Individuals evaluate their physiological state or arousal, and if aversive, they may avoid performing the behavior. Interventions can be used to alter the interpretation of physiological feedback and help individuals to cope with physical sensations, enhancing self-efficacy and resulting in improved performance. Interventions include (a) visualized mastery, which eliminates the emotional reactions to a given situation; (b) enhancement of physical status; and (c) altering the interpretation of bodily states.

RELATIONSHIPS AMONG THE CONCEPTS: THE MODEL The theory of self-efficacy was derived from the social cognitive theory and must be considered within the context of reciprocal determinism. The four sources of experience (direct experience, vicarious experience, judgments by others, and derivation of knowledge by inference) that can potentially influence self-efficacy and outcome expectations interact with characteristics of the individual and the environment. Ideally, self-efficacy and outcome expectations are strengthened by these experiences and subsequently moderate behavior. Since self-efficacy and outcome expectations are influenced by performance of a behavior, it is likely that there is a reciprocal relationship between performance and efficacy expectations (see Figure 9.1).

FIGURE 9.1 Self-Efficacy APPLICATION Effective management of congestive heart failure (CHF) is one of the major challenges in health care today. Heart failure has a substantial impact on care utilization and quality of life. Self-management may play an important role in this regard. Managing CHF is a complex task, and comparable to diabetes in that it touches nearly every important aspect of daily life. It is therefore crucial for patients to cope with CHF adequately, if they are to live an acceptable life. Self-efficacy expectancies refer to the belief that one can successfully perform intended behaviors, and are powerful determinants of behavioral change. There are indications that low levels of self-efficacy expectancies predict functional decline in CHF patients. Barbara Resnicks Theory of Self-Efficacy will help improve self-efficacy expectancies and may therefore change health behavior, improve health-related quality of life, and reduce care utilization by CHF patients.