Self Efficiency in Healthcare and Cognitive Functioning
What is Self Efficiency
Self-efficacy is one component of social cognitive theory, along with outcome expectations, goals, and impediments (Bandura, 1997).
An individual becomes efficacious in a particular domain of function through four mechanisms: enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states.
Bandura differentiates efficacy beliefs and outcome expectancies. An efficacy belief is the conviction that one can successfully execute the behavior required to produce the outcomes. Self-efficacy instruments determine the level, strength, and generality of efficacy beliefs.
Outcome expectancy is defined as a person's estimate that a given behavior will lead to certain outcomes. These expectancies are physical, social, and self-evaluative.
Bandura included the studies of eight nurse scientists conducting self-efficacy research; however, studies from Gortner , Harvey, Jensen, Laschinger , Lin, and Ruiz were not available.
Nursing Research on Selfefficacy
In this review, nursing research in cardiac recovery and/or rehabilitation, chronic disease self-management, memory function, and parent and behavior training are presented as examples of self-efficacy derived programs of nursing research.
For a comprehensive review on self-efficacy research and Albert Bandura, see the Information on Self-Efficacy Maintained by Professor Frank Pajares at http://www. emory.edu/EDUCATION/mfp/effpage and Bandura 's (1997) book on human agency .
Two examples of memory self-efficacy research using qualitative designs are provided for future development of self-efficacy theory. Self-efficacy for activity and exercise following cardiac events has been found to predict better health outcomes, not only in hospitalized patients but also in community residing adults.
Investigators have evaluated the contribution of efficacy expectations for coronary bypass surgery, valve replacement, implantable cardioverter/ defribillator (ICD), and participation in cardiac rehabilitation (Jenkins &Gorter , 1998; Moore, S.M ..Dolansky , Ruland, Pashkow , & Blackburn, 2003).
Removing barriers and increasing social
support clearly build self-efficacy in these individuals who must sustain their
efforts for long periods of time.
Empowering the Individuals
Lorig and colleagues (2001) have developed a program of efficacy based interventions aimed at empowering individuals to self-manage their chronic disease.
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, the formation of a patient-provider partnership , action planning, and self tailoring.
Over 800 participants with
heart disease, lung disease, stroke, or arthritis have participated in the
CDSMP. The longitudinal outcomes include reduced emergency room visits, times
hospitalized, and health distress. In addition, this low-cost program
significantly improved self-efficacy in these diverse populations.
Memory in Relation With Self confidence
Adults begin to lose confidence in their memory after age 40, and this is particularly strong in adults older than 60 years of age, regardless of their functional ability and living arrangement.
Within the psychometric tradition of intelligence and aging, researchers are moving from a decremental model of cognitive function to a health promotion orientation that values an individuals' ability to improve their cognitive abilities through training or mental discipline. In the short term, memory performance may be improved.
However, the ability to sustain these gains may be moderated by an individual's memory self-efficacy. McDougall (2004) found that in community dwelling older. adults greater than 70 years of age, memory self-efficacy predicted everyday memory performance in both black and white elders.
The participants in this
study had lowered correlates of perceived inefficiency and this negatively
influenced their everyday memory performance. Continued investigation of the
subjective aspects of memory function are necessary since memory self-efficacy,
or one type of subjective evaluation, is associated with actual memory
performance.
Change in Behavior in Children Confidence
Problematic behaviors in young children may lead to decreased confidence in the parenting role when the parents believe they cannot successfully master these outbursts with their concomitant untoward outcomes in the emotional and intellectual development of the child.
Using self-efficacy derived psychosocial interventions, Gross and her colleagues (2003) have developed behavioral parent-training interventions for families with toddlers in various settings, most recently in day care and low-income urban communities.
The boosting of parents' self-efficacy through behavioral parent
training promotes longitudinal health outcomes in high-risk preschool age
children.
Research Methodology While Evaluating Memory and Cognitive functions
However, research emphasizing outcome expectations may need to include qualitative methodologies (Bandura, 2001). Two examples of qualitative research evaluating memory function with adults are used to elaborate the methodology.
In the Seattle Midlife Women's Health Study (SMWHS), 230 women averaging 47 years of age were asked to describe types of memory changes, their attributions about the memory changes, and how these changes affected their life roles and stress (Sullivan, Mitchell, & Woods, 2001).
Five categories of memory changes and problems were identified: recalling words or numbers, forgetting related to everyday behaviors, events, concentration problems, and need for memory aids. In addition, the participants identified role burden and stress, getting older, health, menstrual cycle changes/ hormones, inadequate concentration, and emotional factors.
Memory change was attributed to stress, physical health, and aging,not to the menstrual cycle or use of hormones. In another study of subjective memory evaluation with 169 healthy older adults averaging 68 years of age, McDougall and colleagues (2003) evaluated unsolicited comments about memory from 26 participants.
Fifty individuals were between the ages of 50 and 64, 90 between 65 and 74, and 29 were at least 75 and older. In addition to the qualitative themes, this investigation included two quantitative measures of memory self-efficacy, a subjective evaluation of memory function.
One measure consisted of 4 items and the other measure contained 50 items. Content analyzes of the qualitative data yielded five themes: memory management, rationalization, information seeking, reflection, and correlation establishment.
The majority of the themes related to memory management, and all four questions on the memory self-efficacy questionnaire emphasized maintenance skills to prevent decline and strategies for memory management.
The qualitative and quantitative data provided an unusual finding: there were no age-group differences on memory self-efficacy with the 4-item measure, but there were significant age-group differences on the 50-item measure.
This study and the previous study provide a glimpse of what adult's experience regarding memory function and what they believe is important for health care professionals to know.
Examples of memory phenomena captured through qualitative methods were presented to provide examples of multi method research to quantify a domain specific measure of self-efficacy. Both of the examples, including the Mc-Dougall and the Mitchell and Woods studies, are a beginning effort to measure outcome expectancies in the domain of cognitive function, specifically memory performance.
However, neither study developed a quantitative measure of outcome
expectations in the memory function domain as an outcome of the qualitative
analyses. Nevertheless, both studies provided evidence supporting the
theoretical distinction between efficacy beliefs and outcome expectancies that
enforce the belief that an achievable goal.
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