Variable: Self efficacy
Self-efficacy is the extent to which people believe they are capable of performing specific behaviors in order to attain certain goals.
The concept of self-efficacy is the focal point of Bandura's (1997, 2001) Social Cognitive Theory.
Self-efficacy is occasionally conceptualized as a property of a message, such as when a health message contains self-efficacy information (e.g., Turner, Rimal, Morrison, & Kim, 2008). More frequently it is conceptualized as a belief in ones' ability to perform a specific behavior, and is often referred to as perceived self-efficacy. Bandura (1994): "Perceived self-efficacy is defined as people's beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives."
The importance of perceived self-efficacy is it can influence how people feel and behave. The more a person believes that a particular behavior can result in a desirable health outcome, the greater the likelihood increased perceived self-efficacy for that behavior results in its adoption and adherence (Maiback, Flora, & Nass, 1991).
According to Bandura, perceived self-efficacy is "best conceptualized as perceived operative capability. It focuses on the belief in what someone can do with whatever resources one can muster -- rather than with what someone has. The operative nature of perceived self-efficacy is an integral feature of the procedure used to access people's efficacy beliefs. Individuals are not asked to rate the abilities they possess, but rather the strength of their assurance they can execute given activities under designated situational demands" (Bandura, 2007, p. 646).
For example, consider the array of behaviors associated with protective sex. If a researcher is interested in an adult or young person's perceived ability to engage in protective sex, it seems indirect to ask about a person's confidence regarding condom purchase behavior, or once purchased -- about proper application. Instead, it is more direct to focus on a person's belief in his or her ability to use a condom successfully in a preventative health behavioral situation. In the latter case, a person also may encounter social and situational pressures (e.g., from a male partner). For example, Kasen, Vaughan, & Walter (1992) found women have low perceived self-efficacy to exercise control over pressures by a desired partner to engage in unprotected sex. Hence, low perceived self-efficacy increases the likelihood that women engage in unprotected sex, which potentially places them at risk of an HIV infection.
Self-efficacy measures frequently center on a particular behavior or a set of behaviors depending on a study's particular focus. In health communication, self-efficacy often is measured in the context of performing specified healthy behaviors, such as a woman's confidence people in her ability to perform breast self-exams, the confidence of seniors, adults, and young persons to perform the tasks involved to quit smoking, or apply sunscreen, or learn about healthy behaviors. Bandura (1997) recommends the use of measures that are specifically tailored for particular disorders or illnesses. Since items that measure self-efficacy vary as a function of the particular health behavior under study, three indexes are presented as examples, each measuring a different health behavior.
Self-efficacy also is a concept central to fear appeals processing models, such as Protection Motivation Theory (PMT, Rogers, 1983). In PMT, self-efficacy is part of a second appraisal (coping) upon exposure to a fear appeal message. If perceived threat (threat appraisal) is judged to be high, then an individual will engage in appraising both self and response efficacy. If both efficacy appraisals are judged to be sufficiently high, then an individual will be motivated to reduce the threat (by adopting message recommendations). If one or both of the efficacy appraisals are insufficiently high, then the individual will be motivated to reduce the fear by a number of different strategies (e.g., message derogation, message avoidance).
Since self-efficacy tends to be measured in association with a particular health problem, no single measure of perceived self-efficacy exists. Nevertheless, several examples are provided below including one measure of general health self-efficacy and three measures of self-efficacy in specific health contexts (breast self-exam, practice yoga, and condom use).
Self-efficacy measures have been used to measure confidence in executing global health behaviors. An example of this is a health self-efficacy scale provided by Lee, Hwang, Hawkins, & Pingree (2008).
1) Health self-efficacy was measured using five items, asking participants to indicate their level of agreement on the following statements:
- I am confident I can have a positive effect on my health
- I have set some definite goals to improve my health
- I have been able to meet the goals I set for myself to improve my health
- I am actively working to improve my health
- I feel that I am in control of how and what I learn about my health
All items were scored on a 5-point scale ranging from 0 (disagree very much) to 4 (agree very much). α = .84
2) Breast self-exam self-efficacy (Umphrey, 2004).
The self-efficacy measure consisted of responses to the following 4 items:
- I feel confident that I can perform breast self-examinations effectively
- I am confident in my ability to detect changes in my breasts
- I am confident that I know the correct procedures for conducting breast self-examinations
- I feel well informed about how to perform breast self-examinations
All items were scored on a 5-point scale ranging from 1 (strongly disagree) to 5 (strongly agree). α = .90.
3) Yoga self-efficacy items (Rimal, Lapinski, Cook, & Real, 2005).
Self-efficacy was conceptualized as the extent to which participants felt confident in their ability to practice yoga on a regular basis. This was measured through three questions:
- I am confident in my ability to spend about 20 minutes each day practicing yoga
- I am confident in my ability to set aside time every day for practicing yoga
- I believe practicing yoga on a daily basis would be difficult (reverse coded)
All items were scored on a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree). α =.77.
4) Condom self-efficacy (Noar, Zimmerman, Palmgreen, Lustria, & Horosewski, 2006). 5-item index adapted from Redding & Rossi, 1999:
Respondents indicated how confident they were on the following five items:
- When I really want sex
- When I am affected by alcohol or drugs
- When my partner pressures me to take a chance this time
- When I am upset
- When there's not much risk
All items were scored on a 5-point scale ranging from 1 (not confident at all) to 5
(extremely confident) that they could use condoms in situations; α =.84:
Rationale for Selection
These items were chosen because they represent a wide range of contexts in which perceived self-efficacy has been measured reliably. They provide a flavor of the types of items that are typically used in current research, and can be adapted to a particular health context under study.
The alphas for self-efficacy tend to have a broad range in the literature (e.g., .65 to .90) depending on the unique context of a study. The items selected as examples here have a range (.77 to .90).
Use of Measure (with examples)
Self-efficacy is a central concept in popular information processing models used in health communication including Social Cognitive Theory (Bandura, 2001), the Health Belief Model (Maiman & Becker, 1974; Janz & Becker, 1984; Rosenstock, 1974), Protection Motivation Theory (Rogers, 1975; Rogers, 1983), the Extended Parallel Process Model (Witte, 1992, 1998), and the Theory of Planned Behavior (Ajzen, 1985).
Self-efficacy also plays a major role in the maintenance of health behaviors, which has been documented across diverse health domains including: exercise (Fuchs, 1996; Rimal, et al. 2005), sexual activity (Galavotti et al., 1995), diet (Rimal, 2000), and cardiovascular disease prevention (Fleury, 1992). For a review across five varied health domains, see Strecher, DeVellis, Becker, & Rosenstock (1986). Individuals with comparatively higher levels of self-efficacy are more likely to sustain their healthy behaviors, probably because they construe obstacles as challenges to be overcome (Maibach & Murphy, 1995).
In an example of self-efficacy's pragmatic use in health care delivery, Benight and Bandura (2004) synthesized multiple studies on the generalized role of perceived coping self-efficacy to recover from varied traumatic experiences, such as natural disasters, technological catastrophes, terrorist attacks, military combat, and sexual and criminal assaults. They found perceived coping self-efficacy was an important mediator of post-traumatic recovery. They state: "Verification of its independent contribution to post-traumatic recovery across a wide range of traumas lends support to the centrality of the enabling and protective function of belief in one's capability to exercise some measure of control over traumatic adversity" (p. 1129).
Significant effort has been focused on longer self-efficacy scale development and adaptation. Generally, these scales focus on a particular health context. Some have developed multiple-factor scales, several of which can be combined into a general self-efficacy scale. Some employ multiple subscales.
Some examples of extended scales include: Gbenga, Mancuso, Allegrante, and Charlson (2003), who developed a 26-item scale for hypertension self-efficacy; Anderson, Dowds, Pelletz, et al. (1995) developed a 22-item scale to measure self-efficacy beliefs in patients with chronic pain; Grossmann, Brink, & Hauser (1987) developed a 35-item measure for diabetes self-efficacy; Redding & Rossi (1999) developed a 15-item scale on confidence in safer sex; Merluzzi, Nairn, Hegde, Martinez Sanchez, & Dunn (2001) developed the Cancer Behavior Inventory (v2.0), a 33-item, 7-factor measure of self-efficacy for coping with cancer.
If a particular research effort imposes stringent limits on the number of items, as is often the case, then reduced scales may be necessary. Luszczynska & Schwarzer (2005) argue items should be theory-based and include responses to barriers. They suggest using an item stem similar to: "I am certain that I can do xx, even if yy (the operant barriers)"; and the specificity of behaviors will likely vary according to the peculiarities and goals of a given study.