Self-Efficacy

Self-efficacy is the centerpiece of a theory of human agency developed by psychologist Albert Bandura of Stanford University. In his 1997 book, Self-Efficacy: The Exercise of Control, Bandura defined self-efficacy as consisting of “beliefs in one’s capabilities to organize and execute the courses of action required to produce given attainments” (p. 3). Very simply, self-efficacy is the belief that one is able to perform a specified action. Bandura argued that, by developing ways to identify, measure, and alter self-efficacy beliefs, behavioral scientists can devise effective methods to help people control their behavior and influence events that shape their lives and societies.

A large body of research supports this. Beliefs about self-efficacy affect personal decisions about what courses of action to pursue, how much effort to invest in a goal, how long to persevere when the going gets tough, how to cope with adversity, how much stress one experiences, and the amount of success achieved. The evidence supports Bandura’s (1997) claim that “beliefs of personal efficacy constitute the key factor of human agency” (p. 3). Self-efficacy, however, is not the only factor. Bandura argued that people also must believe that their actions will produce a desired result or outcome. Personal beliefs about the potential consequences of acting, or “outcome expectancies,” work together in concert with self-efficacy beliefs to shape human actions.

This may sound straightforward. Understanding self-efficacy, however, is not as simple as it might appear. For one thing, self-efficacy involves more than believing that one can perform the specific behaviors needed to complete a given task, such as preparing a healthy low-fat meal. One must be able to do more than read food labels, measure ingredients, adjust cooking temperatures, and peel, slice, and dice vegetables. All of these behaviors must be timed and coordinated in the right way. Two would-be chefs may be equally skilled at reading, measuring, slicing, and dicing. Yet the two may have very different self-efficacy beliefs about being able to orchestrate everything into a delicious meal. If advised to alter their diets, these two individuals might react in different ways because their levels of self-efficacy are not the same.

Sources Of Confusion

It is very easy to confuse self-efficacy with several concepts that seem similar. Here are some common examples and distinctions.

Self-confidence. This familiar term is more general, and far less precise, than self-efficacy. A patient’s self-confidence when facing an illness may involve a variety of considerations, some related to self-efficacy beliefs and some not. Whereas self-confidence may involve believing that one can perform actions needed to recover (self-efficacy), it also may include feeling loved and supported by one’s family or trusting one’s health care team.

Self-concept. People have many beliefs about themselves; the composite blend of these beliefs is called the self-concept. Unlike self-efficacy, the self-concept usually is defined as a global self-image. Bandura (1997) argued that this fails to do justice to the complexity of efficacy beliefs, which “vary across different domains of activities, within the same activity domain, at different levels of difficulty, and under different circumstances” (p. 11). Research shows that people’s self-efficacy beliefs predict their behavior more reliably than do their self-concepts.

Self-esteem. Self-efficacy refers to beliefs about one’s capabilities; self-esteem, on the other hand, refers to judgments about one’s worth or value as a person. These are very different things. Doubting one’s ability to sing a Verdi aria, for example, may not damage the self-esteem of those who lack operatic pretensions.

Locus of control. Health researchers have considered that motivation to adopt health behaviors may depend on believing that one’s actions will generate desired results; people who believe that they can greatly improve their health by dieting would be said to have a strong internal health locus of control. Self-efficacy, however, refers to the belief that one is capable of performing a specified action quite apart from considering its outcome. For example, an overweight person may strongly believe that he or she can lose 10 lb, yet not believe that dieting will affect his or her health. This individual would exhibit strong dieting self-efficacy, but weak internal health locus of control.

General self-efficacy. It would be very convenient if we could measure a person’s general or overall self-efficacy with a single scale. Bandura cautioned against this. Research indicates that beliefs about personal efficacy are not general across all activity domains and situations, but vary according to the type of performance and the setting. The term general self-efficacy thus should be considered an oxymoron.

Self-Efficacy In Social Cognitive Theory

It is misguided to focus on self-efficacy beliefs in isolation, for they are part of a larger explanatory framework, social cognitive theory (SCT), which Bandura developed from earlier social learning theory. According to SCT, human agency involves the interplay of three major factors that influence each other through a process of “triadic reciprocal causation” (Bandura, 1997, p. 7). This triad consists of personal factors (cognitive, affective, and biological events), behavior factors (what one says or does), and the environment (including ones social milieu). As a belief, self-efficacy is considered a personal factor in this scheme. As part of the causal triad, however, self-efficacy shapes, and is shaped by, behavior and the environment. Self-efficacy shapes behavior by influencing what one chooses to do; it shapes one’s environment by influencing the types of social situations to which one gravitates. The causal process also works the other way around: A performance success or failure (behavior), or a change in one’s social setting (environment), may cause self-efficacy to rise or fall. Environmental changes can have powerful effects on self-efficacy; for example, dieters often find it easier to control calorie consumption in some settings than in others (e.g., lunching alone at work vs. dining with friends at a restaurant).

Measuring Self-Efficacy

Self-efficacy is measured by asking people whether they can perform a specified behavior or task. Many researchers have used a measurement model developed originally by Ewart and his associates at Stanford in their research with cardiac patients. A questionnaire lists performances of increasing difficulty (e.g., walk, run, or climb various distances). For each item, patients are asked, “How confident are you that you could do this activity now?” They are told to indicate their level of certainty on a scale that ranges from “0 = Definitely cannot do it” to “100 = Definitely can do it” (for some populations, an 11-point scale from 0 to 10 is used). Other questions ask about self-efficacy for dietary changes to lower fat intake (e.g., limit myself to two or fewer egg yolks per week, switch from whole milk to nonfat or 1% fat milk), controlling eating (e.g., when anxious, when watching TV, when it is impolite to refuse), and refraining from smoking (e.g., when bored, after a meal, when offered a cigarette). It is important for the behavior to be specific (e.g., walk 2 miles) and to ask whether the person can do it now or within a specified time period (e.g., lose 1 lb per week for 10 weeks). Critical measurement issues must be considered when constructing self-efficacy scales (see sources in the Bibliography).

Strengthening Self-Efficacy

What is the best way to increase self-efficacy? According to Bandura, personal beliefs are altered by new information, and the information we gain directly from our experience has the greatest impact on our self-efficacy. Thus the best way to increase self-efficacy for a particular activity is to perform the activity in gradually increasing amounts. For example, heart patients who doubt their ability to jog 1 mile would be encouraged to start with much shorter distances and gradually increase the distance as their efficacy grows. Next to direct experience, observing someone very much like oneself perform the activity can have a powerful influence. It is important, however, that this person be someone like oneself who appears to have similar ability. A somewhat less powerful but still helpful source of efficacy information consists of feedback from a person one judges to be highly credible, as when a cardiologist explains to a patient, “Your treadmill test performance shows that you can jog a mile.” Other sources of efficacy information come from one’s internal physical states and moods. Discomfort after exercising may undermine self-efficacy if the sensations are interpreted as indicating injury. A negative mood can bias memory, making it easier to recall past failures, which undermines a sense of efficacy, whereas a positive mood can make it easier to recall past efficacy-boosting successes. Training people how to respond to internal cues and manage mood states may help.

Self-Efficacy And Health Promotion

Self-efficacy’s most important contribution to health is in suggesting practical methods for changing health behaviors. Programs derived from SCT have been developed to help people recover from heart disease, manage arthritis, cope with pain, curb addictions, and develop healthy eating and exercise habits. Efforts to apply SCT and self-efficacy to public health problems have led to the development of social action theory, an expanded conceptual framework that integrates self-efficacy with other behavior change mechanisms that must be coordinated when implementing health promotion on a wide scale.

Conclusion

Self-efficacy and SCT offer powerful evidence-based principles for understanding, measuring, predicting, and altering patterns of health behavior. The Bibliography is an introduction to the extensive literature on self-efficacy, scale construction, and applications to health.