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===== Self-efficacy theory =====
===== Self-efficacy theory =====
-
Self- efficacy theory was first proposed by Bandura (1982)<ref name="bandura1982" /> it refers to an individual's sense of confidence in their ability to execute a specific behaviour in different environments<ref name="bandura1997">BANDURA, A. (1997). Self-efficacy: The exercise of control. W.H. Freeman and Company: New York</ref>. An individual’s level of self-efficacy will depend on the amount of perseverance and effort applied to a specific behaviour<ref name="bandura1982" />. The individual's view of their efficacy may shape their actions, effort and attitude
(Bandura
, 1977
; Eysenck
, 1978). An essential component of self-efficacy theory is that the stronger the belief a person has in their ability to perform a set of actions, the more likely they are to comply and maintain participation throughout an intervention. However, those who have an inferior amount of self-efficacy could apply less effort and have an increased chance of relapsing when trying to change their behaviour
(Bandura and Cervone
, 1983). Furthermore Bandura (1997)<ref name="bandura1997" /> suggest that a person's level of self- efficacy is based on personal beliefs rather than objective assessments. Therefore a person’s beliefs can often predict their behaviour more accurately than their capabilities. This can result in a behaviour level that does not match the individual's capabilities and could be why behaviour between individuals varies even when they have similar understanding and skills set
(Lee et al
. 2008). It could then be argued that having self-efficacy alone could be sufficient enough to initiate a behavioural change<ref name="bandura1997" />.
+
Self- efficacy theory was first proposed by Bandura (1982)<ref name="bandura1982" /> it refers to an individual's sense of confidence in their ability to execute a specific behaviour in different environments<ref name="bandura1997">BANDURA, A. (1997). Self-efficacy: The exercise of control. W.H. Freeman and Company: New York</ref>. An individual’s level of self-efficacy will depend on the amount of perseverance and effort applied to a specific behaviour<ref name="bandura1982" />. The individual's view of their efficacy may shape their actions, effort and attitude
<ref name="bandura1977">BANDURA
,
A. (
1977
). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. vol. 84
,
no. 2. pp. 191–215.</ref><ref name="eysenck1978">EYSENCK, H.J. (
1978)
. Expectations as causal elements in behavioural change. Advances in Behaviour Research and Therapy. Vol. 1. pp. 171– 175.</ref>
. An essential component of self-efficacy theory is that the stronger the belief a person has in their ability to perform a set of actions, the more likely they are to comply and maintain participation throughout an intervention. However, those who have an inferior amount of self-efficacy could apply less effort and have an increased chance of relapsing when trying to change their behaviour
<ref name="bandc1983">BANDURA
,
A. AND CERVONE, D. (
1983)
. Self-evaluative and self-efficacy mechanisms governing the motivational effects of goal systems. Journal of Personality and Social Psychology. Vol.45. pp. 1017–1082.</ref>
. Furthermore Bandura (1997)<ref name="bandura1997" /> suggest that a person's level of self- efficacy is based on personal beliefs rather than objective assessments. Therefore a person’s beliefs can often predict their behaviour more accurately than their capabilities. This can result in a behaviour level that does not match the individual's capabilities and could be why behaviour between individuals varies even when they have similar understanding and skills set
<ref name="leeetal2008">LEE, L
.
L., ARTHUR, A. AND AVIS, M. (
2008)
. Using self-efficacy theory to develop interventions that help older people overcome psychological barriers to physical activity: a discussion paper. International journal of nursing studies. vol.45, no.11. pp.1690-1699.</ref>
. It could then be argued that having self-efficacy alone could be sufficient enough to initiate a behavioural change<ref name="bandura1997" />.
<br>
<br>
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[[Image:Selfefficacy.jpg|center|650x650px]]
[[Image:Selfefficacy.jpg|center|650x650px]]
-
There are many barriers to self-efficacy especially in the elderly and vulnerable populations that telehealth interventions are designed for. Misunderstanding the ageing process among older adults may result in restricted activity levels
(Lachman et al
. 1997). Lack of knowledge about the benefits of exercise may produce a dismissive attitude toward participation towards interventions involving physical activity
(King et al
. 1992). More so, Supposed ill health and symptoms related to physical disabilities associated with chronic disease are reasons behind dropping out of an intervention
(Clark
, 1999
; Lian et al
. 1999). Within this population group many of the barriers to activity are attitudinal and we must use the self-efficacy theory in order to provide appropriate interventions that install confidence and believe in the individual to help them to modify their behaviour
. (Lee et al. 2008)
.
+
There are many barriers to self-efficacy especially in the elderly and vulnerable populations that telehealth interventions are designed for. Misunderstanding the ageing process among older adults may result in restricted activity levels
<ref name="lachman1997">LACHMAN, M
.
, JETTE, A., TENNSTEDT, S., HOWLAND, J., HARRIS, B. AND PETERSON, E. (
1997)
. A cognitive–behavioural model for promoting regular physical activity in older adults. Psychology Health and Medicine. Vol.2. pp. 251–261.</ref>
. Lack of knowledge about the benefits of exercise may produce a dismissive attitude toward participation towards interventions involving physical activity
<ref name="kingetal1992">KING, A
.
C., BLAIR, S.N., BILD, D.E., DISHMAN, R.K., DUBBERT, P.M., MARCUS, B.H., OLDRIDGE, N.B., PAFFENBARGER JR., R.S., POWELL, K.E. AND YEAGER, K.K. (
1992)
. Determinants of physical activity and interventions in adults. Medicine and Science in Sports and Exercise. vol.24. pp. 221–236.</ref>
. More so, Supposed ill health and symptoms related to physical disabilities associated with chronic disease are reasons behind dropping out of an intervention
<ref name="clark1999">CLARK
,
D.O. (
1999
)
.
Identifying psychological, physiological, and environmental barriers and facilitators to exercise among older low income adults. Journal of Clinical Geropsychology. Vol. 5. pp. 51–62.</ref><ref name="lian1999">LIAN, W.M., GAN, G.L., PIN, C.H., WEE, S. AND YE, H.C. (
1999)
. Correlates of leisure-time physical activity in an elderly population in Singapore. American Journal of Public Health. Vol. 89. pp.1578–1580.</ref>
. Within this population group many of the barriers to activity are attitudinal and we must use the self-efficacy theory in order to provide appropriate interventions that install confidence and believe in the individual to help them to modify their behaviour
<ref name="leeetal2008" />
.
-
Existing literature has concluded that self-efficacy-based interventions to improve physical activity levels had a significant effect on outcome measures such as distance walked among older adults
(Allison and Keller
, 2004) and improvements in physical activity levels
(Allen
, 1996), but not in self-efficacy itself. This could indicate that self-efficacy is not necessary for bringing change in physical activity behaviour. This has been further emphasised by Calfas et al. (1997) and McAuley et al. (1994) who also used theory based interventions and found no connection between self-efficacy and behavioural change. Another limitation with self-efficacy literature especially with physical activity interventions is the lack of reporting by the authors on the actual content of the intervention making it difficult to compare interventions and standardisation of behavioural change techniques
(Ashford et al
. 2010).
+
Existing literature has concluded that self-efficacy-based interventions to improve physical activity levels had a significant effect on outcome measures such as distance walked among older adults
<ref name="allisonandkeller">ALLISON
,
M.J. AND KELLER, C. (
2004)
. Self-efficacy intervention effect on physical activity in older adults. Western Journal of NursingfckLRResearch. Vol. 26. pp. 31–46.</ref>
and improvements in physical activity levels
<ref name="allen1996">ALLEN
,
J.K. (
1996)
. Coronary risk factor modification in women after coronary artery bypass surgery. Nursing Research. Vol.45. pp.260–265.</ref>
, but not in self-efficacy itself. This could indicate that self-efficacy is not necessary for bringing change in physical activity behaviour. This has been further emphasised by Calfas et al. (1997)
<ref name="calfas1997">CALFAS, K. J., SALLIS, J. F., OLDENBURG, B. AND FRENCH, M. (1997). Mediators of change in physical activity following an intervention in primary care: PACE. Preventive Medicine. Vol. 26. pp. 297–304.</ref>
and McAuley et al. (1994)
<ref name="mcauley1994">MCAULEY, E., LOX, C., RUDOLPH, D. AND TRAVIS, A. (1994). Self-efficacy and intrinsic motivation in exercising middle aged adults. Journal of Applied Gerontology. vol.13. pp.355–370.</ref>
who also used theory based interventions and found no connection between self-efficacy and behavioural change. Another limitation with self-efficacy literature especially with physical activity interventions is the lack of reporting by the authors on the actual content of the intervention making it difficult to compare interventions and standardisation of behavioural change techniques
<ref name="ashford2010">ASHFORD, S
.
, EDMUNDS, J. AND FRENCH, D. P. (
2010)
. What is the best way to change self‐efficacy to promote lifestyle and recreational physical activity? A systematic review with meta‐analysis. British journal of health psychology. Vol.15. no.2. pp.265-288.</ref>
.
-
Conversely, physical activity interventions aiming to improve self -efficacy have improved confidence and the individual's adherence to physical activity interventions
(Dunn et al
. 1999
; Lee et al
. 2007). Existing research confirms that self-efficacy beliefs are critical in the initial adoption of an exercise routine
(Lee et al. 2008)
. If the participant is able to believe that they can exercise under circumstances that could result in the relapsing behaviour it is more likely that they will take part in exercise intervention (
Clark,
1996
; Sallis et al
. 1988). Therefore including self-efficacy theory in the design of physical activity intervention would be advantageous in guiding the participant towards adopting a new behaviour. Furthermore, In a systematic review by (Ashford et al. 2010) they found that self-efficacy was increased when the parts of the intervention was performed by a peer prior to the participant taking part and therefore knowing that another person was able to perform the activity gave the participants increased confidence in their own capabilities.
+
Conversely, physical activity interventions aiming to improve self -efficacy have improved confidence and the individual's adherence to physical activity interventions
<ref name="dunnetal1999">DUNN, A
.
L., MARCUS, B.H., KAMPERT, J.B., GARCIA, M.E., KOHL III, H.W. AND BLAIR, S.N. (
1999
)
.
Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. Journal of The American Medical Association. vol.281. pp.327–334.</ref><ref name="leeetal2007">LEE, L.L., AVIS, M. AND ARTHUR, A. (
2007)
. The role of self-efficacy in older people’s decisions to initiate and maintain regular walking as exercise—findings from a qualitative study. Preventive Medicine. vol.45. pp. 62–65.</ref>
. Existing research confirms that self-efficacy beliefs are critical in the initial adoption of an exercise routine
<ref name="leeetal2008" />
. If the participant is able to believe that they can exercise under circumstances that could result in the relapsing behaviour it is more likely that they will take part in exercise intervention
<ref name="clark1996">CLARK, D.O.
(1996
)
.
Age, socioeconomic status, and exercise selfefficacy. Gerontologist. Vol. 36. pp.157–164</ref><ref name="sallisetal1988">SALLIS, J.F., PINSKI, R.B., GROSSMAN, R.M., PATTERSON. AND T.L., NADER, P.R. (
1988)
. The development of self-efficacy scales for healthrelated diet and exercise behaviors. Health Education Research. vol.3. pp.283–292.</ref>
. Therefore including self-efficacy theory in the design of physical activity intervention would be advantageous in guiding the participant towards adopting a new behaviour. Furthermore, In a systematic review by (Ashford et al. 2010)
<ref name="ashford2010" />
they found that self-efficacy was increased when the parts of the intervention was performed by a peer prior to the participant taking part and therefore knowing that another person was able to perform the activity gave the participants increased confidence in their own capabilities.
In summary self -efficacy is a vital component of behavioural change, confidence in one’s ability to perform a certain behavioural change intervention. Looking at self-efficacy from a physiotherapy perspective it would apply the same principles as the physical activity interventions mentioned above. Influencing beliefs and establishing barriers to interventions could be influential when developing a telehealth intervention. Self-efficacy could be essential in patients complying with any intervention that may be beneficial to their health including mobile applications aimed at a specific injury, a health condition or chronic pain intervention.
In summary self -efficacy is a vital component of behavioural change, confidence in one’s ability to perform a certain behavioural change intervention. Looking at self-efficacy from a physiotherapy perspective it would apply the same principles as the physical activity interventions mentioned above. Influencing beliefs and establishing barriers to interventions could be influential when developing a telehealth intervention. Self-efficacy could be essential in patients complying with any intervention that may be beneficial to their health including mobile applications aimed at a specific injury, a health condition or chronic pain intervention.
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===== Key points =====
===== Key points =====
+
+
'''TTM''': A behaviour change model comprised of 5 stages and 10 processes of change necessary to change a persons behaviour.
+
+
'''Self efficacy''': Looks at the confidence in one's ability to chnage their behaviour and factors which can influence that confidence.
'''Motivation''': a complex term in which the act of doing something is represented by a certain reason: personal satisfaction (internal) or social demands (external). Lack of perceived competence and/or failure leads to Amotivation.
'''Motivation''': a complex term in which the act of doing something is represented by a certain reason: personal satisfaction (internal) or social demands (external). Lack of perceived competence and/or failure leads to Amotivation.