Self-efficacy keeps coming up everywhere I go. I have the honour of working with the California Institute for Mental Health on the Small County Care Integration collaborative. The teams are working on integrating behavioral health and primary care. The clients they work with have serious mental illness and are often also facing physical illness, sometimes partially due to the medications they take for their mental illness. The teams are measuring the self-confidence of their clients using the question Dr. John Wasson and his team developed: 'How confident are you that you can control and manage most of your health problems?' Responses: Not very confident, somewhat confident, very confident. (This question is copyright FNX Corporation USA and the Trustees for Dartmouth College.)
Dr Wasson has actually suggested that what the world needs is a 'Campaign for Confidence.' I agree with him. What would happen if we stopped focusing on clinical outcomes and specific behaviors and helped people feel more confident? I'm looking forward to finding out.
What could we do to improve confidence? First of all, remember that we need to be focusing on the problems the person has, not what health care professionals think they should focus on. Corbin and Strauss, in their qualitative study of people with chronic conditions, Unending Work and Care: Managing Chronic Illness at Home (1988), provide the guidance we need. People with chronic conditions face three tasks:
1) To manage the illness (to take medications, do treatments, monitor the condition, work with the health care team, etc.)
2) To adapt life roles (how to manage daily life and demands of life in light of the illness)
3) To manage emotions (most often anger, fear, frustration, and depression)
Whenever I am in an interaction, I know these three ideas can help shape the encounter. How is the person doing with these three tasks? What can I do to help? Are they confident in these three tasks?
The next thing to do is to build confidence through mastery. This is one of the techniques known to increase efficacy. Learning new skills is important. Making action plans based on self-determined goals and achieving them is another. There are many ways to do this. The Five A's grew out of successful smoking cessation interventions and can be useful. The way that I have found most useful recently is Brief Action Planning. Dr Steve Cole initiated the idea, and several of us have worked together to refine it. The Action Planning process of the peer-lead Chronic Disease Self-management Program is another excellent example.
The basics are the same:
1) Take a goal, which is usually something that is accomplished over months, like 'become for physically fit so I can play ball with my grandson' and break it down into smaller steps that can be achieved in a week or two, like 'walk around the park three times this week on Monday, Wednesday and Friday after breakfast.'
2) A good check on the plan is to complete a confidence scale of 0-10, 0 indicating no confidence to complete the plan and 10 is totally sure. A confidence higher than 7 indicates increased likelihood of success, and if the confidence level is lower, the plan is revised until confidence is high, remembering that success increases confidence.
3) The check-in on the plan is important, too, either with the person who helped make the plan or a self-check in.
4) When plans go awry, problem solving is used. The basic steps are identifying the REAL problem, brainstorming ideas and picking one to try, really try for a week or two, to see if it helps. If the first idea doesn't help, try another, or get ideas from another. If that doesn't help, sometimes now isn't a good time to work on this issue and something else might help.
Self-efficacy is a many faceted concept. Hopefully these ideas provide some guidance on what to do to build it.
Read Connie Davis' Self-EFFICACY, Part 1 here.