Lecture 18: Patient Self-Efficacy

Question 1

What screening tool can be used for depression?

Answer 1

Screening questions for depression:
1. During the past month, have you often been bothered by feeling down, depressed or hopeless?

2. During the past month, have you often been bothered by little interest or pleasure in doing things?

Answering “no” to both of these questions was a very sensitive way or ruling out depression.

Answering “yes” to either of these questions had moderate specificity as a screening tool for depression.

Adding a third question:
3. Is this something with which you would like help?
(Three possible responses: “no,” “yes, but not today,” or “yes.”)

Question 2

What is self-efficacy?

Why is it important in rehab?

Answer 2

Belief in one’s capabilities to organize and execute the course of action required to produce given attainments. (Person’s belief in their capability to carry out a task in a given situation)

2. Pt’s self -efficacy level may influence:
   1) How much effort they invest in rehab
   2) perseverance
   3) Positive attitude
   4) Stress experienced during rehab

Question 3

Why is self-efficacy theory useful to rehab?

What are the four main strategies to promote self-efficacy?
Which is most effective?

Answer 3

1. This theory provides guidance for how self-efficacy can be enhanced in rehab.

2. 
Mastery experience
Vicarious experience 
Verbal Persuasion 
Physiological and affective states 

3. Mastery experience is potential the most effective.

Question 4

What is mastery experience?

How can it be promoted?

Answer 4

1. Successful performance of a behaviour or task increases self-efficacy.
2. • Have patient set their own goals (that are realistic and attainable). Can be facilitated by breaking tasks into small parts, and providing feedback so they can improve skills, etc.

• Identify and reinforce the patient’s past and present successes or accomplishments.
• Provide a sense of mastering tasks that were previously perceived as difficult or that the patient was afraid to attempt.

It is important that people attribute the success to their own efforts and abilities.

Question 5

What is vicarious experience?

How can it be promoted?

Answer 5

1. Observing similar others can raise or lower self-efficacy, most likely to raise SE if model is similar to the observer (age, sex and condition).
   - May be particularly useful in situations where pt has not past experience.
   - Model must overcome difficulties through effort rather than w/ ease.
   - Often happens in rehab w/ group format.
2. -Have the patient learn by observing others
   - Most effective in a group setting and/or with peers acting as models (i.e.
   same condition, and even similar age, sex, ethnicity)

Question 6

What is verbal persuasion?

How can it be promoted?

Answer 6

1. Constructive feedback or encouragement from others (or self).
2. -Information must come from a source that is perceived as trustworthy and
   having expertise in / knowledge of the topic.

-Provide positive feedback for the patient’s efforts or encourage people in the
patient’s social network, such as family members or friends, to do this.

-Provide strategies to self-motivate (self-talk)

Question 7

What are physiological and affective states?

How can they be promoted?

Answer 7

1. Mood, emotion, stress levels can affect self-efficacy.
2. -Facilitate the patient in adopting new health behaviors by ensuring that
   patients do not incorrectly interpret how they are feeling.
   -An example would be information that allows the patient to dissociate the
   experience of pain and/or perceived exertion with damage or injury, and encourage physical activity and exercise (Reinterpretation of physiological/ psychological arousal)

Ex: just b/c you experience pain doesn’t mean it is a dangerous thing (decrease anxiety)

Question 8

What are higher levels of self-efficacy associated with?

Answer 8

Greater self-efficacy associated with:
Less psychological distress, greater tolerance of pain and other symptoms, increased ability to cope, better self-care and physical functioning.

Compliance w/ treatment

Activity status

Better clinical outcomes

Reduced medical services usage.

Question 9

Why is self-efficacy important in PT?

Answer 9

HEP

PT is not a passive Rx, pt must be involved to achieve good results.

Important in chronic conditions.

Question 10

What are some examples of strategies to promote self-efficacy discussed in class?

Answer 10

• Journaling (pain charting)
• Peer exercise classes or support groups (role models)
• Patient-centered goal setting
• Positive self-talk
• Consider stage of recovery and readiness for group interventions
• In rehab constantly remind pt of where they have come relative to where they started.
• Inpatient rehab, others can be a source of vicarious experience.
• Record objective findings during rehabilitation to set realist goals post op.
• Patient education about their condition so they know what to expect.
• Strategies to manage stress and anxiety
• Educate family members so they can provide support.

Question 11

What are some potential barriers to promoting self-efficacy?

Answer 11

• Pt’s psychological response
• Cost of PT
• Location of services
• Home and work environment
• Fitness Level