Self-Efficacy and Health
Brenda M. DeVellis
Robert F. DeVellis
University of North Carolina at Chapel Hill
Kate Lorig, a health educator at Stanford University, tells a story about encouraging people with arthritis to begin exercise programs. Often, she explains, they believe that exercise would be beneficial but they also believe that embarking on a successful exercise program is not something that they can personally do. She will ask them, “Could you exercise for 15 minutes a day?” If they say they cannot, then she asks them if they would be able to exercise for 10 minutes? (Or 5? Or l?) Eventually, virtually everyone admits to being able to exercise at some minimal level. If individuals agree they could exercise for 1 minute, then she might ask them if they could exercise for 1 minute on five separate occasions during the day. If they agree, then she points out that what they have agreed they can do amounts to more than 30 minutes of exercise per week. From this beginning, people often progress quickly to achieving the 15 minutes of exercise per day that they initially felt incapable of doing. What has allowed them to progress from a state of inaction to a modest but significant change in their health behavior? Arguably, the critical factor is the perception that people have the ability to initiate and execute an exercise program. That is, they have a sense of self-efficacy.
In the quest to understand and regulate health behavior, few theoretical constructs have been enlisted as enthusiastically as self-efficacy. The concept has been discussed both as one of the major components of social cognitive theory and as a theory in its own right. Whichever approach is taken, it is clear that self-efficacy has generated a substantial amount of research and has been applied to understanding, predicting, and changing a vast range of human behavior -including behavior related to health and illness. Since its promulgation in the 197Os, self-efficacy has become progressively more visible in the health literature. Entering the text word “self-efficacy” into the MEDLINE database reveals no citations between 1966 and 1975, 9 between 1976 and 1980, 75 between 1881 and 1986, 343 between 1987 and 1992, and 552 between 1993 and July 1997. Thus, it is clear that self-efficacy is a preeminent concept in contemporary health psychology.
Bandura (1995a, 1995b, 1997), the creator of self- efficacy and social cognitive theory, published two major books on self-efficacy that cover much of the research done in the area prior to 1997. In addition, Maddux (1995) published an edited book on self-efficacy containing reviews of self- efficacy in a number of domains, as well as a spirited interchange between Bandura and Kirsch about the relation between efficacy and outcome expectations. Another recent review of self-efficacy has been done by Schwarzer and Fuchs (1995) and, finally, Maibach and Murphy (1995) wrote a very helpful, user friendly article on measuring self-efficacy.
This chapter draws heavily on the aforementioned books and articles. It begins by discussing how self-efficacy has emerged from earlier social learning theory concepts and its present status as a pivotal aspect of social cognitive theory. Next, it discusses processes that mediate the influence of self-efficacy on behavior. This is followed by differentiating self-efficacy from other psychological constructs. It then examines factors that contribute to a sense of self- efficacy and summarizes issues related to its measurement. Finally, it presents a brief overview of studies examining self-efficacy and health.