04.12.2020 in Nursing
Self-Efficacy Theory


Self-efficacy is an individuals judgment of their capabilities to execute causes of action. The theory assumes that people have the ability to exercise influence over their actions. Individuals can use tools of social influence such as reflective thought and generative us of skills and knowledge to perform a specific behaviour. Through the use of these tools of self-influence, an individual will decide how to behave. Self-efficacy is determined when an individual has the opportunity to self-evaluate individual output to some evaluative criterion. On the basis of this comparison process, an individual is able to judge his/her capability to perform and establish self-efficacy expectation.

Historical Background

Self-efficacy conceptualises the interaction of person-behavior-environment as a triadic reciprocity. The middle-rang theory is based on social cognitive theory. The initial study that led to the development of the theory involved random assignment of 33 subjects with snake phobias to three different treatment conditions. The first condition, anactive treatment, involved touching the snakes. The second condition, role modelling, involved watching others touch the snakes. The third condition was the control group. According to the results, self-efficacy predicted subsequent behaviour. Anactive treatment resulted in stronger self-efficacy expectations. The ideal control setting used in the initial self-efficacy research was that individual with snake phobias had no likelihood of seeking opportunities to interact with snakes while out of the laboratory settings. This means that the experiment had controlled input of efficacy information. The theory of self-efficacy has found wide application in studying and predicting health behaviour change and management in various settings.

Reference to the theorists work

The self-efficacy theory traces its source from the Social Learning theory proposed by Miller and Dollard in 1941. The theory was later broadened by Bandura and Walters in 1963 by adding the principles of vicarious reinforcement and observational learning. Resnick also broadened on the social cognitive theory and conceptualised person-behavior-environment as relating in triadic reciprocity. The assumption these theorists present is the ability of people to control their behaviour for a positive performance.

Problems Addressed By Self-Efficacy Theory

The main phenomenon of concern of the theory is that individuals can exercise control over their behaviour, thoughts and feelings and the environment to achieve happiness and positive health outcomes. The theory mainly addresses the feeling of loss of control among people with health problems. Many people, especially those suffering from depression believe that they are less capable of behaving effectively in managing threatening situations. The theory addresses the problem of having less confidence in ones ability to perform and manage difficult situations. People will low confidence in their ability to perform a task and respond to difficulties with anxiety, which disrupts performance (Masoudi Alavi, 2014). The self-efficacy theory seeks to motivate individuals to implement self-control strategies in challenging health situations as a therapeutic intervention to achieve positive health outcomes.

Reasoning of the Theory

The self-efficacy theory uses retroductive reasoning. All its arguments seek to demonstrate that the statements it proposes are true by showing that its denial produces an absurd result. For example, the theory demonstrates that a person can achieve positive health outcomes by believing that they are capable of performing the actions that produce the desired outcome. The theory suggests that individuals who believe that they do not have the ability to perform an action that results in positive health outcomes do not achieve the outcomes. Self-efficacy is the individuals believe that they can perform a behaviour that yields the desired outcome. The denial of an individual about his/her ability to perform a behaviour prevents the individual from achieving the outcome that results from the behaviour.

Theory Description

Concepts of the Theory

According to Bandura, the two components that make up self-efficacy theory are self-efficacy and outcome expectations. He further explains self-efficacy expectations as personal judgments about the ability to perform a task. Outcome expectations are also defined as judgments about what might occur if a task is accomplished successfully. The reason for differentiation of outcome expectations and self-efficacy is because individuals can believe that a specific behaviour will yield a specific outcome but fail to believe they are able to perform the behaviour required to make the outcome to occur. People anticipate different types of outcomes based on their judgments of their ability to perform the behaviour. Individuals who believe that they have a high efficacy in accomplishing a behaviour expect favourable outcomes that result from the behaviour. Therefore, expected outcomes depend on an individuals self-efficacy judgments. On this account, Bandura asserted that expected outcomes do not singularly lead to the prediction of behaviour.

In conditions of fixed extrinsic outcomes, it is possible to partially separate expected outcomes from self-efficacy judgments. Let us take the case of a nurse who provides care to four patients in a 10-hour shift and receives a fixed salary. The nurse will receive the same salary in the same 10-hour shift session when taking care of seven patients. The fixed salary for a varied number of patients will have a negative impact on the performance of the nurse. Individuals can also believe that they are able to perform a specific behaviour but fail to believe that the expected outcome is worthwhile. An example of older adults in rehabilitation may better demonstrate this phenomenon. The adults may believe their capability to perform exercises involved in the rehabilitation process but fail to believe that the activities will yield an improvement in their functional ability.

Outcome expectations are of particular relevance to older adults. This group may have high self-efficacy expectations for exercise. However, if they will not believe in outcomes that result from exercise such as improved health, and strength, there will be a less likelihood of adhering to regular exercise.

Interpretation of How the Concepts Is Defined

The concepts are defined explicitly. According to Bandura, judgment about and individuals self-efficacy can be viewed from four information sources. The first source is an active attainment, defined as the actual performance behaviour. The second information source is vicarious experience, which involves visualising other people with the same characteristic perform a behaviour. The third information source is verbal persuasion, which involves convincing the people to perform a behaviour. The fourth source is the physiological feedback during a behaviour such as fatigue or pain. When these factors are cognitively appraised, a perception of the degree of confidence in the ability of the individuals to perform a behaviour is identified. If the individuals perform the behaviour positively, self-efficacy expectations are reinforced

Enactive attainment

This is the most influential source of self-efficacy information. Empirical studies have repeatedly verified that performing an act strengthens self-efficacy beliefs. A combination of self-efficacy and outcome expectations plays a significant role in the performance of function activities, adoption and maintenance of exercise behaviour and self-management of clinical problems like diabetes and congestive heart failure. Enactive management strengthens self-efficacy to a greater level as compared to other informational sources.

Though, self-efficacy does not single-handedly establish self-efficacy beliefs. Other factors are required to impact a persons cognitive appraisal of self-efficacy beliefs such as the level of effort expended preconceptions of ability, past successes and failures and perceived difficulty of the task. For example, an old adult with a strong belief that he can bathe and dress all by himself because he has consistently done so for the past three months is less likely to change self-efficacy expectations on one morning he wakes up with severe arthritic changes which make him unable to done a shirt. Though, if he repeatedly fails to do a shirt by himself, self-efficacy expectations will be impacted. The stability of self-efficacy expectations is significant because an occasional failure can severely impact behaviour and self-efficacy expectations.

Vicarious Experience

Vicarious experiences imply visualising similar people successfully perform a similar activity. These experiences influence self-efficacy. Certain conditions determine the influence of vicarious experience. For example, if a person has no exposure to the behaviour of interest, vicarious experience will have a greater impact. Further, if the individual is not provided with clear guidelines of for performance, the performance of others will have a greater impact on self-efficacy of the individual.

Verbal Persuasion

Verbal persuasion involves telling individuals that they are capable of mastering a given behaviour. Verbal persuasion has shown great effectiveness in health promotion and in offering recovery support for chronic illness. Persuasion makes people with high efficacy to increase efforts of self-directed changes of risky health behaviour. An example where the information source has shown great achievement is in the rehabilitation settings. Verbal persuasion by nurses creates a positive impact on self-efficacy expectations. It also increases the likelihood of participation in rehabilitation and in exercise. In nursing, verbal persuasions are in the form of educational interventions. Verbal encouragement has been said to yield positive results in areas of infant care, breastfeeding and diabetes.

Physiological Feedback

Individuals judge their abilities partly based on information from their physiological states. Individuals perform behaviour after an evaluation of their physiological states. If the arousal is aversive, they avoid performing the behaviour. An older adult who fears falling while walking limits the performance because of the high arousal state that he associates with walking. This reduces the confidence in his ability to walk. Also, rehabilitation activities that cause pain and fatigue are perceived as physical inefficacy. Older people may develop a feeling of incapability to perform the activities.

However, interventions can be applied to alter the way individuals interpret physiological feedback and help in enhancing self- efficacy and coping with physical sensations. This leads to improved performance. The interventions include elimination of pain and other adverse conditions associated with physical activity.

Relationships among the concepts

Self-efficacy theory was derived from social cognitive theory. To this effect, it is interpreted in the context of reciprocal determinism. Vicarious experience, direct experience, derivation of knowledge through inference and judgment by others interact with the environmental and individual characteristics to influence self-efficacy and outcome expectation. Moderate behavior interacts with these experiences to strengthen self-efficacy and outcome expectation. Performance of a behavior also influences also influences self-efficacy and outcome expectations. Consequently, efficacy expectations and performance have a reciprocal relationship.



The self-efficacy theory builds on three basic assumptions. The first assumption is that individuals have powerful cognitive capabilities that allow them to create internal models of experience, develop innovative courses of action, hypothetically test the courses of action through the ability to predict outcomes and communicate complex experiences to others. This assumption indicates that individuals can engage in self-observation and evaluate their behaviour emotions and thoughts. These are the prerequisites for self-regulation.

The second assumption states that personal factors such as emotion and cognition, environmental events and behaviours have reciprocal influences. Individuals respond effectively, cognitively and behaviorally to environmental events. This assumption implies that individuals exercise control over their behaviour through cognition, which in turn influences environment and the biological states.

The third assumption states that individuals are capable of self-regulation. Individuals choose their goals and regulate their behavior to pursue the goals. Self-regulation is possible because individuals are able to anticipate. This assumption implies that individuals are able to use their past experiences and knowledge to form believes about future states, events, their abilities and behavior.

Clarity of the Theory

The self-efficacy theory is meets the criterion of clarity. The concepts of the theory are well defined. The theoretical framework is clearly defined by showing how efficacy expectations and outcome expectations are sources of self-efficacy. Clarity is achieved more systematically by clearly defining the construct and how they relate. The model also portrays self-efficacy as precedent of human behavior. The clear articulation of propositions to the relationship among key ideas is a demonstration that the theory meets the clarity criterion.

Concepts of the Nursing Metaparadigm

There are four concepts of nursing paradigm. The first concept is persons, referring to individuals who receive nursing care which includes patients, communities and families. The second concept is the environment, defined as the settings where nursing care is offered and the internal factors that affect the client. The third concept is health or illness which indicates an individuals state of well-being. The final concept is nursing, defined as the actions taken to provide care to individuals. In the self-efficacy theory, the nursing paradigm is based on reciprocal determinism. The theory is centred on the discipline of nursing as seen by the extensive use of the framework to generate testable hypotheses. These interactions involve the interaction between the prediction of outcomes of nursing interventions targeting intrinsic patient behaviours and altering the environment to improve the health outcomes of the patients.


How the Theory Would Guide Nursing Actions

The self- efficacy theory has found a wide application in the area of nursing research in areas of education, care, professionalism and nursing competency. Many studies have applied the theory to predict behavior and guide interventions. The specific areas of application include chronic illnesses, nursing education and participation in health-promotion activities like smoking cessation, exercises and weight loss. Self-efficacy expectations guide numerous intervention studies, particularly those touching on behavior.

Self-efficacy and Health Behavior

Self-efficacy has contributed greatly in understanding and improvement of health behaviors associated with exercise. Most of the nursing research studies in this area seek to establish the relationship between self-efficacy, outcome expectations and exercise behaviour. In most studies, outcome expectations were seen to be better predictors of exercise behaviour rather than self-efficacy expectations as postulated by Bandura. The theory has also been applied in addressing health behaviours such as osteoporosis screening, health promotion behaviour in inmates, healthy eating in urban women, and smoking cessation. All these studies exhibited a significant positive behaviour between self-efficacy and the behaviour in question.

Cultural and nursing care competence

Cultural competence is determined by use of knowledge of cultural concepts, and self-efficacy in the performance of cultural nursing skills. Research studies conducted indicate that nurses have moderate efficacy in cultural abilities and knowledge. Self-efficacy has also been also said to be an important concept in restorative care, use of assistive devices and professional nursing behaviour. Self-efficacy in all these areas has been said to influence outcome behaviour or mediate behaviour.


Nursing research has frequently used self-efficacy theory to address self-care and management across many clinical problems. The specific areas where self-efficacy has been applied include self-care management in cases of congestive heart failure, cardiac events, diabetes, peritoneal dialysis, back pain, birth control and managing depression. Self-efficacy guided all the nursing interventions aimed at improving adherence to self-care behaviours. Interventions based on self-efficacy have also been utilised in helping adults to manage multiple chronic illnesses. For example, a 2-hour session of education on management of chronic illness has been proved to improve health among older adults with chronic illnesses.

Cancer Care

Nursing research in oncology has identified a positive relationship between self-efficacy, adaptation to cancer and cancer prevention. Strong efficacy expectations are predictive f behaviours such as participation in cancer screening programs, smoking cessation, and adjustment to cancer diagnosis. High self-efficacy results in increased adherence to treatment decreased psychological symptoms and increased self-care behaviours.

Bone Health and Fall prevention

Self-efficacy interventions have found a wide application in bone health. They are applied in improve adherence to behaviours that boost good bone heath such as exercise and calcium diets. Research studies in this area are descriptive and they apply mastery experience and education to bolster self-efficacy expectations in an exercise aimed at bone strengthening, diet and adherence to medication.

Self-efficacy expectations have also been applied in strengthening self-efficacy expectations associated with fear of falling. The focus of these interventions is based on the assumption that the degree to which people fear to participate in certain activities varies among different individuals. Strengthening the self-efficacy expectations associated with fear of falling results increased the performance of the desired behaviour.

Specific Use of the Theory in My Area of Nursing

Self-efficacy theory can be used in various circumstances to direct nursing care. It is helpful in motivating participation in health-promoting activities like cancer screening, smoking cessation, regular exercise and weight loss. The theory is particularly helpful in function-based care interventions where behaviours of interest are integrated into routine care in clinical settings.

The use of the theory in function-focused care begins with the selection of a champion. The champion should help the Assisted Living community to optimise function and physical activity and also help caregivers achieve the same type of care. The champion uses mid-range theory to implement restorative care activities. The champion engages in verbal encouragement through goal setting, education, ongoing awareness and role modelling to eliminate unpleasant sensations that the assisted Living community holds about physical activity and function. The end result is the strengthening of self-efficacy and increased engagement of the Assisted Living community in function-focused care activities.

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