By Ralf Schwarzer, Freie Universität Berlin, Germany and SWPS University of Social Sciences and Humanities, Poland

Changing behavior may often be desirable but difficult to do. For example, quitting smoking, eating healthily and sticking to a physical exercise regimen all require motivation, effort, and persistence. While many psychological factors play a role in behavior change, self-efficacy is one of the most important.

What is self-efficacy, and what does it do?

Have you ever found it difficult to refrain from drinking alcohol when dining out? Although you may believe that not drinking is the right thing to do, you may find it hard to control. This feeling of difficulty indicates low self-efficacy to abstain from alcohol. Self-efficacy is the amount of personal control that we expect to have over a behavior in difficult situations. It is an optimistic belief in our own capability to tackle new or demanding challenges. If we hold a strong belief that we can master an upcoming task (i.e. have high self-efficacy), then we are likely to work towards it. If we feel confident that we can overcome an upcoming threat or challenge (e.g., an exam), then we are more likely to approach than to avoid this threat. On the contrary, if we have self-doubts (i.e. low self-efficacy), we might hesitate to act. Thus, self-efficacy guides behavioral changes and supports optimal functioning. 

What does the research on health behavior change tell us?

Reviews indicate that high self-efficacy predicts engagement with several important health behaviors, including cigarette smoking cessation, weight control, contraception, alcohol abuse, fruit and vegetable intake, dental flossing, and exercise behavior. Additionally, intervention studies indicate that increasing self-efficacy leads to improvements in behavior (e.g. dietary behaviors and physical activity). Taken together, these findings indicate that individuals need a certain amount of self-efficacy in order to undertake important health behaviors and achieve desired outcomes (e.g. weight loss). 

As self-efficacy is clearly important when guiding people to behavior change, two key questions remain: How can we tell if someone has high or low self-efficacy? And what can we do to increase self-efficacy when it is low? 

How can we assess the level of self-efficacy?

The most common way is to ask individuals to endorse certain statements. A suggested rule for the behavior-specific assessment of self-efficacy is: “I am confident that I can … (perform an action), even if … (a barrier).” An example of a self-efficacy statement is: “I am confident that I can skip desserts even if my family continues to eat them.” Self-efficacy scales have been developed for the measurement of all kinds of health behaviors. Some brief scales to assess self-efficacy for diet, exercise, sunscreen use, dental flossing, hand hygiene, and alcohol intake can be found here and here. When assessing self-efficacy, it is important to note that low self-efficacy for one behavior does not imply low self-efficacy for a different behavior. Self-efficacy should therefore be assessed in relation to a specific behavior.

How can we increase self-efficacy?

Most interventions to improve self-efficacy pertain to four sources of information that form a hierarchy. First, on top of this hierarchy, self-efficacy beliefs can improve through personal accomplishment. To foster these mastery experiences, you can guide clients to perform small steps that are likely be achieved successfully. You can then provide positive feedback to reinforce this mastery experience, and encourage the person to master subsequent more challenging steps as well. Such graded tasks can be useful in clinical settings such as in physiotherapy (e.g., gradual progression of balance and strength exercises), or cognitive behavior therapy for phobias.  

The second source of self-efficacy is vicarious experience, or observing others. When individuals witness other people (similar to themselves) successfully master a difficult situation, social comparison and imitation of the behavior can strengthen self-efficacy beliefs. Imagine you are in the process of smoking cessation but your partner cannot manage to quit due to low self-efficacy. Then try to increase your partner’s self-efficacy by moving through small steps, disclosing your own barriers and coping attempts, demonstrating how you overcome craving situations, expressing your optimistic beliefs, etc. Thus, as a self-efficacious and self-disclosing coping model you can make a difference: you can enhance self-efficacy in someone else when you communicate openly how you cope with cravings and how you master a variety of challenging situations where temptations seem to be overwhelming. 

Third, and less powerfully, self-efficacy beliefs can also be changed through verbal persuasion. For example, you could reassure your clients that they can adhere to a demanding new dietary regimen, due to their competence and ability to plan. Or, you could tell the person that they have what it takes to succeed in anything they put their efforts into. These types of persuasion can strengthen self-efficacy for successfully managing the task at hand. 

The fourth source, the perception and interpretation of physiological arousal, is less relevant in health behavior interventions. However, one could target this source of self-efficacy by preparing clients for potential physiological discomfort when initiating new health behaviors (cravings during smoking quit attempts, muscle aches after exercise etc.), which can help to reduce early relapses. 

In conclusion, self-efficacy is a meaningful and changeable belief that is important for initiating and maintaining healthy behaviors. When self-efficacy is low, taking steps to increase it can help people to change their behaviors. 

Practical recommendations:

• Assess self-efficacy. When discussing a possible health behavior change with a patient or client, assess their self-efficacy for the possible change.  This can be done using a questionnaire or by asking about their confidence for enacting the new behavior in specific difficult situations.
• Intervene to increase self-efficacy. If an individual has low self-efficacy, try target one of these sources of self-efficacy with your behavior change intervention:
  • Encourage mastery experiences. Work with the person to help them structure their efforts to change so that they can achieve small successes with the new behavior early and often. 
  • Identify vicarious experiences. Use tailored testimonials or help the person to identify role models (similar to themselves) who have had success with the new behavior. 
  • Persuade.  Let the person know that you believe in their abilities and that they have what it takes to change.