Principle 8. Patient Self-Efficacy: Enhancing patient selfefficacy
regarding key chronic illness management tasks
improves the process and outcomes of care. Self-efficacy is
defined by Bandura as “people’s beliefs about their capabilities
to produce designated levels of performance that exercise influence
over events that affect their lives.”66 Self-efficacy is not a
process; it is an intermediate outcome or mediator of patient
adoption of self-management behaviors and health behavior
change. A review of fibromyalgia67 notes the extensive work of
Lorig and colleagues on self-management by patients with
rheumatoid arthritis and osteoarthritis.68,69 Behavior and health
status changes could be explained by patients’ attribution of
improved control over symptoms. This sense of control is
implicit in the definition of self-efficacy, that is, confidence in
one’s ability to perform a task. The most powerful component
of self-efficacy is mastery learning, which comes from achieving
success in performing a new behavior. The arthritis
self-management program, as cited earlier,40 provides training in
problem solving (Principle 5) and action planning, which are
used to achieve a sense of mastery over new tasks. A metaanalysisof psychological interventions for arthritis that featured
combinations of relaxation, CBT, stress management, and coping
skills training, either in groups or individually, found evidence
that pain and disability improved compared with
controls.70 Significant effect sizes in coping and self-efficacy
suggested that these factors may contribute to these outcomes.
Asthma patients with enhanced self-efficacy (ability to selfadjust
medications) showed more improvement in lung function
than patients who relied on physicians to adjust their
medication.36 Similarly, in COPD, “self-sufficiency” in managing
medical regimes was associated with a reduction in hospitalization.
71 Self-efficacy includes self-prediction; a metaanalysis
found that making a behavioral