The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.
Get full access to this article
View all access options for this article.
References
1.
Bandura A.: Social Learning Theory. New Jersey, Prentice Hall, 1977.
2.
Bandura A.: Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev84:191-215, 1977.
3.
Bandura A.: Self-efficacy mechanism in human agency. Am Psychol37:122-147, 1982.
4.
Bandura A.: The self and mechanisms of agency, in Suls J (ed): Psychological Perspectives on the Self Vol I. Hillsdale, NJ, Erlbaum, 1982.
5.
Schunk D., Carbonari J.: Self-efficacy models, in Matarazzo J, Weiss S, Herd J, Miller N, Weiss S (eds): Behavioral Health: A Handbook of Health Enhancement and Disease Provention. New York, NY, John Wiley & Sons, 1984.
Wallston BS, Wallston KA : Social Psychological models of health behavior: An examination and integration, in Baum A, Taylor Se, Singer JE (eds): Handbook of Psychology and Health Vol IV. Hillsdale, NJ, Erlbaum, 1984.
8.
Crandall R.: The measurement of self-esteem and related constructs, in Robinson JP.Shaver PR (eds): Measures of Social Psychological Attitudes, Ann Arbor, MI, Institute for Social Research, 1978.
9.
Lazarus RS, Folkman S.: Stress, Appraisal and Coping. New York, Springer Publishing, 1984.
10.
Abramson LY, Garbcr J, Seligman MEP: Learned helplessness in humans: An attributional analysis, in Garber J, Seligman MEP (eds): Human Helplessness: Theory and Applications, NY, Academic Press, 1980.
11.
Pechacek Tgf, Danaher BG: How and why people quit smoking: A cognitive-behavioral analysis, in Kendall PC, Hollow SD (eds): Cognitive-Behavioral Interventions: Theory, Research, and Procedures. New York, Academic Press, 1979.
12.
Prochaska JO, DiClemente CC: Self change processes, self-efficacy and decisional balance across five stages of smoking cessation, in Liss AR (ed): Advances in Cancer Control: Epidemiology and Research. New York, Alan R. Liss, Inc., 1984 .
13.
Brod MI, Hall SM: Joiners and nonjoiners in smoking treatment: A comparison of psychosocial variables. Addict Behav9:217-221, 1984.
14.
Condiotte MM , Lichtenstein E.: Self-efficacy and relapse in smoking cessation program. J Consult Clin Psychol49:648-658, 1981.
15.
McIntyre, DO , Lichtenstein E., Mermelstein RJ: Self-efficacy and relapse in smoking cessation: A replication and extension. J Consult Clin Psychol51:632-633, 1983.
16.
DiClemente CC: Self-efficacy and smoking cessation maintenance: A preliminary report. Cog Ther Res5:175-187, 1981.
17.
Coelho RJ: Self-efficacy and cessation of smoking. Psychol Rep54:309-310, 1984.
18.
Godding PR, Glasgow RE: Self-efficacy and outcome expectations as predictors of controlled smoking status. Cog Ther Res, (in press).
19.
Strecher VJ , Becker MH, Kirscht JP, Eraker SA, Graham-Tomasi RP: Psychosocial aspects of changes in cigarette-smoking behavior. Patient Educ Couns7:249-262, 1985.
20.
Seligman Mep: Helplessness. San Francisco, Freeman , 1975.
21.
Maddux JE, Rogers RW: Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change. J Exp Soc Psychol19:469-479, 1983.
22.
Nicki RM, Remington RE, MacDonald GA: Self-efficacy, nicotine-fading/self-efficacy monitoring and cigarette smoking behavior. Behav Res Ther22:477-485, 1985.
23.
Chambliss CA , Murray EJ: Cognitive procedures for smoking reduction: Symptom attribution versus efficacy attribution. Cog Ther Res3:91-95, 1979.
24.
Rotter JB: Generalized experiences for internal versus external control of reinforcement . Psychol Monogr80:1014-1053, 1966 .
25.
Blittner M. , Goldberg J., Merbaum M.: Cognitive self-control factors in the reduction of smoking behavior. Behav Ther9:553-561. 1978.
26.
Jeffrey RW, Bjornson-Benson WM, Rosenthal BS, Lindquits RA, Kurth CL, and Johnson SL: Correlates of weight loss and its maintenance over two years of follow-up among middle-aged men. Prev Med13:155-168, 1984.
27.
Chambliss CA, Murray EJ: Efficacy attribution: Locus of control, and weight loss. Cog Ther Res3:349-353, 1979.
28.
Gilchrist LD, Schinke SP: Coping with contraception: Cognitive and behavioral methods with adolescents . Cog Ther Res7:379-388, 1983.
29.
McKinney, K.: Perceptions of efficacy and control, and contraceptive behavior. Unpublished Doctoral Dissertation. University of Wisconsin, Madison, Wisconsin, 1982.
30.
Levinson RA: Teenage women and contraceptive behavior: Focus on self-efficacy in sexual and contraceptive situations. Unpublished Doctoral Dissertation, Stanford University, Palo Alto, California, 1982.
31.
Rist F., Watzl H.: Self assessment of relapse risk and assertiveness in relation to treatment outcome of female alcoholics. Addict Behav8:121-127. 1983.
32.
Weinberg RSGould D., Jackson A.: Expectations and performance: An empirical test -of Bandura's self-efficacy theory. J Sport Psychol1:320-331, 1979.
33.
Ewart CK, Taylor CBReese LB, Debusk RF: Effects of early postmyocardial infarcation exercise testing on self-perception and subsequent physical activity. Am J Cardiol41:1076-1080, 1984.
34.
Kaplan RM, Atkins CJReinsch S.: Specific efficacy expectations media exercise compliance in patients with COPD. Health Psychol3:223-242, 1984.
35.
Becker MH (ed): The health belief model and personal health behavior. Health Educ Monogr2:324-508, 1974.
36.
Janz NKBecker MH: The health belief model: A decade later. Health Educ Q11:1-47, 1984.
37.
Kirsch I.: Efficacy expectations or response predictions: The meaning of efficacy ratings as a function of task characteristics. J Pers Soc Psychol42:132-136. 1982.
38.
Kirsch I.: Self-efficacy and expectancy: Old wine with new labels. J Pers Soc Psychol49:824-830, 1985.
39.
Bandura A.: Self-efficacy determinants of anticipated fears and calamities. J Pers Soc Psychol45:464-469. 1983.
40.
Baer JS, Holt CS, Lichtenstein E.: Self-efficacy and smoking re-examined: Construct validity and clinical validity . (in press).
41.
Marlatt GA, Gordon JR (eds): Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors. New York, Guilford Press, 1985.
42.
Bartlett E. : Educational self-help approaches in childhood asthma. J Allergy Clin Immunol72:545-553, 1983.
43.
Brickman P. , Redinowitz VC, Kawzu J., Coates J., Cohn E., Kidder L.: Models of helping and coping. Am Psychol37:368-384, 1982.
44.
Clifford JS : Self-efficacy counseling and the maintenance of sobriety. Pers Guicl J62:111-114, 1983.
45.
Weisz JR, Rothbaum FM, Blackhurn TC: Standing out and standing in: The psychology of control in America and Japan . Am Psychol39:955-969, 1984.
46.
Hamburg DA, Elliott GR, Parson DL (eds): Health Bohavior: Frontiers of Research in the Biobehavioral Sciences. Washington. D.C., National Academy Press, 1982.
47.
Schacter S. : Recidivism and self-care of smoking and obesity . Am Psychol37:436-444, 1982.
48.
Chapman S.: Stop smoking clinics: A case for their abandonment. Lancet1:918-920, 1985.
49.
Strecher VJ : A minimal-contact smoking cessation program for a health care setting. Public Health Rep50:497-502, 1983.
50.
Brownell KD , Marlatt GA, Lichtenstein E., Wilson GT: Understanding and preventing relapse. Am Psychol, (in press).
51.
Prochaska JO , Crimi P., Lapanski D., Martel L., Reid P.: Self-change processes, self-efficacy and self-concept in relapse and maintenance of cessation of smoking. Psychol Rep51:983-990, 1982.
