MARYAM ABACHA

AMERICAN
UNIVERSITY OF
NIGERIA,
KANO.
 SCHOOL OF
NURSING SCIENCE

COURSE:
COMMUNITY
HEALTH NURSING

COURSE CODE: NUR

3205
 GROUP 9

SELF-EFFICACY
THEORY

 EMMANUELLA OLUWADAMILOLA OLADELE

MAAUN/22/NUR/0027
 MOYINOLUWA OLASOJI BEAULAH
MAAUN/22/NUR/0064
 ABDULHAMID RABI AUWAI
MAAUN/22/NUR/0093
 HUSSAINA ABDULWAHAB
MAAUN/22/NUR/0094
 NWADIKE OMELEBERE JACINTA
 MAAUN/22/NUR/0020
 ZAINAB ADO YAKASAI
MAAUN/22/NUR/0010
 CHILAKA CHIOMA CYNTHIA
MAAUN/22/NUR/0002
 MUHAMMAD NIMAT
MAAUN/21/NUR/0078
 KHADIJAH YA’U BWALA
MAAUN/22/NUR/0095
 RUQAYYAH YUSUF
MAAUN/22/NUR/0091

INTRODUTION
The term ‘‘self-efficacy” was first coined by psychologist Albert Bandura
(1977), a Canadian-American psychologist and a professor at Stanford University.
He originally proposed the concept, in his own words, “as a personal judgment of
how well one can execute courses of action required to deal with prospective
situations”.
Self-Efficacy is a person’s particular set of beliefs that determine how well
one can execute a plan of action in prospective situations (Bandura, 1977). To put
it in more simple terms, self-efficacy is a person’s belief in their ability to succeed
in a particular situation. It is an individual's belief in their capacity to act in the
ways necessary to reach specific goals. Bandura was responsible for bringing the
term to light, but psychologists have studied self-efficacy from several
perspectives.
To give an example of another perspective, Kathy Kolbe, an educator and
best-selling author, thinks that believing in one’s own abilities can be vital in
measuring cognitive strength (2009). She believes that self-efficacy also involves
determination and perseverance, seeing as how it helps one overcome obstacles
=that would interfere with utilizing those innate abilities to achieve goals.
Self-efficacy affects every area of human endeavor. By determining the
beliefs a person holds regarding their power to affect situations, self-efficacy
strongly influences both the power a person actually has to face challenges
competently and the choices a person is most likely to make. These effects are
particularly apparent, and compelling, with regard to investment behaviors such
as in health, education, and agriculture.
A strong sense of self-efficacy promotes human accomplishment and
personal well-being. A person with high self-efficacy views challenges as things
that are supposed to be mastered rather than threats to avoid. These people are
able to recover from failure faster and are more likely to attribute failure to a lack
of effort. They approach threatening situations with the belief that they can
control them. These things have been linked to lower levels of stress and a lower
vulnerability to depression. In contrast, people with a low sense of self-efficacy
view difficult tasks as personal threats and shy away from them. Difficult tasks
lead them to look at the skills they lack rather than the ones they have. It is easy
for them to lose faith in their own abilities after a failure. Low self-efficacy can be
linked to higher levels of stress and depression.

HOW DOES SELF-EFFICACY

DEVELOP?
Source: The Pennsylvania State University

Albert Bandura (1977) states individuals develop their self-efficacy beliefs by

interpreting information from four main sources of influence.

1. Mastery Experiences (Performance Outcomes)

The most influential source is the interpreted result of one’s previous
performance or mastery experience. When talking about Mastery experiences,
this refers to the experiences one gain when one takes on a new challenge and
are successful at doing so.
“Mastery experiences are the most influential source of efficacy
information because they provide the most authentic evidence of whether one
can muster whatever it takes to succeed. Success builds a robust belief in one’s
personal efficacy. Failures undermine it, especially if failures occur before a
sense of efficacy is firmly established” (Bandura, 1997).
 One of the best-proven ways to learn a new skill or to improve one’s
performance in a given activity is by practicing. How can one be sure that
practicing and acquiring new skills will lead to mostly positive experiences? In
most cases, part of the reason this works so well is that people, unknowingly
throughout this process, are teaching themselves that they are capable of
acquiring new skills.
This positive way of thinking, believing that one is capable of achieving
tasks they set out for themselves, is a boon because part of the struggle of getting
better at anything or learning something new is making sure the person believes
they are capable of carrying out said task successfully.

2. Vicarious Experiences (Social Role Models)

The second important source of self-efficacy is the vicarious experiences
provided by social models.
Bandura (1977) posits that “Seeing people similar to oneself succeed by
sustained effort raises observers’ beliefs that they too possess the capabilities
to master comparable activities to succeed.”
Vicarious experiences involve observing other people successfully
completing a task. When one has positive role models in their life (especially
those who display a healthy level of self-efficacy), one is more likely to absorb at
least a few of those positive beliefs about the self. Social role models include
older siblings, older friends, camp counselors, parents, aunts and uncles,
grandparents, teachers, coaches, and employers.

3. Social Persuasion
Receiving positive verbal feedback while undertaking a complex task persuades a
person to believe that they have the skills and capabilities to succeed. Self-efficacy
is influence by encouragement and discouragement pertaining to an individual’s
performance or ability to perform (Redmond, 2010)
For example, if one were telling an elementary school child that they are
capable of achieving greatness and that they should set out to achieve anything
their heart desires – this would be how verbal persuasion looks in action. Verbal
persuasion works at any age, but the earlier it is administered, the more likely it is
to encourage the building of self-efficacy.

4. Emotional and Physiological States

The emotional, physical, and psychological well-being of a person can influence
how they feel about their personal abilities in a particular situation. For example,
if you are struggling with depression or anxiety, you might find it harder to have a
healthy level of well-being. Is it impossible to build self-efficacy while suffering
from some of these struggles? Of course not, but boosting your self-efficacy is
much easier when one feels healthy and well (Bandura, 1982).
However, Bandura (1977) states, “it is not the sheer intensity of emotional
and physical reactions that is important but rather how they are perceived and
interpreted”.
People who have a high sense of efficacy are likely to view their state of
affective arousal as an energizing facilitator of performance, whereas those who
are beset by self-doubts regard their arousal as a debilitator.” Thus, individuals
can improve their sense of self-efficacy by learning how to manage anxiety and
enhance their mood when experiencing challenging situations.
Bandura wasn’t the only psychologist to delve into researching self-efficacy.
One example of another influential self-efficacy researcher is James Maddux, who
is actually responsible for suggesting the existence of a fifth main source of self-
efficacy: imaginal experiences, or visualization (Maddux and Meier, 1995).

Imaginal Experiences/Visualization
James Maddux (2013) has suggested a fifth route to self-efficacy through
“imaginal experiences,” the art of visualizing yourself behaving effectively or
successfully in a given situation.”
Imaginal experiences (or visualization) are basically someone attempting to
portray their goals as achievable. It’s like the old saying that goes, “it’s so close
you can almost taste it” – visualization is about putting yourself (in your head) in
a pole position to being capable of achieving anything one sets your mind to. With
this method, in order to enhance one’s own self-efficacy or that of a child, the
focus needs to be on painting a picture – making success seem like the most likely
outcome (Maddux and Meier, 1995).
By painting oneself or others in a favorable position, Maddux (1995)
hypothesized that the levels of self-efficacy in said individuals would rise given
that they are now more susceptible – after portraying themselves at the finish line
– to believe in themselves.

BUILDING SELF EFFICACY

“People’s beliefs about their abilities have a profound effect on those abilities.
Ability is not a fixed property; there is huge variability in how you perform.
People who have a sense of self-efficacy bounce back from failure; they
approach things in terms of how to handle them rather than worrying about
what can go wrong” (Bandura, 1977b).

1. Emphasize Peer Modeling

Learning from examples set by those around you happens at any age (think of
how a teacher is a role model for a student, but in a similar manner an employer
is a model for an employee). This concept of peer modeling, while it can be
applied to any age, is, of course, especially true for children on the early side of
the spectrum and is most effective when a child’s direct peers (brothers, sisters,
parents, teachers, friends) set the example (Bandura, 1988).
To put peer modeling into simple terms, it is when a child or an adult shows
good social behaviors and is interested in passing on those same values to a new
person. Take, for example, a work setting, one employee takes center stage for
the week and shows both business savvy and good social behaviors. This
employee will be a peer model to the rest of the employees of the company. They
will want to learn how to act and behave in that manner, especially if this good
behavior helped them achieve more success or drew more praise from the boss.

2. Seek Feedback
 The problem with understanding feedback is that some people tend to
believe that getting no feedback is the same as being told that one is doing their
job well (hence the common phrase: “no feedback is great feedback”). When
done with both the right intentions in mind and also in the right manner,
feedback can be one of the most important sources of building levels of self-
efficacy. Employees and students alike tend to want to know how they are doing.
In order for the feedback to work positively, feedback must be delivered both
concisely and frequently.
Without frequent feedback, one can be confused as to whether they should
remain doing what they are doing, and without concise feedback, the individual
will not understand what in particular they should fix about themselves. Self-
efficacy and subsequent task performance improve after receiving higher, more
detailed levels of performance feedback (Beattie, Woodman, Fakehy, Dempsey,
2015).

3. Encourage Participation
Participation tends to be essential in any work environment. It encourages the
person to be active and engaged, great qualities in someone that are usually
influential in a person’s levels of self-efficacy. Participation is especially important
at an early age. Those students who engage with the class are not only being
more active in their learning, they are probably absorbing more information in
regards to the material. Active class participation is also correlated to having high
critical and higher-level thinking skills.
Participation is also an essential quality of a peer model – this is a person
who has previously engaged in active learning and can teach others in a similar
manner. The level of thinking associated with an activity that requires
participation goes beyond simple comprehension of text, it engages both the
instigator and the audience. More importantly, participation helps fellow students
learn from each other – and people tend to build their levels of self-efficacy
depending on how those who are most close to them behave.

4. Allow People to Make Their Own Choices

When talking about the importance of letting people make their own
choices, the term self-accountability usually tends to come to mind. Whether the
outcome is positive or negative, making one’s own decisions allows for one to feel
responsible (due to your cunning or due to your negligence, the person
themselves is the one held accountable for if the outcome turned out in your
favor or against you).
Another important reason to emphasize self-accountability is that making
one’s own choices and decisions allow one to make their own mistakes and most
importantly, gives one the opportunity to learn from them. Advice is not the same
as a command. An individual can advise one on something, but it is a person’s
own responsibility to do whatever they feel like with said information. This is why
a peer, although very helpful, is not enough; the person needs to understand that
at the end of the day, if they want to model anyone, the only person capable of
taking action is themselves.

Applications of Self-
Efficacy
High self-efficacy has been linked with numerous benefits to daily life, such
as resilience to adversity and stress, healthy lifestyle habits, improved employees’
performance, and educational achievement.

1. Healthy Habits
According to health psychologists (Bandura, 1988), people are more likely to
engage in healthy behaviors when they feel confident in their capabilities to
successfully carry out those behaviors. To give one example, having higher levels
of self-efficacy could help one stick to an exercise routine. This tends to be a
positive on multiple ends – the goal of finishing the workout is complete due to
the higher levels of self-efficacy, and the finished exercise routine helps with your
bodily and mental wellness.
Self-efficacy is also a factor that helps people adopt other healthy lifestyle choices
– like trying to keep a healthy diet or trying to stop smoking. For whatever one
would want to use it for, health psychologists believe that self-efficacy can be
applied in ways that promote a healthy lifestyle.

2. Academic Success
Mart van Dinther (2011) and a number of his colleagues conducted
research on the link between education and self-efficacy. Their conclusions state
that self-efficacy is linked to factors such as the strategies that students utilize,
the goals that students set out for themselves, and their academic achievements.
In other words, higher levels of self-efficacy are related to what people
everywhere largely consider to be, healthy student life habits. This means that
those individuals with higher levels of self-efficacy could be subject to doing
better in school and being more organized.

3. Treating Phobias
Bandura (1982) proposed that self-efficacy could be used in an effective
manner to treat phobias. He wanted to test this by conducting an experiment.
He started with two groups, one group would directly interact with their
phobia (in this case, snakes), and the members of the second group would
watch someone partake in activities with their phobia.
The point was to assess which group, after different ways of approaching a
phobia would still be more fearful of snakes. According to the results of the
experiment, the participants who had directly interacted with the snake
showed higher self-efficacy and less avoidance.
This suggests that personal experience is more effective than observation
when it comes to developing self-efficacy and facing our fears.

How is Self-Efficacy
Measured?
The General Self-Efficacy Scale (GSE) was developed by Matthias Jerusalem and
Ralf Schwarzer – the scale is composed of only 8 items, rated on a scale from 1
(strongly disagree) to 5 (strongly agree).
 1. “I will be able to achieve most of the goals that I have set for myself”
2. “When facing difficult tasks, I am certain that I will accomplish them”
3. “In general, I think that I can obtain outcomes that are important to me”
4. “I believe I can succeed at most any endeavor to which I set my mind”
5. “I will be able to successfully overcome many challenges”
6. “I am confident that I can perform effectively on many different tasks”
7. “Compared to other people, I can do most tasks very well”
8. “Even when things are tough, I can perform quite well.”
The scores are then calculated by taking the average of all eight responses (these
will respectively range from 1 to 5).
The way the test is supposed to work is so that the higher one’s score is, the
greater the level of self-efficacy in said individual.

Self-Efficacy and Related

Ideas
1. Self-esteem vs. Self-efficacy
Self-esteem is one’s sense of self-worth, while self-efficacy is the perception of
one’s own ability to reach a goal. To give an example, let’s say we have an
individual who is a terrible horse rider. In regards to horse riding, this person
would probably exhibit low levels of self-efficacy given that they themselves
believe they are terrible at horse riding.
This person’s self-esteem, however, will probably not be affected if the
person doesn’t rely on horseback riding to determine self-worth (and with how
out of scope this activity is, it is very unlikely that this is the case). Conversely,
let’s say the individual is actually very skilled at horseback riding, yet this
individual has set such a high standard and has based enough of their self-worth
on this particular skill that their self-esteem is actually quite low. In any case, both
examples illustrate how self-esteem and self-efficacy are indeed related, but they
are not the same term.

2. Confidence vs. Self-Efficacy

When Bandura first began researching self-efficacy (1977), he wanted to
demonstrate that the construct of self-efficacy needed a separate definition from
a more colloquial term like “confidence.” Why was this the case? The issue with a
term like “confidence” and why it can’t mean the same thing as self-efficacy is
that confidence is a nonspecific term that refers to the strength of belief but does
not necessarily specify what certainty is about.
For example, an individual can be confident in their innate ability to screw
up anything. The perception of self-efficacy is distinct – it refers to believing in
one’s own capabilities and that one can produce given levels of attainment.
Therefore, the reason one can’t use confidence in the same vein as the term self-
efficacy is that confidence (unlike self-efficacy) fails to include both an affirmation
of a capability level and the strength of that belief.

3. Motivation vs. Self-Efficacy

Motivation is based on an individual’s desire to achieve a certain goal, while self-
efficacy is based on an individual’s belief in their own capacity to achieve said
goal. While in most cases, those same individuals with high self-efficacy often
have high motivation and vice versa, it is essential to understand that this is not
just a foregone conclusion.
Think of motivation as what makes one get out of bed, and think of self-
efficacy as one’s own perception of believing that they have the necessary
strength to get out of bed – the two terms go hand but are certainly not
exchangeable.
Of course, logically speaking, it still remains true that when an individual
maintains or increases their levels of self-efficacy, that usually tends to make
these individuals get a boost in motivation to continue learning and making
progress. This relationship can go both ways; take, for example, an individual who
is motivated to learn and succeed. When an individual is highly motivated to be
successful, most of the time, it means that they are likelier to achieve whatever
goals they set out for themselves, which contributes to increases in their levels of
self-efficacy.

IMPLICATION OF SELF-
EFFICACY THEIORY TO
COMMUNITY HEALTH
NURSING/SELF EFFICACY
IN A NURSING CONTEXT

Self-Efficacy in Nursing Research

Self-efficacy theory has been receiving much attention as a predictor of
behavioral change and self-care management in health-related and educational
research. This may be partially attributed to the shift in the health care paradigm
from a disease-centered (pathogenic) to a health-centered (salutogenic)
orientation. The salutogenic orientation emphasizes personal well-being and an
ideal state of health as the ultimate goals and works towards achieving these, as
opposed to the pathogenic approach, which is primarily based on identifying
problems or diseases and only attempting to solve them
. One of the major concepts of the salutogenic theory is the sense of
coherence, which refers to an individual’s ability to adopt existing and potential
resources to counter stress and promote health. It is measured based on one’s
perceived value of the outcome of the behavior (meaningfulness), one’s belief
that the behavior will actually lead to that outcome (comprehensibility), and
one’s capability of successfully performing the behavior (manageability), of which
Antonovsky drew analogous comparison to the three conditions for self-
efficacious behavior: self-efficacy beliefs, behavioral efficacy beliefs and the value
of anticipated outcomes.
The salutogenic approach has much in common with Bandura’s self-
efficacy theory that highlighted perceived self-efficacy’s crucial influence on
choice of behavioral settings. Antonovsky drew reference to it stating how an
individual with a strong sense of coherence would more likely choose to enter
situations without evaluating it as stressful, or in stressful situations, would
appraise a stressor as benign. Under the salutogenic umbrella, self-efficacy is one
of the key components that drive health-promoting practices, behavior and self-
care management. In a recent study, self-efficacy is found to be positively related
to sense of coherence, with this association being the strongest among people
with low sense of coherence. Additionally, self-efficacy was found to have either a
significant direct effect on behaviors or it becomes a mediator between other
psychological factors and health behavior.
An electronic search was conducted on four databases (PsycInfo, PubMed,
Embase and Cinahl) for English language articles that were published from each
database’s inception up to December 2019. Keywords used revolved around the
concept of self-efficacy in nursing and health care, such as “self-efficacy”, “chronic
disease”, “nursing education”, and “patients”. The search generated a repertoire
of studies, which primarily involved patients with chronic illnesses, parents during
the perinatal period, nursing or medical students, and the youth or elderly
population.

Use of Self-Efficacy in Health Promotion Among Patients with

Chronic Illness
For patients with chronic medical conditions (e.g. sickle cell disease,
asthma, cardiovascular disease (CVD), inflammatory bowel disease, cancer),
higher levels of self-efficacy to manage their own chronic conditions are related to
higher health-related QoL (Quality of Life}, reduced perceived stress, lesser
anxiety and depressive symptoms and lower symptom severity and also predict
symptom resolution.
 Similar results were found in mental illness studies examining unipolar and
bipolar disorders, where higher self-efficacy was positively related to mental and
physical health-related QoL. Conversely, a study on multi-morbid primary care
patients reported that lower self-efficacy and higher disease burden leads to
lower QoL. The notable two-way relationship between certain predictors and
outcomes highlights the complexity of addressing patient self-efficacy.
Given the rise in the ageing population and an increasing prevalence of
chronic diseases, patient empowerment is imperative to reduce health care
burden. Community and individual empowerment are one of the key health
promotion principles stated in the Ottawa Charter for health promotion that
focuses on enabling people to exercise more control over their health,
environment and health choices. Besides, an intervention study using an
empowering self-management model that focused on self-awareness, goal
setting, planning, adjusting physical, psychological and social structures, and
evaluation was found to improve self-efficacy and sense of coherence among
elderlies with chronic diseases. In particular, self-efficacy is strongly related to the
competence component of the empowerment concept, and it plays a critical role
in the initiation and maintenance of positive behavior change and is a vital
mechanism for effective self-management. Higher self-efficacy results in better
self-management, which leads to improved health outcomes that not only reduce
health care service burdens but also health care utilization.
In terms of patient self-care and management, there is substantial evidence
confirming the relationship between self-efficacy (both general and specific, e.g.
pain self-efficacy) and self-management behaviors. Studies have identified a
positive relationship between self-efficacy and opioid or medication adherence,
increased communication, partnership, self-care and positive patient-centered
communication. A diabetes study reported diabetes management self-efficacy as
the only predictor of diabetes control. Higher education level and receiving health
education were shown to boost management self-efficacy that was associated
with self-care activities (i.e. nutrition, medication, physical exercise) and glycemic
control. This also holds true for cancer patients, where self-efficacy and social
support directly and indirectly affected self-management behaviors, specifically,
patient communication (e.g. communicating concerns, asking questions,
expressing treatment expectations), exercise and information seeking. Pertaining
to patients with physical disabilities, social functioning, stronger resilience and
less pain and fatigue were strongly associated with disability management self-
efficacy, which is crucial for increasing odds of employment among disabled
youths.
Studies have identified a few predictors of self-efficacy among patients with
chronic diseases such as duration of diagnosis, severity of disease symptoms, age,
availability of social support and health education, and absence of complications
and depression. Of these variables, availability of social support and healthy
literacy can easily be manipulated through intervention programs. Most studies
have found a positive relationship between self-efficacy and health literacy,
especially functional health literacy, but there are a few that found no significant
associations between self-efficacy and health literacy. In addition, social support
is a major factor affecting patients’ self-efficacy and self-management behaviors.
Apart from boosting self-efficacy and self-management, higher social support was
shown to reduce difficulties in medical interactions among breast cancer patients
and enhance well-being among diabetes patients. Therefore, it is necessary for
health care and educational interventions to include components of social
support, health education when targeting patients’ management self-efficacy.
According to a recent review by Allegrante et al., much of the empirical
research and reviews that have been conducted on the effectiveness of
interventions to support behavioral self-management of chronic diseases have
demonstrated small to moderate effects for changes in health behaviors, health
status, and health care utilization for certain chronic conditions. Such
interventions that targeted or examined self-efficacy as an outcome included
web-based, mobile app-based and face-to-face educational training or programs.
In Chao et al.’s study, a cloud-based mobile health platform and mobile app
service for diabetic patients to self-monitor progress and goals set was found to
increase self-efficacy, improve health knowledge and increase behavior
compliance rate, especially in women. Ali and colleagues reported higher
pharmaceutical knowledge, patient satisfaction and self-efficacy among
cardiovascular disease patients who were qualified to self-administer medication,
as compared to those who were just provided educational brochures by nurses.
 In another study, an 8-week Patient and Partner Education Programme for
Pituitary disease (PPEP-Pituitary) was found to increase patient and partner’s self-
efficacy. Self-care behavior and self-efficacy of asthma patients also improved
after attending a self-efficacy intervention constituting educational videos,
resources, social support group and phone-based medical follow-up. Other
interventions focused on caregivers’ self-efficacy by providing caregiver trainings
and stress management trainings, which were effective in improving caregivers’
self-efficacy in managing patients’ symptoms, reducing caregiver stress and
increasing preparedness in caregiving. The effectiveness of these interventions in
improving self-efficacy suggests the importance of education, progress
monitoring, information resources, social support, and patient–provider trust and
communication in self-management behavior, promoting interventions for
patients with chronic diseases and their caregivers.

Role of Self-Efficacy in Parental Outcomes in the Perinatal

Period
The emergence of self-efficacy studies on new parents or parents during
the perinatal period has revealed the association of self-efficacy with childbirth
and psychological well-being and childbirth outcomes. During pregnancy,
maternal childbirth self-efficacy is positively correlated with vigor, sense of
coherence, maternal support and childbirth knowledge, and negatively correlated
with history of mental illnesses. Moreover, maternal childbirth self-efficacy affects
maternal well-being during pregnancy in terms of negative mood, anxiety,
depressive symptoms and fear of childbirth. The level of maternal self-efficacy
also influences birth choices, with elective caesarean and higher dosage of
analgesic epidural during childbirth being more common among mothers with
lower childbirth self-efficacy. In order to better prepare mothers for childbirth,
few studies have adopted a blended approach of antenatal mindfulness practice
and skill-based education programs, which was effective in improving childbirth
self-efficacy, mindfulness, reducing fear of childbirth, stress, antenatal depression,
and opioid analgesic use. The mindfulness programs also saw a reduction in
postnatal depression, anxiety, and stress. Other studies that implemented
antenatal psychoeducation programs also report increase in childbirth self-
efficacy among mothers and reduction in fear of childbirth.
After childbirth, receiving informal social support is essential for maternal
parenting self-efficacy, which helps to reduce risk of postnatal depression. A study
by Salonen et al. comparing parenting self-efficacy levels between mothers and
fathers revealed that mothers tend to score higher than fathers on parenting self-
efficacy. Age, multiparity, presence of depressive symptoms, perception of
infant’s health and contentment, and quality of partner relationship were shown
to be significant predictors of parenting self-efficacy in mothers and fathers.
Parenting self-efficacy not only is crucial for personal health and well-being
but also contributes to healthy marital relations, family functioning and child
development. Therefore, various educational and technology-based interventions
have been developed in hopes of boosting parental self-efficacy in the
postpartum period. A postnatal psychoeducation program designed for the first-
time mothers, consisting of a face-to-face educational session during a home visit,
an educational booklet and three follow-up telephone calls was found to be
effective at enhancing maternal self-efficacy, reducing postnatal depression, and
increasing perceived social support.
A more recent technology-based Supportive Educational Parenting
Program (SEPP) targeting both parents, comprised of two telephone-based
educational sessions and 1-month follow-up via an educational mobile health
app. As compared to routine postpartum care, the SEPP was effective in
promoting parenting self-efficacy, parenting satisfaction, parental bonding, better
perceived social support and reducing postnatal depression in both mothers and
fathers.
Self-efficacy in the postpartum period also includes breastfeeding. Dennis
reported significant predictors of breastfeeding self-efficacy as maternal
education, support from other mothers, type of delivery, satisfaction with labor
pain relief, satisfaction with postpartum care, perceptions of breastfeeding
progress, infant feeding method as planned and maternal anxiety.
 A study conducted among Japanese women found that breastfeeding self-
efficacy is also associated with maternal perceptions of insufficient milk, leading
to discontinuation of breastfeeding during the immediate postpartum period.
Breastfeeding is highly encouraged by health care professionals due to its
nutritional value, benefits to the infant’s development and potential mother–child
bonding; therefore, studies seek to develop educational or support programs to
promote breastfeeding. During pregnancy, antenatal educational interventions
using breastfeeding workbook or videos and demonstrations have shown to be
effective in increasing mothers’ breastfeeding self-efficacy at 4 weeks postpartum.
During the postpartum period, peer-support interventions for
breastfeeding are more common. Combined with professional support, peer-
support breastfeeding programs are effective in boosting breastfeeding self-
efficacy.
Despite the heavy focus on maternal self-efficacy during and after
pregnancy, there has also been an increase in health care research on fathers’
involvement during the perinatal period, as early paternal involvement during and
after pregnancy was found to positively influence maternal well-being and benefit
the biopsychosocial development of infants 14 months and below. A recent study
by Shorey et al., found that high paternal self-efficacy is one of the main factors of
high paternal involvement during infancy, especially among first-time fathers.
Higher paternal self-efficacy also leads to increase in parenting satisfaction
over the first 6 months postpartum. According to a review on informational
interventions aiming to improve paternal outcomes, there were only three
interventions (via online dissemination of information or self-modelled
videotaped interaction and feedback) that reported on paternal self-efficacy, but
only Hudson et al.’s study found an intervention effect on parenting self-efficacy
and parenting satisfaction in fathers. In addition to informational interventions,
educational interventions are also useful and important in boosting paternal self-
efficacy and other paternal outcomes.

Overall, in order to effectively enhance parental self-efficacy across these

various aspects (i.e. childbirth, parenting, breastfeeding) during the perinatal
period, it is necessary for interventions to incorporate and target at least a
component of the self-efficacy theory (mastery experiences, vicarious
experiences, verbal persuasion, and emotional and physiological arousal).

Role of Self-Efficacy in Nursing Education

Another application of self-efficacy in the health care setting is with regard
to nursing education and training. Effective clinical trainings should establish a
sense of self-efficacy among nursing students, which is a key component for
acting independently and competently in the nursing profession. Students’ clinical
performance, course completion and achievement motivations are also
dependent on individual perceived self-efficacy. According to Bandura, students
with low self-efficacy will tend to avoid situations that led to past failures;
therefore, strong sense of self-efficacy and job satisfaction is crucial in reducing
attrition in the nursing profession. Lastly, as a future health care practitioner,
clinical self-efficacy and competence are essential for providing quality health
care and ensuring patient safety.
Evidence has suggested that older age, being married, more working
experience in the nursing field, individual interest and willingness to work in a
nursing unit contributes to high nursing self-efficacy in students, which is also an
important factor in creating clinical confidence. Clinical environments, nursing
colleagues, and clinical educator’s capabilities can influence the creation of
clinical self-efficacy in nursing students.
A weak relationship between faculty and hospitals, lack of staff and training
facilities, and unprofessional trainers could adversely influence self-efficacy. More
specifically, students have reported that using logbooks, having more authentic
clinical simulations, working alone, more ward time, being under the guidance of
one instructor, and receiving constant verbal validation, positive feedback and
support can increase one’s own sense of self-efficacy. These corresponds with
components of the self-efficacy theory in terms of mastery experiences, vicarious
experiences and verbal persuasion.
Numerous education and clinical training curriculums are being developed
and constantly revised to target promotion of self-efficacy in specific clinical skills
among nursing students. Sabeti and colleagues found that students’ self-efficacy
ranges from weak to excellent across different skills, with high self-efficacy in
medication administration and nursing procedures, and low self-efficacy in care
before, during and after diagnostic procedures. In Pike et al.’s study, despite
undergoing a clinical simulation program aimed to improve learning self-efficacy,
students still reported low self-efficacy in communication skills. However, in
another study, a blended learning pedagogy was used to redesign a nursing
communication module from didactic lectures to an online and face-to-face
interactive classroom sessions, which resulted in increased communication self-
efficacy and better learning attitudes among nursing students.
In nursing education, clinical simulations are widely used to create
authentic scenarios and training environments and were often the most effective
method in boosting students’ self-efficacy. A study comparing the effectiveness of
a peritoneal dialysis simulation with watching videos reported higher
psychomotor skills score and self-efficacy among students who underwent the
simulation than those who just watched videos of the procedure. Similarly, a
Diverse Standardized Patient Simulation was also seen to improve students’
transcultural self-efficacy perceptions. Notably, simulation exercises were more
effective at improving students’ self-efficacy and critical thinking skills when
conducted after a role-play than after a lecture. Overall, nursing curriculum and
clinical simulations play a vital role in mastery experiences, and the integration of
positive feedback (verbal persuasion) and observation of clinical educators in
ward settings (vicarious experiences) would present an ideal method of enhancing
self-efficacy among nursing students.

SUMMARY
The term ‘‘self-efficacy” was first coined by psychologist Albert Bandura
(1977), a Canadian-American psychologist and a professor at Stanford University.
Self-Efficacy is a person’s particular set of beliefs that determine how well one can
execute a plan of action in prospective situations (Bandura, 1977). According to
Albert Bandura, individuals develop their self-efficacy beliefs by interpreting
information from four main sources of influence which include: Mastery
Experiences (Performance Outcomes), Vicarious Experiences (Social Role Models),
Social Persuasion and Emotional and Physiological States.
Bandura wasn’t the only psychologist to delve into researching self-
efficacy. One example of another influential self-efficacy researcher is James
Maddux, who is actually responsible for suggesting the existence of a fifth main
source of self-efficacy: imaginal experiences, or visualization (Maddux and Meier,
1995). Imaginal experiences (or visualization) are basically someone attempting to
portray their goals as achievable. It’s like the old saying that goes, “it’s so close
you can almost taste it” – visualization is about putting yourself (in your head) in
a pole position to being capable of achieving anything one sets your mind to.
There are four ways in which self-efficacy can be built. They include:
Emphasizing on Peer Modeling, Seeking Feedback, Encouraging Participation and
Allowing people to make their own decisions.
High self-efficacy has been linked with numerous benefits to daily life, such
as resilience to adversity and stress, healthy lifestyle habits, improved employees’
performance, and educational achievement. It can also be applied to Treating
Phobias: Bandura (1982) proposed that self-efficacy could be used in an effective
manner to treat phobias. He wanted to test this by conducting an experiment. He
started with two groups, one group would directly interact with their phobia (in
this case, snakes), and the members of the second group would watch someone
partake in activities with their phobia. The point was to assess which group, after
different ways of approaching a phobia would still be more fearful of snakes.
According to the results of the experiment, the participants who had directly
interacted with the snake showed higher self-efficacy and less avoidance. This
suggests that personal experience is more effective than observation when it
comes to developing self-efficacy and facing our fears.
 CONCLUSION
The self-efficacy theory is in itself linked with other psychological theories
to influence health-promoting behavioral changes in various life situations. The
applications of self-efficacy in various nursing contexts ultimately boil down to
health promotion and improvement of the quality of health care and patient
safety.
The concept of self-efficacy has played a significant role in not only
predicting individual physical and psychological wellbeing, competencies, and
self-care management, but also often serve as a theoretical framework for
existing clinical and educational interventions.
Despite its well-established literature base, emerging evidence on self-
efficacy’s positive relationship with sense of coherence and the gradual shift of
the health care paradigm to a salutogenic orientation indicate a need for
subsequent nursing research to continue to tailor and refine ways to enhance
self-efficacy in specific population groups.

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