Empowerment is an important concept in the context of self-management. It is the precondition for and the consequence of self-management ability. Empowered patients are able to develop and strength their own competencies e.g., appropriate knowledge, attitudes and skill needed to cope with the disease within their own life (Virtanen et al 2007). This is an important construct for patients with chronic rheumatological conditions such as AS as they will constantly have to improve their knowledge and skills in relation to their condition to control the variability of their condition.
Self-efficacy perceptions plays an important mediating role in self-management activities, adoptine and maintaining health behaviour changes, and health outcomes. Bandura first introduced the concept of self-efficacy in 1977. Given equal disease severity, some patients are incapacitated by their condition, while others continue to live a full life and take control in the management of their condition. Self-efficacy may explain this discrepancy. It has been defined as: ‘Beliefs in one’s capabilities to organise and execute the course of action required to produce given attainments’.
(Bandura, 1997) It is thought that self-efficacy beliefs influence the courses of action pursued, the effort expended, perseverance in the face of difficulties, the nature of thought processes (e.g. encouraging or self-depreciating thoughts) and the amount of stress experienced in demanding situations (Barlow, 2002).Patients need to have self- efficacy to undertake and adhere to the self-management programme optimally and, thus, benefit from self-management.
It has been observed that having a high sense of confidence in a chronically ill person’s ability to perform behaviours that will enable them to control their symptoms may be health enhancing in and of itself (Daltroy, 1993). Equally, having low self-efficacy may mediate changes in health-related or disease self-management behaviours, thus worsening health outcomes, especially pain and mental health status (Shifren et al 1999).
Low self-efficacy has been associated with:
Poorer physical functioning
Greater physical impairment
Increased depression levels
Decreased acceptance of the condition(Barlow et al 2002, Beckham et al 1994)
Self-efficacy may also be fundamental to the individual’s willingness to perform desirable behaviours, to avoid undesirable behaviours, to invoke disinhibition of specific behaviours (Stretcher et al 1986), and to undertake favourable behaviour changes (Clark and Dodge, 1999). Higher pain self-efficacy levels have been found to be predictive of physical functioning (Dwyer 1997), adaptive coping efforts (Jensen et al 1991), less disability and depression (Arstein et al 1999) and reduces avoidance behaviours over an extended period (Asgari and Nicholas, 2001).
In clinical terms, it is important to note that although self-efficacy perceptions are open to intervention, it is the individual’s perceptions or beliefs about his or her true capabilities that can influence the individual’s behaviour. To achieve optimal disease management goals, the health education specialist should be prepared to facilitate patients and caregivers in enhancing self-efficacy for disease self-care and management (Marks et al 2005).
Assessing which patients have low self-efficacy, and identifying those who might be less likely to perform self-management behaviours as a result is likely to prove especially helpful in modifying health behaviours among those with chronic conditions. Because self-efficacy is potentially modifiable and can impact health status, motivation levels and adherence to prescribed regimens, intervention approaches that focus on self-efficacy hold much promise for improving chronic disease outcomes (Marks et al 2005 ).