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Promoting Self-Efficacy for Healthy Behaviors

Buckworth, Janet Ph.D., FACSM

doi: 10.1249/FIT.0000000000000318
Columns: Enhancing Your Behavioral Toolkit

Janet Buckworth, Ph.D., FACSM, has spent more than 25 years studying exercise adherence and theory-based behavior change interventions. She has master’s degrees in clinical social work and health education and a Ph.D. in exercise psychology, with work experiences in medical and college settings. Dr. Buckworth is a fellow of the American College of Sports Medicine, serving on the Behavioral Strategies Special Interest Group. Dr. Buckworth is a department head in kinesiology at the University of Georgia.

Disclosure: The author declares no conflict of interest and does not have any financial disclosures.

Self-efficacy is a belief in your capability to organize and execute actions that will lead to a specific outcome. This is a powerful belief that influences the adoption and maintenance of health-promoting behavior. Self-efficacy is a construct in several theories that are used to design and guide behavior change interventions. In social cognitive theory, the interaction among self-efficacy, the value one places on the outcome, and expectations about positive or negative physical, social, and psychological consequences of the outcome are used to explain and predict the behavior (2). Someone who expects and values benefits from cutting out fast food will still continue to eat fast food if he/she has little confidence in his/her ability to prepare healthy meals. Self-efficacy is also one of the key constructs of the transtheoretical model. Self-efficacy is predicted to increase as one progresses through stages of change and can be targeted in an intervention to help someone progress to the next stage (4). Moving from the preparation to the action stage for regular exercise can be fostered by making sure clients have confidence in their ability to make time to exercise. The self-determination theory assumes three basic needs (autonomy, relatedness, and competency), and the need for a sense of competency, that is, the need to experience mastery and achieve desired outcomes, is closely aligned with one’s self-efficacy (3). Thus, we stick with behaviors we believe we can do well (self-efficacy) to meet our need to feel competent, and we avoid those actions in which we doubt our ability. A successful runner who loses his/her first pickle-ball match will be more likely to continue running than joining a pickle-ball league.

Self-efficacy influences the choice of activities, and the stronger the self-efficacy for a particular behavior, the more effort and persistence.

Expectations of personal efficacy come from four main sources of information: performance accomplishments, vicarious experiences, verbal persuasion, and physiological states. Performance accomplishments are the most influential because they provide authentic evidence of whether one has the ability to act successfully. Success raises mastery expectations, and failure, especially early on, lowers expectations. However, appraisal of personal efficacy after performing a task also depends on evaluation of one’s capabilities before the task. Decreases in self-efficacy after someone starts a diet or exercise program might not be surprising given that initial self-efficacy for a new behavior is not based on experience, but beliefs about the new behavior and one’s abilities. Often, clients discover that behavior change and supporting activities (e.g., making it to a fitness class after work) are harder and more effortful than they thought, and their efficacy expectancies decrease to match their actual experiences. Likewise, we typically avoid situations that we believe exceed our coping skills, so we don’t get the opportunities to enhance those skills, and our self-efficacy remains low.

Self-efficacy influences behavior, and behavior influences self-efficacy.

Vicarious experiences, or social modeling, include observing someone engaging in the target behavior. These observations contribute to self-efficacy through symbolic construction that serves as a guide to behavior and opportunities for social comparison. If you see someone successfully doing what you have little confidence to do, expectations are generated that you too can succeed. For example, when a dinner companion chooses fruit for dessert, others at the table aiming to reduce sugar intake can experience an increase in their self-efficacy for making a healthier choice. Social modeling is more effective when the subject is similar to you. Seeing older women lifting heavy weights will have a greater impact on self-efficacy for strength training in other older women than for young men.

Providing encouragement can inform efficacy judgments by promoting the idea that clients can successfully cope with what has overwhelmed them in the past. This source of efficacy information is also called social or verbal persuasion and can take the form of motivation, support, and performance feedback. Encouragement is not as effective as mastery experiences in influencing self-efficacy because feedback and comments from other people do not provide an authentic experiential base. However, encouragement can contribute to success achieved by giving practical and specific feedback that enables clients to correct and improve their performance. This feedback can help enhance task and self-regulation skills that foster success and build a sense of mastery. The effectiveness of encouragement and performance feedback depends on the persuader’s perceived credibility, prestige, trustworthiness, expertise, and assuredness. A fitness professional perceived as well qualified by the client, such as through certifications and experience, will be more effective in enhancing the client’s self-efficacy than someone who is perceived as being unprepared and inexperienced.

Self-efficacy for behavior change includes self-efficacy for specific tasks (e.g., using the elliptical, cooking tasty fresh vegetables, or running a 5K road race) and for self-regulation skills (e.g., goal setting, self-monitoring, self-reinforcement, time management, decision-making, and problem-solving).

Physiological states (physical arousal) influence judgments of ability and can increase or decrease self-efficacy and behavioral choices. People are prone to ascribe arousal to personal deficiencies, especially in a threatening situation. Reducing emotional arousal can reduce avoidance of a specific behavior and open opportunities to receive performance feedback and develop mastery. Helping a client manage stress associated with finding time to walk at least 10,000 steps a day can help open up his/her focus to realistic problem-solving and ideas for creative time management. In addition, if someone perceives he/she has more control over a situation, such as through being given choices, arousal usually decreases.

Approaches you can use to enhance your clients’ self-efficacy are based on targeting these sources of self-efficacy information. Ensuring mastery experiences is important because clients may have a history with exercise and diet that include perceived failures. They don’t believe they can learn a sport skill, decrease sugar or fat in their diets, lift free weights, and so on because they have not been successful before. Make sure the client has chosen activities that are appropriate for his/her fitness and skill level, and if not, provide a plan to start with manageable goals that you are confident the client will achieve. Some examples of mastery experiences include choosing one healthy change per meal, setting a timer to stand and stretch several times a day, and adding 1 km to total run distance each week. Fitness professionals can make sure to adjust an exercise prescription to target observable gains. For example, including strength training at the beginning of a program may be useful because noticeable gains in muscular strength can be quicker than improvements in aerobic endurance. Increases in self-efficacy have a positive effect on persistence, which increases opportunities for additional reinforcing experiences to enhance confidence.

In a meta-analysis of the literature on intervention techniques to increase self-efficacy for physical activity, vicarious experience produced large positive effects on self-efficacy (4). Fitness professionals can bolster exercise self-efficacy in clients who perceive themselves as very different from “typical” fit and lean men and women by using testimonials and demonstrations from “models” similar to their clients. For example, having a retired dietitian offer a heart-healthy cooking class can influence self-efficacy for older adults striving to improve their diets.

Verbal persuasion (feedback and encouragement) is another source of efficacy information that is probably already in your toolbox. Instructive, clear, and positive feedback is powerful for improving performance and enhancing self-efficacy. Other ways to enhance the effects of verbal persuasion on self-efficacy include providing social support and feedback from different people and using several different modes of communication, such as video, voice, and text. Some studies found that feedback via email or online was associated with higher self-efficacy than verbal feedback (1), so think about ways you can use technology to supplement in-person communications. In addition, researchers have found that physical activity interventions including feedback on past performance or others’ performance produced the highest levels of self-efficacy. Group training during which clients receive corrections and encouragement highlights ways to target verbal persuasion and social modeling to bolster self-efficacy.

People rely on how aroused they feel to judge their confidence in a particular situation. Being highly aroused can debilitate performance, so clients are more likely to expect and experience success when they are less tense. Stress management strategies such as positive imagery and relaxation in addition to guidance in health behavior change make a potent combination. Fitness professionals with an accepting and welcoming demeanor can decrease some anxiety and avoidance behavior that may be associated with joining a program or hiring a personal trainer. Novice exercisers may experience increased heart rate, respiration, and muscle tension during exercise with anxiety or discomfort. The fitness professional can be sure that participants have information about the normal physiological responses to exercise and know how to interpret these responses. Connecting mood before a bout of exercise to mood after also can affect self-efficacy. Although many clients feel better physically and psychologically after a workout, reinforcing this awareness can help them interpret their response as evidence that they can exercise with success. Perception of physiological responses to food can be used to enhance self-efficacy for healthy eating by teaching clients to attend to feelings of hunger before and feelings of fullness during a meal, and how to eat more mindfully.

Many of the strategies described are already in the fitness professional’s toolbox, but understanding the sources of self-efficacy information can guide the fitness professional to new or modified strategies that will increase a client’s confidence to start a program, stay on track, and try something new.

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Confidence; Feedback; Modeling; Mastery

© 2017 American College of Sports Medicine.