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Theories and Strategies - Self Efficacy Theory and Stages of Change Theory

SELF EFFICACY THEORY

• Self Efficacy is a person’s belief in their ability to change their behavior.
• A person’s belief in their ability to change a specific behavior strongly, predicts their ability to make that change.
• Strategies which increase self efficacy are powerful tools to foster behavioral change.

THE FOUR SKILLS

1. Mastering Skills
2. Modeling
3. Clarifying the Meaning of the Disease/Symptom and
4. Persuasion with Social Support

MASTERING SKILLS

• Helping people master specific skills creates successful experiences and builds the confidence to continue
• Skills are broken down into very small tasks and each task is mastered before adding a new task.

TIPS FOR HELPING PEOPLE

1. Start with a task the person chooses and be SURE they can achieve it.
2. Have the person say what they want to do (like going for a walk two days a week).
3. When the person is more confident give him/her an opportunity to change the goal.
4. When that goal is reached. Build on the success by increasing the goal only a small amount.
5. Make sure that the goal is what the person wants and the person is willing and able to carry it through.

SOME GOOD OPTIONS

• Support groups help set goals.
• People can write their own goals.
• Keep a log of results.
• Make changes, set new goals and talk to people.

MODELING

• Seeing someone who is coping with the same problem.
• Talking with people we respect and are similar to us.
• When we see someone we know who quit smoking or losing weight and it gives us confidence that we can do the same.
• Role playing and brainstorming can help.
• People we know well can often help.
• Support groups and peer-led groups can use modeling effective.
• Super achievers are not helpful models.

FATIGUE AND REST

• Fatigue is a side effect of many chronic condition.
• A common response to fatigue is rest. However, fatigue can also be caused by depression, stress, medications or weakness.
• When fatigue is caused by depression, stress, or weakness, exercise will alleviate the fatigue and rest will only increase it.
• Once a person starts exercising, s/he will gain confidence in their ability to control their symptoms.
• Behavior change programs need to help people learn to understand symptoms.
• They also need to reach logical conclusions to minimize them.
• People often fear their symptoms have serious health consequences.
• Teaching people which symptoms can be a serious threat is crucial.

PERSUASION AND SUPPORT

• Give the clear message that a person is capable of change.
• Encourage them to take steps toward change.
• Create an atmosphere that is supportive of change.
• Change helps people do the hard work.
• In a group you need a sensitive leader, shared group norms, and a consistent agenda building trust, safety, and support.
• Working with a partner offers the opportunity to both give and receive support.
• Arousing fear can be a form of persuasion when used in the right situations and in a very limited way.
• Fear should be used with great sensitivity and caution or not at all.
• Fear can cause defensiveness and make the person less likely to want to change

RELAPSE/RECYCLE

• When people try to change they often don’t reach their goal on the first try.
• Only 20% reach their goal on their first try.
• People who take action toward a new behavior and fail, are twice as likely to take action again in the next 6 months and succeed.
• WHY DO PEOPLE RELAPSE?
  • Old behaviors meet a need.
  • When they are eliminated, the need still exists.
  • That is why substituting a new behavior for an old one is effective
• People often try to change through trial and error rather than using a careful plan and specific techniques
• People may take action before they are really ready to change when someone else insists that they change.
• Change often costs more than people expect in terms of time, energy and money.
• They forget it took years to create the situation.
• They don’t realize that it takes a lots of time and energy to change it.
• Stress can cause relapse.
• A response to stress is to return to comfortable old habits and stop putting forth the effort change requires.
• Social pressure or lack of social support can cause relapse.

USEFUL TECHNIQUES

• Set an expectation in the beginning of an intervention that a lapse is likely and can be overcome.
• Help the person see the return to old behaviors.
• Call it a slip or a lapse, rather than a relapse.
• Remind them of the progress they made up to the point of the slip - most people lapse.
• Encourage the person NOT to beat up on themselves.
• Feeling guilt and shame is not useful.
• Move forward by revising your plan based on what you learned.
• Write a plan for when you relapse and carry it in your pocket or purse.
• When you develop a behavioral change program, apply the theories that fit with your goals, the available resources and the population you are trying to reach
• Changing behavior take more than will power. The strategies outlined offer effective tools to help older people make changes to improve their health and quality of life.

Updated 02/7/05

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