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People Factors
'Self-efficacy' is your ability to confidently manage your health condition and return to normal activities, including work

At a glance:
Those who are confident they can successfully manage their chronic
continuing a long time or recurring frequently
 health condition are more likely to achieve positive outcomes. This confidence is called self-efficacy. This study investigates the importance of self-efficacy
An impression that one is capable of performing in a certain manner or attaining certain goals. Belief that one can manage whatever life brings.
 and how it can be improved.
If you believe you can cope with returning to work you are likely to manage better than someone who doesn't think they can do it. When people are confident they find ways to do what they want to. When people are less confident, they focus on fears and the obstacles, and have no energy left for finding solutions.

Uncertainty won't make your back pain worse, but it does make it harder to cope with.

How do you become confident? Get good information about your condition – this might mean getting a second opinion, or finding a doctor you're comfortable with. You need to know enough about your condition so that you can take responsibility for your situation and manage it confidently.

Back pain usually gets better by itself (this takes longer than a few weeks), and treatment is designed to give respite from symptoms rather than get rid of the problem. This knowledge makes what's happening day to day less worrying and gives you more energy to find ways to manage the condition.

Find people who have had the same problem as you and overcome it. They will have good advice to give.

If, however, you have a long term disability,
A condition or function that leaves a person unable to do tasks that most other people can do.
 you should be aware that it's more likely to get worse if you become less active. Try to keep up as many of your normal activities as possible – this is easier if you're confident about the management of your condition. If you are confident you are more likely to get to back to work, and you will be able to adapt smoothly at home.
Beliefs and confidence have a powerful impact on health outcomes. Positive examples, sharing experiences with someone who has a similar problem and has done well, encouraging the person to acknowledge their own progress - these things can all help in the return to work process.

When people understand more about the return to work process, they can make better choices and be more active participants. This makes a positive outcome more likely.

Letting people know that they are important and valued can also help. Encouraging them to make positive suggestions can improve the process and develop it into a partnership.
A number of studies have indicated that a person's expectations about return to work have a substantial influence on what happens. If people expect to return to work, they are much more likely to do so and do well.

This study suggests that people who are confident of their ability to cope do better on a broad range of health measures. It also identifies some approaches to help improve the person's confidence. These include making sure they understand the condition, how to achieve their health goals and the likely outcomes if their condition does not improve.

It's important to explain the purpose of treatment and the normal course of a condition if it's not treated. Back pain, for example will improve without treatment. The treatment given is to relieve symptoms. Knowing this increases people's confidence and gives them options about choosing treatments, rather than worrying that they must get the “right one.'

Seeing positive examples may improve the person's confidence that they can do well. This was the idea behind cricketer Merv Hughes' back campaign advertisements of the 1990s. Here was a high-level sportsman who had a long-term back problem, but was able to continue the physically demanding task of fast bowling. He also modelled good management by exercising regularly, and stretching throughout a game.

In contrast, if a person with a sore back has a next-door neighbour who has had three unsuccessful back operations and is now very slow and restricted, they are more likely to be very worried about the future of their back problem.

Encouraging a person to understand the difference between 'hurt' and 'harm', to be more active, take on things in the home, the workplace, or community can improve their confidence and well being.
A person's beliefs and level of confidence can have a powerful impact on their health outcomes. Positive examples, sharing experiences with someone who has done well and encouraging the person to acknowledge their own progress can all help in the return to work process.

Some people have little confidence in their abilities, meaning they have more fears and uncertainties about managing their condition. This can make their health outcomes worse.

When people understand more about the return to work process, they can make better choices and be more active participants. This makes a positive outcome more likely.

Letting people know that they are important and valued can help. Encouraging them to make positive suggestions can improve the process and its outcome.

Encourage people to develop a clear understanding of their condition, to know the difference between 'hurt' and 'harm', and the likely path forwards. This may require you to organise for them to have a long consultation with their doctor.
Original Article, Authors & Publication Details:
Marks R, Allegrante JP, Lorig K:

A review and synthesis of research evidence for self-efficacy-enhancing interventions
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 for reducing chronic disability: implications for health education practice (part I).
Health Promotion Practice 2005, 6(1):37-43.
Background, Study Objectives, How It Was Done:
In the context of return to work, self-efficacy refers to a person's confidence in their own ability to manage the return-to-work process, and achieve a positive outcome.

When people believe they can achieve something, they are more motivated to participate and work towards the goal. In cases of chronic health problems and rehabilitation,
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 the more a patient can participate in managing their condition, the better their health outcome will be.

A growing number of self-management programs emphasise the person's central role in managing their own condition. The authors of this study note that this approach helps with medical management, but also helps participants maintain their life roles, and reduce negative emotions such as fear or depression.
A symptom of mood disorder characterized by intense feelings of loss, sadness, hopelessness, failure, and rejection. Major depression is likely to interfere significantly with everyday activity, with symptoms including insomnia, irritability, weight loss, and a lack of interest in outside events. The disorder may last several months or longer and may recur, but it is generally reversible in the short run.
 This approach can improve general well-being.

This study is a review of research projects undertaken on patients' self management of various chronic diseases such as arthritis.
Study Findings:
The authors started by looking at studies in which there had been a focus on improving the individuals' beliefs and ability to manage their health problem. Some of their findings were:

Self-efficacy in a group of people with heart disease predicted a number of health-related behaviours including getting adequate exercise, managing stress, and following recommended diets and medication regimes.
Patients who participated in a self-management program spent about half as much time in hospital as those who had not.
Patients with asthma who had greater perceived control and greater “asthma self-efficacy' had significantly improved mental and physical health in the two years following a self-management program.
Self-management and self-efficacy programs for people with chronic disease improve health and increase healthy behaviour. This in turn reduces medical and hospital visits.

The authors of this review went on to examine the specific approaches that improve self efficacy. They determined that successful approaches ensure that the participant:

1. Has the knowledge required to achieve their goals
2. Can share the experience of others in similar circumstances
3. Is persuaded by others who are knowledgeable about the situation
4. Can see the difference in their physical and emotional state before and after the desired improvements

As an example, helping people with chronic knee arthritis involved:

1. Teaching relevant exercises, so the individual understood them and had mastered the techniques
2. The participant meeting others who had achieved success
3. Group activities in a supported environment led by an empathetic and knowledgeable professional
4. A leader encouraging the participants to recognise and acknowledge their improvement

It is important for the treating practitioner
treating practitioner
A health professional that treats patients. In return to work this may include doctors, physiotherapists, chiropractors, osteopaths, psychologists, masseurs, etc.
 to address an individual's lack of confidence in their ability to cope. This lack of confidence may have come about through negative past experiences. Understanding how to manage a recurrence of that experience improves the person's confidence.

It is important to recognise that failures may occur, particularly in the early stages of learning how to change a situation. Recognising and dealing with those failures can be a learning exercise.

Improving self efficacy of family caregivers is also important. Caregivers who rate their self-efficacy highly are less strained, and their positive mood will often influence the person with the condition.
To improve health care and outcomes for people with chronic health conditions, it is necessary for the individual to take some responsibility for their own health care.

To promote self efficacy the following recommendations were made:

Help patients understand their health problems, and make sure they are aware of the many and varied ways they can help themselves
Identify and reinforce the person's past and present successes in managing the situation
Advise people to observe successful behaviours and coping mechanisms in others with similar problems
Provide positive feedback on the person's efforts and encourage those in their family and social network to do the same
PubMed Abstract
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