iscos pre-conference 2018 self-efficacy and recovery

ISCOS pre-conference 2018

Self-efficacy and recovery following SCI injury

Tijn van Diemen,

Clinical Psychologist and researcher

content

• Self-efficacy

• Self-efficacy within SCIAM model

• Self-efficacy measures

• Self-efficacy and secondary health conditions

• Clinical implications

• Discussion

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Self-efficacy

• Bandura 1977

• Social Cognitive Theory

One's belief in one's ability to succeed in specific situations or accomplish a task.

One's sense of self-efficacy can play a major role in how one approaches goals, tasks, and challenges.

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Self-efficacy

• Bandura 1977


One's belief in one's ability to succeed in specific situations or accomplish a task.

One's sense of self-efficacy can play a major role in how one approaches goals, tasks, and challenges.

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Self-efficacy

• Bandura 1977


• SE situation specific → General SE

• General SE mixed up with:

– Mastery

– Locus of control

– Self-esteem

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Self-efficacy

• Different scales are developed

• Different levels of Self-efficacy

– General Self-efficacy

– Disability Management Self-efficacy

– Specific Self-efficacy

•Self-Care Self-efficacy

•Wheelchair Self-efficacy

• Presure injury Self-efficacy

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Trait

State

State

content

• Self-efficacy





• Discussion

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Self-efficacy within SCIAM model

• Middleton and Craig

• 2008

• Based on Transaction Model of Stress andCoping (Folkman and Lazarus, 1980)

• 2017 revised

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SCIAM

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content

• Self-efficacy





• Discussion

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Self-efficacy scales used in SCI

• Who of you uses self-efficacy scales (on regular basis)?

– Which one do you use?

• Who has never used or seen SE-scale?

• Example and research question.

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1. General self-efficacy: the beliefs of a person to cope with a variety of difficult commands in general.

2. Disability-management self-efficacy: the confidence that people have in their ability to manage the consequences of their chronic condition in their daily activities and social life.

3. Self-care self-efficacy: the confidence that people have in their ability to perform specific appropriate self-care behaviours.

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• Moorong Self-efficacy Scale

• General Self-efficacy Scale (Schwartzer)

• University of Washington Self-efficacy Scale

• General Self-efficacy Scale (Sherer)

• Beliefs Scale

• Self-efficacy for Managing Chronic Disease

• Chronic Disease Self-efficacy Scale

• Leisure Time Physical Activity Self-efficacy

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Moorong Self-Efficacy Scale(Middleton et al, 2003)

• To measure specific issues encountered by people with SCI in their adjustment to disability after SCI

• 16 items with 7-point scales (very uncertain – verycertain). Score 16-112

• Valid, responsive

• SCI studies: Middleton (2003), Middelton (2007), Miller (2009), Nicholson-Perry (2009), Craig (2013), Kilic(2013), Brooks (2014), Munce (2016), Middleton (2016)

• Weakness: unclear factor structure– Middleton (2003): 2 factors (daily activities, social functioning)

– Miller (2009): 2 factors (instrumental, interpersonal)

– Brooks (2014): 3 fact. (instrumental, participation, interpersonal)

– Middleton (2016): 3 factors (general, personal function, social funct.)

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General Self-Efficacy Scale(Schwartzer et al., 1995)

• https://userpage.fu-berlin.de/health/engscal.htm

1 I can always manage to solve difficult problems if I try hard enough.

2 If someone opposes me, I can find the means and ways to get what I want.

3 It is easy for me to stick to my aims and accomplish my goals.

4 I am confident that I could deal efficiently with unexpected events.

5 Thanks to my resourcefulness, I know how to handle unforeseen situations.

6 I can solve most problems if I invest the necessary effort.

7 I can remain calm when facing difficulties because I can rely on my coping abilities.

8 When I am confronted with a problem, I can usually find several solutions.

9 If I am in trouble, I can usually think of a solution.

10 I can usually handle whatever comes my way.

Response Format

1=Not at all true 2=Hardly true 3=Moderately true 4=Exactly true

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General Self-Efficacy Scale(Schwartzer et al., 1995)

• Measure of general beliefs about one’s ability to respondto, and control demands and challenges

• 10 items with 1-4 point scales (not at all true – exactlytrue)

• Total score 10-40

• Unidimensional, reliable, valid, predictive of adjustment

• SCI studies: Kennedy (2006), Geyh (2012), Peter (2014)

• Weakness: does not tap into specific behavioral change.In most applications it is necessary to add a few items to cover the particular content of the survey or intervention (such as physical exercise self-efficacy).

• https://userpage.fu-berlin.de/health/engscal.htm 16

• https://userpage.fu-berlin.de/health/engscal.htm

How Confident Are You That…

1 You can keep the physical discomfort of your spinal cord injury from interfering with the things you want to do?

2 You can keep your spinal cord injury from interfering with your ability to deal with unexpected events?

3 You can keep your spinal cord injury from interfering with your ability to interact socially?

4 You can keep your spinal cord injury from being the center of your life?

5 You can bounce back from frustration, discouragement or disappointment that spinal cord injury may cause you?

6 You can figure out effective solutions to spinal cord injury-related issues that come up?

Response Format

1=Not at all 2=A little 3=Quite a bit 4=A lot 5=Completely

University of Washington SE Scale(Amtmann 2012)

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University of Washington Self-Efficacy Scale (Amtmann 2012)

• To measure self-perceived confidence in managing challenges related to MS and SCI, and other conditions.

• 17 or 6 items with 5-point scale (not at all –completely)

• Total score converted to T-score (M=50; SD=10)

• SCI studies: Amtmann (2012), Chung (2016), Cijsouw(2017), Post (2018)

• Weakness: responsiveness unknown, difficult questions

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content

• Self-efficacy





• Discussion

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Systematic review SE and SecondaryHealth Conditions (SHCs)

• Associations between SE and SHCs

– Somatic SHCs

– Psychological SHCs

• Start electronic database till september 2016

• PubMed, Embase, the Cochrane library and CINAHL

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Van Diemen et all. (2017) Associations Between Self-Efficacy and Secondary Health Conditions in People Living With Spinal Cord Injury: A Systematic Review and Meta-Analysis; Archives of Physical Medicine and Rehabilitation; 98:2566-77.

Systematic review SE and SHCs

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SE and somatic SHCs

• 7 studies

• Trend negative relation SE and pain

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Type of SHC Article N= SE-scale Outcome scale ValuePain Kilic (2013)27 60 MSES NRS (0-10) -0.27

Craig (2013)23 70 MSES SFMPQ -0.54*

Nicholson-Perry (2009/I)32 47 MSES PRSS -0.28

Nicholson-Perry (2009/II)33 45 MSES PRSS -0.46*

Pain intensity Craig (2013)23 70 MSES PPI -0.45*

Geyh (2012)25 102 GSES BPI NS

Nicholson-Perry (2009/I)32 47 MSES NRS (0-10) -0.47*

Nicholson-Perry (2009/II)33 45 MSES NRS (0-10) -0.36

Pain interference

Geyh (2012)25 102 GSES BPI -0.24*

Pang (2009)34 49 SEMCD PIS -0.59*

Fatigue Craig (2013)23 70 MSES CFS -0.54*

General SHCs Geyh (2012)25 102 GSES SHCS-L -0.25*

SHCS-N NS

Suzuki (2007)53 270 BRFSS 18 selected SHCs

-0.13*

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SE and psychological SHCs

• 21 studies

• Mainly

– Depression (18)

– Anxiety (7)

– Quality of life (2)

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Type of SHC Article N= SE-scale Outcome scale ValueDepression Munce (2016)31 99 MSES HADS-D -0.56*

Driver (2016)24 44 CDSES PHQ-9 -0.74*

Peter (2015)35 516 GSES HADS-D -0.54*

Craig (2014)22 107 MSES SF-36a 0.48*

Sweet (2013)37 395 LTPA-SE PHQ-9 -0.32*

Kilic (2013)27 60 MSES DASS-21 -0.63*

Craig (2013)23 70 MSES POMS -0.64*

van Leeuwen (2012)38 143 GSES SF-36a 0.52*

Geyh (2012)25 102 GSES HADS-D -0.57*

Bombardier (2012)21 244 CDSES PHQ-9 -0.58*

Pang (2009)34 49 SEMCD CESD-10 -0.46*

Nicholson-Perry (2009/I)32 47 MSES HADS-D -0.61*

Nicholson-Perry (2009/II)33

45 MSES HADS-D -0.59*

Miller (2009)30 162 MSES CESD-10 -0.54*

Middleton (2007)29 106 MSES SF-36a 0.41*

Kennedy (2006)26 35 GSES HADS-D -0.43*

Middleton (2003)28 36 MSES HADS-D -0.61*

Shnek (1997)36 80 BS CESD-10 -0.58* 25

SE and Depression

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SE and Depression

• 18 studies

• Strong pooled correlation r= -0.536

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Type of SHC Article N= SE-scale Outcome scale Value

AnxietyMunce (2016)31 99 MSES HADS-A -0.32*

Kilic (2013)27 60 MSES DASS-21 -0.54*

Geyh (2012)25 102 GSES HADS-A -0.61*

Nicholson-Perry (2009/I)32 47 MSES HADS-A -0.52*

Nicholson-Perry (2009/II)33 45 MSES HADS-A -0.43*

Kennedy (2006)26 35 GSES HADS-A -0.45*

Middleton (2003)28 36 MSES HADS-A -0.58*

Quality of Life van Leeuwen (2012)38 143 GSES 2LS 0.33*

Mortenson (2010)55 93 GSES QLI (3 months) 0.62*

QLI (15 months)

0.47*

Affective / subjective disorder

Hampton (2008)56 119 GSES IPWB -0.09b

Psychological disorders

Craig (2015)54 88 MSES MINI-plus 1.05c

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SE and Anxiety

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SE and Anxiety

• 7 studies

• Strong pooled correlation r= -0.493

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content

• Self-efficacy





• Discussion

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Clinical implications

• SE is strongly associated with depression and anxiety but also with resilience.

• SE seems protective against pain and fatigue

• High SE (especially Disability Management SE) predicts positive adjustment to SCI

• Low SE predicts poor adjustment

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• SE influenced by:

– Performance accomplishments

– Vicarious experience

– Verbal persuasion

– Physiological feedback

– Imaginal experiences

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• Use moderately difficult tasks

• Remind patients of their former successes

• Use peer models

• Teach strategies to deal with difficulties

• Capitalize on patients choice and interests

• Allow patients to make their own choices

• Encourage to try

• Give frequent, focused feedback

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Adapted from: Margolis & McCabe (2006) Improving Self-Efficacy and Motivation: What to do, What to say. Intervention in School and Clinic; 41 (4): 218-27.


Conclusions:

• SE can be target for intervention (CBT is actually tapping into SE in different protocols)

• Whole team is working on SE (although most are unaware of their competence)

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content

• Self-efficacy





• Discussion

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Discussion

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Contact:[email protected]

iscos pre-conference 2018 self-efficacy and recovery

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