Behavioral, social, and affective factors associated with self-efficacy for self-management among people with epilepsy

Abstract

The purpose of the study described in this article was to evaluate the extent to which selected behavioral, social, and affective factors contribute to self-reported epilepsy self-efficacy. Participants completed three assessments 3 months apart, with only those completing both the first and second assessments included in this analysis. Self-efficacy scores at the second assessment were regressed on the behavioral, social, and affective characteristics ascertained at the first assessment. The analysis revealed that self-management, depressive symptoms, and seizure severity explain the most variance in self-efficacy; patient satisfaction and stigma are less important predictors; and social support and regimen-specific support are not significant predictors. The results provide direction for identifying people with low levels of self-efficacy and highlighting areas that might help enhance self-efficacy in persons with epilepsy.

Introduction

Much research has been directed toward the study of health behaviors and factors associated with successful behavior change and maintenance. One factor that has received considerable attention is that of self-efficacy, which Bandura [1] defines as “beliefs in one’s capabilities to organize and execute the courses of action required to produce given attainments.” The construct is a central concept within social cognitive theory, which suggests that people who have high levels of self-efficacy are more likely to perform a given behavior [1]. Moreover, they are more likely to persevere to overcome barriers and to work longer at mastering the behavior before giving up. Studies of people with chronic health problems such as epilepsy, diabetes, arthritis, and asthma repeatedly demonstrate the value of this construct. The findings of several studies indicate that people with high levels of self-efficacy are more successful at managing self-care tasks such as taking medications, avoiding triggers for symptoms, and monitoring health status [2], [3], [4], [5], [6].

Although much is known about the association between self-efficacy and self-management, less is known about factors that foster the development of self-efficacy itself. Several investigators have explored sources of self-efficacy related to career choice [7], [8]; however, only a few have examined factors associated with self-efficacy related to health behaviors. Cousins and Tan [9] evaluated cognitive and contextual elements that contribute to self-efficacy for walking blocks and climbing stairs. The self-referent beliefs they evaluated included those about exercise, social support, and risks and benefits of exercise, and the contextual characteristics included age, education, and health. The results indicated that both cognitive and contextual variables were important in fostering self-efficacy. McAuley et al. studied, social, affective and behavioral influences of exercise self-efficacy among older adults [10]. They found that exercise self-efficacy of older men and women participants was associated with more frequent exercise, a perception that the exercise group was more supportive and feeling good after exercising.

The findings of previous studies of self-management in epilepsy indicate that self-efficacy is a primary determinant of general epilepsy self-management and medication management [3], [11]. Moreover, people who have high levels of social support are more likely to express a strong sense of self-efficacy [3]. In the present study, we sought to expand the previous research by exploring behavioral, social, and affective factors associated with self-efficacy for self-management in persons with epilepsy. Variables selected for evaluation were based on social cognitive theory and a review of the self-efficacy literature. The variables selected were previous performance of self-management behaviors, social support, regimen-specific support, satisfaction with communication with physician, depressive symptoms, and stigma. Previous self-management behavior was selected because Bandura [1] notes that people who have successfully mastered a behavior are likely to have a strong sense of efficacy related to that behavior. Repeated success increases or sustains confidence, whereas continued failure leads to defeat and a weak sense of efficacy. Based on previous research, it was expected that individuals who perceive more support from various sources would exhibit higher levels of self-efficacy. Because affective states can influence performance, we included a measure of depressive symptoms and a measure of stigma to explore how these variables would affect one’s self-efficacy for self-management of epilepsy.

Data for this study were taken from a larger study on epilepsy self-management. This study was a longitudinal study that included three interviews over a 6-month period. Thus, we were able to use data from the predictor variables that were measured 3 months before self-efficacy. This approach strengthened our model that sought to determine which of the predictor variables fostered the development of self-efficacy. If self-efficacy is an important concept in promoting self-management behavior, then it is important to understand the factors needed to improve or sustain self-efficacy.