The self-management of health requires development of self-regulatory skills. This is achieved through self-regulatory subfunctions that provide guides and motivators for self-directed change. People have to keep track of their health habits. Self-monitoring provides the information needed for setting realistic goals and for evaluating one's progress toward them. People motivate themselves and guide their behavior by the goals and challenges they set for themselves. Goals motivate by enlisting self-evaluative involvement in the activity. The evaluative self-reactions provide the means by which personal standards regulate courses of action.
PERSONAL EFFICACY
The self-management system operating through self-monitoring, goal setting, and self-reactive influence is rooted in beliefs of personal efficacy. This core belief system is the foundation of human motivation and action. Unless people believe they can produce desired effects by their actions, they have little incentive to act or to persevere in the face of difficulties.
In social cognitive theory, perceived efficacy is a key determinant because it affects lifestyle habits both directly and by its influence on other determinants. The stronger the perceived efficacy, the higher the goals people set for themselves, the more they expect their efforts to produce desired outcomes, and the more they view obstacles and impediments to personal change as surmountable.
Development of self-regulatory capabilities requires instilling a resilient sense of efficacy as well as imparting skills. Experiences in exercising control over troublesome situations serve as efficacy builders. If people are not convinced of their personal efficacy, they rapidly abandon the skills they have been taught when they fail to get quick results or suffer reverses. Efficacy beliefs affect every phase of personal change: whether people even consider changing their health habits; whether they enlist the motivation and perseverance needed to succeed; their facility to recover from setbacks; and how well they maintain the habit changes they have achieved. The self-efficacy belief system operates as a common mechanism through which psychosocial treatments affect different types of health outcomes.
PUBLIC HEALTH APPLICATIONS
People see little point in even trying if they believe they do not have what it takes to succeed. In community-wide health campaigns, people's preexisting efficacy beliefs and the efficacy beliefs instilled by the campaign contribute to adoption of health promoting habits. This calls for a change in emphasis from trying to scare people into health to enabling them to achieve self-directed change.
Effective self-management models inform people of the health risks and benefits of different lifestyles habits; create the self-regulatory skills needed to translate informed concerns into health promotive actions; build a resilient sense of efficacy to support control in the face of difficulties; and enlist social supports for desired personal changes. The guiding principles, implementative practices, and empirical documentation of effectiveness are reviewed in some detail in Self-Efficacy: The Exercise of Control (Bandura, 1997). By combining the high individualization of the clinical approach with the large-scale applicability of the public health approach, health self-management systems ensure high social utility.
It is easier to prevent detrimental health habits than to try to change them after they have become deeply entrenched as part of a lifestyle. The social cognitive model provides a valuable public health tool for societal efforts to promote the health of its youth. Preventive programs often produce weak results because they are heavy on didactics but meager on personal enablement. Health knowledge can be conveyed readily, but changes in values, attitudes, and health habits require greater effort. Health promotion programs that encompass the essential elements of the self-regulatory model achieve greater success.
The quality of health of a nation is a social matter, not just a personal one. It requires changing the practices of social systems that impair health rather than just changing the habits of individuals. People's beliefs in their collective efficacy to accomplish social change by perseverant group action play a key role in the policy and public health approach to health promotion. Given that health is heavily influenced by behavioral, environmental, and economic factors, health promotion requires emphasis on the development and enlistment of collective efficacy for socially oriented initiatives.
Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall.
—— (1997). Self-Efficacy: The Exercise of Control. New York: Freeman.
Holden, G. (1991). "The Relationship of Self-Efficacy Appraisals to Subsequent Health Related Outcomes: A Meta-Analysis." Social Work in Health Care 16:53–93.
Maibach, E.; Flora, J.; and Nass, C. (1991). "Changes in Self-Efficacy and Health Behavior in Response to a Minimal Contact Community Health Campaign." Health Communication 3:1–15.
