Integrating Development of Self-Efficacy into Treatment Decisions

TitleIntegrating Development of Self-Efficacy into Treatment Decisions
Publication TypeConference Paper
Year of Publication2014
AuthorsYorkston K, Baylor C, Amtmann D, Verrall AM
Conference LocationOral presentation at the American Speech-Language-Hearing Association’s Convention, Orlando, Florida



People living with chronic communication problems such as aphasia learn to manage their own conditions.  They decide whether or not to adhere to exercise programs, to participate in social activities and roles, and to use the health-care resources available to them. Self-management is based on the idea that those with a chronic condition should take an active, central role in managing their disease, secondary conditions, and health care (Rae-Grant et al, 2011). Development of self-efficacy is an important component of self-management. Self-efficacy is the belief in one’s ability to produce the effects or outcomes one wants (Bandura, 1977).  Because self-efficacy can be taught, speech-language pathologists should incorporate principles of self-efficacy into treatment plans.  Bandura suggests self-efficacy can be improved by focusing on four factors that are potentially amendable to intervention: performance accomplishment, vicarious experience, verbal persuasion and maintenance of an optimal physiological state. 

Background of Qualitative & Quantitative Research

Self-efficacy has been studied in people with various communication disorders including, voice disorders, stuttering, and hearing loss.  Recently, Runne (2012) conducted a series of semi-structured interviews with people in the chronic phase of stroke.  The five participants experienced either aphasia, dysarthria or both.  Questions related to their level of confidence regarding communication and the development of confidence over time.  Thematic analysis suggests that progress requires hard work, develops over a long period of time, and involves “working with what you have.”  Participants indicated that their family member’s role should be one of encouragement and praise.  For healthcare providers, the suggestions included “treat me like an individual and take time to get to know me.” 

In a series of focus groups, we asked people aging with chronic physical disability to help us define the meaning of “aging well with disability.”  Many participants alluded to issues related to self-efficacy.  One participant told us, “successful aging with disability is recreating yourself.” Another indicated that successful aging was “to pull yourself up by your own bootstraps and do the things you need to do . . and want to do.”

Treatment Decisions:  In planning and implementing treatment, clinicians and clients should share in the decisions.

Participation Focused Intervention:  Because it is important that intervention be individualized, targeted to real-world communication situations and focused on development of self-efficacy, we use the acronym PACE to describe a four step procedure for developing communication strategies (Yorkston et al, 2006):

  • Priorities: Given limited energy and resources, it is important for those with communication problems to set priorities, to define what is important.
  • Awareness: After setting priorities, people with communication problems need to become aware of potential barriers to participation and the resources available to get around those barriers.
  • Constructing the Strategies:  Many of the people describe a process where they begin to do things in a different way.  Changing how things get done involves constructing and employing a personal set of strategies.  At first this is done with the clinician and later, people with communication disorders can set priorities and construct potential strategies independently.
  • Evaluation: An important last step in the development of strategies is to evaluate them by asking the question - does the strategy work for me? Evaluation involves weighing cost and benefits of the strategies and modifying them as needed.

Outcome Measures:  Because current healthcare trends demand documentation that healthcare services are regarded as valuable and bring about meaningful change from client perspectives, self-reported outcome measures are becoming increasingly important.  Self-reported measures of communicative participation are available (Baylor et al, 2013).  This item bank was developed using modern psychometric methods and validated with community-dwelling adults with various communication conditions.  A ten item short form is available.  A measure of self-efficacy for disease management has also recently been developed using rigorous psychometric methods.  Called the University of Washington Self-Efficacy Scale, the full item bank contains 17 items with five response options ranging from ‘not at all (confident)’ to ‘completely (confident)’. Examples of items include: Can you keep your [condition] from being the center of your life? and Can you figure out effective solutions to [condition] related issues that come up? A 6-item short form is also available.  Taken together these scales allow clinicians to document treatment outcome both in terms of enhanced participation and self-efficacy.


Understanding the nature of self-efficacy is important for a number of reasons.  First, self-efficacy has been shown to be a predictor of physical, cognitive and social functioning.  It is also associated with improved health status, health behaviors and reduced medical services usage. It may also be a valuable predictor of healthy aging in individuals with degenerative conditions such as multiple sclerosis. In addition to its value as a predictor, self-efficacy is important because it is increasingly seen as a fruitful target for intervention.


Amtmann, D., Bamer, A. M., Cook, K. F., Askew, R. L., Noonan, V. K., & Brockway, J. A. (2012). University of Washington self-efficacy scale: a new self-efficacy scale for people with disabilities. Arch Phys Med Rehabil, 93(10), 1757-1765.

Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.

Baylor, C., Yorkston, K., Eadie, T., Kim, J., Chung, H., & Amtmann, D. (2013). The Communicative Participation Item Bank (CPIB):  Item bank calibration and development of a disorder-generic short form. Journal of Speech Language and Hearing Research, 56, 1190-1208.

Rae-Grant, A. D., Turner, A., Sloan, A., Miller, D., Hunziker, J., & Haselkorn, J. (2011). Self-management in neurological disorders: Systematic review of the the literature and potential