<?xml version="1.0" encoding="UTF-8"?><xml><records><record><source-app name="Biblio" version="7.x">Drupal-Biblio</source-app><ref-type>47</ref-type><contributors><authors><author><style face="normal" font="default" size="100%">Yorkston, Kathryn</style></author><author><style face="normal" font="default" size="100%">Baylor, Carolyn</style></author><author><style face="normal" font="default" size="100%">Amtmann, Dagmar</style></author><author><style face="normal" font="default" size="100%">Verrall, Aimee M</style></author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Integrating Development of Self-Efficacy into Treatment Decisions</style></title></titles><dates><year><style  face="normal" font="default" size="100%">2014</style></year></dates><pub-location><style face="normal" font="default" size="100%">Oral presentation at the American Speech-Language-Hearing Association’s Convention, Orlando, Florida</style></pub-location><language><style face="normal" font="default" size="100%">eng</style></language><abstract><style face="normal" font="default" size="100%">&lt;p&gt;Summary&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Definitions:&amp;nbsp; &lt;/u&gt;&lt;/p&gt;
&lt;p&gt;People living with chronic communication problems such as aphasia learn to manage their own conditions.&amp;nbsp; 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. &lt;u&gt;Self-efficacy&lt;/u&gt; is the belief in one&amp;rsquo;s ability to produce the effects or outcomes one wants (Bandura, 1977).&amp;nbsp; Because self-efficacy can be taught, speech-language pathologists should incorporate principles of self-efficacy into treatment plans.&amp;nbsp; 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.&amp;nbsp;&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Background&lt;/u&gt; &lt;u&gt;of Qualitative &amp;amp; Quantitative Research&lt;/u&gt;&lt;/p&gt;
&lt;p&gt;Self-efficacy has been studied in people with various communication disorders including, voice disorders, stuttering, and hearing loss.&amp;nbsp; Recently, Runne (2012) conducted a series of semi-structured interviews with people in the chronic phase of stroke.&amp;nbsp; The five participants experienced either aphasia, dysarthria or both.&amp;nbsp; Questions related to their level of confidence regarding communication and the development of confidence over time.&amp;nbsp; Thematic analysis suggests that progress requires hard work, develops over a long period of time, and involves &amp;ldquo;working with what you have.&amp;rdquo;&amp;nbsp; Participants indicated that their family member&amp;rsquo;s role should be one of encouragement and praise.&amp;nbsp; For healthcare providers, the suggestions included &amp;ldquo;treat me like an individual and take time to get to know me.&amp;rdquo;&amp;nbsp;&lt;/p&gt;
&lt;p&gt;In a series of focus groups, we asked people aging with chronic physical disability to help us define the meaning of &amp;ldquo;aging well with disability.&amp;rdquo;&amp;nbsp; Many participants alluded to issues related to self-efficacy.&amp;nbsp; One participant told us, &amp;ldquo;successful aging with disability is recreating yourself.&amp;rdquo; Another indicated that successful aging was &amp;ldquo;to pull yourself up by your own bootstraps and do the things you need to do . . and want to do.&amp;rdquo;&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Treatment Decisions:&lt;/u&gt;&amp;nbsp; In planning and implementing treatment, clinicians and clients should share in the decisions.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Participation Focused Intervention&lt;/u&gt;:&amp;nbsp; 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):&lt;/p&gt;
&lt;ul&gt;
	&lt;li&gt;
		Priorities: Given limited energy and resources, it is important for those with communication problems to set priorities, to define what is important.&lt;/li&gt;
	&lt;li&gt;
		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.&lt;/li&gt;
	&lt;li&gt;
		Constructing the Strategies: &amp;nbsp;Many of the people describe a process where they begin to do things in a different way.&amp;nbsp; Changing how things get done involves constructing and employing a personal set of strategies.&amp;nbsp; At first this is done with the clinician and later, people with communication disorders can set priorities and construct potential strategies independently.&lt;/li&gt;
	&lt;li&gt;
		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.&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&lt;u&gt;Outcome Measures&lt;/u&gt;:&amp;nbsp; 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.&amp;nbsp; Self-reported measures of communicative participation are available (Baylor et al, 2013).&amp;nbsp; This item bank was developed using modern psychometric methods and validated with community-dwelling adults with various communication conditions.&amp;nbsp; A ten item short form is available.&amp;nbsp; A measure of self-efficacy for disease management has also recently been developed using rigorous psychometric methods.&amp;nbsp; Called the University of Washington Self-Efficacy Scale, the full item bank contains 17 items with five response options ranging from &amp;lsquo;not at all (confident)&amp;rsquo; to &amp;lsquo;completely (confident)&amp;rsquo;. 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.&amp;nbsp; Taken together these scales allow clinicians to document treatment outcome both in terms of enhanced participation and self-efficacy.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;Conclusions:&lt;/u&gt;&lt;/p&gt;
&lt;p&gt;Understanding the nature of self-efficacy is important for a number of reasons.&amp;nbsp; First, self-efficacy has been shown to be a predictor of physical, cognitive and social functioning.&amp;nbsp; 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.&lt;/p&gt;
&lt;p&gt;&lt;u&gt;References&lt;/u&gt;&lt;/p&gt;
&lt;p&gt;Amtmann, D., Bamer, A. M., Cook, K. F., Askew, R. L., Noonan, V. K., &amp;amp; Brockway, J. A. (2012). University of Washington self-efficacy scale: a new self-efficacy scale for people with disabilities. &lt;em&gt;Arch Phys Med Rehabil, 93&lt;/em&gt;(10), 1757-1765.&lt;/p&gt;
&lt;p&gt;Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. &lt;em&gt;Psychological Review, 84&lt;/em&gt;, 191-215.&lt;/p&gt;
&lt;p&gt;Baylor, C., Yorkston, K., Eadie, T., Kim, J., Chung, H., &amp;amp; Amtmann, D. (2013). The Communicative Participation Item Bank (CPIB):&amp;nbsp; Item bank calibration and development of a disorder-generic short form. &lt;em&gt;Journal of Speech Language and Hearing Research, 56&lt;/em&gt;, 1190-1208.&lt;/p&gt;
&lt;p&gt;Rae-Grant, A. D., Turner, A., Sloan, A., Miller, D., Hunziker, J., &amp;amp; Haselkorn, J. (2011). Self-management in neurological disorders: Systematic review of the the literature and potential&amp;nbsp;&lt;/p&gt;
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