Page 182 - Nutrition Counseling and Education Skills: A Guide for Professionals

behavior, such as eating or exercising, must make decisions about whether or not to attempt different food
choices, how long to continue, how much effort to make, and in the face of difficulties, whether or not to
persist. Bandura believes that these decisions are partly governed by judgments of SE. People tend to avoid
situations that they believe exceed their coping capabilities, but are willing to undertake activities they judge
themselves capable of executing.21 The stronger the perceived SE, or sense of personal mastery, the more
persistent are the efforts, even in the presence of obstacles. When difficulties arise, those with lower
perceptions of SE make less effort or may give up entirely.20

A study of levels of exercise among adults with type 2 diabetes found variables in moderate intensity
exercise included task SE, self-monitoring, overcoming barriers, making time to exercise, self-reward, social
support from family and friends, and self-evaluative outcome expectations.22 Increasing SE was associated
with physical activity in healthy nonobese adults who did self-monitoring.23 Interventions with cancer
survivors found meaningful changes in nutrition behavior and physical activity.24

A person’s SE is generally a good predictor of how that individual is likely to behave on specific tasks.11 SE
affects whether or not people consider changing a health habit, whether they mobilize the motivation and
perseverance to succeed, whether they are able to recover from setbacks and relapses, and whether they are
able to maintain the changes made.20 The evidence is overwhelming that there is a close association between
SE and nutrition and health behavior change, and that SE is a powerful predictor of change.

In addition, personal goals enhance performance.20 Motivation to perform a task can improve in part
through one’s self-evaluation of performance, such as having lost 2 lb, when compared with an adopted goal
of losing weight. A person with strong SE increases effort and persistence in achieving subgoals and that
results in higher performance. For clients, the counselor needs to break down tasks into easily mastered steps
that are within the person’s capabilities while requiring some degree of effort. Behavioral contracting and self-
monitoring discussed in other chapters may be helpful also.

Dimensions of Efficacy Expectations

The counselor needs to assess clients’ thoughts and confidence concerning their abilities to make changes in
eating and exercise behaviors. Different dimensions of thoughts may be examined, such as level of difficulty of
the task, strength of SE to succeed at the task, and generalization to other situations. When tasks have
different levels of difficulty, efficacy expectations may limit some people to the simple tasks, while others may
feel comfortable with more difficult ones. Weak self-beliefs are easily extinguished by disconfirming
experiences, whereas those with strong efficacy expectations will persevere in their efforts even through
difficulties.20

Measuring Self-Efficacy

A two-step approach to measuring SE is suggested. First, given a group of tasks of varying levels of difficulty,
ask clients which dietary goals or changes they can undertake. It is preferable to start off with the simpler ones
in order to guarantee success as that will increase SE. Then the client can work up slowly to more difficult
ones.

Second, for each designated change in the behavior, ask clients to rate the strength of their confidence of
success in making a specific change on a 5-point scale, with 5 being very confident to 1 being not at all

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