Page 183 - Nutrition Counseling and Education Skills: A Guide for Professionals

confident. If not confident, a different task or goal should be found. Self-appraisals are reasonably accurate,
because people successfully execute tasks within their perceived capabilities, but shun those that exceed them.

Efficacy expectations and performance should be assessed periodically during the dietary change process,
because the stronger the perceived efficacy, the more likely people are to persist. In the Transtheoretical
Model or Stages of Change, discussed in Chapter 5, SE scores were generally found to increase in the later
stages of change and were significantly higher for those in action and maintenance stages. They are low in the
precontemplation and contemplation stages, where people may have little confidence in their ability to
change.

Sources of Efficacy Information

When planning food and exercise interventions, it is important to consider the four major sources of efficacy
information. Beliefs about SE are based on (1) actual performance accomplishments, (2) vicarious experiences
(modeling) by observing the performance of others, (3) verbal persuasion, and (4) physiologic and emotional
states.11,18,20 All four have been used in food and exercise interventions.

Actual Performance
The most influential and effective way to increase SE is actual performance accomplishments. The counselor
needs to divide changes into many small, easily managed steps, let the client select the ones to try first, and be
sure the person has the confidence to succeed. Setting personal goals and self-rewards may be beneficial in
enhancing performance and increasing SE. An increase in SE and motivation results from successfully
performing the behavior and attaining subgoals.16 For example, attaining the subgoal of following the dietary
change today is an immediate commitment rather than a future goal of never eating desserts again. With
employees, a goal of improving performance today is preferable to a more distant goal of improving during the
month.

Personal successes raise mastery expectations while failures lower them, especially early in the course of a
health behavior change. Repeated success in overcoming obstacles through perseverance strengthens SE.
People also perfect their coping skills. Success begets success; failure begets failure.

Modeling
A second source of efficacy information comes from modeling or observational learning followed by guided
performance. Bandura believed that people learn by watching or observing the actions of others.16 Clients can
learn how to handle situations by observing a model demonstrating the appropriate behavior, such as ordering
healthful food from a restaurant menu or saying “no thank you” to dessert offerings. The vicarious experience
of seeing another perform can generate expectations that if another person can do it, “so can I.”

To enhance imitation, the model should be perceived as similar to oneself or possessing competencies to
which one aspires. Clients should then be given an opportunity to perform the modeled behavior successfully.
In group counseling sessions, negative role models are a problem and should be avoided. Employees also learn
by observing and modeling after other employees. Stronger efficacy expectations, however, are produced by
personal accomplishments than by only observing another.

Verbal Persuasion

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