Self-efficacy and functional change among home care recipients

BACKGROUND AND PURPOSE: Since Bandura (1986) introduced the idea of self-efficacy, researchers have been eager to empirically test how useful the concept is. Self-efficacy is defined as one's confidence in successfully performing intended behavior. A prior study of the first author found that believing in one's capability to increase functional independence does predict positive change in physical disability among home care elderly. Based on the previous study, the present study aims to: (a) verify the prior study's finding using a different sample, and (b) examine how the combination of caregiver and care recipient's perception about the recipient's ability to increase functional independence affects functional change of the recipient.

METHODS: The sample included a cohort of home care participants in Michigan's home and community-based long-term care programs (N=3,853). The majority were female (70%), older age (78% aged 65+), and White (82%). For care planning purposes, each participant was assessed at baseline, then about every three months, using a standardized instrument. This study followed this cohort for two years during which they had been assessed 6 times on average. The outcome variable was dependence in activities of daily living (ADL), which was measured by 8 items (e.g., dressing, eating, bathing). Each item was rated from 0 (independent) to 4 (totally dependent). An ADL scale was formed by summing all items (range= 0 to 32). The key independent variables were: (a) self-efficacy which was measured by one item asking the home care recipient whether he/she believed that he/she was capable of increased functional independence, (b) caregiver's belief which was measured by another item asking the caregiver whether he/she believed that his/her care recipient was capable of increased functional independence. Multilevel analysis was conducted to estimate the effects of baseline self-efficacy, caregiver belief, and their combination on changes in ADL dependence of the care recipients. The models controlled for baseline ADL dependence, sociodemographic and health-related covariates.

RESULTS: About 21% of care recipients and 8% of caregivers believed that the recipients were able to have increased functional independence. Their perception was mostly consistent. The results of the multilevel analysis verify prior findings and show that home care recipients who believe in their ability to increase functional independence have slower increase in ADL dependence. When both caregiver and care recipient believe in the recipient's ability to have increased functional independence, the effects are stronger than when only the recipient but not the caregiver believe in it. However, without the recipient's sense of self-efficacy, the caregiver's belief in the recipient's ability does not seem to matter to functional change of the recipient.

CONCLUSIONS AND IMPLICATIONS: Self-efficacy helps to sustain health among persons with relatively severe disability. More efforts should be made by social workers to increase self-efficacy of their clients suffering from poor health. Moreover, caregivers' belief in their recipient's ability adds to the effect. Self-efficacy training for both caregivers and care recipients should be considered when working with caregiving families.