The Role of Self-Efficacy in the Recovery Trajectory of Mental Health Service Recipients

Background: This study examines the mediating effect of self-efficacy on the recovery trajectory of mental health service recipients. Self-efficacy implies a personal judgment of one’s capabilities to organize and perform behaviors to overcome barriers and attain goals. It has been identified as an essential contributor to mental health recovery. However, the role of self-efficacy in the recovery trajectory seen in the process of mental health services remains unclear. Examining the role of self-efficacy in such trajectory can enhance knowledge about mental health service recipients and help practitioners carry out more effective intervention programs.

Methods: This study is a cross-sectional research using a non-probability convenience sample (N=310). A self-administered survey was used to collect data on service provision, self-efficacy, and service outcomes among participants recruited from community rehabilitation centers in Taiwan. More than half of the participants were male (57.4%). 41.8% aged between 41 and 50 (mean = 43.52, SD = 9.92). More than half were diagnosed with schizophrenia (70.2%). Most were never married (80.3%); 95% lived with families or in a group home; 60.5% were from a low-income family. Near half of the participants have a part-/full-time job (42%).

In this study, the concept of service provision includes three aspects: working alliances, information about health care choices, and empowerment. These aspects were measured using Working Alliance Inventory-Short Form (WAI-S), Information and Advice Scale (IAS), and Empowerment Scale, respectively. Self-efficacy was measured using General Self-Efficacy Scale. Service outcomes were defined as a function of satisfaction of services and quality of life. They were measured using Client Experiences Questionnaire (CEQ) and Quality of Life Questionnaire (QLQ), respectively.

Pairwise correlation and path analysis were conducted to evaluate the causal model in which the predicting variables were working alliances, information about health care choices, and empowerment, the dependent variables were satisfaction of services and quality of life, and the mediating variable was self-efficacy.

Results: The correlation coefficients suggested all variables were significantly correlated with each other. The results of path analysis indicated the examined causal model has a satisfactory fit (X²=9.679, df=6); goodness of fit index (GFI)=.990; adjusted goodness of fit index (AGFI)=.965. In the model, working alliances has a significant direct impact on satisfaction of services and quality of life; information about health care choices has a significant direct impact on satisfaction of services; empowerment has a significant direct effect on satisfaction of services and a significant indirect impact on quality of life. Self-efficacy mediated the effect of empowerment on quality of life.

Implications: This study provides useful information for practitioners seeking to create contexts of mental health intervention. The findings suggest that self-efficacy mediates the effect of mental health service provision on service outcomes. Specifically, self-efficacy is a mechanism by which empowerment can produce changes in the service recipients’ quality of life. In other words, an effective empowerment approach should seek to improve self-efficacy for better service outcomes.