Perceived Self-Efficacy in Health Behaviour Change The Construct of

Perceived Self-Efficacy in Health Behaviour Change
Ralf Schwarzer 1 , Aleksandra Luszczynska 2 and Amelie U. Wiedemann 1
1 Freie University, Berlin
2 Warsaw School of Social Psychology, Poland
Perceived self-efficacy is a competence-based, prospective, and operative construct that can be
used to predict, explain, and change health behaviours. Numerous studies attest to the fact that
self-efficacy is a substantial factor when it comes to changing behaviours. Moreover, the nature of
self-efficacy changes as people progress through a course of action, beginning with some
motivation to change and ending with habitual performance or relapse. Thus, research on phasespecific
self-efficacy is an important agenda in psychology.
The Construct of Perceived Self-Efficacy
Perceived self-efficacy is concerned with individuals’ beliefs in their capability to exercise
control over challenging demands and their own functioning. In his unifying Social Cognitive
Theory (SCT), Bandura (1977, 1997) hypothesized that expectations of self-efficacy are selfregulatory
cognitions that determine whether instrumental actions will be initiated, how much
effort will be expended, and how long it will be sustained in the face of obstacles and failures.
In particular, self-efficacy has an influence on preparing for action because self-efficacy
levels can enhance or impede motivation: self-efficacy not only influences the challenges that
people decide to meet, but also how high they set their goals (e.g., “I intend to reduce my
smoking,” or “I intend to quit smoking altogether”). That is, individuals with high selfefficacy
select more challenging and ambitious goals than those low in self-efficacy.
Additionally, persons with low self-efficacy harbour pessimistic thoughts about their likely
accomplishments and personal development. However, self-efficacy is also directly related to
behaviour, referring to the confidence that one can employ the skills necessary to resist
temptation, cope with stress, and mobilize one's resources required to meet the situational
demands. During action, individuals with high self-efficacy focus on opportunities, rather
than on obstacles (e.g., “At my university there is a smoking ban, anyway,” instead of “There
are still a lot of ashtrays at my university.”). In sum, self-efficacy beliefs affect the persistence
to continue goal striving in the face of barriers and setbacks that may undermine motivation.
Self-efficacy is based on different sources (Bandura, 1997). First, self-efficacy beliefs can
be enhanced through personal accomplishment or mastery, as far as success is attributed
internally and can be repeated. A second source is vicarious experience. When a ‘model
person’, that is similar to the individual, successfully masters a difficult situation, social
comparison processes can enhance self-efficacy beliefs. Third, self-efficacy beliefs can also
be enhanced through verbal persuasion by others (e.g., a health educator reassures a patient
that she will certainly perform cancer screening properly due to her competence). The last
source of influence is emotional arousal, that is, the person may experience no apprehension
in a threatening situation and, as a result, may feel capable of mastering the situation. These
four informational sources vary in strength and importance in the order presented here, with
personal mastery being the strongest source of self-efficacy. However, self-efficacy can also
influence behaviour change through the emotions that might arise while pursuing the goal:
optimistic self-beliefs about one’s own competence create positive affective states instead of
negative ones (e.g., anxiety). While positive emotions may positively influence goal pursuit,
negative emotions may generate cognitive confusion that leads to worse outcomes. Selfefficacy
may also affect an individual’s emotional states by the appraisal of stressful stimuli

as a threat, harm, or challenge. Thus, optimistic self-beliefs about one’s ability to execute an
action successfully can influence one’s cognitive, motivational, and affective processes.
Self-efficacy can be differentiated from other self-related cognitions. For example, selfefficacy
is not the same as unrealistic optimism, since it is based on experience and does not
lead to unreasonable risk taking. Instead, it leads to venturesome behaviour that is within
reach of one's capabilities. Compared to other similar constructs such as self-esteem, selfconcept,
and sense of control, the essential characteristic of self-efficacy lies in three aspects:
(a) self-efficacy implies an internal attribution (the person is the cause of the action), (b) it is
prospective, referring to future behaviours, and (c) it is an operative construct, which means
that this cognition is proximal to the critical behaviour.
Self-Efficacy Predicts Health-Promoting Behaviours
A large body of research supports the predictive value of self-efficacy. To illustrate the
association between perceived self-efficacy and health-promoting behaviours, some examples
from the areas of physical exercise and dietary behaviours are chosen. What both behaviours
have in common is they have to be executed regularly to be effective and that most people do
not meet the recommended criteria. Regarding physical activity, studies employing a motion
detector to measure physical activity objectively showed that 12.6 minutes daily are spent on
vigorous physical activity (Strauss, Rodzilsky, Burack, & Colin, 2001). Besides
demographics, biological factors, physical environment factors, and physical activity
characteristics, psychological determinants that are open to change, such as self-efficacy,
intention, and perceived barriers play a crucial role in the adoption of an active lifestyle
(Sallis & Owen, 1999). In this regard, self-efficacy is expected to operate regardless of ethnic
background and culture. However, there is some evidence of an ethnicity effect: optimistic
self-beliefs are associated with moderate physical activity among White girls, but not among
African-American girls (Bungum et al., 1999).
Self-efficacy is related to objective measures (motion detectors) of current physical activity
that monitor physical activity over a specified time period, and for example, related to higher
levels of physical activity among 10- to 16-year-old people (Strauss et al., 2001). Selfefficacy
is also a strong predictor of future activity: in a sample of cardiac patients, selfefficacy
was associated with physical activity measured after 4 and 12 months (Scholz,
Sniehotta, & Schwarzer, 2005). Across a set of psychosocial and environmental variables,
perceived confidence in the ability to be active was the only variable that differentiated
between both, active and low-active African-American boys and girls (Trost, Pate, Ward,
Saunders, & Riner, 1999). This result was obtained after the measurement of social cognitive
variables by means of an accelerometer attached to an elastic belt and worn over the right hip
for seven days. For boys, involvement in sport organizations was another predictor of activity
levels, while active girls also perceived more positive outcomes of activity.
When assessing relations between self-efficacy and physical activity, the conceptualization
of self-efficacy may be more or less specific in terms of behaviours or barriers. For example,
optimistic beliefs about one’s competencies for moderate and vigorous physical exercise can
be distinguished. These beliefs might be subdivided further, for example into beliefs about
overcoming external and internal barriers to vigorous physical activity. Both kinds of selfefficacy
were found to be related to physical activity of high-school students (Dwyer, Allison,
& Makin, 1998).
Self-efficacy can mediate between other cognitions and people’s physical activity.
Employing self-efficacy in conjunction with constructs from the Theory of Planned
Behaviour (TPB; Ajzen, 1991), Motl et al. (2002) searched for predictors of moderate and
vigorous physical activity among Black and White adolescent girls. Self-efficacy turned out

to be the only significant direct predictor of moderate physical activity. For vigorous activity,
two significant direct predictors were found: self-efficacy and behavioural control. Intentions,
attitudes, and subjective norms were interrelated and were moderately or strongly related to
self-efficacy. Intentions, attitudes and subjective norms were only indirectly related to
physical activity, and they’re effects were mediated by self-efficacy.
Self-efficacy might also mediate the relations between physical activity and other
constructs, for example parental support for the child’s physical activity (Trost et al., 2003).
Other studies provide evidence that self-efficacy is the strongest correlate of people’ physical
activity, when compared with other cognitions such as perceived benefits, perceived barriers,
and social norms (Wu, Pender, & Noureddine, 2003).
Regarding behaviour change, intervention studies that aimed at an increase of self-efficacy
and healthy nutrition employed computer games to facilitate mastery experience. Based on
SCT, the educational activities in the game aimed at increasing the preference for healthy
foods (Baranowski et al., 2003). Using multiple exposures, this approach increased mastery
experience in asking for healthy food at home and when eating out, as well as the skills to
prepare healthy foods by means of virtual recipes and virtual food preparation. Compared to
persons in control groups, people participating in such an intervention increased their
consumption of fruits and vegetables significantly (Baranowski et al., 2003).
Interventions aimed at changing self-efficacy along with other social-cognitive variables
were effective in changing physical activity and nutrition in children and adolescents. In a
sample of over 6,000 children and adolescents, self-efficacy and intentions determined
healthy food choices while self-efficacy and perceived social support determined physical
activity, as measured three years later (Edmundson et al., 1996). Treatment based on SCT
combined with an intervention aimed at increasing motivation affected self-efficacy levels
and fruit and vegetable intake among people (Wilson et al., 2002).
The Role of Perceived Self-Efficacy in Health Behaviour Theories
Self-efficacy instigates the adoption, initiation, and maintenance of health-promoting
behaviours. Prominent theories of behaviour change such as the Theory of Planned Behaviour
(Ajzen, 1991), the Social Cognitive Theory (Bandura, 1977, 1997), the Transtheoretical
Model (Prochaska, DiClemente, & Norcross, 1992), and the Health Action Process Approach
(Schwarzer, 2008), include a variety of cognitions that either directly or indirectly influence
health behaviours (Lippke, & Ziegelmann, 2008).
The Theory of Planned Behaviour (TPB; Ajzen, 1991) claims that intention is the most
proximal predictor of behaviour. Cognitions that affect a specific intention are (a) attitude
toward the behaviour (evaluation of performing the behaviour), (b) subjective norm, (the
extent to which a person believes that significant others would want them to perform a
behaviour), and (c) perceived behavioural control (perception about being able to perform a
specific behaviour). Self-efficacy and behavioural control may be seen as almost synonymous
constructs.
According to Social Cognitive Theory (SCT; Bandura, 1997), personal sense of control
facilitates a change of health behaviour. Perceived self-efficacy pertains to a sense of control
over one's environment and behaviour. Self-efficacy expectations are cognitions that
determine whether health behaviour change will be initiated, how much effort will be
invested, and how long efforts will be maintained in the face of setbacks (Schwarzer, 2008).
Self-efficacy beliefs affect the amount of effort to change risk behaviour. Perceived selfefficacy
is directly related to health behaviour, but it also affects health behaviours indirectly,
through the impact on goals. Both, TPB and SCT are not theories developed particularly to

explain and predict health behaviour. However, a large body of research underlines their
value regarding health-related behaviour (Conner & Norman, 2005).
The Transtheoretical Model (TTM; Prochaska, DiClemente, & Norcross, 1992) proposes
five stages of health behaviour change. The first one is the precontemplation stage, in which
individuals do not consider making any behaviour change. In the contemplation stage,
individuals consider changing a specific health behaviour, but they have not yet decided to
make any changes. In the preparation stage, they prepare to change the behaviour. In the
action stage, a new goal behaviour is initiated. When the action is performed for a longer time
period, the maintenance stage is reached (Prochaska et al., 1992). A sixth stage is sometimes
mentioned, the termination stage, in which individuals no longer experience any temptation to
revert to their old habits. According to the TTM, self-efficacy and perceived positive (“pros”)
and negative (“cons”) outcomes are seen as the main social-cognitive variables that change
across the stages. Self-efficacy beliefs are typically low in early stages and increase when
individuals move on to the later stages.
The Health Action Process Approach (HAPA; Schwarzer, 2008) suggests a distinction
between (a) a motivation phase in which preintentional processes may lead to a behavioural
intention, and (b) a volition phase, in which postintentional processes may lead to actual
health behaviour.
Different patterns of social-cognitive predictors may emerge in both phases, and particular
attention is paid to postintentional mechanisms. The HAPA applies to all health behaviours.
More precisely, in the initial motivation phase, a person develops an intention to act. In this
phase, risk perception (“I have a high risk of suffering from diabetes because of my body
weight”) is merely seen as a distal antecedent within the motivation phase. Risk perception in
itself is not enough to entice a person to form an intention. Rather, it sets the stage for a
contemplation process and further elaboration about consequences and competencies.
Similarly, outcome expectancies (“If I eat healthy foods, I will reduce my weight”) are chiefly
seen as being important in the motivation phase, when a person balances the pros and cons of
the consequences of a certain behaviour. Further, one needs to believe in one's capability to
perform a desired action (“I am capable of initiating a healthier diet in spite of temptations”),
otherwise one will fail to initiate that action. Outcome expectancies operate in concert with
perceived self-efficacy, both of them contributing substantially to the formation of an
intention.
In the subsequent volitional phase, after a person has developed an inclination toward
adopting a particular health behaviour, the “good intention” has to be transformed into
detailed instructions on how to perform the desired action. These plans, which specify the
when, where, and how of a desired action, carry the structure of “When situation S arises, I
will perform response R.” Thus, a global intention can be specified by a set of subordinate
intentions and action plans that contain algorithms of action sequences. The volition phase is
also strongly affected by self-efficacy. The number and quality of action plans depend on
one’s perceived competence and experience, and it has been shown that recovery self-efficacy
predicts both action plans as well as coping plans, which are plans to overcome anticipated
barriers (Ziegelmann & Lippke, 2007). Self-efficacy beliefs influence the cognitive
construction of specific action plans, for example by visualizing scenarios that may guide goal
attainment. The volition phase includes the processes of taking initiative, maintaining
behaviour change, and managing relapse, and self-efficacy beliefs might be specific for these
processes (see Schwarzer & Luszczynska, 2008; Marlatt, Baer, & Quigley, 1995).
As seen in the above-mentioned examples, most prominent health behaviour theories
include self-efficacy beliefs (or synonymous constructs). Self-efficacy is a proximal and
direct predictor of intention or behaviour. Its effects on behaviour might be mediated by other
cognitions, such as intentions (see SCT, TPB, HAPA). Across stages of change, an increase

of self-efficacy is expected (see HAPA, TTM), and self-efficacy can predict movements
between such stages (Wiedemann, Lippke, Reuter, Schüz, Ziegelmann, & Schwarzer, in
press).
Self-Efficacy Reflecting Different Challenges within the Behaviour Change Process
Perceived self-efficacy has been found to be important at all stages in the health behaviour
change process (Bandura, 1997), but it does not always constitute exactly the same construct.
Its meaning depends on the particular situation of individuals who may be more or less
advanced in the change process. Action self-efficacy, coping self-efficacy, and recovery selfefficacy
have been distinguished by Marlatt, Baer, and Quigley (1995) in the domain of
addictive behaviours. The rationale for several phase-specific self-efficacy beliefs is that
during the course of health behaviour change, different beliefs are required to master different
tasks. For example, a person might be confident in his or her capability to make an attempt to
quit a certain behaviour (i.e., high action self-efficacy), but might not be very confident to
resume abstinence after a lapse (low recovery self-efficacy).
Preaction self-efficacy (also called action self-efficacy or task self-efficacy) refers to the
first phase of the process, in which an individual does not yet act, but develops a motivation
to do so. Individuals high in preaction self-efficacy imagine success, and anticipate potential
outcomes of diverse strategies. While preaction self-efficacy is instrumental in the motivation
phase, the two following constructs are instrumental in the subsequent volition phase, and
can, therefore, be summarized under the heading of “volitional self-efficacy.”
Maintenance self-efficacy (also called coping self-efficacy) represents optimistic beliefs
about one’s capability to deal with barriers that arise during the maintenance period (the term
“coping self-efficacy” has also been used in a different sense; therefore, we prefer the term
“maintenance self-efficacy”). A novel health behaviour might turn out to be much more
difficult to adhere to than expected, but a self-efficacious person responds confidently with
better strategies, more effort, and prolonged persistence in overcoming such hurdles. Once an
action has been taken, individuals with high maintenance self-efficacy invest more effort and
persist longer than those who are less self-efficacious.
Recovery self-efficacy addresses the experience of failure, lapses, and setbacks. High selfefficacious
individuals are optimistic to get back on track after being derailed. They trust their
competence to regain control after a setback and to reduce harm (Marlatt et al., 2005).
There is a functional difference between these self-efficacy constructs, whereas their temporal
sequence is less important. Different phase-specific self-efficacy beliefs may be harbored at
the same point in time. The assumption is that they operate in a different manner. For
example, recovery self-efficacy is most functional when it comes to resuming an interrupted
chain of action, whereas action self-efficacy is most functional when facing a novel
challenging demand (Luszczynska, Mazurkiewicz, Ziegelmann, & Schwarzer, 2007;
Luszczynska & Sutton, 2006). This distinction between phase-specific self-efficacy beliefs
has proven useful in various domains of behaviour change. Preaction self-efficacy tends to
predict intentions, whereas maintenance self-efficacy tends to predict behaviours. Individuals
who had recovered from a setback needed different self-beliefs than those who had
maintained their levels of activity (Scholz et al., 2005). Rodgers, Hall, Blanchard, McAuley,
and Munroe (2002) have found evidence for phase-specific self-efficacy beliefs in the domain
of exercise behaviour (i.e., task self-efficacy, coping self-efficacy, and scheduling selfefficacy).
In studies applying the HAPA, phase-specific self-efficacy differed in the effects on
various preventive health behaviours such as breast self-examination (Luszczynska &
Schwarzer, 2003), dietary behaviours (Renner et al., 2008), and physical exercise (Renner,

Spivak, Kwon & Schwarzer, 2007; Scholz et al., 2005; Schwarzer, Luszczynska, Ziegelmann,
Scholz, & Lippke, 2008).
Self-Efficacy in Dietary Behaviour Change: Two Studies
Perceived self-efficacy is supposed to act as a mediator or as a moderator between
intentions and behaviours. Studies are needed to examine the mechanisms that might play a
role in different contexts for different samples and different health behaviours. Study I aims at
improving dietary self-efficacy and at comparing such self-efficacy interventions with a
planning intervention.
Our general assumption is that people need a minimum level of perceived self-efficacy for
most processes of health behaviour change. Thus, self-efficacy may serve as a moderator of
various mediating processes. Study II analyzes whether coping planning (mediator variable)
mediates the effect of intentions (independent variable) on dietary behaviour (dependent
variable) as a function of self-efficacy levels (moderator).
Study I: Improving Fruit and Vegetable Consumption: A Self-Efficacy Intervention
Compared to a Combined Self-Efficacy and Planning Intervention
Effects of interventions targeting self-efficacy alone or combined with action plans were
examined in the context of fruit and vegetable consumption (Luszczynska, Tryburcy, &
Schwarzer, 2007). E-mail messages were sent to a self-efficacy group, a combined selfefficacy
and action planning group, and a control group. At a 6-month follow-up, 200 adults
reported their fruit and vegetable consumption, along with current levels of self-efficacy and
planning. The two experimental groups gained equally from the interventions, as documented
by changes in behaviour (see Figure 1). In both intervention groups, change in respective
cognitions predicted change in fruit and vegetable consumption.
Figure 1. Changes in fruit and vegetable consumption in two intervention groups and the
control group

The results also shed light on the working mechanism of these interventions: self-efficacy
change mediated the effects of the self-efficacy intervention on change in fruit and vegetable
consumption, whereas changes in both self-efficacy and planning mediated the effects of the
combined intervention (addressing self-efficacy and planning). The results support Bandura’s
(1997) suggestions, showing that an enhancement of self-efficacy by means of verbal
persuasion and positive emotion may result in behaviour change. The results are also in line
with studies showing that planning interventions may work because they encourage a person
to engage in more frequent use of strategy planning.
Study II: Moderated Mediation of Dietary Behaviour Change in South Korean Women
Previous analyses (Lippke et al., in press) have confirmed the partial mediation of the
intention-behaviour relationship by planning, and identified levels of perceived self-efficacy
as moderators of this mediation. As this study predicted dietary behaviours, and not
behavioural change, the analyses needed to be replicated. This was done in a longitudinal
sample of 358 women that responded to two questionnaires six months apart in a study in
South Korea (Gutierrez et al., 2009; Renner et al., 2008).
Moderated mediation analyses indicated a moderation effect (see Figure 2). The path
diagram consists of a mediator model (to explain planning) and a dependent variable model
(to explain behaviour). First, intentions emerged as the best predictor of coping planning,
followed by the interaction between intentions and self-efficacy, whereas the main effect of
self-efficacy was rather negligible, overall accounting for 18% of the planning variance.
Second, baseline behaviour was the best predictor of Time 2 low-fat diet, followed by
planning, whereas intentions did not make a contribution, overall accounting for 51% of the
behaviour variance. Thus, there is a full mediation of the intention-behaviour relation via
planning, moderated by self-efficacy.
Figure 2. Moderated mediation model for South Korean women
This analysis corroborated the hypothesized mediation effect, conditional upon the value of
self-efficacy, underscoring the finding that planning translated intentions into behaviour, but
not within the subgroup of individuals who had very low levels of self-efficacy.

Discussion: Implications for Interventions
If individuals are in a more advanced stage in the health behaviour change process and have
already given it a try, interventions should aim at maintenance self-efficacy. For example, if
people try to adhere to a healthy nutrition, an intervention should address their ability to deal
with specific barriers that arise during the maintenance phase, such as high-risk situations that
impose temptations and might be a trap for relapses. Self-efficacy that refers to the
maintenance of physical activity, however, is a poor predictor of the intensity of relapse to a
sedentary life style. People who relapsed to their old habits (e.g., not using condoms) should
be treated in a manner that enhances their beliefs about their ability to regain control after a
setback. It may not be sufficient if an intervention raises optimistic beliefs about being able to
maintain condom use. Instead, improved beliefs about the ability to renegotiate condom use
may get people who experienced a relapse back on track (recovery self-efficacy).
Future interventions for changing health behaviours and health perceptions should distinguish
between three research perspectives: the first perspective, employed most often so far, focuses
on enhancing behaviour-specific self-efficacy but does not take into account the stages within
the health behaviour change process. The second perspective might focus on general selfefficacy
beliefs, under the assumption that if an intervention aims at more general beliefs, it
would affect a wider range of behaviours and life skills. These, in turn, would then be
transferred to other behaviours. The focus in the third approach could be on the distinct
mindsets of those people currently in the motivation (preaction self-efficacy) or volition
(maintenance and recovery self-efficacy) stages. Here, the object would be to enhance
optimistic beliefs that are exclusive for a particular stage. Such a process strategy, as part of a
more comprehensive health behaviour theory, may increase the likelihood that people would
reduce their risk-taking and adhere to a healthier lifestyle.
Contact Author:
Ralf Schwarzer
Freie Universität Berlin
Health Psychology Department
Habelschwerdter Allee 45, 14195 Berlin, Germany
FAX +49 30 838 55634
Email: health@zedat.fu-berlin.de
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