Perceived Self-Efficacy in Health Behaviour Change The Construct of

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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,
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