Self-Efficacy - IntNSA · Bourbeau; 2008 : Senbanjo, Wolff, Marshall & Strang; 2009 Alcoholics with...
Transcript of Self-Efficacy - IntNSA · Bourbeau; 2008 : Senbanjo, Wolff, Marshall & Strang; 2009 Alcoholics with...
The Effect of Self-Efficacy on Treatment Outcomes of Clients Enrolled in a Methadone Treatment Program in Rural Maryland
Bonnie A. Franckowiak, DNP, FNP, CARN-AP
Self-Efficacy
“The belief in one’s capabilities to organize and execute the courses of action required to manage prospective situations.”
- Albert Bandura, 1986
Self-Efficacy is belief in one’s ability to
succeed at tasks.
General Self-Efficacy is belief in one’s
general ability to succeed at tasks.
Specific Self-Efficacy refers to beliefs
about one’s ability to handle specific
tasks.
Why Study Self-Efficacy?
Addiction is a Medical Disease
Addiction is a “chronic, relapsing brain
disease”, which has implications not only as an
individual health problem, but also as a public
health problem. It impacts the drug abuser and
the community on a physical, mental,
psychological and social level.
(Qureshi, Al-Ghamdy, & Al-Habeeb, 2000)
Background: Opiate Addiction
▪ 24.6 million Americans used illicit drugs in
2013 (9.4%)
▪ National cost is approx. $700 billion annually
▪ >8,000 new users daily
(SAMHSA, 2014)
Background (cont.)
▪ Public health problem with global implications
▪ Contributes to global mortality and morbidity
(NIDA, 2011)
Global Burden of Disease
DALY = Disability Adjusted Life Years
The number of years of potential life lost due to premature mortality and the years of productive life lost due to disability.
Global Burden of Substance Abuse
▪ Drug dependence responsible for
20 million DALYs in 2010
▪ Opioid dependence was the largest
contributor, with 9.2 million
▪ Highest burden in higher income
countries
▪ Illustrates increased need for
treatment
(Degenhardt, et al. 2013)
Principles of Addiction Treatment: A Research-based Guide (NIDA, 1999)
▪ No single treatment is appropriate for all
individuals.
▪ Treatment must attend to multiple need
of the individual, not just drug use.
▪ Remaining in treatment for an adequate
period of time is critical for treatment effectiveness.
Medication assisted treatment (MAT) using Methadone
▪Gold standard of opiate treatment
▪ Strict state and federal regulations
▪ Individualized according to need
MAT (cont.)
▪ Pharmacology, counseling, and behavioral therapy
▪ Comprehensive approach; Individualized care
▪ Goal: return to a state of health and well-being,
and function well in family and community
▪ Low cost, safe, and effective; Accepted world-wide
LITERATURE REVIEW
Retention in treatment
Psychosocial support
Behavior change
Self-Efficacy
Health Belief Model
Literature Review
Retention in Treatment
▪ Client satisfaction leads to improved outcomes.
Kelly, O’Grady, Mitchell, Brown & Schwartz; 2011
▪ Chronic illness is best treated collaboratively by client and
provider.
VonKorff, Gruman, Curry & Wagner; 1997
▪ Adequate methadone dosing, psychiatric care, and
behavioral counseling are key to successful treatment.
Ciraulo, Piechniczek-Buczek & Iscan; 2003
▪ Individualized treatment plans are associated with better
retention and outcomes.
Hser, Evans, Huang & Anglin; 2004
Psychosocial Support
▪ Satisfaction and rapport with staff leads to a decrease in
illicit drug use, better compliance with treatment, and
improved outcomes.
Joe, Simpson, Dansereau Rowan-Szal; 2001
▪ Clients who felt that needs were met during treatment
stayed abstinent longer… at 1 year follow up.
Zhang, Gerstein & Freidmann; 2008
▪ Outcomes improve when psychosocial support is added to
medication treatment, compared to medication alone.
Amato, Minozzi, Davoli, Vecchi, Ferri & Mayet; 2009
Behavior Change
▪Motivation is an important factor in behavior change.
Kelly, Zyzanski & Alemagno;
1991
▪ Self-efficacy affects the decision whether or not to initiate
behavior change.
Stewart, Wolfe, Maeder & Hartz; 1996
▪Maintenance of new behaviors is related to self-efficacy.
Scherbaum; 2008
Self-Efficacy
▪ Positive health behavior is related to high self-efficacy.
Schwarzer & Fuchs; 1995
▪ Efforts to improve self-efficacy lead to improved treatment outcome and retention.
Bourbeau; 2008 : Senbanjo, Wolff, Marshall & Strang; 2009
▪ Alcoholics with high self-efficacy resisted temptation to drink for longer time periods.
Vielva & Iraurgi; 2001: Allsop,Saunders&Phillips;2000
Self-efficacy is a fluid, dynamic concept.
Why is Self-Efficacy important?
Self-Efficacy
·Feelings
·Thoughts
·Motivation
·Actions
·Past
Performance
·Verbal
Persuasion
·Vicarious
Experience
·Psychological
/ Emotional
States
Health Belief Model (HBM)
▪ One of the most widely accepted and frequently used
models for study and implementation of behavior change.
Harrison, Mullen & Green; 1992
▪ Proven useful in improving patient compliance in many
studies related to various chronic illnesses.
HEALTH B Orel et al.; 2010: Ghaddar et al.; 2009: Koch; 2002
HBM (cont.)
Four conditions for behavior change:
The belief that one is at risk of developing a specific condition.
The belief that the risk is serious and the consequences are
undesirable.
The belief that the risk will be reduced by behavior change.
The belief that barriers to behavior change can be overcome and
managed.
(Janz & Becker, 1984)
Perceived Susceptability
to Disease “X”
Perceived Seriousness
(Severity) of Disease “X”
Demographic variables
(age, sex, race,
ethnicity, etc.)
Sociopsychological variables
Perceived Threat of
Disease “X”
Cues to Action
Mass media campaigns
Advice from others
Reminder postcard from physician/dentist
Illness of family member or friend
Newspaper or magazine article
Perceived benefits of
preventive action
minus
Perceived barriers to
preventive action
Likelihood of Taking
Recommended
Preventive Health Action
Health Belief Model
Janz & Becker, 1984
METHODOLOGY
Purpose:To determine if measurement of self-efficacy can be a useful tool in treatment of the opiate addicted client.
Research Questions
1. Are MAT and self-efficacy
related?
2. Are self-efficacy and
treatment outcomes
related?
1. I can always manage to solve difficult problems if I try hard enough.
2. If someone opposes me, I can find the means to get what I want.
3. It is easy for me to stick to my aims and accomplish my goals.
4. I am confident that I could deal efficiently with unexpected events.
5. Thanks to my resourcefulness, I can handle unforeseen circumstances.
6. I can solve most problems if I invest the necessary effort.
7. I can remain calm when facing difficulties because I can rely on my coping abilities.
8. When I am confronted with a problem, I can usually find several solutions.
9. If I am in trouble, I can usually think of a solution.
10. I can usually handle whatever comes my way.
The General Self-efficacy Scale (GSE)
Responses: 1= Not at all true. 2 = Hardly true. 3 = Moderately true. 4 = Exactly true.
English version by Schwarzer & Jerusalem, 1995
Specific Self-efficacy
11. If I ran into old friends who offered me pills or heroin, I could resist.
12. I can stay away from people I used to use with, and I feel strong.
13. If I was in a situation where people were using drugs, I would have
the strength to leave.
14. I feel that I am able to cope with stress in ways other than
using drugs.
Responses: 1= Not at all true. 2 = Hardly true. 3 = Moderately true. 4 = Exactly true.
Franckowiak, 2011
Additional questions relating specifically to opiate dependence
added by researcher.
Variables
▪ change in self-efficacy scores
▪ number of opiate-free urines
▪monthly group attendance
▪monthly individual counseling sessions
STUDY DESIGN
The Study
Admission
process
including
GSE
Initiate
Standard
MAT
After 6
months +/- 4
days
Obtain
informed
consent
Repeat GSE
Retrospective
record
review
of outcome
measures
Study Site:
Serenity Health, LLC Elkton, MD
Site Demographics:
96% Caucasian, 3% African American
54% female, 70% unemployed, 4% disabled
80% Medicaid, 20% self-pay
Average age 34 years
QUESTION #1: Are MAT and self-efficacy related?
Comparison of (Post- minus Pre-treatment) scores using Paired t-test
QUESTION #2: Are self-efficacy and treatment outcomes related?
Correlation of group and individual sessions, and number of opiate-negative urine screens using Pearson
Correlation
Analysis of Data
RESULTS
Gender Mean N Std. Dev.
Pre GSE
(General)
Females 25.86 14 4.276
Males 26.36 14 5.652
Combined 26.11 28 4.924
Pre GSE
(Specific)
Females 7.07 14 3.245
Males 8.50 14 3.391
Combined 7.79 28 3.337
Pre GSE
(Total)
Females 32.93 14 4.358
Males 34.86 14 8.047
Combined 33.89 28 6.425
MEAN PRE-TREATMENT GSE SCORES BY GENDER
Post GSE
(General)
Females 30.43 14 2.243
Males 31.07 14 5.166
Combined 30.75 28 3.922
Post GSE
(Specific)
Females 12.71 14 2.758
Males 13.79 14 3.118
Combined 13.25 28 2.939
Post GSE
(Total)
Females 43.14 14 3.780
Males 44.86 14 7.695
Combined 44.00 28 6.012
MEAN POST-TREATMENT GSE SCORES BY GENDER
t p value RangeAverageIncrease
Post-Pre
GSE score
(general)
5.730 .000 3.28 – 6.94 5.2
Post-Pre
GSE score
(specific)
7.163 .000 3.77 – 6.805.1
Post-Pre
GSE score
(total)
7.928 .000 7.49 – 12.72 10.1
COMPARISON OF PRE- & POST- TREATMENT
GSE SCORES
Research Question #1
Is MAT related to self-efficacy?
In this study, MAT does appear to
be related to self-efficacy.
Pre GSE
(General)
Pre GSE
(Specific)
Pre GSE
(Total)
Negative
Urine
Pearson
Correlation-.152 .047 -.092
Sig. (2-tailed) .441 .810 .643
N 28 28 28
CORRELATION OF GSE SCORES
AND NUMBER OF OPIATE NEGATIVE
URINE SCREENS
Pre GSE
(General)
Pre GSE
(Specific)
Pre GSE
(Total)
Individual Sessions Pearson
Correlation.010 .168 .095
Sig. (2-
tailed).962 .392 .632
Group Sessions Pearson
Correlation-.283 -.234 -.338
Sig. (2-
tailed).145 .232 .078
N 28 28 28
CORRELATION OF GSE SCORES
AND INDIVIDUAL AND GROUP SESSIONS
Research Question #2
Are self-efficacy and
treatment outcomes related?
No correlation was found
between self-efficacy scores and
any of the treatment outcomes
measured.
Descriptive Data
High GSE scores yielded more opiate negative urine
screens.
Subjects with high GSE scores preferred groups.
Subjects with low GSE scores preferred individual sessions.
Five subjects had unchanged or lowered GSE scores.
28 of 50 subjects identified completed the study.
Transferred to other treatment
facility 3
Moved out of area
2
Medical issues / Hospitalization
4
Incarceration
6
Administrative discharge
1
Referred to pain management
1
Left AMA
2
Unknown
3
Participants
who did not
complete the
study
(n = 22)
DISCUSSION & RECOMMENDATIONS
Strengths of the Study
Homogeneity of sample
All subjects received same MAT protocol
Inter-rater reliability
Met 6 month minimum for MAT
Limitations of the Study
Small sample size
High attrition rate
Did not control for additional group attendance
Did not control for type of group attended
Recommendations for Research Replicate with larger sample size and longer
duration.
Add measure of stress level.
Assess motivation for treatment.
Control for other variables (onset of drug use,
treatment history, and concurrent substance use).
Add control group who receives an intervention to
increase self-efficacy.
Recommendations for Practice
Repeat GSE at intervals throughout treatment, and
incorporate into Relapse Prevention programs.
Continue use of GSE testing as an aid in treatment
planning and counselor assignment.
Use GSE testing to strengthen patient assessment,
and view of “whole person”.
Follow Up at One Year…
Of the 28 subjects who completed the original study, 22 remained in treatment.
“Self-belief does not necessarily ensure success, but self-disbelief assuredly spawns failure.”
- Albert Bandura
From Self-Efficacy: The exercise of Control, 1997
Final thought...
Questions & Discussion
Thank you.