A look at the internal factors of motivation, namely self efficacy, and how to hone in on it.

Health practitioners can manipulate the factors that surround a patient's rehabilitation to increase their motivation. These factors can be external, such as environment, or internal factors, such as a sense of self-competence or, the one we're going to focus on here, self-efficacy.

In the mid-1950s Canadian psychologist Albert Bandura developed a social theory based around the concept of self-efficacy. The term doesn't so much describe a person's feelings of self-worth as their belief in their ability to reach a goal. It is a major part of motivation and something rehabilitation and health practitioners can tap into in their patients to help them reach more successful results.

In his article 'The Motivation Factor', published in The Interdisciplinary Journal of Rehabilitation (Aug/Sep 2004), Keiba L. Shaw describes motivation as linked to self-efficacy as being when “the individual's motivation to engage in behaviour is dependent upon their perception of their abilities to successfully engage in and complete a behaviour or task.”

According to Shaw it is important that the health care practitioner utilizes strategies to increase self-efficacy in their patients. “It is presumed that increasing self-efficacy will positively influence functional ability,” he writes.

Some of the things that are known to increase self-efficacy, writes Shaw, include: “role modelling, emotional arousal, realistic goal setting, reduction of negative feedback, verbal persuasion from a voice of authority, verbal encouragement, individual care [and] social supports.”

Let's pick these apart a little:

• role modelling: patients can feel inspired by seeing other patients in similar positions who have successfully undertaken their rehabilitation
• emotional arousal: one example of this is engaging with a patient's sense of humour. “Humour helps to relieve the tension and stress often associated with the rehabilitation process,” writes Shaw. With less tension a patient is less distracted from reaching their goal
• realistic goal setting: helping a patient set small, attainable goals and providing feedback on these goals, is vital says Shaw
• reduction of negative feedback: positive reinforcement is likely to achieve positive results, and stimulate a patient to keep trying
• verbal persuasion from a voice of authority
• verbal encouragement: encouragement should not be underestimated. Rehab and health practitioners have the power to encourage a belief in their patients that they can reach set goals
• individual care: this relates to the value of seeing patients as individuals, and treating them as such. Practitioners with an increased rapport would be able, for example, to tap into their patients' prior knowledge and experience of rehabilitation, which, writes Shaw, “will help them to see themselves as 'experts' in their own care,” increasing their sense of powerfulness in their own recovery
• social supports: this could be friends and family, who can provide care and recognition of goals achieved, which helps patients achieve sense of competence.

“It is known that individuals will act and perform an activity if they deem that activity important to them. Therefore, to increase motivation, it is essential for health care providers to maximize activities determined to be meaningful and valuable to a particular individual,” writes Shaw. Building on internal factors such as self-efficacy we can get to the very roots of motivation; not a bad place to start when looking at encouraging the quality in patients and nurturing it to grow.