Analysis system for self-efficacy training: development and validation of an evaluation tool in diabetes care

Abstract

The research reported in this thesis investigates the self-efficacy construct in the context of (real world) diabetes self-management programmes. Self-efficacy interventions, although widely implemented in diabetes care, lack basic information on what exactly was delivered. More importantly, there has been no assessment tool which would enable researchers to externally evaluate the use of self-efficacy-based techniques in interventions and provide accurate report information about the process of intervention delivery.
To address this gap, the present PhD aimed to develop a reliable and valid coding tool to assess the use of self-efficacy-based techniques among nurses delivering education for people with diabetes and test its clinical utility by delivering a self-efficacy-based intervention to diabetes nurses.
The four sources of self-efficacy: mastery experience, role modelling, verbal persuasion and physiological and affective states formed the conceptual basis of the coding tool. The findings of the literature review and observation of three educational programmes provided an operationalisation of the four sources of self-efficacy and resulted in 11 verbal behavioural techniques. Four coders rated diabetes programmes to establish reliability of the coding tool. Cross-sectional and longitudinal data from 52 patients, based on self-report and objective measures, as well as demographic information about five nurses were related to nurse-led self-efficacy based techniques to establish the validity of ASSET. In a single pre-post design, the feasibility and effectiveness of ASSET-based interventions delivered to five nurses were evaluated.
The key findings were that ASSET could be a useful tool to identify the use of self-efficacy in interventions. The use of self-efficacy-based techniques reflected nurses’ work-related experience gained prior to the study, and to some extent predicted patientrelated outcomes including intention and behaviour regarding diabetes management. The use of self-efficacy based techniques by nurses, however, did not predict patients’ selfefficacy beliefs. ASSET-based training guided nurses in reflecting on their practice. As a result of that, nurses started using more self-efficacy-based techniques when delivering group-based education. The effect was, however, not maintained over time. Nurses who were less experienced prior to the intervention increased their use of self-efficacy-based techniques to a greater extent than those with prior experience. One of the major limitations of the thesis was that only the author of the thesis coded all nurse-led speech utterances. The other three coders rated a selection of utterances. Therefore, there is no sufficient evidence to conclude on the reliability or validity of ASSET.

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