Educational Session

Horm Res 2002;57(suppl 1):69–71

Self-Efficacy and Diabetes:

Why Is Emotional ‘Education’ Important
and How Can It Be Achieved?
Lesley A.L. Howells
Tayside Institute of Child Health, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK

Key Words number of emotional attitudes to self-management to

Diabetes education W Diabetes mellitus W Self-efficacy
Abstract
Adequate age-appropriate diabetes knowledge and skills
are essential to the success of diabetes self- and parental
care. Health professionals have a central role in provid-
ing diabetes education. A direct link between diabetes
knowledge and diabetes regimen behaviour cannot be
assumed. Health professionals have to help children and
their parents to develop the emotional concept of ‘self-
efficacy for diabetes self-care’, to ensure optimal dia-
betes control.
Copyright © 2002 S. Karger AG, Basel
‘If self-efficacy is lacking, people
tend to behave ineffectually, even
though they know what to do.’
Bandura, 1986
Emotional Education
Ensuring adequate age-appropriate diabetes knowl-
edge and skills is pivotal to the optimal control of type 1
diabetes. However, a young person needs to develop a
assist in the use of such knowledge and skills. A direct
route between diabetes knowledge and diabetes regimen
behaviour cannot be assumed [1]. To provide an empow-
ering relationship which enables the child to develop self-
efficacy for diabetes self-care (a constructive emotional
attitude for effective self-management of diabetes) has to
be a parallel educational consideration for diabetes teams
[2–4].
Self-Efficacy
Self-efficacy, a key concept in Social Learning Theory
[5], is a person’s belief in his or her ability to overcome the
difficulties inherent in a specific task, in a particular situa-
tion. Self-efficacy influences the choices a person makes,
the effort applied to a task and how long a person will
persist when confronted with obstacles or failure [5]. Peo-
ple tend to pursue the tasks for which they have self-effica-
cy, and repeatedly it has been found to be a significant
predictor of health-related behaviour [6].
Research has shown that adherence to recommended
management routines of a chronic disease can be en-
hanced by increasing self-efficacy [6]. A higher self-effica-
cy in young people with type 1 diabetes is associated with
a better quality of life, less depression and higher self-
esteem [7, 8]. A higher self-efficacy score for diabetes self-

© 2002 S. Karger AG, Basel Lesley A.L. Howells

ABC 0301–0163/02/0577–0069$18.50/0 Tayside Institute of Child Health, Ninewells Hospital and Medical School
Fax + 41 61 306 12 34 University of Dundee
E-Mail karger@karger.ch Accessible online at: Dundee DD1 9SY (UK)
www.karger.com www.karger.com/journals/hre Tel. +44 1382 6325 41, Fax +44 1382 6457 83, E-Mail L.Howells@dundee.ac.uk
Fig. 1.

70 Horm Res 2002;57(suppl 1):69–71 Howells

care has also been found to be associated with lower
HbA1c and the perception of lower barriers to diabetes
regimen adherence [9].
Enhancing Self-Efficacy for Self Management:
Problem-Solving
Self-efficacy can be enhanced using problem-solving
techniques [10] to plan realistic and achievable self-man-
agement goals, within the context of an empowering rela-
tionship, i.e. the support of someone who is encouraging
and believes in the person’s ability to achieve such goals
[5]. Guiding a young person in the use of problem-solving
steps as a part of routine consultation provides a struc-
tured but simple opportunity to:
E teach and model a constructive self-management skill;
E help build an empowering relationship by working
through a problem in close discussion with the young
person;
E ensure an effective problem solution is attempted, so
increasing the likelihood of the young person achieving
a realistic management goal.
‘Our prescriptions ... should not be heard as orders, but
as negotiable propositions.’ Alvin, 1992.

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