Self-efficacy: understanding a psychological concept which can improve the quality of health care.

EVIDENCE-BASED MEDICAL PRACTICE DEPENDS upon the randomised placebo controlled trial. What the trial does is dissect the specific effect of a physical intervention from the nonspecific, or placebo, effects inherent in any interaction between physician and patient. It is important to realise that, whilst we would wish all medical interventions to have a specific effect, many do not, and all have an inherent placebo component. The effect of the placebo is extraordinarily powerful, and comprises at least three elements: expectation, conditioning and self-efficacy. These elements are psychological formulations which the physician can readily manipulate to improve the outcome for the patients. In the accompanying article, Bar-Mor and his colleagues have investigated the roles of self-efficacy and physical activity in the setting of adolescents with congenital cardiac malformations. In this comment, I will outline the background and context of self-efficacy, a concept which is crucial to the success of the 'patientcentred' model of care.