Middle-Range Theory for the Nursing Diagnosis of Low Self-Efficacy in Health

construction of a middle-range theory for validating diagnoses, comprised of five stages: definition of the approach for building the theory; definition of the main concepts; creation of a pictorial diagram; formulation of proposals; establishment of causal relationships and evidence for clinical practice. The main concepts were identified through a literature review and the studies were taken from the LILACS, SCOPUS, CINAHL and PubMed/MEDLINE databases. The final sample was comprised of 92 articles.

Results:

eighteen etiological factors and 16 clinical indicators were identified; characterized as antecedents and manifestations for inferring a diagnosis of low self-efficacy in health.

Conclusions:

the related concepts of the new nursing diagnosis of low self-efficacy in health, to be applied in clinical nursing practice, were identified and defined.

Descriptors:
Nursing; Nursing Theory; Nursing Diagnosis; Self-Efficacy; Health

Etiological factors of the nursing diagnosis of low self-efficacy in health
Cognitive	Emotional	Physiological	Socioeconomic	Behavioral
Perception of serious consequences of the disease⁽¹⁵15 Zelber-Sagi S, Bord S, Dror-Lavi G, Smith ML, Towne Jr SD, Buch A, et al. Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients. World J Gastroenterol. 2017;23(10):1881-90. doi: 10.3748/wjg.v23.i10.1881 https://doi.org/10.3748/wjg.v23.i10.1881... ⁾	Feelings of lack of trust in health professionals⁽⁶6 Finney Rutten LJ, Hesse BW, St-Sauver Jl, Wilson P, Chawla N, Hartigan DB, et al. Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Adv Ther. 2016;33(8):1440-51. doi: 10.1007/s12325-016-0369-7 https://doi.org/10.1007/s12325-016-0369-... ⁾	Greater health status impairment due to severity of the disease⁽¹⁵15 Zelber-Sagi S, Bord S, Dror-Lavi G, Smith ML, Towne Jr SD, Buch A, et al. Role of illness perception and self-efficacy in lifestyle modification among non-alcoholic fatty liver disease patients. World J Gastroenterol. 2017;23(10):1881-90. doi: 10.3748/wjg.v23.i10.1881 https://doi.org/10.3748/wjg.v23.i10.1881... ⁾	Insufficient social support⁽²⁶26 Carballo NJ, Alessi CA, Martin JL, Mitchell MN, Hays RD, Col N, et al. Perceived effectiveness, self-efficacy, and social support for oral appliance therapy among older veterans with obstructive sleep apnea. Clin Therap. 2016;38(11):2407-15. doi: 10.1016/j.clinthera.2016.09.008 https://doi.org/10.1016/j.clinthera.2016... ⁾	Impaired verbal communication⁽²⁸28 Cruz AC, Angelo M, Santos BP. Self-efficacy scale for the establishment of good relationships with families in neonatal and pediatric hospital settings. Rev Esc Enferm USP. 2017;51:e03222. doi: 10.1590/s1980-220x2016033803222 https://doi.org/10.1590/s1980-220x201603... ⁾
			Low educational level⁽²⁷27 Yong HH, Siahpush M, Borland R, Li L, O’connor Rj, Yang J, et al. Urban Chinese smokers from lower socioeconomic backgrounds face more barriers to quitting: results from the international tobacco control - China Survey. Nicotine Tobacco Res. 2013;15(6):1044-51. doi: 10.1093/ntr/nts234 https://doi.org/10.1093/ntr/nts234... ⁾
Perception of barriers⁽¹⁶16 Meuleman Y, Hoekstra T, Dekker F, Van Der Boog P, Van Dijk S, Study. GE. Perceived sodium reduction barriers among patients with chronic kidney disease: which barriers are important and which patients experience barriers? J Behav Medicine. 2018;25(1):93-102. doi: 10.1007/s12529-017-9668-x https://doi.org/10.1007/s12529-017-9668-... ⁾	Fear⁽²⁰20 Schwartz L, Toohill J, Creedy Dk, Baird K, Gamble J, & Fenwick J. Factors associated with childbirth self-efficacy in Australian childbearing women. BMC Pregnancy Childbirth. 2015;15(29):1-9. doi: 10.1186/s12884-015-0465-8 https://doi.org/10.1186/s12884-015-0465-... ⁾	Fatigue⁽²²22 Armbrust W, Lelieveld OHTM, Tuinstra J, Wulffraat NM, Bos GJFJ, Cappon J, et al. Fatigue in patients with juvenile idiopathic arthritis: relationship to perceived health, physical health, self-efficacy, and participation. Pediatr Rheumatol O J. 2016;14(65):1-9. doi: 10.1186/s12969-016-0125-1 https://doi.org/10.1186/s12969-016-0125-... ⁾	Poor economic situation⁽²⁷27 Yong HH, Siahpush M, Borland R, Li L, O’connor Rj, Yang J, et al. Urban Chinese smokers from lower socioeconomic backgrounds face more barriers to quitting: results from the international tobacco control - China Survey. Nicotine Tobacco Res. 2013;15(6):1044-51. doi: 10.1093/ntr/nts234 https://doi.org/10.1093/ntr/nts234... ⁾
Knowledge deficits⁽¹⁷17 Bailey RA, Pfeifer M, Shillington AC, Harshaw Q, Funnell MM, Vanwingen J, et al. Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict. BMC Health Serv Res. 2016;16(10):2-14. doi: 10.1186/s12913-016-1262-4 https://doi.org/10.1186/s12913-016-1262-... ⁾	Feelings of impotence⁽²¹21 Sturrock BA, Xie J, Holloway EE, Hegel M, Casten M, Mellor D, Fenwick E, et al. Illness cognitions and coping self-efficacy in depression among persons with low vision. Invest Ophthalmol Vis Sci. 2016;57(7):3032-8. doi: 10.1167/iovs.16-19110 https://doi.org/10.1167/iovs.16-19110... ⁾	Age limits⁽²³23 Bay A, Sandberg C, Thilén U, Wadell K, Johansson B. Exercise self-efficacy in adults with congenital heart disease. IJC Heart Vascul. 2018;18:7-11. doi: 10.1016/j.ijcha.2017.12.002 https://doi.org/10.1016/j.ijcha.2017.12.... ⁾
Compensatory health beliefs⁽¹⁸18 Storm V, Reinwand D, Wienert J, Kuhlmann T, De Vries H, Lippke S. Brief report: Compensatory health beliefs are negatively associated with intentions for regular fruit and vegetable consumption when self-efficacy is low. J Health Psychol. 2017;22(8):1094-100. doi: 10.1177/1359105315625358 https://doi.org/10.1177/1359105315625358... ⁾	Anxiety⁽⁶6 Finney Rutten LJ, Hesse BW, St-Sauver Jl, Wilson P, Chawla N, Hartigan DB, et al. Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Adv Ther. 2016;33(8):1440-51. doi: 10.1007/s12325-016-0369-7 https://doi.org/10.1007/s12325-016-0369-... ⁾	Stress⁽²⁴24 Jamieson LM, Parker EJ, Roberts-Thomson KF, Lawrence HP, Broughton J. Self-efficacy and self-rated oral health among pregnant aboriginal Australian women. BMC Oral Health. 2014;14(29):1-7. doi: 10.1186/1472-6831-14-29 https://doi.org/10.1186/1472-6831-14-29... ⁾
Experiencing failure⁽¹⁹19 Cafazzo JA, Leonard K, Easty AC, Rossos PG, Chan CT. Patient-perceived barriers to the adoption of nocturnal home hemodialysis. Clinl J Am Soc Nephrol. 2009;4(4):784-9. doi: 10.2215/CJN.05501008 https://doi.org/10.2215/CJN.05501008... ⁾		Pain⁽²⁵25 Brouwer S, Franche RL, Hogg-Johnson S, Lee H, Krause N, Shaw WS. Return-to-work self-efficacy: development and validation of a scale in claimants with musculoskeletal disorders. J Occup Rehab. 2011;21(2):244-58. doi: 10.1007/s10926-010-9262-4 https://doi.org/10.1007/s10926-010-9262-... ⁾

Clinical indicators of the nursing diagnosis of low self-efficacy in health
Behavioral	Cognitive	Emotional	Physiological
Risk prone health behavior⁽²⁹29 Castro V, Benjet C, Juárez F, Jurado S, Lucio Gómez-Maqueo M, Valencia A. Non-suicidal self-injuries in a sample of Mexican university students. Salud Mental. 2017;40(5):191-200. doi: 10.17711/sm.0185-3325.2017.025 https://doi.org/10.17711/sm.0185-3325.20... ⁾	Lower quality of life⁽¹⁰10 Silva M, Hortense P, Napoleão A, Stefane T. Autoeficácia, intensidade de dor e qualidade de vida em indivíduos com dor crônica. Rev Eletrôn Enferm. 2016;18:(e1145). doi: 10.5216/ree.v18.29308 https://doi.org/10.5216/ree.v18.29308... ⁾	Feelings of anger⁽³⁸38 Jones DL, Owens MI, Lydston D, Tobin JN, Brondolo E, & Weiss SM. Self-efficacy and distress in women with AIDS: the SMART/EST Women’s Project. AIDS Care. 2010;22(12):1499-508. doi: 10.1080/09540121.2010.484454 https://doi.org/10.1080/09540121.2010.48... ⁾	More complaints about pain⁽²⁵25 Brouwer S, Franche RL, Hogg-Johnson S, Lee H, Krause N, Shaw WS. Return-to-work self-efficacy: development and validation of a scale in claimants with musculoskeletal disorders. J Occup Rehab. 2011;21(2):244-58. doi: 10.1007/s10926-010-9262-4 https://doi.org/10.1007/s10926-010-9262-... ⁾
Low adherence⁽³⁰30 Berg KM, Cooperman NA, Newville H, Arnsten JH. Self-efficacy and depression as mediators of the relationship between pain and antiretroviral adherence. J Health AIDS Care. 2009;21(2):244-8. doi: 10.1080/09540120802001697 https://doi.org/10.1080/0954012080200169... ⁾	Insufficient self-control⁽³⁶36 Gruber-Baldini AL, Velozo C, Romero S, Shulman LM. Validation of the PROMIS® measures of self-efficacy for managing chronic conditions. Qual Life Res. 2017;26(7):1915-24. doi: 10.1007/s11136-017-1527-3 https://doi.org/10.1007/s11136-017-1527-... ⁾	Denial of changes in health status⁽²⁷27 Yong HH, Siahpush M, Borland R, Li L, O’connor Rj, Yang J, et al. Urban Chinese smokers from lower socioeconomic backgrounds face more barriers to quitting: results from the international tobacco control - China Survey. Nicotine Tobacco Res. 2013;15(6):1044-51. doi: 10.1093/ntr/nts234 https://doi.org/10.1093/ntr/nts234... ⁾
Co-dependency⁽³¹31 Mansyur C, Pavlik V, Hyman D, Taylor W, Goodrick G. Self-efficacy and barriers to multiple behavior change in low-income African Americans with hypertension. J Behav Medicine. 2013;36(1):75-85. doi: 10.1007/s10865-012-9403-7 https://doi.org/10.1007/s10865-012-9403-... ⁾	Lower degree of health empowerment⁽²²22 Armbrust W, Lelieveld OHTM, Tuinstra J, Wulffraat NM, Bos GJFJ, Cappon J, et al. Fatigue in patients with juvenile idiopathic arthritis: relationship to perceived health, physical health, self-efficacy, and participation. Pediatr Rheumatol O J. 2016;14(65):1-9. doi: 10.1186/s12969-016-0125-1 https://doi.org/10.1186/s12969-016-0125-... ^,³⁷37 Náfrádi L, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS ONE. 2017;12(10):e0186458. doi: 10.1371/journal.pone.0186458 https://doi.org/10.1371/journal.pone.018... ⁾
Lack of interest in improving health behaviors⁽²⁷27 Yong HH, Siahpush M, Borland R, Li L, O’connor Rj, Yang J, et al. Urban Chinese smokers from lower socioeconomic backgrounds face more barriers to quitting: results from the international tobacco control - China Survey. Nicotine Tobacco Res. 2013;15(6):1044-51. doi: 10.1093/ntr/nts234 https://doi.org/10.1093/ntr/nts234... ⁾	Low self-perception of health⁽²⁴24 Jamieson LM, Parker EJ, Roberts-Thomson KF, Lawrence HP, Broughton J. Self-efficacy and self-rated oral health among pregnant aboriginal Australian women. BMC Oral Health. 2014;14(29):1-7. doi: 10.1186/1472-6831-14-29 https://doi.org/10.1186/1472-6831-14-29... ⁾
Failure to act to prevent health problems⁽³²32 Clum, GA, Rice, JC, Broussard, M, Johnson, CC, & Webber, LS. Associations between depressive symptoms, self-efficacy, eating styles, exercise and body mass index in women. J Behav Medicine. 2014;37(4):577-86. doi: 10.1007/s10865-013-9526-5 https://doi.org/10.1007/s10865-013-9526-... ⁾
Self-care deficit⁽¹⁷17 Bailey RA, Pfeifer M, Shillington AC, Harshaw Q, Funnell MM, Vanwingen J, et al. Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict. BMC Health Serv Res. 2016;16(10):2-14. doi: 10.1186/s12913-016-1262-4 https://doi.org/10.1186/s12913-016-1262-... ^,³³33 Gutiérrez R, Gómez AM. Agencia de autocuidado y autoeficacia percibida en personas con cardiopatías isquémicas. Av Enferm. 2018;36(2):161-9. doi: 10.15446/av.enferm.v36n2.65674 https://doi.org/10.15446/av.enferm.v36n2... ⁾
Reduced problem-solving ability⁽¹⁰10 Silva M, Hortense P, Napoleão A, Stefane T. Autoeficácia, intensidade de dor e qualidade de vida em indivíduos com dor crônica. Rev Eletrôn Enferm. 2016;18:(e1145). doi: 10.5216/ree.v18.29308 https://doi.org/10.5216/ree.v18.29308... ⁾
Avoidance behavior⁽³⁴34 Cho Y, Thrasher J, Yong H, Szklod A, O’connor Bt, D H, et al. Path analysis of warning label effects on negative emotions and quit attempts: a longitudinal study of smokers in Australia, Canada, Mexico, and the US. Soc Sci Medicine. 2018;197:226-34. doi: 10.1016/j.socscimed.2017.10.003 https://doi.org/10.1016/j.socscimed.2017... ^-³⁵35 Umubyeyi A, Mogren I, Ntaganira J, Krantz G. Help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care: a population-based study in Rwanda. Soc Psychiatr Psychiatr Epidemiol. 2016;51(1):81-92. doi: 10.1007/s00127-015-1130-2 https://doi.org/10.1007/s00127-015-1130-... ⁾
Impaired verbal communication⁽⁶6 Finney Rutten LJ, Hesse BW, St-Sauver Jl, Wilson P, Chawla N, Hartigan DB, et al. Health self-efficacy among populations with multiple chronic conditions: the value of patient-centered communication. Adv Ther. 2016;33(8):1440-51. doi: 10.1007/s12325-016-0369-7 https://doi.org/10.1007/s12325-016-0369-... ⁾

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[1] Corresponding author: Reinaldo Gutiérrez Barreiro. E-mail: gutrey@gmail.com