Courtesy of the persistent "I think I can" rhythm of the little engine that could, most of us know the basic principles of self-efficacy. Self efficacy—a person’s beliefs about whether or not they can cope with their circumstances and influence their situation—has a huge influence on rehabilitation prospects and return to work. This quick guide outlines the signs of poor self efficacy in ill and injured workers and provides tips for encouraging a go-get-em attitude in those who doubt their capacity to recover.

Why is self efficacy important?

According to Albert Bandura, a Canadian psychologist who has led the way in self-efficacy research, a person's level of self-efficacy determines how they "feel, think, motivate themselves and behave".

A person with high self-efficacy is likely to:

• Perceive a difficult task, such as recovering from an injury or illness and returning to work, as a challenge to be mastered;
• Be focused on and committed to recovery;
• Attribute any set-backs to insufficient effort or a lack of knowledge and skills that they are able to acquire;
• Feel that they have control over threatening situations; and
• Have a strong sense of human accomplishment and personal wellbeing.

A person with low self-efficacy is likely to:

• Shy away from difficult tasks, such as painful rehab exercises, which they may view as personal threats;
• Have low aspirations regarding recovery and less commitment to the process;
• Dwell on obstacles to RTW rather than concentrating on what they can do to improve their situation;
• Give up quickly in the face of difficulties, which they associate with low personal ability; and
• Struggle with stress and depression. 

Significantly in the RTW field, people who are in pain and under stress are more likely to have low self efficacy because we:

• Often interpret signs of stress and tension as making us vulnerable to poor performance;
• Perceive fatigue, aches and pain as signs of physical debility; and
• Feel less confident about our capabilities when our mood is low.

What are the signs of poor self efficacy?

Low self-efficacy might reveal itself in a number of ways, including:

• Negative statements about a person's prospects for recovery and return to work:
  • "My cousin had an injury like this, and he's been useless ever since."
  • "I don't think I can cope with work when my wrist hurts like this."
  • "My supervisor isn't going to make working modified duties easy for me."
• Missing medical appointments, or meetings with the RTW case manager;
• A consistently low or anxious mood; and 
• An association of the experience of pain with physical damage, for example, "I'm sore at the end of four hours of work, and I can't afford to do my back in again."

How can high self efficacy be encouraged?

To a certain extent, a person's level of self efficacy has been shaped by their beliefs about the world and their place in it, and their whole life's experiences, of which their working life is just a small part.

However, there are things that can be done to improve self efficacy amongst those who have less confidence in their abilities. Albert Bandura has identified four ways of bolstering self efficacy:

1. Personally mastering difficult experiences;
2. Seeing people similar to yourself succeed through hard work;
3. Receiving positive feedback and support from the people around you; and
4. Learning how to cope with stress and difficult emotions, and interpreting physical states (for example, pain) in a more appropriate way.

ALL these self efficacy bolsters can be applied to the workplace. If you've identified a worker with low self efficacy who is struggling to rehabilitate and return to work, consider:

• Breaking their RTW journey down into small, achievable tasks, and celebrating each milestone with them;
• Making everyone in the workplace aware of RTW success stories, via a newsletter, a RTW award, or some other form of public acknowledgement;
• Having supervisors, managers and coworkers to provide injured or ill colleagues with support and encouragement; and
• If beliefs about pain are holding back rehabilitation, pain counselling may be appropriate.