1. What self-efficacy means
Self-efficacy means that you trust yourself to manage a particular task, even when it gets difficult. In everyday language: confidence. The psychologist Albert Bandura introduced the term in 1977 [1].
Confidence always applies to a particular activity. A person may feel confident about walking for half an hour despite back pain. The same person may lack the confidence to go down a staircase without a handrail. You can rate each of these separately and strengthen each separately.
Confidence grows mainly through your own experience. When you manage one task, you tend to feel more confident about the next. That is why section 4 sets out a simple method. You set yourself goals you feel confident about, and you record what you have achieved.
You can measure your confidence yourself. For example, ask yourself: "How sure am I that I will go for a 20-minute walk three times this week, even on days with pain?" Answer with a number from 0 to 10. 0 means "not at all sure". 10 means "completely sure". This number is your confidence for this one task.
This article does not replace an examination. What your doctor decides for your situation takes precedence.
2. Why confidence matters for your health
Many studies have looked at whether people with more confidence cope better with an illness. Most of them are observational studies. They show that more confidence and a better course of the illness often occur together. They do not show for certain whether confidence is the cause. Section 2.5 describes what is known about programmes that aim to strengthen confidence.
2.1 With long-lasting pain
Researchers have studied confidence most in pain that has lasted for months. A summary of 86 study groups with 15,616 people found that those with more confidence were less limited in everyday life [2]. These people were also less low in mood and had less severe pain. The association also appeared in studies that followed people over a longer period [2].
A second review analysed 27 studies that followed people with long-lasting pain in muscles and joints over time [3]. In these studies, more confidence went with more physical activity. These people coped better physically in everyday life and were more often able to work. They had less pain. They were less limited, less low in mood and less tired. However, the studies were of low quality. The research team therefore advises caution.
An English study followed people with back pain who consulted their GP [4]. At the start, 1,591 people took part. After six months, 810 were still taking part. The research team compared 20 psychological characteristics. Four of them best predicted how much their back limited people after six months:
- the confidence to be active despite pain,
- the sense of being able to influence their symptoms,
- the expectation of how long the symptoms would last,
- the number of symptoms a person put down to their back problem.
When the research team looked at all the characteristics together, other characteristics predicted nothing extra. These included low mood, fear of movement and the tendency to expect the worst when in pain [4].
A summary of 12 studies with 2,961 people with back or neck pain asked by what route pain leads to limitations in everyday life [5]. According to the statistical model, part of this route ran through confidence. In this model, pain weakens confidence, and less confidence leads to more limitation. A larger part of the route ran through confidence than through psychological distress or fear. These studies also had weaknesses in their methods.
Our article on Cognitive Functional Therapy describes how confidence can change during treatment. You can read more about back pain in the article Back pain.
2.2 With fear of falling
You can describe fear of falling as a lack of confidence. In 1990, a research group in the USA defined it as low confidence in managing everyday activities without falling [6]. These are activities such as getting dressed, shopping or climbing stairs. In their study, people who avoided activities because of this fear had less confidence than people without this fear [6].
If you do less out of fear, you move less. Our article on Fall prevention describes what you can do to prevent falls. A fall risk assessment shows whether your risk of falling is raised.
2.3 After a stroke and with heart disease
A review of 22 studies looked at confidence after a stroke [7]. In these studies, more confidence went with better quality of life, less low mood and more independence in everyday life. The review left open whether confidence predicts the course better than an examination of the physical limitations.
An American study examined 1,024 people with a disease of the coronary arteries [8]. Those with less confidence had more symptoms and more limitations in everyday life. This still held after the research team allowed for the severity of the heart disease and for low mood. The data come from a single point in time. So they cannot show what came first.
2.4 In older age
A review from the USA describes confidence as a link between physical activity and independence in older age [9]. In this view, regular physical activity strengthens confidence. More confidence in turn helps people to stay independent in everyday life. This view rests on observational studies. It has not yet been proven.
2.5 Can confidence be strengthened, and does it help?
The studies on this are mainly about courses in which people learn to deal with their illness in everyday life. Experts call this self-management. It includes action plans, solving problems and working together with your doctor [10]. Experts suspect that such courses work mainly by strengthening confidence [10].
An American study included 952 people aged 40 and over [11]. They had heart or lung disease or a joint disease, or they had had a stroke. Some of them attended a self-management course. The rest went on a waiting list. After six months, the course group exercised for more minutes per week. This group rated its health as better. Its members were less tired and less limited in everyday life. They had to go into hospital less often and stayed there for fewer days. The study found no difference in pain, shortness of breath or psychological well-being [11].
Two reviews each analysed 27 physical activity programmes for healthy adults that aimed to strengthen confidence [12][13]. On average, the programmes changed confidence only a little. Some approaches worked better than others. Section 3 names them, and section 4 builds on them.
3. Where confidence comes from
Albert Bandura named four sources of confidence [1]:
- Your own successes. You manage something that seemed difficult to you. According to Bandura, this is the strongest source. A success counts especially when you see it as the result of your own effort.
- Role models. You see a person in a similar situation manage something. The more similar this person is to you, the more their example counts.
- Encouragement. Someone tells you that you can do it. Encouragement on its own has the weakest effect. Its effect lasts mainly when your own experience confirms it.
- Body signals. Many people read a pounding heart, fast breathing or pain during a task as a sign that they will not manage the task. How you read these signals affects your confidence.
The two reviews of physical activity programmes confirm part of this. Confidence grew most when participants received feedback on their past performance or could compare themselves with others [12]. Role models also strengthened confidence [12]. Action plans, clear instruction and recognition of effort increased confidence and physical activity the most [13].
Encouragement alone, tasks that got harder step by step and simply listing obstacles strengthened confidence less [12][13]. The same applied to talks about how to avoid relapses [13]. These findings come from healthy adults and concern physical activity. There is less research on whether they apply in the same way to pain or after an operation.
4. What you can do yourself
The following steps combine the approaches that did best in the studies. You need paper and a pen, or your phone.
4.1 Choose a goal that matters to you
Choose an activity that you find hard at the moment and that means something to you. Examples are going to the playground with your grandchild, carrying your shopping home yourself or working in the garden for an hour again.
Turn it into a plan for the next week. A good plan says what you will do, how much, when and how often [13]. For example: "I will go for a 15-minute walk after lunch on Monday, Wednesday and Friday."
4.2 Check your confidence before you start
- Read your plan aloud.
- Ask yourself: "How sure am I that I will carry out this plan?" Answer with a number from 0 to 10.
- If the number is 7 or higher, start.
- If the number is below 7, make the plan smaller. Shorten the time, or choose fewer days or an easier activity.
- Ask yourself again until the number is 7 or higher.
This rule comes from a method for brief action plans in general practice [14]. If you start at 7 or higher, you are more likely to carry out the plan. People with less confidence give up on a plan more often [14]. A small plan that you carry out is a success of your own. According to Bandura, this kind of success is what strengthens confidence [1].
4.3 Plan ahead for obstacles with an if-then plan
Think about what could get in the way of your plan. For each obstacle, decide what you will do then. Write it down in this form: "If …, then …"
- "If it rains on Monday, then I will walk through the shopping centre."
- "If my back hurts more in the morning, then I will still go, but only for 10 minutes."
- "If I am tired after lunch, then I will set off straight after clearing the table."
In 94 studies, people with if-then plans like these reached their goals more often than people who had only set themselves a goal [15]. The plans helped people to get started and to resist distractions. They also helped people to drop an approach that was not working [15].
An if-then plan sets out an action for each obstacle. In the studies, simply listing obstacles strengthened confidence less (section 3).
4.4 Record what you have achieved
Each day, write down which parts of your plan you carried out. A calendar, a notebook or an app will do. Also note how you felt afterwards. After two to four weeks, compare where you are now with where you started.
An analysis of 122 programmes for more physical activity and healthier eating examined 26 approaches [16]. Keeping a record of your own behaviour was most strongly linked to success. It was most effective together with a goal and a regular check against that goal [16]. Feedback on your own past performance also strengthened confidence [12].
For strength training, our website has a strength training diary (in German). It runs in your browser and sends no data to a server.
4.5 Recognise your own effort
See a success as the result of your own effort. For example, tell yourself: "I walked three times this week because I planned it." A success that you see as the result of your own actions strengthens confidence the most [1].
Also recognise your effort on days when you managed less than you planned. In the studies, recognition of effort was among the approaches that increased confidence and physical activity the most [13].
4.6 Look for role models
Look for people in a similar situation who have achieved what you are aiming for. This can be someone you know with the same illness. In an exercise group, you see how others with similar limitations make progress. In the studies, role models like these strengthened confidence [12]. The more similar the person is to you, the more their example counts [1].
4.7 Make sense of body signals
During an effort you are not used to, your heart beats faster and you breathe more deeply. This is how a healthy body responds to exercise. These signs show that you are working hard.
With long-lasting pain, the signals are harder to make sense of. Agree with your physiotherapist which pain is fine during an exercise and which pain means you should stop. With this agreement, you can make sense of a signal instead of feeling unsure every time something hurts.
5. How physiotherapy can support you
You can raise the following points during your treatment:
- Shared goals. The starting point is activities that matter to you. Your physiotherapist helps you turn them into a plan you are at least 7 out of 10 confident about.
- Instruction and practice. You learn each exercise well enough to do it safely on your own. Clear instruction was one of the most effective approaches [13].
- Measuring progress. Your physiotherapist can measure your walking distance, your number of repetitions or your time for a test several times over. Comparing the results with the start shows you your progress.
- Assessing confidence. With long-lasting pain, your physiotherapist can assess your confidence with a questionnaire called the Pain Self-Efficacy Questionnaire [17]. Its ten questions ask how sure you are that you can do certain things despite pain.
- Group training. In a group, you see people in a similar situation who are making progress.
6. When to get help
- If you have hardly left the house for weeks because of pain or fear, talk to your GP or to us.
- If you have felt low almost every day for weeks, or you no longer enjoy anything, talk to your GP. These can be signs of depression.
- If you notice new, severe or unusual symptoms, have them checked by a doctor before you continue with your plan.
- If little changes over several weeks despite your plan, adjust the plan together with your physiotherapist.
7. In summary
- Self-efficacy means confidence: you trust yourself to manage a particular task, even when it gets difficult [1].
- More confidence often goes with a better course, especially with long-lasting pain [2][3]. Most studies show an association. Whether confidence is the cause remains open.
- Confidence grows mainly through your own successes [1].
- Plan in concrete terms: what, how much, when and how often [13].
- Start only when your confidence is 7 out of 10 or higher. Otherwise, make the plan smaller [14].
- Set if-then plans for obstacles [15].
- Write down what you have achieved, and compare it with the start [16][12].
References
All Digital Object Identifiers (DOIs) were checked against the Crossref register. The links in the reference list lead via the DOI service to the publishers' pages, and for the one work without a DOI directly to the journal. Some of these are outside Switzerland and the EU. When you click, your IP address is transmitted to the respective provider. This does not happen on our own site.
[1] Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychological Review. 1977;84(2):191–215. https://doi.org/10.1037/0033-295X.84.2.191
[2] Jackson T, Wang Y, Wang Y, Fan H. Self-efficacy and chronic pain outcomes: a meta-analytic review. The Journal of Pain. 2014;15(8):800–814. https://doi.org/10.1016/j.jpain.2014.05.002
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[7] Jones F, Riazi A. Self-efficacy and self-management after stroke: a systematic review. Disability and Rehabilitation. 2011;33(10):797–810. https://doi.org/10.3109/09638288.2010.511415
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[9] McAuley E, Szabo A, Gothe N, Olson EA. Self-efficacy: implications for physical activity, function, and functional limitations in older adults. American Journal of Lifestyle Medicine. 2011;5(4):361–369. https://doi.org/10.1177/1559827610392704
[10] Lorig KR, Holman HR. Self-management education: history, definition, outcomes, and mechanisms. Annals of Behavioral Medicine. 2003;26(1):1–7. https://doi.org/10.1207/S15324796ABM2601_01
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[12] Ashford S, Edmunds J, French DP. What is the best way to change self-efficacy to promote lifestyle and recreational physical activity? A systematic review with meta-analysis. British Journal of Health Psychology. 2010;15(2):265–288. https://doi.org/10.1348/135910709X461752
[13] Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour – and are they the same? Health Education Research. 2011;26(2):308–322. https://doi.org/10.1093/her/cyr005
[14] Gutnick D, Reims K, Davis C, Gainforth H, Jay M, Cole S. Brief action planning to facilitate behavior change and support patient self-management. Journal of Clinical Outcomes Management. 2014;21(1). mdedge.com
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[17] Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. European Journal of Pain. 2007;11(2):153–163. https://doi.org/10.1016/j.ejpain.2005.12.008
Transparency
- Author: Roger Hilfiker
- AI assistance: the literature search and the draft text were produced with Claude (Anthropic). The professional review by Roger Hilfiker is still pending.
- Created: 3 October 2026
- Last updated: 3 October 2026
- Sources: the 17 works in the reference list. All DOIs were checked against the Crossref register, and the findings against the abstracts of the works.
- How the sources were found: targeted searches of the Crossref, Europe PMC and PubMed databases in October 2026 on self-efficacy in pain, fear of falling, stroke, heart disease and older age, and on programmes that strengthen confidence. This was not a systematic search.
- Conflicts of interest: our practice offers physiotherapy that uses the approaches described here. You can carry out the steps in section 4 yourself, without treatment.
- Funding: Physiotherapie Tschopp & Hilfiker, 3902 Glis. The article was produced from the practice's own funds.
- Next review: 1 October 2027