Confidence or Intention? Comparing Self-Efficacy Theory and the Theory of Planned Behavior as Guides for Helping Older Adults Keep Wearing Hearing Aids After the First Month
[Student Name]
University of Phoenix
NRP/513: Clinical Applications of Theory and Research
Week 3 Assignment
[Instructor Name]
[Date]
The clinic and patients are composites written for a model paper.
Obtaining hearing aids is only the first step. In my clinical site, several older patients fitted with hearing aids told me months later that the devices sat in a drawer. The behavior I now want to explain is continued use after the first month. This paper compares two middle-range theories that could guide an intervention and chooses one.
Why Middle-Range Theories
Pender's model, used in Week 2, is broad. For a specific behavior such as continued hearing aid use, a narrower theory may offer clearer concepts and testable predictions. Middle-range theories address specific phenomena, are more concrete than grand theories and are more readily tested and applied in practice.
Self-Efficacy Theory
Bandura (1977) proposed that people's expectations of their own efficacy determine whether they will attempt a behavior, how much effort they will spend and how long they will persist in the face of obstacles. He identified four sources of efficacy expectations: performance accomplishments, or mastery experiences; vicarious experience, or seeing others succeed; verbal persuasion; and emotional arousal, or physiological and emotional states. Mastery experiences are the most powerful source.
Applied to hearing aids, self-efficacy concerns a person's confidence in inserting and removing the devices, cleaning and charging them, adjusting settings and coping with the adjustment period, when sounds seem loud and unnatural. An older adult who fumbles with the devices and hears a flood of noise on the first day may conclude that she cannot manage them and stop.
Theory of Planned Behavior
Ajzen (1991) proposed that intention is the immediate antecedent of behavior and that intention depends on three factors: attitude toward the behavior, whether the person evaluates it favorably; subjective norm, perceived social pressure to perform it; and perceived behavioral control, the perceived ease or difficulty of performing it. Perceived behavioral control can also affect behavior directly when it reflects actual control.
Applied to hearing aids, a person may continue if she believes they improve her life, feels that people important to her expect her to wear them and believes she can manage them.
Comparing the Theories
Clarity: both theories have clearly defined concepts. Self-efficacy has one central concept with four sources; the theory of planned behavior has three predictors of intention.
Scope: the theory of planned behavior is broader, including attitudes and social norms, which matter for hearing aid use because of stigma. Self-efficacy theory focuses on confidence but explains persistence in the face of difficulty particularly well.
Testability: both have been widely tested, with validated measures for their concepts.
Usefulness in primary care: self-efficacy theory specifies how to change the key concept, through its four sources. The theory of planned behavior predicts well but offers less direct guidance on how to change intention.
Fit with the problem: the drop-off after the first month suggests that the problem is persistence through a difficult adjustment period, which self-efficacy theory addresses directly (Bandura, 1977). Intention, in contrast, appears to have been present at fitting; the patients bought the devices.
The patients with hearing aids in their drawers had already intended to use them; what they lost was the belief that they could.
What the Help-Seeking Research Adds
Research on hearing aid use supports attention to the post-fitting period. A literature review found that what predicts a person's first step toward help, or a purchase, is not always the same as those associated with continued use and satisfaction, and that many questions about use have not been examined in controlled studies (Knudsen et al., 2010). That gap is a reason to choose a theory that directly addresses persistence and to measure use objectively rather than assume that purchase means benefit.
Overlap
The theories overlap: Ajzen (1991) acknowledged that perceived behavioral control is closely related to self-efficacy. The difference lies in emphasis. The theory of planned behavior places confidence among other predictors of intention, while self-efficacy theory makes confidence the center and explains how to build it.
What Each Theory Would Measure
The choice also determines what I would measure. A study guided by the theory of planned behavior would measure attitudes, norms, perceived control and intention at fitting. A study guided by self-efficacy theory would measure confidence in specific hearing aid tasks at fitting and after the adjustment period, and would track which of the four sources the patient experienced.
My Choice
For the behavior of continued hearing aid use after fitting, I choose self-efficacy theory. The problem appears after intention is formed, during the early weeks of adjustment, when mastery and persistence matter most. The theory's four sources translate into specific interventions.
Interventions From Self-Efficacy Theory
Mastery experiences: a hands-on session in which the patient inserts, removes, cleans and charges the devices until she can do each without help, with the steps practiced again at a two-week visit. Vicarious experience: a brief conversation with an older patient who wears hearing aids successfully, perhaps through a peer volunteer. Verbal persuasion: specific encouragement that the adjustment period is normal and temporary. Emotional states: preparing patients for the initial loudness and teaching them to increase wearing time gradually, so the first days do not overwhelm them.
Where Self-Efficacy Theory Falls Short
Self-efficacy theory has limits for this problem. It says little about stigma, which the theory of planned behavior captures through attitudes and norms, and which some older adults describe as their main reason for leaving hearing aids at home. It also assumes that the device, properly used, works well; if a poorly fitted aid provides little benefit, building confidence will not keep a person wearing it. I will therefore pair the self-efficacy intervention with a check of fit and benefit at two weeks and a brief conversation about how the patient feels wearing the devices in public.
Applying It to One Patient
Mr. T., 79, bought hearing aids after his wife's encouragement but stopped wearing them after ten days, saying restaurants were too noisy and the devices kept falling out. In self-efficacy terms, he had two failure experiences, one with noise and one with insertion, and no successful mastery to balance them. An intervention would begin with insertion practice until he could do it five times in a row, then a program setting for noisy places, then a gradual return to wearing them first at home, where success is easiest.
How I Would Test It
Using a validated self-efficacy measure for hearing aid use at fitting and at two weeks, along with hours of daily use from the device's data log at three months, I could test whether higher self-efficacy predicts continued use, and whether the intervention increases both.
Conclusion
Self-efficacy theory and the theory of planned behavior both explain aspects of hearing aid use. Because the drop-off happens after intention is formed, during a difficult adjustment period, self-efficacy theory fits the problem better and offers clearer guidance through its four sources. It will guide the intervention developed in later weeks.
References
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84(2), 191-215. https://doi.org/10.1037/0033-295X.84.2.191
Knudsen, L. V., Öberg, M., Nielsen, C., Naylor, G., & Kramer, S. E. (2010). Factors influencing help seeking, hearing aid uptake, hearing aid use and satisfaction with hearing aids: A review of the literature. Trends in Amplification, 14(3), 127-154. https://doi.org/10.1177/1084713810385712
How this NRP 513 Week 3 example is structured
The NRP/513 Week 3 work usually asks students to examine middle-range theories that could guide nurse practitioner practice. This paper narrows the Week 2 problem to a specific behavior, describes two theories in their own terms, compares them with explicit criteria and makes a choice with reasons. Students search this week as NRP 513 Week 3, NRP513 Wk 3 or NRP/513 Wk 3; all three are the same assignment.
NRP/513 Week 3 questions, answered
What does NRP/513 Week 3 usually ask for?
Many sections ask students to describe, compare or evaluate middle-range theories and explain how one could guide practice.
What is self-efficacy?
A person's belief in their ability to carry out the actions needed to achieve a goal. Bandura proposed that it is shaped by mastery experiences, observing others, verbal persuasion and physiological and emotional states.
What is the theory of planned behavior?
A theory proposing that behavior is predicted by intention, which is shaped by attitudes toward the behavior, subjective norms and perceived behavioral control.
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