title: Self-efficacy in the context of heart transplantation - a new perspective.
abstract: OBJECTIVE
  An in-depth exploration of self-efficacy among heart transplant recipients by means of Bandura's self-efficacy theory.
  
  
  BACKGROUND
  An essential component of chronic illness management is self-management, which refers to activities carried out by people to create order, structure and control in their lives. Self-efficacy is an important aspect of self-management, which seems to have become the main paradigm for long-term management after solid organ transplantation.
  
  
  METHODS
  A directed content analysis using Bandura's self-efficacy theory.
  
  
  METHODS
  Open-ended, in-depth interviews were conducted with 14 heart transplant recipients at their 12-month follow-up after heart transplantation.
  
  
  RESULTS
  This study generated the hypothesis that from the patients' perspective, self-efficacy after heart transplantation concerns balancing expectations to find the optimum level of self-efficacy. Performance accomplishment was found to have the greatest impact on self-efficacy, while its absence was the main source of disappointments. It was also revealed that the gap between performance accomplishment and efficacy expectations can be understood as uncertainty.
  
  
  CONCLUSIONS
  It is essential to assess both expectations and disappointments from the patient perspective in order to promote an optimum level of self-efficacy among heart transplant recipients. This includes supporting the heart recipient to adopt mental and physical adjustment strategies to balance her/his expectations as a means of minimising disappointments. The understanding that uncertainty can undermine self-efficacy is crucial.
  
  
  CONCLUSIONS
  The merging of the uncertainty in illness and self-efficacy theories provides an excellent framework for the provision of self-management support. In addition, focusing on a partnership between the transplant professionals and the recipient is essential because it minimises the use of a behavioural approach.
authors.affiliation: Thoracic Intensive Care Unit, Skåne University Hospital, Lund, Sweden.|Department of Health Sciences, Lund University, Lund, Sweden.
authors.forename: Matilda
authors.initials: M
authors.lastname: Almgren
authors.affiliation: The Transplant Center, Sahlgrenska University Hospital, Gothenburg, Sweden.|The Institute of Health and Caring Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Annette
authors.initials: A
authors.lastname: Lennerling
authors.affiliation: Thoracic Intensive Care Unit, Skåne University Hospital, Lund, Sweden.|Department of Health Sciences, Lund University, Lund, Sweden.
authors.forename: Martina
authors.initials: M
authors.lastname: Lundmark
authors.affiliation: Department of Health Sciences, Lund University, Lund, Sweden.|Department of Transplantation and Cardiology, Skåne University Hospital, Lund, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Forsberg
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D005260:Female; D016027:Heart Transplantation / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009742:Nursing Theory; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D035501:Uncertainty
keywords: chronic illness management; content analysis; heart transplantation; patient perspective; qualitative; self-efficacy; self-management; uncertainty