An application of Bandura's 'Four Sources of Self-Efficacy' to the self-management of type 2 diabetes in people with intellectual disability: An inductive and deductive thematic analysis.
Adults with ID can describe self-efficacy, yet programs must add structured reflection and rewards to turn confidence into daily diabetes care.
01Research in Context
What this study did
Rogers et al. (2017) talked with 10 adults who have intellectual disability and type 2 diabetes.
The team asked how the clients felt about checking blood sugar, picking food, and taking medicine.
They sorted every answer into Bandura’s four sources of self-efficacy: mastery, vicarious experience, verbal persuasion, and emotional state.
What they found
Clients could name times they felt confident and times they felt stuck.
The four buckets made sense, yet people needed extra help to turn feelings into daily action.
Staff had to add structured reflection—simple check-ins, pictures, and praise—so confidence turned into real self-care.
How this fits with other research
Sáez-Suanes et al. (2023) extends this idea. They wrapped Social Cognitive Theory into an 8-week home exercise plan. Adults with ID boosted fall efficacy and activity confidence when staff used the same four sources and handed out small rewards.
Freeman et al. (2015) also extends the picture. Their 10-session program moved clients from “I have to” to “I want to” for addiction treatment. It shows you can train autonomous motivation in the same population once you add guided practice and choice.
Bondár et al. (2020) pulls the lens wider. A review of exercise studies found most adults with ID raised exercise self-efficacy when caregivers gave tailored support. The review agrees with Andrew: confidence grows, but only if staff shape the experience.
Kooijmans et al. (2024) nails the method point. They proved that simplified language and clear formats let adults with mild ID report feelings more accurately. If you want clients to track self-efficacy, you must first make the tool easy to read.
Why it matters
You now know adults with ID can talk about confidence, but the talk alone does not change behavior. Build brief reflection breaks into every health routine. Use pictures, star charts, or quick role-plays to let clients see wins, hear praise, and label emotions. Link each small success to the next task so confidence moves from words to action.
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02At a glance
03Original abstract
BACKGROUND: Little is known about the successful experiences and positive perceptions of people with intellectual disabilities (ID) self-managing Type 2 Diabetes (T2D). This study sought to address this gap using Bandura's (1977) 'Four Sources of Self-Efficacy' as a framework of enquiry. METHOD: Semi-structured interviews were conducted with 10 adults with ID. Interviews were recorded, transcribed verbatim and analysed using inductive and deductive thematic analysis RESULTS: Nine sub-themes were identified following analysis of the data: 1) Mastery through knowledge; 2) Mastery through tools and strategies; 3) Mastery through autonomy; 4) Influence of social setting; 5) Positive social comparisons; 6) Positive and negative self-statements; 7) Feedback from caregivers; 8) Adjustment experiences; 9) Symptom awareness. These were mapped onto Bandura's (1977) Four Sources of efficacy enhancement model and were consistent with its proposed mechanisms. CONCLUSION: The Four Sources model serves as a useful mode of enquiry for exploring people with ID's experiences and perceptions of self-managing diabetes. It also confirms the appropriateness of Self-efficacy as a potential intervention component for this population. However, additional support may be required for people with ID to reflect meaningfully on their experiences and thus have a sense of self-efficacy. WHAT THIS PAPER ADDS: This paper builds upon the limited existing literature on people with ID self-managing type 2 diabetes and provides a robust, qualitative account of the participants' experiences, whilst confirming some of the existing challenges, both for people with ID and their supporters. To self-manage with autonomy and overcome the difficulties of adjustment, further strategies such as training and education needs are highlighted. In addition, the meaning and relevance of the Self-efficacy construct is evaluated in the context of people with ID self-managing T2D. This provides useful information in terms of tailoring existing mainstream T2D interventions to meet the needs of people with ID, as such programs are commonly theoretically guided by Self-efficacy. Furthermore, this evaluation provides rationale for the exploration of people with IDs' Self-efficacy in relation to other chronic diseases, such as cardiovascular disease, cancer symptoms and gastrointestinal disorders.
Research in developmental disabilities, 2017 · doi:10.1016/j.ridd.2017.09.004