Effects of a Self-Efficacy Promotion Program on Health Behaviors and Disease Severity in Patients with Moderate-to-Severe Psoriasis

Abstract

Background: Psoriasis is a chronic inflammatory skin disease that affects patients’ quality of life, particularly in moderate to severe cases. Promoting appropriate health behaviors is crucial for disease control. Self-efficacy, a key psychosocial factor, can influence behavioral change and help reduce disease severity. Objective: To examine the effects of a self-efficacy promotion program, developed based on Bandura’s concept, on health behaviors and disease severity among patients with moderate to severe psoriasis. Methods: This quasi-experimental one-group pretest–posttest study was conducted among 145 psoriasis patients receiving treatment at The Regional Hospital for Tropical Dermatology. Inclusion criteria were patients aged 18–65 years diagnosed by dermatologists with moderate to severe psoriasis, able to communicate in Thai, and willing to participate. Exclusion criteria included participation in other studies during the same period, severe psychiatric or neurological disorders, and other skin diseases interfering with assessment (e.g., fungal infections or allergic dermatitis). The program consisted of five components: role modeling, perceived capability, health belief patterns, social support, and health-related behaviors triggered by stimuli. Outcomes were assessed before and after the program, including health behaviors, Body Surface Area (BSA), and disease severity. Data were analyzed using descriptive statistics, paired t-test, and Stuart-Maxwell test. Results: After participation, patients showed significant improvements in health behaviors (p < .05). Bland diet adherence increased from 22.0% to 97.7% (+75.7), smoking and alcohol consumption decreased by 5.5% and 3.5%, respectively, and medication adherence increased by 10.4%. The average BSA decreased from 22.58% to 12.49% (p < .0001). The severe disease group decreased from 22.8% to 4.8%, while the mild group increased from 0% to 60.7%. Conclusion: The self-efficacy promotion program effectively improved health behaviors and reduced disease severity among patients with moderate to severe psoriasis, supporting its integration into specialized dermatology clinics to enhance patients’ quality of life.