Redefining transition: Self-efficacy in urologic care

Advances in pediatric urology have transformed once fatal, congenital anomalies into chronic, manageable conditions, creating a growing population of adults living with childhood-onset urologic disorders. Despite international transition initiatives, most readiness tools emphasize task completion rather than the acquisition of confidence, motivation, and adaptability required for sustained self-management. This review integrates evidence from behavioral science to propose an enhanced, self-efficacy-driven approach to transitional urology. Drawing on established health behavior change models including Social Cognitive Theory, the Health Belief Model, the Transtheoretical Model, and Health Action Process Approach, we synthesize data showing that self-efficacy, resilience, and motivation are key predictors of durable behavior change. These principles informed the preliminary development of the Uro-TRAQ, a conceptual adaptation of the Transition Readiness Assessment Questionnaire (TRAQ) that adds items designed to incorporate confidence, resilience, motivation, environmental context, and urology-specific skills into readiness assessment. The Uro-TRAQ provides a foundation for action by identifying confidence gaps, barriers, and skill needs. It is embedded within an Individualized Transition Plan (ITP), a structured, clinic-based roadmap that organizes readiness assessment, goal-setting, and longitudinal follow-up. Guided by the ITP, clinicians can support transition readiness through the following complementary strategies: (1) motivational interviewing to elicit confidence ratings and connect real-world strengths to health behaviors; (2) resilience-building through individualized "if-then" plans that anticipate common barriers; and (3) graded mastery pathways that progressively strengthen skill and confidence through supported practice. Additionally, the questionnaire asks specifically about environmental and social barriers so these can be addressed in the context of transition planning. Informed by evidence-based behavioral strategies clinicians can move beyond documenting task performance to actively cultivating confidence, resilience, and autonomy, core determinants of competent lifelong self-management.