Hbhe600 2008 04 Social Cognative Theory Ii
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• Social Cognitive Theory (SCT)
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Theory of Planned Behavior (TPB)*: Behavioral Beliefs
Evaluations of Behavioral Outcomes
Attitude Toward Behavior Behavioral Intention
Normative Beliefs
Behavior
Subjective Norm
Motivation to Comply
Perceived Behavioral Control Coping skills/ resources Perceived/ Actual Barriers
*Slightly modified, and elaborated upon, by Vic Strecher UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory
Efficacy expectations Outcome expectations
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory
Person
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Behavior
Outcome
Social Cognitive Theory
Behavior
Outcome
Outcome expectations: The beliefs about a behavior leading to a certain outcome
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory Efficacy expectations: The beliefs about a person’s ability to perform a behavior
Person
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Behavior
Social Cognitive Theory Efficacy expectations: The beliefs about a person’s ability to perform a behavior
Person
Behavior
Outcome
Outcome expectations: The beliefs about a behavior leading to a certain outcome UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory Efficacy expectations: High self-efficacy for eating less fat:
“Mr. Jones believes he is capable of changing his diet to include less fat.”
Mr. Jones
Eat less fat
Improved health
Outcome expectations: Positive outcome expectation:
“Mr. Jones believes that eating less fat will lead to improved health.”
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory
Efficacy expectations and outcome expectations are beliefs, not necessarily truths
Self-efficacy is not a global trait or personality characteristic; it relates to specific behaviors in specific settings
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Self-efficacy: Why is it important? In many studies, across a wide range of health-related behaviors, persons with higher self-efficacy are more likely to change behavior than those with lower selfefficacy. This includes: initiation of new behaviors as well as maintenance putting forth greater effort greater persistence of effort performing behavior in a wider range of settings
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Sources of efficacy information:
Previous performance accomplishments
Vicarious experience
Verbal reinforcement
Emotional arousal
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Sources of efficacy information: Which one source is the most important? Previous performance accomplishments
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Concepts related, but not the same as, self-efficacy:
Locus of Control Self-esteem Anxiety Depression Learned Helplessness Persistence Concentration (focus)
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Efficacy Expectations
“How confident are you that you can (change some behavior)?”
Example:
“How confident are you that you can follow this low sodium diet once you return home?”
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Generality of self-efficacy:
Efficacy beliefs for one type of activity will generalize to other activities that are governed by similar skills, i.e. within domains
Distinct from “generalized self-efficacy”
No empirical support that self-efficacy operates across all situations and domains of functioning
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Measure of self-efficacy must be specifically related to the behavior in question Examples:
self-efficacy for condom use self-efficacy for exercise self-efficacy to delay sex
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement Please rate how confident you are that you can keep from smoking cigarettes in the following situations: Not at all confident
Extremely confident
1
2
3
4
5
When I feel stressed
O
O
O
O
O
After I have just finished a meal
O
O
O
O
O
While drinking coffee with friends
O
O
O
O
O
When I feel sad or lonely
O
O
O
O
O
While talking on the telephone
O
O
O
O
O
When I am around people who are smoking
O
O
O
O
O
When I feel angry or frustrated
O
O
O
O
O
When I am happy and feel like celebrating
O
O
O
O
O
While driving
O
O
O
O
O
When I feel nervous or anxious
O
O
O
O
O
When I am bored
O
O
O
O
O
When at a bar or a party
O
O
O
O
O
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Should include the behavior, the level of situational demand
Elicitation interviews or focus groups could be used to identify those conditions that make performance of desired behaviors difficult
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Outcome Expectations
“If you (change some behavior), how likely do you think it is that (some specific outcome) will occur ?”
Example:
“If you eat less sodium in your food do you think it is likely that your risk of serious health problems will be reduced?”
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Research Findings
Self-efficacy may be more important for those who feel that their personal health actions control health outcomes Efficacy perceptions can be manipulated: improved, reduced
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
If efficacy expectations are low:
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
If efficacy expectations are low:
Build self-efficacy by starting with simple, achievable tasks and provide positive reinforcement for task accomplishment
Focus on positive aspects of an incomplete performance
Show your confidence in the person’s ability and provide sincere encouragement
Identify similar others who have accomplished the task
Teach specific skills to overcome problem areas
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
If outcome expectations are low:
For health-related outcomes, focus on immediate and tangible outcomes, not just long-term risk reduction
Explain in “lay terms” the relationship between the desired behavior and the outcome; where possible show models or examples
Focus on outcomes relevant to the person, not you; these may include other, non-health related, outcomes
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Efforts to enhance efficacy must:
Demonstrate the person’s relative progress toward the target behavior Attribute previous accomplishments to the person’s own abilities
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Other methods for enhancing self-efficacy:
Verbal reinforcements and encouragement to enhance efficacy Relaxation training to reduce anxiety during the behavior change process
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
The Health Belief Model (HBM): Individual Perceptions
Modifying Factors Demographics, SES, Personality
Susceptibility and Severity of Disease
Perceived threat of disease
Likelihood of Action Perceived benefits minus barriers
Likelihood of behavior change
Cues to action
Social-Cognitive Theory (SCT): Person
Behavior
The Theory of Reasoned Action (TRA): Efficacy expectations
Behavioral Beliefs
Evaluations of Behavioral Outcomes
Attitude Toward Behavior Behavioral Intention
Normative Beliefs
Motivation to Comply
Subjective Norm
Coping skills/ resources
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Behavior
Perceived Behavioral Control
Perceived/ Actual Barriers
Outcome expectations
Outcome
Overview of meta concepts shared by theories Person
–Social Cognitive Theory
Behavior
Efficacy expectations
Outcome
Outcome expectations
–Health Belief Model
Perceived benefits Demographics, Social support, Personality Traits
minus Perceived barriers
–TRA/TPB
Susceptibility and Severity of Disease
Attitude Toward Behavior Behavioral Intention
Normative Beliefs
Motivation to Comply
Likelihood of behavior change
Cues to action
Behavioral Beliefs
Evaluations of Behavioral Outcomes
Perceived threat of disease
Subjective Norm
Behavior
Perceived Behavioral Control Coping skills/ resources Perceived/ Actual Barriers
Motivation UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Self-efficacy
Case Study 1
Kate’s 51-year old mom found out she had a benign breast lump 5 years ago and had biopsy for it. Although now she knows having mammography yearly is really important for her to find out early if she has breast cancer, she insists that if there is something wrong, she can find it from self-exam. she’s very confident doing breast self exam every month.
Plus, she says she doesn’t have a car now and Kate is so far away from her. She really doesn’t feel it’s necessary to bother someone else taking her to the clinic when she feels good about her health.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Case Study 1-con’t
Last month, Kate’s mom found out again she has another breast lump. Knowing that the fear of finding cancer is the main concern shared by every member in the family, include herself, Kate said: “4 out of 5 breast lumps are benign. Also this may be a good thing if you got it diagnosed in an early stage.” Now, Kate’s mom knows she has to see a doctor. This reminds her that 5 years ago, she went through exactly same things, having Clinical Breast Exam, ultra-sound, and biopsy. She is ready to it.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Case Study 2
Julia is a 3rd year doctoral student. She usually has to stay in her lab all day until 9 pm. Although she knows eating more fruits and vegetable will be very good for her health, she just doesn’t have time to prepare healthy food. Actually, she enjoys much more the free pizza provided by seminars at noon and KFC chicken. She thinks f & v are less tasty. She was not considering to change her diet also because she thinks she is still too young to worry about her health.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Case Study 2-con’t
One day, Julia was invited by a friend to see a fortune teller together. she got a crazy message: “You will die from cancer when you’re 50.” This message really scares her.
After Julia’s best friend Sarah heard about the fortune message, she told Julia an unhealthy diet is a much stronger predictor of getting cancer than a fortune teller’s prophecy. Sarah encouraged Julia to bring f and v to school every day.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Case Study 2-con’t
Sarah then told Julia:” It isn’t as hard as you think. It takes me only 5 minutes to simply wash the fruits and put them into a bag for next day. It not only prevents cancer, but also helps my skin and weight. Actually, You can still enjoy pizza and KFC in a smaller but satisfying amount. I know you can do it!”
Julia is now trying to include vegetable in her breakfast, also bring fruits to school every day.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Theory of Planned Behavior (TPB)*: Behavioral Beliefs
Evaluations of Behavioral Outcomes
Attitude Toward Behavior Behavioral Intention
Normative Beliefs
Behavior
Subjective Norm
Motivation to Comply
Perceived Behavioral Control Coping skills/ resources Perceived/ Actual Barriers
*Slightly modified, and elaborated upon, by Vic Strecher UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory
Efficacy expectations Outcome expectations
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory
Person
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Behavior
Outcome
Social Cognitive Theory
Behavior
Outcome
Outcome expectations: The beliefs about a behavior leading to a certain outcome
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory Efficacy expectations: The beliefs about a person’s ability to perform a behavior
Person
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Behavior
Social Cognitive Theory Efficacy expectations: The beliefs about a person’s ability to perform a behavior
Person
Behavior
Outcome
Outcome expectations: The beliefs about a behavior leading to a certain outcome UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory Efficacy expectations: High self-efficacy for eating less fat:
“Mr. Jones believes he is capable of changing his diet to include less fat.”
Mr. Jones
Eat less fat
Improved health
Outcome expectations: Positive outcome expectation:
“Mr. Jones believes that eating less fat will lead to improved health.”
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Social Cognitive Theory
Efficacy expectations and outcome expectations are beliefs, not necessarily truths
Self-efficacy is not a global trait or personality characteristic; it relates to specific behaviors in specific settings
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Self-efficacy: Why is it important? In many studies, across a wide range of health-related behaviors, persons with higher self-efficacy are more likely to change behavior than those with lower selfefficacy. This includes: initiation of new behaviors as well as maintenance putting forth greater effort greater persistence of effort performing behavior in a wider range of settings
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Sources of efficacy information:
Previous performance accomplishments
Vicarious experience
Verbal reinforcement
Emotional arousal
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Sources of efficacy information: Which one source is the most important? Previous performance accomplishments
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Concepts related, but not the same as, self-efficacy:
Locus of Control Self-esteem Anxiety Depression Learned Helplessness Persistence Concentration (focus)
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Efficacy Expectations
“How confident are you that you can (change some behavior)?”
Example:
“How confident are you that you can follow this low sodium diet once you return home?”
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Generality of self-efficacy:
Efficacy beliefs for one type of activity will generalize to other activities that are governed by similar skills, i.e. within domains
Distinct from “generalized self-efficacy”
No empirical support that self-efficacy operates across all situations and domains of functioning
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Measure of self-efficacy must be specifically related to the behavior in question Examples:
self-efficacy for condom use self-efficacy for exercise self-efficacy to delay sex
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement Please rate how confident you are that you can keep from smoking cigarettes in the following situations: Not at all confident
Extremely confident
1
2
3
4
5
When I feel stressed
O
O
O
O
O
After I have just finished a meal
O
O
O
O
O
While drinking coffee with friends
O
O
O
O
O
When I feel sad or lonely
O
O
O
O
O
While talking on the telephone
O
O
O
O
O
When I am around people who are smoking
O
O
O
O
O
When I feel angry or frustrated
O
O
O
O
O
When I am happy and feel like celebrating
O
O
O
O
O
While driving
O
O
O
O
O
When I feel nervous or anxious
O
O
O
O
O
When I am bored
O
O
O
O
O
When at a bar or a party
O
O
O
O
O
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Should include the behavior, the level of situational demand
Elicitation interviews or focus groups could be used to identify those conditions that make performance of desired behaviors difficult
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Measurement
Outcome Expectations
“If you (change some behavior), how likely do you think it is that (some specific outcome) will occur ?”
Example:
“If you eat less sodium in your food do you think it is likely that your risk of serious health problems will be reduced?”
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Research Findings
Self-efficacy may be more important for those who feel that their personal health actions control health outcomes Efficacy perceptions can be manipulated: improved, reduced
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
If efficacy expectations are low:
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
If efficacy expectations are low:
Build self-efficacy by starting with simple, achievable tasks and provide positive reinforcement for task accomplishment
Focus on positive aspects of an incomplete performance
Show your confidence in the person’s ability and provide sincere encouragement
Identify similar others who have accomplished the task
Teach specific skills to overcome problem areas
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
If outcome expectations are low:
For health-related outcomes, focus on immediate and tangible outcomes, not just long-term risk reduction
Explain in “lay terms” the relationship between the desired behavior and the outcome; where possible show models or examples
Focus on outcomes relevant to the person, not you; these may include other, non-health related, outcomes
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Efforts to enhance efficacy must:
Demonstrate the person’s relative progress toward the target behavior Attribute previous accomplishments to the person’s own abilities
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Other methods for enhancing self-efficacy:
Verbal reinforcements and encouragement to enhance efficacy Relaxation training to reduce anxiety during the behavior change process
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
The Health Belief Model (HBM): Individual Perceptions
Modifying Factors Demographics, SES, Personality
Susceptibility and Severity of Disease
Perceived threat of disease
Likelihood of Action Perceived benefits minus barriers
Likelihood of behavior change
Cues to action
Social-Cognitive Theory (SCT): Person
Behavior
The Theory of Reasoned Action (TRA): Efficacy expectations
Behavioral Beliefs
Evaluations of Behavioral Outcomes
Attitude Toward Behavior Behavioral Intention
Normative Beliefs
Motivation to Comply
Subjective Norm
Coping skills/ resources
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Behavior
Perceived Behavioral Control
Perceived/ Actual Barriers
Outcome expectations
Outcome
Overview of meta concepts shared by theories Person
–Social Cognitive Theory
Behavior
Efficacy expectations
Outcome
Outcome expectations
–Health Belief Model
Perceived benefits Demographics, Social support, Personality Traits
minus Perceived barriers
–TRA/TPB
Susceptibility and Severity of Disease
Attitude Toward Behavior Behavioral Intention
Normative Beliefs
Motivation to Comply
Likelihood of behavior change
Cues to action
Behavioral Beliefs
Evaluations of Behavioral Outcomes
Perceived threat of disease
Subjective Norm
Behavior
Perceived Behavioral Control Coping skills/ resources Perceived/ Actual Barriers
Motivation UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Self-efficacy
Case Study 1
Kate’s 51-year old mom found out she had a benign breast lump 5 years ago and had biopsy for it. Although now she knows having mammography yearly is really important for her to find out early if she has breast cancer, she insists that if there is something wrong, she can find it from self-exam. she’s very confident doing breast self exam every month.
Plus, she says she doesn’t have a car now and Kate is so far away from her. She really doesn’t feel it’s necessary to bother someone else taking her to the clinic when she feels good about her health.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Case Study 1-con’t
Last month, Kate’s mom found out again she has another breast lump. Knowing that the fear of finding cancer is the main concern shared by every member in the family, include herself, Kate said: “4 out of 5 breast lumps are benign. Also this may be a good thing if you got it diagnosed in an early stage.” Now, Kate’s mom knows she has to see a doctor. This reminds her that 5 years ago, she went through exactly same things, having Clinical Breast Exam, ultra-sound, and biopsy. She is ready to it.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Case Study 2
Julia is a 3rd year doctoral student. She usually has to stay in her lab all day until 9 pm. Although she knows eating more fruits and vegetable will be very good for her health, she just doesn’t have time to prepare healthy food. Actually, she enjoys much more the free pizza provided by seminars at noon and KFC chicken. She thinks f & v are less tasty. She was not considering to change her diet also because she thinks she is still too young to worry about her health.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Case Study 2-con’t
One day, Julia was invited by a friend to see a fortune teller together. she got a crazy message: “You will die from cancer when you’re 50.” This message really scares her.
After Julia’s best friend Sarah heard about the fortune message, she told Julia an unhealthy diet is a much stronger predictor of getting cancer than a fortune teller’s prophecy. Sarah encouraged Julia to bring f and v to school every day.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Case Study 2-con’t
Sarah then told Julia:” It isn’t as hard as you think. It takes me only 5 minutes to simply wash the fruits and put them into a bag for next day. It not only prevents cancer, but also helps my skin and weight. Actually, You can still enjoy pizza and KFC in a smaller but satisfying amount. I know you can do it!”
Julia is now trying to include vegetable in her breakfast, also bring fruits to school every day.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
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