Hbhe600_2008_04_social Cognative Theory

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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

Subjective Norm

Motivation to Comply

UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH

Behavior

Outcome expectations

Outcome

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