• Social Cognitive Theory (SCT)
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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
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Social Cognitive Theory
Person
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Behavior
Outcome
Social Cognitive Theory
Behavior
Outcome
Outcome expectations: The beliefs about a behavior leading to a certain outcome
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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.”
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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
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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
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Sources of efficacy information:
Previous performance accomplishments
Vicarious experience
Verbal reinforcement
Emotional arousal
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Sources of efficacy information: Which one source is the most important? Previous performance accomplishments
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Concepts related, but not the same as, self-efficacy:
Locus of Control Self-esteem Anxiety Depression Learned Helplessness Persistence Concentration (focus)
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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
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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
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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
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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?”
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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
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If efficacy expectations are low:
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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
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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
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Efforts to enhance efficacy must:
Demonstrate the person’s relative progress toward the target behavior Attribute previous accomplishments to the person’s own abilities
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Other methods for enhancing self-efficacy:
Verbal reinforcements and encouragement to enhance efficacy Relaxation training to reduce anxiety during the behavior change process
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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