Download BS914 - Lecture 6

BS914 - Lecture 6
Social Cognitive Theories
of Exercise Behaviour
You would think that..
• An MI would make someone
–
–
–
–
Stop smoking
Eat healthily
Exercise
Take a pill
• Hangovers, damaged relationships,
crashes, & blackouts
– Would convince someone to stop drinking.
You would think that..
• The threat of:
– blindness,
– amputation,
– death
• Would motivate a diabetic to lose weight
• Prison would dissuade people from re-offending
Why do people…
• Knowingly do things that compromise
health?
• Fail to do things that enhance health
• The fundamental questions in health
psychology
Lecture Plan
• Defining health behaviour
• Social Cognition Theories of Health
Behaviour
• Social Cognition Theory & Behaviour
Change
• Intentions and Behaviour
• Applied Health Psychology
–
Introduction
Lecture Learning Objectives
• Understand various health behavior
models.
• Understand how CR uses models health
behaviour models
Health Behaviours
(Kasel and Cobb 1966)
• Health behaviour
– ‘any behaviour undertaken by a person
believing himself to be healthy for the
purpose of preventing disease or detecting it
at an asymptomatic stage.’
• Illness bevaviour
– ‘…aimed to seek remedy’
• Sick role behaviour
– ‘…aimed to get well’
Health
Illness
Behaviour
Behaviour
Cardiac
Rehabilitation
Sick Role
Behaviour
CR Spans The 3 Health Behaviour
Domains
• Matarazzo (1984)
• Health impairing habits
– Behavioural pathogens:
– Smoking, diet
• Health Protective Habits
– Behavioural immunogens:
– Exercise, diet
Social Cognitive Theories
Definition
• Models using concept of social cognition
to account for behaviour
• Social cognition
– Rational decision made on basis of…
– past experience
– current social environment
Use in Health Psychology
• Some Social Cognition Theories can
explain health behaviours
• Example: CHD preventative behaviour
– Health Belief Model
– Protection Motivation Theory
– Theory of Reasoned Action & Planned
Behaviour
– Transtheoretical Model
Health Belief Model: Rosenstock (1974)
Perceived Vulnerability
Probable Severity
Benefit Beliefs
Perceived Barriers
‘Readiness’
Intention
Health Belief Model Concepts
• Severity
– Consequences of not changing current
behaviour
• Vulnerability
– Self appraisal: susceptibility to consequences
• Benefits
– Intended behaviour vs. outcome &
vulnerability
• Barriers
– Counterbalances to benefits
Health Belief Model: Rosenstock (1974)
Perceived Vulnerability
Probable Severity
Benefit Beliefs
Perceived Barriers
‘Readiness’
Intention
Usefulness of Health Belief Model
• Simple & Clear
– Appealing to health care providers
• Explanatory value
– Descriptive studies
– Intervention studies
Problems with Health Belief Model
• Antecedents not well described
• Fails to account for interaction between
antecedents
• Limited direct effects on health
behaviour
• Readiness
– (Abraham et al. 1999)
• Constructs missing
– E.g Self efficacy
Protection Motivation Theory:
Rogers (1987)
Information
Cognitive Mediating Process
Environment
Threat Appraisal
Communication
Observation
Learning
Perceived Vulnerability
Perceived Severity
Fear
Behaviour
Maladaptive Coping
(Hodgkins & Orbell, 1988)
Avoidance,
Denial,
Wishful Thinking,
Hopelessness
Intrapersonal
Coping Appraisal
Personality
Experience
Perceived Self-efficacy
Perceived Response-efficacy
Perceived Response-cost
Protection
Motivation
Health
Protective
Behaviour
Health Belief Model
&
Protection Motivation Theory
Similarities?
Beliefs and Attitudes
• Beliefs
– Knowledge, information
• Attitudes
– Value ‘ingredient’
– Good/bad, desirable/undesirable
• ‘is’ness vs. ‘ought’ness
Theory of Reasoned Action:
Azjen & Fishbein (1980)
Behavioural
Beliefs
x
Values
Attitudes
Intentions
Normative
Beliefs
x
Compliance
Subjective
Norms
Behaviour
Theory of Reasoned Action
• Distinguishes between
– Attitudes toward object (exercise)
– Attitude toward behaviour related to object
(exercise)
• Attitudes toward behaviour correlate
with actual behaviour
– Attitude toward CHD – poor correlate
– Attitude toward risk reduction – good
correlate
Three Boundary Conditions: TRA
• Correspondence
–
–
–
–
Action
Target
Time
Context
• Stability
– Intentions  time  action
• Volitional Control
– Personal barriers
– Environmental barriers
Theory of Planned Behaviour:
Azjen (1985)
Behavioural
Beliefs
x
Values
Attitudes
Intentions
Normative
Beliefs
x
Compliance
Subjective
Norms
Control:
Beliefs
x
Power
Perceived
Behavioural
Control
Behaviour
Evaluation:
Theory of Planned Behaviour
• Less intuitive than HBM
• More difficult to apply
• Concepts well described / explained
• Accounts for wide range of behaviours
• Easy to measure, causal links between
stages
• Key concepts included
TPB Meta-Analysis:
Armitage & Conner (2001)
BB
NBs
CBs
r = .50
r = .50
r = .52
ATT
SN
PBC
r = .34 Intention r = .47 Behaviour
Research Problems
• Observing behaviour
– Not best way to determine
– Beliefs
– Attitudes
• Specific problems
–
–
–
–
Misinterpretation
Difficulty in quantification
Ethical problems
Hawthorne Effect
Task
• Write two questions
• Designed to measure one attitude toward
CR
Questions
• Open vs. closed
• Quantifiable – scaled?
• Question wording
– Strong language
– Ambiguity
– Suggestive or leading
• Order of questions?
Sufficiency of TPB
• Frequency of past ‘habit’
• Personality
– Extroversion
• Attitude Strength
• Normatively Controlled individuals
• Anticipated Regret
Maintenance
Action
Preparation
Contemplation
Precontemplation
Transtheoretical Model:
Prochaska & DiClemento (1982)
Precontemplation
• No intention of change
– 6-mo
• Unaware of problem
– & Aware but no intention
Contemplation
• Serious consideration
• Intention: change in 6-mo
– Open to feedback
– Open to info
• Ambivalent regarding costs:benefits
Preparation
• Intention to change behaviour
– 1-mo
• Failure in past 12-mo
• Active planning
• Taking steps
– Recipes & shopping lists
– Activities
From Contemplation to Action
Action
• Implementation of planned behaviour
• Over behaviour change
– Commitment
– Energy
• Diet changed in last 6-mo
Maintenance
• Work to prevent relapse
• Sustaining change & resisting temptation
Evaluation of Transtheoretical
Model
• Pros & cons
– Combine to form balance sheet for gains &
losses
• Balance varies by stage of change
• Synonymous with: ‘strength of intention’
• Simple
Maintenance
Action
Preparation
Contemplation
Precontemplation
Transtheoretical Model:
Prochaska & DiClemento (1982)
Importance?
• Interventions grounded in HB models
more successful
• Guide choices of measures/variables
• Provide targets for change
• Suggest methods for change
• Inform programme evaluation &
refinement
• Avoid ‘black box’ phenomenon
Questions
• Why is human behaviour so difficult to
change?
• How can social cognition theories
influence design strategies?
Concluding Thoughts
• Social Cognitive Theories vary in how
they:
– Describe patterns of behaviour (in CR
patients)
– Explain patterns of behaviour (in CR patients)
– Account for variation in behaviour (of CR
patients)
• Provide a basis with which to:
– Measure
– Predict
– Control