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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