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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’
Cardiac Rehabilitation
Health
Behaviour
Sick Role
Behaviour
Illness
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)
‘Readiness’ Intention
Perceived Vulnerability
Probable Severity
Benefit Beliefs
Perceived Barriers
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)
‘Readiness’ Intention
Perceived Vulnerability
Probable Severity
Benefit Beliefs
Perceived Barriers
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)
Protection Motivation
Threat AppraisalPerceived VulnerabilityPerceived SeverityFear
Coping AppraisalPerceived Self-efficacyPerceived Response-efficacyPerceived Response-cost
Health Protective Behaviour
Maladaptive Coping(Hodgkins & Orbell, 1988)Avoidance, Denial, Wishful Thinking, Hopelessness
EnvironmentCommunicationObservationLearning
IntrapersonalPersonalityExperience
Information Cognitive Mediating Process Behaviour
Health Belief Model &
Protection Motivation TheorySimilarities?
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)
Normative Beliefs
xCompliance
Behavioural Beliefs
xValues
Attitudes
Intentions Behaviour
Subjective Norms
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)
Normative Beliefs
xCompliance
Behavioural Beliefs
xValues
Attitudes
Intentions Behaviour
Subjective Norms
Perceived Behavioural
Control
Control:Beliefs
xPower
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
BB
CBs
NBs
ATT
SN
PBC
BehaviourIntention
r = .50
r = .50
r = .52
r = .49r = .34
r = .4
3
r = .47
r = .37
TPB Meta-Analysis: Armitage & Conner (2001)
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
Transtheoretical Model:Prochaska & DiClemento
(1982)Pr
econ
tem
plat
ion
Con
tem
plat
ion
Prep
arat
ion
Act
ion
Mai
nten
ance
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
Transtheoretical Model:Prochaska & DiClemento
(1982)Pr
econ
tem
plat
ion
Con
tem
plat
ion
Prep
arat
ion
Act
ion
Mai
nten
ance
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