fe Ns ae Explaining health behaviour g | s Pl “J = Sl rs Ft - ~ 4 ta ES e i = wv > r Sc i = | ry ryOBJECTIVES By the end of this chapter, you should understand and be able to describe: - How demographic, social, cognitive and motivational factors influence the uptake of health or risk behaviour - Key psychosocial models of health behaviour and health behaviour change - How ‘continuum’ or ‘static’ models differ from ‘stage’ models in terms of how they consider behaviour change processes - The research evidence that supports or refutes the models in terms of which factors are predictive of health behaviour and health behaviour changeCONTENTS 1. Distal influences on health behavior 2. Models of health behavior 3. Sociocognitive models of behaviour change 4. Stage models of behaviour changeDistal influences on health behaviour - Examples = culture, environment, ethnicity, socio-economic status, age, gender and personality vs. Proximal = specific beliefs and attitudes towards health-risk and health-protective behaviour - Some distal influences operate on behaviour indirectly by means of their effects on other more proximal factors - Thus proximal factors mediate the effect of e.g socioeconomic status on healthDistal influences on health behaviour - Explanation found in evidence showing that social class can affect health beliefs which in turn affect behaviour - These behaviours are better to target interventions at because they are closer to the behaviours rather than e.g. trying to change a person's social class TCDistal influences on health behaviour Demographic influences - Most targeted age group for attention regarding educational, medical and public health specialists = childhood behavioural patterns/ early adulthood e.g anti-smoking campaigns - Gender differences have been found - seeking help is not ‘masculine’ enough, drinking excessively is. Some behaviours compensate for others e.g. sport can ‘compensate’ for reduced masculinity attributed to those who drink lessDistal influences on health behaviour Demographic influences - Exceptions seen amongst asian, black and muslim populations whose religions exerted stronger influence over needing to be seen as masculine. E.g. Health-promoting behaviours (exercise, good diet, low substance use etc.) were associated with younger age and conformity to masculinity norms in all sub groups apart from the South Asian men. Positive effects of masculinity norms exist, probably because different, multifaceted constructions of masculinity exist and culture influences these constructions. In addition gendered constructions are also changing over time.Distal influences on health behaviour Personality - Eysenck’s 3 factor model Personality reflected on individuals score along three dimensions: Extroversion (outgoing social nature): dimensionallyopposite to introversion (shy, solitary nature). Neuroticism (anxious, worried, guilt-ridden nature): dimensionally opposite to emotional stability (relaxed, contented nature). Psychoticism (egocentric, aggressive, antisocial nature): dimensionally opposite to self-control (kind, considerate, obedient nature).Distal influences on health behaviour Personality - McCrae and Costa's 5 factor model + Neuroticism, extroversion, openness, agreeableness, conscientiousness + Studies show that depending on these personality traits people are more likely to display certain health behaviours eg extraversion predicting weight gain, openness predicting low meat fat consumption perhaps due to willingness to try new food types, neuroticism predicting pickiness with food even to extent of neophobiaDistal influences on health behaviour Personality - Locus of control (loc) also been found to have an influence on health behaviours - internal vs external loc = responsibility of outcomes outward as luck, vs responsibility of outcomes inward as in control of own life - Multidimensional Health Locus of Control scale (MHLC) + Internal - individual themselves as prime determinant of health + External - luck, fate or chance as determinant of health + Powerful others - health state determined by powerful others e.g doctor _ TT 7 (5Distal influences on health behaviour Personality - Locus of control (loc) also been found to have an influence on health behaviours - internal vs external loc = responsibility of outcomes outward as luck, vs responsibility of outcomes inward as in control of own life + These only become relevant if individual values their health + Have been found to be weak predictors of behaviour + Researchers now looking at perceived behavioural control, self-efficacy and dispositional pessimism instead [TT 7 3Distal influences on health behaviour Personality Self-determination theory - Distinguishes between intrinsic and extrinsic motivation for carrying out behaviour + Intrinsic = person is motivated to behave in a certain way for the inherent personal satisfaction or rewards it produces, such as feelings of increased competence, autonomy, or relatedness to others + Extrinsic = person is motivated for perceived externally situated rewards, such as a need for peer approval _ TT 7Distal influences on health behaviour Social influences - Behaviour as a result of culture, environment, groups, personal emotions, beliefs, values, attitudes. - Learn ‘vicariously’ through others. - Social norms e.g smoking, drinking. - Descriptive vs prescriptive norms - what relevant others do vs how others think you should behave. _ TT 7 3Distal influences on health behaviour Social influences - People have outcome expectancies attached to them as described in social cognition theory (SCT - beliefs attitudes create behaviour) and thus behaviour tends to be goal-directed. - Cognitive and emotion regulation necessary for success in organising and executing goal-directed activity (intentions turned into actions). _ TT 7 7Distal influences on health behaviour Social influences - Suggestion that women use self-regulatory behaviour more than men. - Existential theory states that meaning must be found in life in order to achieve mental health and happiness - derived from achieving self goals. _ TT 7Distal influences on health behaviour Models of health behaviour - Adopting health habits only reduces statistical risk of ill health - Early theories based on implicit assumption that: + Information — Attitude change — Behaviour change + But these were found to be naive _ a T 6Distal influences on health behaviour Models of health behaviour Attitudes (common-sense representations that individuals hold in relation to objects, people and events) - 3 factor model: 1. Cognitive: beliefs about the attitude-object - for example, cigarette smoking is a good way to relieve stress; cigarette smoking is a sign of weakness 2. Emotional: feelings towards the attitude-object — for example, cigarette smoking is disgusting/pleasurable 3. Behavioural (or intentional): intended action towards the attitude-object — for example, I am/am not going to smoke —_ TT 7Distal influences on health behaviour Models of health behaviour Attitudes - However, individuals may hold conflicting attitudes which produces dissonance sometimes referred to as ambivalence - person's motivation to change may be undermined by ambivalent attitudes - Implicit attitudes = less prone to social desirability bias _ TT 7 3Distal influences on health behaviour Models of health behaviour Risk perceptions - Unrealistic optimism comes into play in particular with comparisons of health behaviours. => '‘Ismoke less than person X’. - Social comparisons tend to be based on ones that work best for ourselves _ TT 7Distal influences on health behaviour Models of health behaviour Risk perceptions - Weinstein - 4 factors associated with unrealistic optimism: 1. A lack of personal experience with the behaviour. 2. A belief that their individual actions can prevent the problem. 3. The belief that if the problem has not emerged already, it is unlikely to do so in the future. 4. The beliefs that the problem is rare. TTDistal influences on health behaviour Models of health behaviour Self efficacy - Efficacy beliefs promote perseverance - Success in reaching a goal feeds back in a self-regulatory manner to further a person's sense of self-efficacy and to further efforts to attain goals _ TT 3Distal influences on health behaviour Social Cognitive models of behaviour change Static or continuum models with additive components whereby beliefs (or sets of them) are combined to try to predict where an individual will lie on an outcome continuum. - Social cognition = describes how people encode, process, interpret, remember and then learn from and use information in social interactions in order to make sense of the behaviour of others and make sense of the world in which they operate. T/T 2Distal influences on health behaviour Social Cognitive models of behaviour change Social cognitive theory 1986 - Behaviour is determined by 3 types of experience: + Sjituation-outcomes expectancies whereby a_ person connects a situation to an outcome e.g, smoking to heart attack; + Outcome expectancies: e.g. believing that stopping smoking would reduce the risk of heart attack; + Self efficacy beliefs: e.g, the extent to which the person believes they can stop smoking TT 3Distal influences on health behaviour Social Cognitive models of behaviour change Social cognitive theory 1986 - Theory considers barriers and facilitators eg social support, environmental factors _ a 5 73 | s Pl “J >= Sl rs Ft - ~ 4 ta ES e i = wv > r Se i = | ry ry Distal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 Perceived susceptibility Perceived severity Perceived benefits Demographic variables, e.g. gender, age Likelihood of behaviour Perceived barriers Cues to action Health motivation TT 5Distal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 - Cognitive model derived from subjective expected utility theory (SEU) (a decision-making model where an individual evaluates the expected utility (cf. desirability) of certain actions and their outcomes and selects the action with the highest SEU). - Proposes that the likelihood that a person will engage in particular health behaviour depends on demographic factors: for example, social class, gender, age and four beliefs that may arise following a particular internal or external cue to action. _ TTDistal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 - Various components: + Perception of threat: + Behavioural evaluation + Cues to action + Health motivation [5 7Distal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 Perception of threat: + Perceived severity + Perceived susceptibility | 5 3Distal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 - Behavioural evaluation + Perceived benefits (of change) + Perceived barriers (to change) TT 5 3Distal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 - Cues to action + External + Internal _ TT 5 6Distal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 - The HBM and risk behaviour: positive behaviour change would occur when the perceived benefits of change outweigh the perceived benefits of continued risk-taking. - However, evidence of this is mixed because an important predictor of what we do in the future is what we have done in the past. - Past behaviour = predictive _T 3Distal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 Limitations of HBM: - More relevant to predicting initiation of health preventive behaviours than reducing health risk behaviours - Older studies didn’t include cues to action - Lack of specificity concerning interaction and interrelations between variables - Lack of indication of weather barriers/ benefits are equally weighted TT 3 2Distal influences on health behaviour Social Cognitive models of behaviour change The health belief model (HBM) 1984 Limitations of HBM: - Overestimation of role of threat - Limited account of social influence of contextual influences - Does not account for self control of self-efficacy - Insufficient attention paid to role of mood/ negative affect - HBM is a static model (beliefs occur simultaneously) - no dynamics accounted for _ TT 3Distal influences on health behaviour 3 Social Cognitive models of behaviour change ry Fo Theory of planned behaviour + a Fr = Outcome Attitude P| expectanciesX ———P towards Py It r beh ry amore ‘outcome value ehaviour B 7 e.g. age, E a gender H Normative beliefs ; , —+A S Personality Xmotivation to. = ——p ane — Beatin — v 5 comply — | cy Past 0 $ experience y = Perceived intemal Perceived = and external ——*>> behavioural 2 control factors control CtDistal influences on health behaviour Social Cognitive models of behaviour change Theory of planned behaviour Explores and develops the psychological processes linked between attitude and behaviour by incorporating + Wider social influences. + beliefs in personal behavioural control. + The necessity of intention formation. _T 3Distal influences on health behaviour Social Cognitive models of behaviour change Theory of planned behaviour - Behaviour is thought to be proximally determined by intention, which in turn is influenced by a person's attitude towards the object behaviour and their perception of social norms and_ pressures regarding the behaviour. - The model states that the importance of the person's attitudes towards the behaviour is weighted against the subjective norm beliefs. TTDistal influences on health behaviour Social Cognitive models of behaviour change Theory of planned behaviour - TPB and preventative behaviour + Eg. eating breakfast, exercise behaviour, chlamydia testing intentions, vaccination + Attitudes, perceived behavioural control and intention = significant predictors on exercise behaviour. Inconsistent findings regarding the strength of influence played by normative beliefs _ TT 7Distal influences on health behaviour Social Cognitive models of behaviour change Theory of planned behaviour - TPB and preventative behaviour + Social influence = big predictor + Predictors of seeking help for breast cancer symptoms: attitudes towards help seeking and perceived behavioural control + Intention not sufficient to motivate behaviour _ TT 3Distal influences on health behaviour Research focus - Evidence suggests that adolescents know about the importance of healthy eating, but that many fail to follow nutritional guidance. - Study explores whether perceived social norms that are unsupportive of healthy eating intervene between putting available knowledge into action. _ TT 3Distal influences on health behaviour Research focus - Hypotheses tested whether ps receiving a descriptive norm message would report higher intended and actual fruit consumption than those who received an injunctive norm message. - Findings showed that injunctive (what others think is appropriate) norms affected intention negatively, and descriptive (what others do) norms in contrast, affected behaviour positively. _ TTDistal influences on health behaviour Research focus - The prescriptive norm message affected behaviour but not intention - contrary to TPB hypotheses where intention is the proximal determinant of behaviour. Possibly due to heuristics being created from what other people do. - The presentation of an injunctive message had a negative effect by reducing intentions to eat fruit. Authors suggest this may reflect adolescent resistance to a message suggesting how they should be behaving. _ I 43Distal influences on health behaviour Research focus The TPB and risk behaviour - Eg smoking (individual behaviour) and unprotected sexual intercourse (two person interaction). - Smoking: frequency explained by low perceived behavioural control over quitting beliefs. Best predictor of intention to quit was not only perceived behavioural control, but also beliefs in one’s susceptibility to the negative health consequences of continued smoking. _ TTDistal influences on health behaviour Research focus The TPB and risk behaviour Sexual risk behaviour: studies show that + Previous use of condoms, + a positive attitude towards use, + subjective norms of use by others, + partner support of use, + self-efficacy in relation to both the purchase and use of condoms, + intentions are important predictors. Interventions should target early in sex careers so as to facilitate safe sex - use of condoms less governed by intention, more so by habit. TT 4Distal influences on health behaviour Limitations of the TPB - Does not acknowledge bidirectional relationships between predictor variables (attitudes and subjective norms) and outcome variables, either intention or behaviour) - ‘Intention-behaviour gap’ — medium-sized changes in intention only result in trivial-sized changes in behaviour - Assumes that the same factors and processes predict the initiation of a behaviour/behaviour change and its maintenance — could be why interventions fail to have long term effects on behaviour change maintenanceDistal influences on health behaviour Extending the TPB New predictors of behaviour have emerged - Past behaviour - best predictor of what you do today is likely to be what you have done in the past - Affective (emotional) variables - Self-regulatory processes - Attentional control - Automaticity/ habit - see in the spotlight below _ TyDistal influences on health behaviour Extending the TPB New predictors of behaviour have emerged - Moral norms - some intentions and behaviour may be partially motivated by moral norms, particularly behaviours that directly involve others. - Self identity - We tend to behave in a manner that affirms our self- image. - Anticipatory regret - anticipatory emotions arise from a person's consideration of the likelihood of attaining (success) or not attaining (failure) the desirable outcomes of the behaviour. _ TTY 6Distal influences on health behaviour Extending the TPB New predictors of behaviour have emerged - Behaviour change tends to occur in contexts where social support is important yet more attention needs to be paid to the type of support that social networks exert, in terms of their social and action control. - Planning - Coping planning involves anticipating and planning for how to deal with barriers to behaviour. _ 4Distal influences on health behaviour The problem of non-reflective action - good and bad habits - Habits form repeated performance in stable contexts — automatic triggers of behaviour Habits don’t use up cognitive resource so they can override competing intentions in determining behaviour - Self reports of habitual behaviour may be unreliable as does not rely on cognitive processes rational or motivated behaviour - THUS very difficult to build interventions for these bad health automatic habits _ VT 4 5Distal influences on health behaviour Implementation intentions (IIs) - One reason why good intentions don't become actions is because of inadequate planning. - Research suggests that individuals need to shift from a mindset typical of the motivation (pre doing) phase towards an implementational mindset, which is found in the volition (doing) phase. - Implementation intentions have been shown to increase a person's commitment to their decision. _ TT 4Distal influences on health behaviour Implementation intentions (IIs) - Makes actions more automatic i.e next monday I will stop smoking. - Forming proximal (more immediate) goals leads to better goal attainment than forming distal (long-term) goals BUT IIs do show persistence over time. - Research shows having someone help you set IIs is more beneficial than simply setting them on your own. | TT SDistal influences on health behaviour Implementation intentions (IIs) - However, there is evidence that forming an II may not be so effective in changing habitual behaviour (spoken about in spotlight). — Generally, we succeed in achieving our goal when we value the likely outcome; believe that the goal is attainable through our actions and when we receive feedback on progress made. _ i T S 3Distal influences on health behaviour Issues: How the wording and ordering of questions may influence the data obtained? Stage models of behaviour change - models of behaviour change which consider individuals as being at ‘discrete ordered stages’, each one denoting a greater inclination to change outcome than the previous stage. ee)Distal influences on health behaviour Stage theory requires 4 properties 1. Classification system to define stages 2. Ordering of stages 3. Similar barriers to change facing people within the same stage - helpful in encouraging progression through the stages 4. Different barriers to change facing people in different stages - producing movement to the next stage were the same regardless of starting stage, then the concept of stages would be redundant | 3Distal influences on health behaviour The transtheoretical model (TTM or ‘Stages of Change’ model) - This model was developed to describe processes of elicitation and maintenance of intentional behaviour change - Initially applied to smoking cessation - The model makes two broad assumptions: that people move through stages of change; and that the processes involved at each stage differ and are independent _ TS 7Distal influences on health behaviour The transtheoretical model (TTM or ‘Stages of Change’ model) Stages of change proposed by the TTM are stages of motivational readiness: + Pre-contemplation + Contemplation + Preparation + Action + Maintenance — 5 most common + Termination + Relapse S| 5Distal influences on health behaviour The transtheoretical model (TTM or ‘Stages of Change’ model) - People do not move smoothly from one stage to another - The first two stages are generally considered defined by intention or motivation; the preparation stage combines intentional and behavioural (volitional) criteria, whereas the action and maintenance stages are purely behavioural - Psychological processes of change considered to be at play in different stages - covert or overt processes people engage in to help them progress __ TT 6Distal influences on health behaviour The transtheoretical model (TTM or ‘Stages of Change’ model) Limitations of the TTM - Several studies have questioned whether these change processes are in fact useful predictors of change - It has been suggested that some changes in the TTM processes resulted from the transition to action, rather than preceded it: for example, increases in situational confidence and counter-conditioning - Doesn't account for past behaviour [TSDistal influences on health behaviour The transtheoretical model (TTM or ‘Stages of Change’ model) Limitations of the TTM - The model, as with many psychological models, insufficiently addresses the social aspects of much health behaviour - The model does not allow for some people not knowing about the behaviour or the issue in question. This is likely when a rare or new illness is being considered - e.g rare new illness _ TTS 2Distal influences on health behaviour The precaution adoption process model (PAPM) - Framework for understanding deliberate actions taken to reduce health risks which meet Weinstein's criteria for a stage theory (see above). - Has 7 stages, people pass through in sequences but no time limit - Major difference between PAPM and TTM is that PAPM gives greater consideration to the pre-action stages. _ TTT SoDistal influences on health behaviour The precaution adoption process model (PAPM) - Stage 1. a person has no knowledge/is basically ‘unaware’ of the threat to health posed by a certain risk behaviour or the absence of a protective behaviour - Stage 2. termed ‘unengaged’, a person has become aware of the risks attached to a certain behaviour but believes that the levels at which they engage in does not pose a threat — optimistic bias - Stage 3. people become engaged for some reason - consideration stage _ TTDistal influences on health behaviour The precaution adoption process model (PAPM) - Stage 4. although perceived threat and susceptibility may be high, some people actively ‘decide not to act’, which is very different from intending to act but then not doing so Stage 5. some enter a ‘decide to act’ stage, similar to intention/preparation - Stage 6. the action stage, when a person has initiated what is necessary to reduce their risk - Stage 7. this final stage is not always required/relevant as it is about maintenance e.g. deciding to have a vaccination _ i TT 3Distal influences on health behaviour The precaution adoption process model (PAPM) Limitations of the PAPM - Lack of longitudinal testing [| 5Distal influences on health behaviour The health action process approach (HAPA) - Hybrid model having both ‘static’ and staged qualities. - Suggests that the adoption, initiation and maintenance of health behaviour must be explicitly viewed as a process that consists of at least a pre-intentional motivation phase and a post-intentional volition phase (where a conscious choice or decision is made) which leads to the actual behaviour. _ TT 3Distal influences on health behaviour The health action process approach (HAPA) - Highlights the role of post-motivational self-efficacy and action planning, factors not addressed by the TPB or PMT. Updated version further divided self-regulatory processes into sequences of planning, initiation, maintenance, relapse management and disengagementDistal influences on health behaviour The health action process approach (HAPA) - Motivation phase + Individuals form an intention to either adopt a precautionary measure or change a risk behaviour as a result of various attitudes, cognitions and social factors + HAPA proposes that self-efficacy and outcome expectancies are important predictors of goal intention + Perceptions of threat severity and personal susceptibility = distal influence on actual behaviour — play role on motivation + intention in the motivation phases is considered as a goal intention TT 5Distal influences on health behaviour The health action process approach (HAPA) 4 | sc = Ss a Task Maintenance Recovery a self-efficacy self-efficacy self-efficacy = = | < my Action = . Action contro! Outcome panne Sc : Intention 4 expectancies ath ee Action z planning = ¥ cy FS Risk ~ Barriers and resources, e.g., social support is perception = Py Preintenders Intenders Actors a The motivation phase a 6Distal influences on health behaviour The health action process approach (HAPA) Volition phase - Once an intention has been formed, the HAPA proposes that in order to turn intention into action, a conscious decision to act is made which involves planning. - Such volitional processes are thought to be particularly important in the context of complex behaviours where multiple barriers might be anticipated. [7Distal influences on health behaviour The health action process approach (HAPA) Limitations of the HAPA - HAPA models the behaviour of middle-aged and older people better than it did that of younger people. - More is still needed in terms of our understanding of volition-action processes. - Insufficient attention is again given to non-conscious processes. _ a T 5Distal influences on health behaviour The need to consider self-regulatory processes - Self-regulation requires self-control, and individuals likely vary in that regard. - Newer constructs such as ‘action control’, ‘implementation intentions’ and behavioural monitoring are highly pertinent. - For behaviors that require daily performance and daily maintenance, self-monitoring of one’s behaviour against one’s goals becomes increasingly important if relapse is to be avoided. _ TT 6Understanding and changing behavior Social cognition models of behavior The health belief model Central = perceived threat a person experiences, health motivation and cues to action (reminder cues) The Health Belief Model Demographic Variables class, gender, age, etc. Psychological Characteristics peony, peer group presse 70Understanding and changing behavior Social cognition models of behavior Bandura’s social cognitive theory Central = outcome expectancies BUT not these alone, also self-efficacy expectations (V. critical for behaviour change). | So Cognitive processes Behavioral processes Behavior initiation and maintenance TT 7Understanding and changing behavior Social cognition models of behavior Protection motivation theory Adapted from the health belief model to incorporate self-efficacy, severity + vulnerability =threat appraisal = experience fear, response efficacy to counter this. Another addition = rewards of current unhealthy behaviors (maladaptive response) _ TT 7 7Understanding and changing behavior Social cognition models of behavior Protection motivation theory Cognitive Mediating Processes ananaaagitve Intrinsic Rewards Severity Response Extrinsic Rewards | ~ | Vulnerability Protection Motivation Adaptive Response Efficacy Response Self - Efficacy Figure 2. Cognitive mediating processes of protection motivation theory TTS 3Understanding and changing behavior Social cognition models of behavior Reasoned action approach Adapted from theory of reasoned action and theory of planned behaviour. Intention = most proximal determinant of behaviour, intention determined by 3 other factors: attitude (behavioural beliefs), perceived norms (normative beliefs) and perceived behavioural control (control beliefs). _ VT 7Understanding and changing behavior Social cognition models of behavior Reasoned action approach Adapted from theory of reasoned action and theory of planned behaviour. Intention = most proximal determinant of behaviour, intention determined by 3 other factors: attitude (behavioural beliefs), perceived norms (normative beliefs) and perceived behavioural control (control beliefs). _ TTUnderstanding and changing behavior Social cognition models of behavior Reasoned action approachUnderstanding and changing behavior Preparation for action & starting to change Self- determination theory People are driven by 3 basic needs: connected, competent, autonomousUnderstanding and changing behavior Preparation for action & starting to change Health action process model Change is more than motivation alone, intentions, planning and action must occur. Self-efficacy still an important role. Task Maintenance Recovery a, oS = ‘Action mee i ee nn = expectancies entio coe + : Ss — Tr t Barriers and resources, e.9., social perception 3 | s Pl “J >= Sl rs Ft = ~ 4 ta ES e = = wv > r Se i = | ry ry Preintenders Intenders Actors The motivation phase TTT 7:Understanding and changing behavior Preparation for action & starting to change Self-regulation as a core process - Self-regulation as systematic approach involving consciousness effort to module thoughts, emotions and behaviour in order to achieve goals within a changing environment, can be internal and external. - Implies modulation of thought, affect, behaviour or attention via deliberate or automated use of specific mechanisms and supportive metaskills. TTF 5Understanding and changing behavior Preparation for action & starting to change Control theory/ self-regulation theory Self-regulation encompassed interrelated and iterative phases: 1. Fore thought: self-monitoring and goal selection. 2. Performance and volitional control: goal initiation. 3. Self-reflection: outcome evaluation and comparison to goal and behavior. 4. Adjustment: directional change or reprioritization (changing goal, behavior, or disengage). 5. Goal termination (end-state: new habit, or disengagement). _ TTUnderstanding and changing behavior Preparation for action & starting to change Control theory/ self-regulation theory SETTING PERFORMANCE TARGETS FEEDBACK Fig. 1. Control Theory, adapted to include behaviour change techniques (Carver & Scheier, 1998; Abraham & Michie, 2008). VT S|Understanding and changing behavior Preparation for action & starting to change Self-regulatory skills (Zimmerman, 2002): (a) adopting powerful strategies for attaining the goals (b) monitoring one's performance selectively for signs of progress (c) restructuring one’s physical and social context to make it compatible with one’s goals (d) managing one’s time use efficiently _ TT?Understanding and changing behavior Preparation for action & starting to change Self-regulatory skills (Zimmerman, 2002): (cont) (e) self-evaluating one’s methods, (f) attributing causation to results, and (g) adapting future methods — The processes of self-regulation are initiated when routinized activity is impeded or when goal directedness is otherwise made salient _ TT 3Understanding and changing behavior Preparation for action & starting to change Relapse prevention model Set of strategies to prevent or limit relapse episodes Central concept = high risk situations + negative emotional states Probability of _ TT 4Understanding and changing behavior Changing behaviour - increasing motivation Parallel Process model Coping Procedures (Action plans) Situational Stimuli Inner and Outer Representation of Fear 85Understanding and changing behavior Changing behaviour - increasing motivation Parallel Process model Fear > 1. Danger control, i.e(cognitive) need to reduce the negative consequences (protection motivation) 2. Fear control, i.e, need to reduce the emotion of fear (denial, avoidance, distraction) But under which conditions? — Reduce risk rather than reduce fear of danger _ TT 6Understanding and changing behavior Changing behaviour - increasing motivation Parallel Process model Fear > 1. Danger control, i.e.(cognitive) need to reduce the negative consequences (protection motivation) 2. Fear control, i.e., need to reduce the emotion of fear (denial, avoidance, distraction) But under which conditions? — Reduce risk rather than reduce fear of danger _ TT 7Understanding and changing behavior Changing behaviour - increasing motivation Parallel Process model High Efficacy Low Efficacy Beliefs that one is able to | Beliefs that one cammot avert a effectively avert a threat threat, and even if s/he could, it wouldn't work anyway Danger Control Fear Control High Threat People taking protective People in denial about health Beliefs that one is at-risk for a | action against health threat. threat, reacting against it. ignificantly harmful threat Lesser Amount No Response ow Threat of Danger Control People not considering the Belief that a threat is People taking some protective | threat to be real or relevant to irrelevant and/or trivial action, but not really them; often not even aware of motivated to do much. threat. TTS 53 | s Pl “J = Sl rs Ft - ~ 4 ta ES e i = wv > r Se i = | ry r Understanding and changing behavior Changing behaviour - increasing motivation Elaboration Likelihood model * Central route Persuasive Peripheral route : communication erie Ff Peripheral J a cues eee Motivated process J J yes ‘neutral Weak attitude change Able to process Strong Weak case case Strong Negative attitude attitude change change TT 3Understanding and changing behavior Changing behaviour - increasing motivation Elaboration Likelihood model How to make people more likely to change their attitude through a message: Make it... - Personally relevant - Near to existing views - Strong and new arguments - Understandable - Short and clear - Frequent repetition of core message - Peripheral cues: e.g., reliable source _ TTUnderstanding and changing behavior Changing behaviour - increasing motivation Bandura’s Social Cognitive model for looking into self-efficacy Source of selt-elficacy Effects of selt-elficacyUnderstanding and changing behavior Changing behaviour - increasing motivation Preparing for action: Implementation intentions and cues to action/ nudging Implementation intentions: - Enhances accessibility of specified opportunities and automated respective goal-directed outcomes - E.g. Goal intention: “I intend to reach Z!" Implementation intention: “If situation Y is encountered, then I will initiate goal-directed behavior X SITUATIONAL CUE RESPONSE (If...,) (then...) “If am in a situation X, | then | will do Y." TT %Understanding and changing behavior Changing behaviour - increasing motivation Extension of relapse prevention model — but we focus on grey part (specific events) Global SpecificSummary - The salience of potential predictors of behavior may differ by behaviour and by characteristics of the sample. - The role of culture, ethnicity and religion may influence beliefs about health and preventive health. - Cognitive models do not account very well for habitual behaviours driven more by non- conscious processes, nor for dependency- producing behaviours where physiological cues create impulses which may override rational thought.Summary - There may be bias in self-reports of illegal or socially undesirable behaviour or of behavior perceived to be unconventional. - Incorporating objective measures into our research should be carried out where possible. - We need to consider non-rational processes. People differ in the extent to which they can, or even wish to, control their impulses. When drunk, angry or tired, for example, we may reflect less on our behaviours or our decision-making or be biased in the cues we attend to. - The influence of context on the shifting.Summary - Finally, in considering the social, cognitive, emotional and behavioural processes that occur once a person has engaged in health behavior change we will better inform interventions that seek to maximise maintenance of that change.THANK YOU FOR YOUR ATTENTION ! 97