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