1. H571 – Week 2 Value-Expectancy Theories Any questions from last week? Value-Expectancy Theories Theory of Reasoned Action – Lindsay Miller Richardson et al. test of TRA – Stefanie Theory of Planned Behavior – Steven Brantley Plotnikoff test of TPB – Evan Hilberg Break Normative Beliefs – Jessica Seifert Behavioral Intentions – Justin Roudabush Information-Motivation-Behavioral Skills Model – Jill French et al – importance of affective beliefs Group discussion activity

2. Value-Expectancy Theories or Expectancy-Value Theories Assume that people will engage in or change a behavior if they anticipate the personal “benefits” derived from the outcome will outweigh any “costs” incurred through enacting the behavior –Costs and benefits may be social, emotional, physical or financial

3. Expectancies Expectations of a behavior Expected consequences or outcomes of a behavior They are beliefs, i.e., they are cognitive They can have a confidence/efficacy aspect They are Probabilistic –e.g., 1-100 or 1-10 or 1-7 scales

4. Values Expected value (or evaluation) of those consequences – costs or benefits Instrumental or affective E.g, how useful, important or enjoyable Negative or positive values –bi-directional scales –e.g., -3 to +3 scale

5. Valuing Costs and Benefits Because costs and benefits are not always clear, perceptions may be an important aspect of the “mental math” that accounts for behavior Value-expectancy theories must also account for perceptions of immediate vs. delayed benefits E.g. Social benefits of losing weight to increase sex appeal may materialize soon compared to physical benefit of delayed heart disease

6. Theory of Reasoned Action

7. Theory of Reasoned Action (TRA) dual focus: –Attitudes toward a behavior –Social normative beliefs re that behavior It suggests that value-expectancy beliefs about health behaviors and social influences are both (equally) important in shaping behavioral intention How different are normative beliefs and behavioral beliefs? (NCI Trafimow)

8. TRA: Attitudes The first construct in TRA is attitude toward the health behavior: this construct is centered on expectancy beliefs and the values attached to them, which combine to form attitudes –Once a person considers all relevant behavioral expectancy beliefs toward a very specific health behavior, and evaluates each expectancy as being good or bad, then attitude formation takes place

9. TRA: Social Normative Beliefs The second construct is subjective normative beliefs: –people are motivated by their normative beliefs (perceptions of what is considered normative and acceptable to others) and their desire to please (or motivation to comply with) those others (i.e. parent, peer/friend, wife, doctor, neighbor, media personality) To arrive at a subjective norm toward a health behavior, and individual will first identify all relevant normative beliefs and then weight each normative belief by the level of motivation to comply with the referent source Two important factors that increase importance of normative beliefs: –Group identification – you want to please members of your group –“Priming the collective self” – the memory of your group affiliations

10. TRA (&TPB): Intentions Behavioral Intent(ions) is the one key predictor of actual behavior in these models –Intention = decision = willingness = proximal goal –= Goal states –“Effort one is willing to expend to reach a goal” Accounts for 20-30% of the variance in behavior

11. Theory of Reasoned Action

12. TRA: Measurement The Principle of Correspondence In TRA, measures of intent include 4 components: –A time frame for performance of the behavior, –Description of the action comprising the behavior, –The target (desired) outcome of the behavior and –The context of the behavior Ex: Intent to use condoms for STI prevention (target) in the next 6 months (time) for every act of penile- vaginal sex (action) with people other than your primary sex partner (context) Factors that affect BI  B relationship –Aggregation, compatibility, commitment, stability

13. Richardson et al’s test of TRA

14. TRA: Limitations The often weak connection between behavioral intent and actual behavior is most likely attributable to external circumstances such as perceptions of environmental factors or actual environmental barriers that confound the translation of behavioral intent into action E.g.: May have strong intent to quit smoking but perceive absence of affordable cessation program, but without structural supports intent remains a “good idea for someday”

15. Theory of Planned Behavior

16. The Theory of Planned Behavior (TPB) is simply TRA with an added construct This construct, perceived behavioral control is primarily concerned with the extent to which a person or a group of people perceive/believe that they are able to control the performance of the behavior Perception of control is based on an intersection of factors external to the person making the decision together with their evaluation (valuing) of those factors

17. TPB: Cognitive Beliefs Perceptions include the existence of facilitating and inhibiting factors –Facilitating factor is any actual or perceived internal or external factor that increases the likelihood of the occurrence off the behavior in question E.g., Easily-accessible clinics that offer expanded hours for testing Also includes having the needed skills –Inhibiting factors are actual or perceived internal or external factors that may inhibit performance of a behavior Includes lack of access Also includes lack of skill

18. TPB: Affective Beliefs In addition to facilitating and inhibiting factors TPB suggests that the perceived power of these factors is considered by people in the process of adopting a health-protective behavior Perceived power is the strength of the facilitating and inhibiting factor –A single but strong inhibiting factor may negate translation of behavioral intent into behavior E.g., Cost associated with a Pap test for uninsured Also includes strength of self-determination or will to do the behavior

19. TPB: Measurement Perceived behavioral control is assessed by considering all the facilitating and inhibiting factors and the relative power of each See Figure 4-4 (next slide)

21. TPB: The NCI monograph version

22. TPB: Another Version

23. TPB: Flay Version Knowledge/Expectancies Values/Evaluations Skill Will, Self-determination, with Flay adaptations

24. More about Measurement

25. Plotnikoff et al’s test of TPB

26. The Information-Motivation- Behavioral Skills Model

27. The Information-Motivation-Behavioral Skills Model (IMB) is a relatively recent innovation/adaptation in behavioral science –Created in response to HIV epidemic To prevent HIV, people… –Need to know…? –Need to feel compelled to…? –Need to feel confident performing…? Sound familiar?

28. IMB: Information The first construct, Information, suggests that having a high degree of relevant knowledge pertaining to the health behavior is considered a prerequisite to behavior change. –In TRA/TPB, information is only one component of Attitudes –As a rule, while information is necessary, it alone is usually not sufficient to change most behaviors

29. IMB: Motivation The second construct, Motivation, is conceived as a construct that embodies a range of perceptions related to the behavior in question Motivation is the combined influence of a person’s attitude toward the behavior and their socially- inspired motives to perform the behavior –Very similar to TRA Must be assessed on a behavior-specific basis E.g., Using a condom to prevent pregnancy vs. STI

30. IMB: Behavioral Skills The third construct, Behavioral Skills, is an integration of both actual skills and self efficacy Self-efficacy can be thought of as a task- specific perception of personal ability

31. IMB: Partially mediated model The model speculates that Information and Motivation can influence health behavior directly or indirectly through Behavioral Skills For many behaviors skill is required to perform the behavior, but not always

32. Application of IMB Application of the IMB model has three phases: Elicitation, Intervention and Evaluation The Elicitation phase assesses analytic associations between “I”, “M” and “BS” which informs the design of the Intervention Phase Once the intervention has been designed and delivered, the Evaluation Phase collects follow-up data which is analyzed for associations between IMB constructs Similar to the application of other models

33. French et al., Importance of Affective Beliefs Fishbein and Ajzen did not understand or communicate very well the affective nature of evaluations, motivation to comply, and power/will Two components of Attitudes/SNB/BC –Affective component refers to emotions and drives engendered by the prospect of performing a behavior –Instrumental component refers to more cognitive consideration of the extent to which performing a behavior would be advantageous

34. Human Behavior Not always driven, primarily, by rationality or cognitive forces Decisions often made with our “hearts” - according to ancient wisdom literatures Driven by –Emotions –Desires –Habits –Likes/Dislikes –Biological imperatives –Memories buried in the subconscious mind

35. Dual Process Theories – Beyond Rationality Renewed appreciation for dual process theories: –Affective and Cognitive Elements –These elements interact continually –Theories vary on how much emphasis is put into each element Recently applied to the study of how people manage risk information Scholars have been calling for the addition of affect, emotions, or feelings to current theoretical models of human behavior.

36. An Alternative Include affect-type variables within existing behavioral models. Adopt other, dual process theories. Other examples of available options: –Cognitive Experiential Self-Theory (CEST) Developed by Epstein (1994) adds AFFECT to a set of cognitive factors. –Model of Interpersonal Behavior (MIP) Developed by Triandis (1980) adds HABITS, or habitual behavior, to reasoning constructs

37. Motivation 1.Expectancy-value theories are generally better for explaining behavior - and not very explicit about how to change behavior, except for providing information. 2.Knowledge is important in each theory, but different knowledge is emphasized in each. 3.Some attitudes may be more amenable or more resistant to change. Only TRA/TPB emphasize the relative importance of certain cognitive variables. 4.The term motivation is used in TRA and IMB to reflect intentions, and not in ways that are consistent with the way it is defined more generally All predictors are motivational

38. Activity: Small-Group Discussion Topics 1.How important is information in influencing/changing behavior? 2.Are normative beliefs and behavioral beliefs (that determine attitudes) really different? How? 3.Similarities and differences between cognitive and affective predictors of behavior 4.Factors that affect the relationship between intentions and behavior 6.Are people logical/rational or illogical/irrational in decision- making? 7.Can affect/emotions be included in a “rational-choice” process? How? 8.Conditions/contexts in which feelings or emotions (rather than cognitions) drive behavioral choices? And vice versa? 9.Health promotion strategies suggested by value-expectancy theories