1. BS914 - Lecture 6 Social Cognitive Theories of Exercise Behaviour

2. 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.

3. You would think that.. The threat of: –blindness, –amputation, –death Would motivate a diabetic to lose weight Prison would dissuade people from re-offending

4. Why do people… Knowingly do things that compromise health? Fail to do things that enhance health The fundamental questions in health psychology

5. Lecture Plan Defining health behaviour Social Cognition Theories of Health Behaviour Social Cognition Theory & Behaviour Change Intentions and Behaviour Applied Health Psychology –Introduction

6. Lecture Learning Objectives Understand various health behavior models. Understand how CR uses models health behaviour models

7. 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’

8. Cardiac Rehabilitation Health Behaviour Sick Role Behaviour Illness Behaviour

9. CR Spans The 3 Health Behaviour Domains Matarazzo (1984) Health impairing habits –Behavioural pathogens: –Smoking, diet Health Protective Habits –Behavioural immunogens: –Exercise, diet

10. Social Cognitive Theories

11. Definition Models using concept of social cognition to account for behaviour Social cognition –Rational decision made on basis of… –past experience –current social environment

12. 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

13. Health Belief Model: Rosenstock (1974) ‘Readiness’ Intention Perceived VulnerabilityProbable Severity Benefit Beliefs Perceived Barriers

14. 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

15. Health Belief Model: Rosenstock (1974) ‘Readiness’ Intention Perceived VulnerabilityProbable Severity Benefit Beliefs Perceived Barriers

16. Usefulness of Health Belief Model Simple & Clear –Appealing to health care providers Explanatory value –Descriptive studies –Intervention studies

17. 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

18. Protection Motivation Theory: Rogers (1987)

19. Protection Motivation Threat Appraisal Perceived Vulnerability Perceived Severity Fear Coping Appraisal Perceived Self-efficacy Perceived Response-efficacy Perceived Response-cost Health Protective Behaviour Maladaptive Coping (Hodgkins & Orbell, 1988) Avoidance, Denial, Wishful Thinking, Hopelessness Environment Communication Observation Learning Intrapersonal Personality Experience Information Cognitive Mediating ProcessBehaviour

20. Health Belief Model & Protection Motivation Theory Similarities?

21. Beliefs and Attitudes Beliefs –Knowledge, information Attitudes –Value ‘ingredient’ –Good/bad, desirable/undesirable ‘is’ness vs. ‘ought’ness

22. Theory of Reasoned Action: Azjen & Fishbein (1980) Normative Beliefs x Compliance Behavioural Beliefs x Values Attitudes Intentions Behaviour Subjective Norms

23. 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

24. Three Boundary Conditions: TRA Correspondence –Action –Target –Time –Context Stability –Intentions  time  action Volitional Control –Personal barriers –Environmental barriers

25. Theory of Planned Behaviour: Azjen (1985) Normative Beliefs x Compliance Behavioural Beliefs x Values Attitudes Intentions Behaviour Subjective Norms Perceived Behavioural Control Control: Beliefs x Power

26. 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

27. BB CBs NBs ATT SN PBC Behaviour Intention r =.50 r =.52 r =.49 r =.34 r =.43 r =.47 r =.37 TPB Meta-Analysis: Armitage & Conner (2001)

28. Research Problems Observing behaviour –Not best way to determine –Beliefs –Attitudes Specific problems –Misinterpretation –Difficulty in quantification –Ethical problems –Hawthorne Effect

29. Task Write two questions Designed to measure one attitude toward CR

30. Questions Open vs. closed Quantifiable – scaled? Question wording –Strong language –Ambiguity –Suggestive or leading Order of questions?

31. Sufficiency of TPB Frequency of past ‘habit’ Personality –Extroversion Attitude Strength Normatively Controlled individuals Anticipated Regret

32. Transtheoretical Model: Prochaska & DiClemento (1982) Precontemplation Contemplation Preparation Action Maintenance

33. Precontemplation No intention of change –6-mo Unaware of problem –& Aware but no intention

34. Contemplation Serious consideration Intention: change in 6-mo –Open to feedback –Open to info Ambivalent regarding costs:benefits

35. Preparation Intention to change behaviour –1-mo Failure in past 12-mo Active planning Taking steps –Recipes & shopping lists –Activities

36. From Contemplation to Action

37. Action Implementation of planned behaviour Over behaviour change –Commitment –Energy Diet changed in last 6-mo

38. Maintenance Work to prevent relapse Sustaining change & resisting temptation

39. 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

40. Transtheoretical Model: Prochaska & DiClemento (1982) Precontemplation Contemplation Preparation Action Maintenance

41. 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

42. Questions Why is human behaviour so difficult to change? How can social cognition theories influence design strategies?

43. 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