Lect 10: Social Cognitive Theory

Q. How can pharmacists increase patients' self- efficacy beliefs to enhance adherence?

- strong encouragement -collective efficacy

SCT image

- to change behavior, need to change personal factors and environmental factors -important to notice behavior also influences personal and environmental factors -personal factors = beliefs, knowledge, biological factors (gender), fears

Outcome Expectations 1. There are different classes of outcome expectations a. Physical b. Social c. Self-evaluative 2. Expectations are influenced by: (3)

1. a. bodily sensations and material gains or losses b. -anticipated approval or disapproval c. —how one expects that they will feel about themselves after preforming the behavior. 2. - past experiences in similar situations - observing others or hearing about others in a similar situation. - the emotional or physical response that occurs as a result of the behavior

Reciprocal Determinism SCT emphasizes reciprocal determinism. 1. description (The person, behavior and environment are, behavior is the product of, changing one) 2. the way in which 3. people's behaviors affect 4. personal factors affect 5. people can alter and construct

1. - The person, behavior and environment are continually interacting. - Behavior is the product of the dynamic interplay of personal, behavioral, and environmental influences. - Changing one of these changes them all. 2. people interpret their environment and their personal factors affect their behaviors. 3. their personal factors. 4. the environment 5. environments to suit their purposes.

Outcome Expectations 1. is when 2. Expectations are the

1. -People behave in certain ways because of the results they expect. - People behave in ways that they believe will lead to positive and valued outcomes, while avoiding behaviors that they expect to result in unfavorable outcomes. 2. anticipated outcomes of the behavior. - EX 1. People exercise to loose weight. - EX 2. People expect to get sick from the flu vaccine. - EX 3. Men expect to be embarrassed having a digital rectal exam.

H. Locus of Control (LOC) 1. Internal locus of control 2. External locus of control

1. Believe that everything that happens to them is a result of their own decisions and behaviors 2. Believe that forces outside of their control, such as fate, important or powerful others, or God's will, govern all aspects of their lives.

F. Behavioral Capability 1. what is it 2. Before doing something you have to know:

1. Having knowledge of the behavior and skills to perform a behavior. 2. - What it is you're going to do and - How to do it.

G. Reinforcement 1. what is it 2. People do something in order to 3. examples

1. Is a system of rewards (+ve reinforcement) and punishment (-ve reinforcement) in response to behavior. 2. get a reward or avoid a punishment 3. - Ex 1: Quit smoking to get reduced insurance premiums (reward) - Ex 2. Quit smoking to avoid higher insurance premiums for smokers (punishment)

Strengths of SCT

1. SCT is broad and comprehensive - Can be used to explain virtually all human phenomena. 2. SCT's best known concept (self-efficacy) has been validated repeatedly. 3. SCT constructs can be added or used in conjunction with other theories. - "Work that is informed by other theories and conceptual models may also be enhanced by incorporating SCT concepts and principles"

Self regulation -best predictor of nutrition of all the SCT constructs 1. what is it 2. is when 3. makes people endure

1. basically self-efficacy + expectations + goal setting. 2. people form beliefs about what they can do, anticipate the likely outcome of their actions, set goals, and plan a course of action that will result in the expected outcome 3. short-term negative outcomes in anticipation of important long-term positive outcomes, that is, to discount the immediate costs of behaviors that lead to a more distant goal

SCT & Constructs Many SCT constructs are used extensively in health education and other theories and models. 1. SCT is a

1. comprehensive and well-supported conceptual framework for understanding the factors that influence human behavior and the processes through which learning occurs, offering insight into a wide variety of health- related issues.

B. Observational Learning (Modeling) 1. People can acquire new behaviors and knowledge by simply observing a model - A model is a person who 2. Observational learning is EX: If a parent (role model) smokes, it is more likely that the child will also smoke. (Children learn and do what they see). Peer modeling helps change behavior.- Use of drama & storytelling are effective

1. demonstrates the behavior for someone else (e.g., peers, family, role models, & media models via mass communications) 2. learning by watching others and copying their behavior. - So much of our behavior results from observational learning.

Uses of SCT 1. SCT has been applied to

1. design interventions to meet challenges in public health, medicine and pharmacy.

Main Concept of SCT 1. Behavior, personal factors, and environmental factors 2. reciprocal determinism.

1. interact with each other, and changing one changes them all. 2. SCT posits that human behavior is the product of the dynamic interplay of personal, behavioral, and environmental influences.

Social Cognitive Theory (SCT) 1. SCT is a theory of 2. SCT is attributed to Albert Bandura. - conducted research on - at the time, behavior acquisition was believed to be a result of -experiment

1. interpersonal behavior 2. - conducted research on observation, social learning, and aggressive behavior dating back to the late 1950s. - At the time, behavior acquisition was believed to result from environmental stimuli, consequences, rewards, and punishments. - Bobo Doll Experiment

6 ways to achieve self regulation 1. self monitoring 2. goal setting 3. feedback 4. self-reward 5. self instruction 6. enlistment

1. is a person's systematic observation of her own behavior 2. is the identification of incremental and long- term changes that can be obtained 3. is information about the quality of performance and how it might be improved 4. is a person's provision of tangible or intangible rewards for himself 5. occurs when people talk to themselves before and during the performance of a complex behavior 6. is achieved when a person finds people who encourage her efforts to exert self-control.

Reinforcement 1. Using rewards to maintain positive health behaviors is more 2. Example:

1. likely to result in repeated positive behavior rather than using punishment. 2. - Giving extra vacation days for maintaining a healthy weight is more likely to support healthier eating and exercise than is taking days away from those who are over weight.

A. Self-efficacy 1. Behavior is determined by 2. Self-efficacy consists of 3. Self-efficacy is 4. Self-efficacy is more important for

1. self-efficacy beliefs. 2. a person's beliefs about his/her capacity to influence the quality of functioning and the events that affect his/her life. 3. the most widely known SCT concept - has been integrated into other models/theories. 4. complex or difficult behaviors.

H. Locus of Control (LOC) 1. Is 2. This belief influences 3. example

1. the degree of your belief in your ability to control what happens to you. - Ranges from internal to external 2. health decisions and thus health behavior. 3. In the case of breast cancer, women who are more externally controlled are not likely to have mammograms unless their physicians tell them to have one.

Observational Learning 1. Impact of observational learning depends on 2. Attention is influenced by: (5) 3. How can pharmacists promote observational learning by patients to enhance adherence?

1. the extent of attention given the model. 2. - attractiveness of the model - circumstances of observation - personal motivation to learn the behavior, - importance of learning the behavior - complexity of the behavior 3. use an attractive model -put a person of someone good looking -something that catches people's attention then talk about the flu

E. Emotional Arousal 1. Refers to 2. Fear can support positive health behaviors 3. Fear can hinder good health practices

1. the fear we may feel in certain situations or when engaging in certain behaviors. • Fear of contracting HIV/AIDS 2. - Fear of skin cancer = avoid tanning 3. - Avoid going to the dentist because of fear & anxiety.

D. Expectancies 1. Expectancies are 2. The expected outcome can be viewed as

1. the values the person places on the outcomes (expectations) of a particular behavior. 2. same outcome but different values - Good or bad - Positive or negative - Useful or useless - Healthy or unhealthy

Self-Efficacy (Cont'd) People will only try to do what they think they can do, and won't try what they think they can't do. - I think I can, I think I can....... 1. Even when people have the skills and knowledge to accomplish a task, it is

1. their belief in their ability to use them that enables people to actually perform the task (Bandura, 1993).

Self Efficacy: Collective Efficacy 1. Many of the things that people seek are achievable only by

1. working together with others. - People can work in organizations and on their political participation to achieve their ends. - EX: Student governance; patient groups; pharmacy associations etc.

Which of the following is a theory of interpersonal behavior 1. Health belief model 2. Theory of reasoned action 3. Theory of planned behavior 4. Social cognitive theory 5. Transtheoretical model (stages of change)

4. -rest of them looks at personal behavior

Self regulation example

In an effort to understand how it is possible that even though the US population has access to healthier foods, the overall diet of the population has not improved, self-regulation was found to be the best predictor of nutrition of all the SCT constructs. -People who plan and track their eating, plan different strategies to increase fruit, vegetable, and fiber consumption, and to decrease fat, have healthier diets" <- know this is self regulation

How and Why People Change: SCT Constructs (9)

LE3S2BRO - Self-efficacy - Observational learning (modeling) - Expectations (outcome expectations) - Expectancies - Emotional arousal - Behavioral capability - Reinforcement - Locus of control - Self regulation

Reinforcement Strategies (5)

a) Passing laws forbidding minors' possession of cigarettes. b) Increasing taxes for cigarettes c) Providing financial incentives for validated quitting. d) Discontinuing medication for Type II diabetes because dietary changes and exercise have it under control. e) Verbal praise from pharmacist/physician.

Criticisms/Limitations of SCT

• Few studies have applied/evaluated the complete theory. - Many studies only apply selected SCT constructs. • Has been applied to limited behaviors. • Is behavior rational?