behavioral health quiz 2
external resources
§ Emotional § Instrumental · Tangible aid and services § Informational · Advice § Appraisal · Information that is useful for self-evaluation
different types of stress
o Positive stress-->tolerable stress-->toxic stress
outcome expectations
o The anticipation that certain actions will result in outcomes/reactions. It is what a person learns related to behavior. Specific results
pregnant womens intentions to implement safety practices for preventing infant injury
· Unintentional injury is a major cause of death in children o 93.4% of unintended injuries among infants occur at home · Injury prevention is currently perceived as a global public health challenge that requires a strategic response · Currently, public health professionals provide injury prevention information at a child's four month check up o Meaning there are few opportunities to learn how to prevent injuries before 4 months · This study focuses on giving injury prevention education during pregnancy rather than after birth · The study focused on the prevention of: o Suffocation o Falls § Most common cause of nonfatal injuries in infants o Burns o Accidental ingestion o Injury during traffic accidents o SIDS àprecaution adoption process model · For people to adopt preventative behaviors, they need to know the risks · PAPM suggests that people at different stages in the precaution adoption process behave in different ways and that the information needed to move people closer to action vary across stages
predictors of vaping behavior change in young adults
· both cigs and vapes produce inflammation and alter our innate immune system—the lung epithelium o HOWEVER, due to the novelty of vape devices and introduction of these products only a decade ago, research is in its infancy, compared to cigs that have been researched for decades · Influences include peers, environments and consumption of alcohol · ttm can be applied to this! 1. Precontemplation a. People are not thinking about change and do not intend to quit smoking within the next 6 months 2. Contemplation stage a. Individuals are weighing the pros (benefits) and cons (costs) of changing and consider smoking cessation within the next 6 months 3. Preparation stage a. People are already making small changes and decided to quit smoking within the next 30 days 4. Action stage a. People changed their behavior and quit smoking, but for less than 6 months 5. Maintenance stage a. People maintained smoking cessation for more than 6 months · Vaping is becoming less of an experimental behavior and more of a habit
application of snt
-infectious disease epi -examination of how social relationships influence individual behavior -examination of how individual behavior influences social relationships -examination of levels of social capital of individual actors within a social network -organizational dynamics
reinforcement
A favorite from behaviorist psychology - the idea that a reward (positive reinforcement) increases the likelihood that the behavior will be repeated, and negative reinforcement does the opposite. But now it includes social reinforcement.
enviornment
Factors external to a person - social, or physical -- which all together comprise the SITUATION with which a person interacts
the experience of stress
Potential stressor--> primary appraisal--> secondary appraisal stress
sct constructs
o Reciprocal Determinism o Environment o Observational Learning o Behavioral Capability o Reinforcement o Outcome Expectations o Outcome Expectancies o Self-Efficacy o Self-Control of Performance o Managing Emotional Arousal o Connects these between individual and environment (original constructs) o In thinking about SCT: You can see from the list in the previous slide that SCT includes a relatively large number of constructs
what is stress
o Elusive concept to define and study o However, most of us know this experience o Stressor: stressful events o Stress in an interplay between the individual and the environment Stress is a consequence of a person's appraisal process
· The ecological model and behavior theory
o AS YOU KNOW BY NOW...If many factors shape and motivate behavior as it relates to health, we can say that for any given health issue there is an ecology of behavior. o may include factors: § close to the individual (e.g., attitudes, knowledge, skills); § those related to social groups individuals participate in (e.g., social group norms, structures, families); § those related to community, society and culture (e.g., policies, resources, cultural beliefs and knowledge) § Political and socioeconomic structures o For each of these ecological "levels," there are corresponding theories related to behavior. o For any heath issue there is an encology of behavior o Behaviors can be related to different things and different groups Factors come from different levels (community etc)
Ongoing evolution of sct: qualifying the constructs
o Bandura has, for example, suggested that individual self efficacy is in part based on four sources of information: 1) one's own previous experience; 2) watching others perform a behavior; 3) verbal persuasion; and 4) emotional arousal (1997b). o Has also noted that when behavior change re involves a 'regular performance of familiar behaviors," that selfregulatory efficacy supersedes performance self-efficacy (see Anderson et al., 2007). o There has even been a recent effort (Riley et al., 2016) to try and capture the dynamic nature of the SCT reciprocal determinism model by using fluid analogies and systems approaches from engineering
outcome expectancies
o Closely related to Outcome Expectations, but focusing on the VALUE a person places on certain outcomes. § Is it a good thing?
4 models of infection
o Core infection model o Inverse core model o Bridge between disjoint populations o Spanning tree
uses of sct
o Currently one of the most widely cited theoretical rationales for interventions. § Social networks is an example of who uses it o Communications, social support and social network interventions often draw on the construct of vicarious learning or "social modeling." o Many interventions utilize the constructs related to skill-building (behavioral capability) and self-efficacy - e.g., physical activity/diet change interventions, condom use/sexual risk reduction (HIV/AIDS) interventions, refusal skill interventions directed at adolescents concerning substance use, smoking. o More focused interventions regarding, for example, smoking cessation or weight loss utilize social support/reinforcement together with self-control and management constructs
Constructs of Transtheoretical Model
o Decisional Balance § Pros-benefits § Cons-costs o Self-Efficacy § Confidence one can engage in healthy behaviors § Temptation that one will be tempted to engage in unhealthy behaviors and resist o can apply to other things aside addictionà ex: taking prepà ex: can connect it to weight watch/loss, eating disorders, intimate partner violence o Does not take into account anything external! o Not sleeping stone modelà can start anywhere on wheelà people only tend to move up to 1 or 2 next stages
behavioral capability
o Distinguishes between LEARNING and PERFORMANCE. A person must know what the behavior is (knowledge) and how to perform it (skill). A lot of SCT interventions include skill-building. Being able to carry out behavior in environment
behavior change mechanisms
o Every different theory implies a particular behavior change mechanism - that is, a process (or related processes) by which behavior change takes place. At different ecological levels, these mechanisms are different. § Different types of processes, individual etc o Useful to consider this before we talk about the specifics of Social Cognitive Theory. o As an example, for the Health Belief Model (HBM), what is the mechanism of behavior change (how does behavior change happen)? Where does HBM fit in the ecological levels? § Individual § What does individual do in their head? · Perceived benefits, pros and cons o What about the Theory of Planned Behavior? § Has to have an attitude towards the behavior itself § Perceived social norms (internal) § Perception of behavioral control § Most resides primarily in the individual
implementation
o Extent to which a program is delivered as intended o Efficacy x Implementation = Effectiveness o Individual level: measure of participant follow-through or "adherence" to regimens are necessary for interpreting study outcomes o Setting level: The extent to which staff members deliver the intervention as intended is important o Implementation research is crucial in determining which set of interventions may be practical enough to be effective in representative settings
reach
o Individual-level measure (patient or employee) of participation o Refers to percentage and risk characteristics if persons who receive or are affect by a policy or program o Measured by comparing records or program participants and complete sample information for a defined population (e.g., clinic, health maintenance organization, or worksite) § Participation rates = Numerator (participants) / denominator (population) o Concerns characteristics of participants Representativeness
Precaution Adoption Process Model
o Janis and Mann (1977); Refined by Weinstein and Sandman in 1992 o attempts to explain how people decide to take action; specifically looking at the mental state and how people respond/cope to discreet stressors (NOT habitual patterns of behavior like TTM) o How people translate that decision to action Stage 1 looks like stages of change
observational learning
o Key early construct. Learning by observing the positive or negative reinforcements that happen to someone else. § Social media often still uses this, like in ads
what makes an event more stressful
o Negative events § Are more likely to produce stress than positive events o Uncontrollable or unpredictable § Events are more stressful than controllable ones or predictable ones o Ambiguous § Events are often perceived as more stressful than clear cut events o Overloaded § People are more stressed than people with fewer tasks to perform
critique of transtheoretical model
o No single theory can account for all complexities of behavior change o Behavior change is a process that unfolds over time o Stages are both stable and open to change similar to chronic risk behavioral factors o Majority of risk populations are not prepared for action and will not be served well by traditional programs o Specific processes and principles of change should be emphasized at specific stages to maximize efficacy o Not good very problem
social cognitive theory
o Originator was psychologist Albert Bandura - who began as a behaviorist. [What is that?] § Came from classical conditioning psychologists § Positive reinforcement through seeing other people do thingsàsetting exà big move outward o His first "move" came from behaviorist principle of reinforcement to include observation of consequences (instead of experiencing them firsthand). This idea had surfaced in 1941 in the work of two other psychologists. § Big move outwards from individual theories o The theory was first called Social Learning Theory (SLT) - key principle was learning by observation of others (vicarious learning) o Over time, SLT grew to include other constructs related to an individual's interaction with an environment. One of the most important of these is self efficacy. It was then renamed as Social Cognitive Theory (SCT) - in 1986. § "a lot" o Self-efficacy: The idea of self-efficacy as a key element in how people change behavior moves beyond the mechanistic conditioning process of change. § Main concept of sct o The idea of reciprocal determinism was introduced to reflect theoretical position that behavior is the outcome of a continuous interactive cycle that includes individuals and their social environment. § Other constructs came in that were connected to this
Adelante intervention—pyd constructs
o PYD has been operationalized as "Five Cs" of positive youth development (* constructs used for the intervention): § Competence* § Confidence* § Connection* § Character § Caring o Together, these constitute "thriving", and a 6th C, contribution*, or contributions to self, to family, to community, and to the institutions of civil society o Focused on building the environment around the youth so the positive development characteristics had somewhere to go
what is social network theory?
o People are interconnected and so their health is interconnected o Social networks affect health through a variety of mechanisms: § Provision of social support § Social influence § Social engagement § Person to person contacts § Access to resources o Views of social relationships o Views social relationships in terms of nodes and ties § Nodes=individuals in the network § Ties=the relationships between the actors in the network There can be many types of ties between the nodes
in what way does stress affect us
o Physical health § Lack of appetite § Back aches § Loss of hair o Socially o Mental health § Can make you angry or sad o Personally o Professionally § Have to take a day off of work because of stress o Community wide
what is interesting about social network theory
o Puts the emphasis on the strength of the network's relationship and ties rather than on individual characteristics of actors with the network § Useful for explaining real world phenomena § Relies less on individual agency § Relies more on the structure of networks
critique of reaim
o R- Not including a relevant, high risk sample o E- Not thoroughly understanding outcomes or how they come about o A- Program only conducts studies in high functioning optimal settings o I-Protocols not delivered as intended (Type III error) o M- Program or effects not maintained over time (i.e. attrition) o A Type III error is when a statistical test is used to answer the wrong question, or the error committed by giving the right answer to the wrong problem.* Miscommunication between a statistical consultant and a researcher often occurs due to a lack of competencies and understanding of each other's science and empirical frame of reference. Lack of a hypothesis or testing multiple hypothesis concurrently
ongoing evolution of sct
o SCT continues to evolve. More recently, Bandura has shifted emphasis more to self-efficacy and the relationship of other constructs to self-efficacy (See Bandura 2004; 1997). o Many different "types" of self-efficacy - self-regulatory self-efficacy, performance (of a behavior) self-efficacy, general self-efficacy, etc. These may vary depending upon the behavior and other variables. And, self-efficacy affects other constructs: High SE can impact outcome expectations, and self-management, for example. o Social support, modeling, self-management (increasing sense of control) can increase self-efficacy.
self efficacy
o SCT has come to be identified with this construct - which has also become part of other theories. It refers to the CONFIDENCE a person feels about performing a behavior, and about overcoming the obstacles to performing it. Bandura has viewed this as the most important predictive construct in SCT. § Most important predictive construct in sct In a specific situation
critique of sct
o SCT is very complex; it can be viewed as less of a theory than a related "grab-bag" of constructs. o SCT has gone through a number of evolutions; as it evolved, it retained earlier constructs, increasing the general complexity of SCT and reducing its clarity as a theory. o The "person-environment" dynamic is powerful, but analytically difficult.
Stages of Precaution Adoption Process Model
o Seven stages of an individual's journey from awareness to action. It begins with lack of awareness to action, advances through subsequent stages of becoming aware, deciding whether to act, acting or NOT, and maintaining the behavior. o PAPM looks at how people decide to protect themselves from harm
commonly analyzed social network characteristics
o Size o Density o Connectivity o Boundedness o Homogeneity o Geodesic distance o Centralization Cohesion
how important is social support?
o Social support provides § Sense of belonging § Decrease sense of loneliness resources[MH1] [MH1]Lonliness is associated with almost every health problem
Examples of Factors Most Likely to determine progress between changes
o Stage ½ media messages about hazard or precaution o Stage 2/3 media messages about hazards, communication from others, personal experience with hazard o Stage 3/4/5 Beliefs about hazard severity; beliefs about personal susceptibility; beliefs about precaution effectiveness/difficulty; perceived social norms; fear and worry o Stage 5/6 Time, effort, resources needed to act; detailed how to info; reminders and other cues to action, assistance in carrying out action
Stress... how individuals, environments and health behavior interact
o Stress and health behavior o Social networks and social support o Stress and social support... the ultimate social determinant of health and well being
self control of performance
o The idea of monitoring one's behavior within a social environment. Includes the idea of self-assessment against a goal, self-rewards. § The ability to monitor how well you are doing
reciprocal determinism
o This sums up a lot about SCT - the idea that there is an "interactive loop" between individuals and an environment. § Behavior is an outcome of a interactive loop Interactive cycle
stress and brain development
o Toxic stress can impair the connection of the brain circuits. This can cause an individual to develop a low threshold for stress, thereby becoming overly reactive to adverse experience throughout life o High levels of stress hormones, including cortisol, can suppress the immune response leading to vulnerability to infections and chronic health problems o Sustained high levels of cortisol can damage the hippocampus, an area of the brain responsible for learning and memory. These cognitive deficits can continue into adulthood.
efficacy
o Two Issues § Importance of assessing both positive and negative consequences of programs · Critical not only to determine benefits but also to be certain that harm does not outweigh benefits § The need to include behavioral, quality of life, and participant satisfaction outcomes as well as physiological endpoints · Behavioral outcomes should be assessed for participants, staff, and payers and purchasers who support intervention
what can you do relieve stress
o Understand how you experience stress o Identify your sources of stress o Learn your own stress signals o Recognize how you deal with stress o Find healthy ways to manage stress o Take care of yourself o Reach out for support and give support o Take a break from news and social media o Find three good things that happened to you today o Practice self-care in 15 or 30 mins increments throughout the day o Stay connected with friends and family o Keep things in perspective
critique of papm
o Variables are usually subjective and may be the ones researchers think are important o Mixture of individuals can be problematic for analyses--- i.e. Comparison of those who decide to act/those who decide not to act o Assumes behaviors are dichotomous o Interpretations - this model is NOT about assessing individual perception of vulnerability / risk perception o The focus is the Mental State of person in regard to the health action in question
implications of stress in ph
o We need to incorporate an integrated/ multidisciplinary approach to health, wellbeing and program development o Develop resources and capacities for effective use of social support o Develop appropriate policies (especially to change structural forms of stress) o Consideration of positive outcomes/changes...
sct as a theory
o What is a theory (in the Western tradition)? Explanatory model postulating relationships among variables - should be able to formulate a hypothesis from the model that is "falsifiable". o How do you formulate a hypothesis for SCT related to health behavior change? § Can be difficult with all the different constructs o How do you include each of the constructs in a hypothetical formulation? Or can you? o Many constructs overlap. How, for example, do you distinguish between behavioral capability, outcome expectations, and self efficacy? How do you determine hierarchy - which constructs are necessary for others to operate? What is the implied mechanism of change
Stress, social support and health projects: lessoned learned
o Women living with hiv o Gender based violence o Breast cancer patients and survivors o Work stress o Chronic pelvic pain o Parenting and child development o Negative birth outcomes o Structural stress o Covid response
transtheoretical model
o describes an individuals' motivation and readiness to change a behavior (Prochaska and DiClemente) i.e. Smokers o The premise is that behavior change is a process, not an event o Change is a process not an event and does not take into account how one interacts with their environment o Usually within a 6 month timeframe (per stage) o posits that individuals move through six stages of change: precontemplation, contemplation, preparation, action, maintenance, and termination. Termination was not part of the original model and is less often used in application of stages of change for health-related behaviors.à you can start anywhere and go back to anywhereà people always relapse (happens more often than not)à should teach that relapse happens more often than not http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html o maintenance stage: most difficult stage § Enviornment is very important § Family is very important (both positive and negative influence o factors within ones environment that can impact whether they vape § Friends and familyà vanity and looking cool § Where advertisements areà primarily in food desserts
social support and social networks
o social integration § existence of social ties o social network § web of social relationships that surround individuals o social support important function of social networks
reaim framework
o was first developed to help make research findings more generalizable by encouraging scientists and evaluators to balance internal and external validity when developing and testing interventions (1). o The goal was to produce programs and policies with a higher likelihood for uptake and sustainability in typical community or clinical settings. o Created in the late 1990's, planning and evaluation framework has been applied broadly, but users often have difficulty in applying the model because of data collection needs across multiple domains and sources.
managing emotional arousal
said to inhibit learning, so its management is part of learning. (Think of emotional management, for example, as part of a conflict resolution intervention)
stress
§ A process by which internal or external influences are perceived to disrupt an individuals state of well being · Why is this the definition used? o Because emphasizes a process o Stress is not uniform Can disrupt an individual state of being
To organize these constructs, we can say that changing a behavior is a function of the following kinds of factors
§ Individual (internal) characteristics — A person's sense of self-efficacy about a new behavior, behavioral capabilities, managing emotions, outcome expectancies, etc. · Outcome expectations § Environmental (external) factors — The social/physical environment surrounding individuals, including the modeling behavior of others, reinforcement, and other factors. · Negative or positive § The interactive process of reciprocal determinism, where an individual interacts with an environment, receives a response from the environment, adjusts behavior, interacts again, etc.
coping
§ The process of managing demands internal or external, that are appraised as taxing or exceeding the resources of the person
CHAPTER 10 SOCIAL SUPPORT AND HEALTH
· Definition and conceptualizations of social support o Terms such as social support, social networks, and social integration are often used interchangeably but are distinct concepts. o Generally, these two approaches distinguish the aspects of social networks and the support that they provide. Structural aspects of relationships refer to the extent to which individuals are situated within or integrated into social networks. Social network describes connections between individuals and their relationships or network ties (see Chapter Eleven). Measures of social networks typically assess the density, size, or number of social contacts. Social integration describes the extent of an individual's participation in a broad range of social relationships, including active engagement in a variety of social activities or relationships and a sense of communality and identification with one's social roles. In contrast, functional measures focus on the specific functions served by relationships, and they are measured by actual or perceived availability of support, aid, or resources from these relationships. Thus three major components of social relationships are evaluated consistently: (1) degree of integration in social networks, (2) social interactions that are intended to be supportive (e.g., received social support), and (3) beliefs and perceptions about support availability held by individuals · Theoretical models o Social support as a buffer for stress § Finally, adequate social support may decrease exposure to secondary stressors § A major variant of the stress-buffering model is what has been called the matching hypothesis
SOCIAL COGNITIVE THEORY AS A THEORETICAL FRAMEWORK TO PREDICT SEXUAL RISK BEHAVIORS AMONG OLDER ADULTS
· Having a model to help explain what drives sexual risk behavior may allow for the development of intervention, educational campaigns, and improve treatment outcome · SCT is grounded in the principle that human behavior is the product of reciprocal determinismàthe interaction between the variables of cognitive self, behavior and environmentàand that these variables and interconnected and interdependent · SCT behaviors determined by: (a) Self efficacy (b) Socio-cultural environmental factors (c) Goals (d) Outcome expectancies · Self efficacy and sexual riskàbehavioral factors o Influences behavior through cognitive, environmental and behavioral mechanisms o Emerge through 4 sources (a) Previous experience where mastery occurs (b) Vicarious experiences where the actor experienced failure or success (c) Social persuasion (d) Emotional arousal · Goal motivationàcognitive factor o Increase likelihood that outcome behaviors will be shaped · Age and genderàenvironmental factors · Findings from study o Did not support a direct relation between self-efficacy and sexual risk behaviors o Sexual health discussions related to age
CHAPTER 12 STRESS, COPING, AND HEALTH BEHAVIOR
· Historical concepts of health, stress, coping and resilience o Cannon (1932) first described the fight-or-flight reaction to stress. o He hypothesized that all living organisms exhibited nonspecific changes in response to stressors, labeling these changes the three-stage general adaptation syndrome (GAS). o The resilience perspective, translated from developmental science, posits that most individuals possess traits or resources that promote recovery after stressor exposure Transactional model of stress and coping: overview and key constructs o Primary appraisal § Primary appraisal is a person's judgment about the significance of an event as stressful, positive, controllable, challenging, benign, and/or irrelevant o Secondary appraisal § Secondary appraisal is an assessment of coping resources and options in a situation o Coping efforts § According to the Transactional Model, the emotional and functional effects of primary and secondary appraisals are mediated by actual coping strategies (Lazarus & Folkman, 1984). Original formulations of the model conceptualized coping efforts along two dimensions: problem management and emotional regulation.
CHAPTER 11 SOCIAL NETWORKS AND HEALTH BEHAVIOR
· History of social network analysis and social network theory o By the 1950s, various research groups had begun to create the field called social network analysis, or sociometry · Social network theory o Social network theory has three main components: (1) people or actors (organizations, states, collectives, etc.) take actions based on their network environment, (2) a person's position in a network influences his or her behaviors, and (3) networks have structure and these network (or system-level) properties influence system performance. o This homophily derives from at least two network processes: influence and selection. Influence occurs when an individual changes his or her behavior to be the same as his or her network partners. For example, in Figure 11.1, the dark nodes are smokers and the light ones nonsmokers (smoking data are hypothetical here) o Selection occurs when an individual changes his or her network to make it compatible with his or her behavior. o Position in network § Bridging individuals, people who connect otherwise disconnected groups, can also be associated with behavior for several reasons (Valente & Fujimoto, 2010): (1) bridging provides access to different subgroups in the network, (2) bridging individuals may be less beholden to the status quo, and (3) bridging individuals are less constrained by their immediate personal network § Peripheral individuals are free from the social norms in the community or network and so may be less constrained in their behavior and freer to innovate
chapter 9
· Key points o He proposed instead that behavior is more strongly mediated by cognitive processes that occur through observation of social modeling. The process can occur via the observation of a social role model. o In Bandura's fully developed SCT model, human behavior is explained in terms of a triadic and dynamic model of causation in which behavior, personal cognitive factors, and socioenvironmental influences all interact, called reciprocal determinism. · Major constructs for social cognitive theory o Cognitive influences on behavior comprise three main factors: self-efficacy, outcome expectations, and knowledge. o Personal cognitive factors include the individual's ability to self determine or self-regulate behavior and to reflect upon and analyze experience. This is reflected in three major constructs: confidence to engage in a behavior (self-efficacy), ability to foresee the outcomes of given behavior patterns (outcome expectations), and level of understanding about enacting a behavior (knowledge) (Bandura, 2004). Socioenvironmental factors are aspects of the perceived and/or physical environment that promote, permit, or discourage engagement in a particular behavior. These factors include influential role models (observational learning), cultural beliefs about the social acceptability and perceived prevalence of a behavior (normative beliefs), perceptions of encouragement (social support) and facilitation of or impediments to engagement in the health behavior (opportunities and barriers). Behavioral factors affect health directly. Health behaviors are actions taken by individuals that are health-enhancing (leading to improved health) or health-compromising (leading to poorer health). Behavioral factors include a person's existing repertoire of health behavior capabilities, or coping skills (behavioral skills); their goals to add or modify a behavior (intentions); and the rewards or punishments they receive for engaging in a health behavior (reinforcement) o TABLE 9.1 IN TEXTBOOK o Personal cognitive influences on behavior § Self-efficacy · Self-efficacy regulates a number of cognitive processes that enhance or impede the development or maintenance of a behavior. · Because it is an internal mental process, it is often called perceived self-efficacy and is defined by a person's level of confidence in his capability to control his behavior. · Not surprisingly, behavioral interventions based on SCT include components designed to increase a person's perceived level of situational self-efficacy, the confidence to succeed with a specific task. · Bandura describes a person's formation of self-efficacy through four primary sources: (1) previous mastery experiences, (2) vicarious experience, (3) social persuasion, and (4) emotional arousal (Bandura, 1997). Self-efficacy is strongly influenced by previous experience with a particular behavioral task, which in turn is related to a person's likelihood to engage in the behavior again · As an intervention strategy, active learning strategies that coach a person through incremental steps toward a mastery experience should raise self-efficacy and increase the frequency of a healthful behavior · An important construct that distinguishes SCT from stimulus-response theory is observational learning. In addition to forming self-efficacy from personal experience, self-efficacy is also formed through vicarious experience by watching the success or failure of other people performing a task · The third method of forming self-efficacy beliefs includes social persuasion, support, and reinforcement. Social persuasion generally manifests as direct encouragement or discouragement from a socially desirable individual. · Fourth and finally, a person's self-efficacy is influenced by emotional arousal. Strong emotional arousal in response to a task acts as a cue to the person about anticipated failure or success. Negative emotions and anger may generate a state of cognitive confusion and lower self-efficacy, leading to poorer task performance, whereas a positive emotional state creates an optimistic viewpoint and higher performance. § Cost efficacy · The second form of cognitive influence on behavior is collective efficacy. There are many circumstances in which individuals do not have control over the social conditions or institutions that affect their lives, and thus cannot achieve their goals by acting on their own § Outcome expectations · Self-efficacy and collective efficacy refer to the confidence, capability, and personal control or agency to engage in and complete a task. Outcome expectations refer to a person's expectation about the consequences, either physical or social, of taking action. A physical outcome expectation is an understanding of the relationship between a behavior and a health or physical outcome, either positive or negative (e.g., pleasure, pain, or change in disease symptoms) · Social outcome expectations are the social responses to behavior change (such as approval, disapproval, power, or applause). § Self evaluation outcome expectations · Bandura describes self-evaluative outcome expectations as the anticipated feelings that arise from a comparison between a person's behavior and his or her internal standards § Knowledge · Bandura (2004) describes knowledge of the health risks and benefits of different health practices as a precondition for change. · The combination of skills and knowledge is often referred to as behavioral capability (knowledge of what to do and how to do it). o Environmental influences on behavior § Socioenvironmental factors are aspects of the perceived or physical environment that promote, permit, or discourage engagement in a particular behavior. These factors are observational learning, normative beliefs, social support, and barriers and opportunities. § Observational learning · The underpinning of SCT rests on a person's ability to learn by observing someone else's behavior and the consequences of that behavior (see the self-efficacy section above). In theory, if you observe a person receiving positive reinforcement for a behavior, then you are more likely to imitate the behavior in anticipation that you too will receive the reinforcement · Bandura (1986, 2006b, 2008) suggests that four processes influence observational learning: (1) attention, (2) retention, (3) production, and (4) motivation. When viewing a behavior, a person's level of attention depends on the internal functional value of the observed behavior. People are less likely to attend to consequences they do not value. Cognitive retention can depend on a person's intellectual capacity (such as ability to read or readiness to learn), stage of physical growth and maturity, state of inebriation, or psychological impairment. · Production is the level of knowledge, skills, and self-efficacy already possessed (or the level of willingness to learn them) for performing the modeled behavior. The richer the knowledge and repertoire of needed subskills, the easier it is to integrate them into new forms of behavior. Motivation is determined by the expected costs and benefits of the observed behavior. § Normative beliefs · In Social Cognitive Theory, norms influence behavior through two types of outcome expectations: social consequences and self-evaluative consequences · The rationale for changing normative beliefs is based on two consistent findings: (1) most individuals overestimate the prevalence of many undesirable behaviors, such as tobacco use among peers, and (2) individuals use their perceptions of peer norms as a standard against which to compare their own behaviors. § Social support · Social support is generally classified into four categories: (1) emotional support (expressing positive affect, caring, love, and companionship), (2) esteem support (validating beliefs, emotions, and actions), (3) informational support (providing information or advice,), and (4) instrumental support (providing materials or equipment necessary for the behavior). Social support not only aids adherence to a new behavior but also contributes to perceived self-efficacy. Self-efficacy is strengthened through observation, modeling, and activation of social support systems, social networks, and self-help activities § Barriers and opportunities · Personal change would be much easier if there were no barriers on the path to success. SCT distinguishes between two classes of barriers: cognitive and environmental (see the discussion in Chapter Five of the Health Belief Model). o Supporting behavioral factors § The term Social Cognitive Theory conveys the importance of cognitive factors in the adoption and maintenance of health behaviors. § Behavioral skills · The concept of behavioral capability maintains that if a person is to perform a particular behavior he must know the behavior's significance and components (knowledge) and know how to perform the behavior (skills). · Bandura (1997) describes five ways in which behavioral skill acquisition and self-regulation are achieved: (1) self-monitoring, or a person's systematic observation of her own behavior; (2) goal setting, or the identification of incremental and long-term changes; (3) feedback about the quality of performance and how to improve; (4) self-reward, or the provision of tangible and intangible rewards; and (5) selfinstruction, or self-critique, before and during performance of a complex behavior. § Reinforcement and punishment · A reinforcer is the stimulus that strengthens the behavior, in contrast to a punishment, which is the stimulus that weakens the behavior. According to stimulus-response theory, both reinforcement and punishment can be either positive or negative. Positive reinforcement occurs when a stimulus or reward is given to a person after she performs a specific behavior, so that the behavior increases (giving students a dance party after they have eaten a specific number of servings of fruits and vegetables for a week). Negative reinforcement occurs when an aversive (unpleasant) stimulus is removed as a result of performing a specific behavior, so that the behavior increases (e.g., the buzzing of a car indicator stops when the passenger fastens the seatbelt). Positive punishment is the addition of an aversive (unpleasant) stimulus to decrease a specific behavior (giving students time out from the class when they misbehave). Negative punishment is the removal of a pleasant stimulus to decrease a behavior or response (not letting students attend a football game if they are tardy too many times) · A key distinction between stimulus-response theory and SCT lies in outcome expectations. In stimulusresponse theory, primary reinforcers (e.g., sleeping, breathing, or sustenance) are not conditioned and do not require repeated pairings of behavior (response) and behavioral outcome (stimulus). Secondary reinforcers are conditioned; that is, they acquire power as reinforcers only after repeated pairings, usually with an unconditioned stimulus · According to SCT, an individual develops his outcome expectations for a specific behavior not just through repeated pairings with reinforcements but also through cognitive and environmental influences on behavior. · Case studies o Case study 1: coordinated approach to child health § CATCH illustrates reciprocal determinism in that it targets cognitive, environmental, and behavioral factors that influence children's health behaviors related to obesity prevention · Future directions in sct Health promotion and prevention programs often produce short-lived or weak results because they rely too heavily on didactic, knowledge-based strategies and place too little emphasis on the development of behavioral capability
chapter 7
· Key points o The Transtheoretical Model (TTM) uses stages of change to integrate processes and principles of change across major theories of intervention, hence the term transtheoretical · Core constructs o TABLE 7.1 IN TEXTBOOK o Stages of change § Precontemplation is the stage in which people do not intend to take action in the near term, usually measured as the next six months. § People may be in this stage because they are not informed enough about the consequences of their behavior. Or they may have tried to change a number of times and become demoralized about their abilities to change. § People in contemplation intend to change their behaviors in the next six months. They are more aware of the pros of changing than precontemplators and are also acutely aware of the cons. § In the preparation stage, people intend to take action soon, usually measured as the next month. Typically, they have taken some steps in the past year. § People in the action stage have made specific overt modifications in their lifestyles within the past six months. § People in maintenance have made specific, overt modifications in their lifestyles. They are working to prevent relapse, and they do not apply change processes as frequently as people in action § People in termination report having zero temptation and 100 percent self-efficacy. Whether they are depressed, anxious, bored, lonely, angry, or stressed, they are sure they will not return to their old, unhealthy behaviors o Process and principles of change § Decisional balance reflects an individual's weighing of the pros and cons of changing. § Self-efficacy is the situation-specific confidence that one can cope with high-risk situations (temptations) without relapsing to one's former behaviors. § Temptation reflects the converse of self-efficacy, the intensity of urges to engage in a specific unhealthy behavior when in difficult situations. § Critical assumptions · Theories of health behavior change differ from theories of health behavior. · No single theory can account for all complexities of behavior change. A more comprehensive model is most likely to emerge from integration across major theories, hence the name Transtheoretical. · Behavior change is a process that unfolds over time through a sequence of stages. · Stages are stable and open to change, just as health behavior risks are stable and open to change. · Most at-risk populations are not prepared for action and will not be served effectively by traditional action-oriented behavior change programs. · Specific processes and principles of change should be emphasized at specific stages. o Other stage models § Precaution Adoption Process Model (PAPM) was developed to describe and explain the process by which people adopt precautions against a new risk § PAPM specifies seven stages: Stage 1: unaware; Stage 2: aware, but no thought of adopting precautions; Stage 3: thinking but undecided; Stage 4: decided against adopting the precaution; Stage 5: decided to adopt but have not yet acted; Stage 6: acted on their decision to adopt; and Stage 7: for some behaviors, maintenance may be needed. § The Health Action Process Approach (HAPA) was developed by Ralf Schwarzer (2008), one of Europe's leading health psychologists. Five major principles make it distinct. Principle 1 is that the behavior change process is divided into two phases: motivation, where people develop their intentions to change, and volition, which displays two subphases—individuals who have not yet translated intentions into actions, and those who have. Principle 2 is that individuals can be categorized into three stages: pretenders, intenders, and actors. Principles 3 and 4 state that planning is a key strategy for translating intentions into action. Action planning pertains to the when, where, and how of intended action. Coping planning includes the anticipation of barriers and the design of alternative actions to reach one's goals in spite of barriers. Principle 5 is that the nature of self-efficacy differs from phase to phase: pre-action or task selfefficacy affects one's motivation, coping self-efficacy deals with barriers, and recovery self-efficacy allows rebounding from relapse. · Limitations o TTM does not apply very well to children and adolescents
A TALE OF MANY SOURCES
· Nestled within these theoretical deliberations is the question of whether the perceived utility of and, consequently, individuals' preference for certain types of support might depend upon their source · Even fewer have examined perceptions of support provided by persons who are both experientially similar and personally significant, presumably because such individuals are rare · Within stress research, social support is conceptualized as the functional properties of social relationships which individuals can mobilize in stressful circumstances to "buffer" against stressors or their consequences (Cohen 2004; House and Kahn 1985; Thoits 1995). · Stress scholars generally classify social support according to whether it fulfills an instrumental, informational, or emotional purpose (e.g., House and Kahn 1985; Thoits 1995, 2011). o Support that involves the provision of tangible resources (e.g., material, financial, or logistical) intended to mitigate stressful situations is classified as instrumental support (House and Kahn 1985; Thoits 1995, 2011). · Advice or information that can help an individual reduce, reevaluate, or overcome a stressor is categorized as informational support (House and Kahn 1985; Thoits 1995, 2011). · Finally, support that is directed at elevating an individual's emotional state is defined as emotional support (House and Kahn 1985; Thoits 1995, 2011). o This literature also distinguishes between perceived and received support (Thoits 2011), but generally finds that individuals' belief that support is available carries greater benefit than the support received (Cohen and Wills 1985; Taylor 2007). · Among supporters perceived to be both experientially similar and personally significant, three categories of supporters emerged based on the relative salience of their significant and similar other role identities: (1) similar, significant others, (2) significant, similar others, and (3) similar significant others.
SOCIAL NETWORK THEORY
· for this epidemic to have reached its current scale, two conditions must have been met: (1) rise in opioid supply to facilitate ease of use and (2) conditions leading to a demand for opioid use arising from opportunity in social networks and environment · Sociology attributes the clustering of behaviors in a social contagion model to three mechanisms: homophily, confounding, and induction (6). o Homophily is the tendency for people to choose relationships with those who bear similar attributes (6). o Confounding results from a shared exposure or experience (6). o And, induction is the spread of a behavior from one person to another (6). · The social contagion model suggests that the architecture of a social network may influence the behavior of individuals and implies that studying the individual alone may be inadequate when analyzing certain behaviors · The influence of social contagion is broad and has also been demonstrated for teenage pregnancy (11), happiness (12), depression (13), loneliness (14), sleep deprivation (15), emotions (16), eating patterns (17), and suicide (18). · Political mobilization (19), voting behavior (19), gang violence (20), homicide victimization (21), and firearm injury (22) have also been found to spread to some degree through social networks.
maintenance
• Long-term maintenance of behavior change • Extent to which innovations become a relatively stable, enduring part of the behavioral repertoire of an individual (or organization or community) • Extent to which a health promotion practice or policy becomes routine and part of the everyday culture and norms of an organization
adoption
• Proportion and representatives of settings or programs • There are common temporal patterns in the type and percentage of settings that will adopt an innovative change • Typically, assessed by direct observation or structured interviews or surveys