Using Social Cognition Models to Develop Health Behaviours Interventions
11 important questions on Using Social Cognition Models to Develop Health Behaviours Interventions
Social cognition models
- social cognitive theory (Bandura)
- the theory of reasoned action (Ajzen & Fishbein)
- the theory of planned behaviour (Ajzen) → most well-know model
- the health belief model (Strecher & Rosenstock)
- protection motivation theory (Rogers)
- the 'continuum' version of the health action process approach; HAPA-C (Schwarzer)
- information-motivation-behavioral skills model
Theories inform us which variables should be targeted in interventions.
Advantages Theory of Planned Behaviour (TPB)
1) general theory (not health or behaviour specific)
2) constructs (and causal relationships) clearly defined
3) clear recommendations for measurement
4) widely used to study health behaviours
5) explains substantial amount of variance in intentions and behaviour
Theory of Planned Behaviour (TPB) - part 1
Behaviour is determinded by:
- strength of intention to perform behaviour
- amount of actual control over performing behaviour
intention: precursor (voorloper) of actual behaviour
actual behavioral control: skills, resourves, and other conditions needed to perform behaviour
perceived behavioral control (≈ self-efficacy): proxy for actual behavioral control (is assumed to reflect actual behavioural control more or less accurately.
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Theory of planned behaviour (TPB) – part 2
Attitude (overall evaluation of performing the behaviour) towards behaviour, determined by:
- behavioural beliefs about outcome of behaviour
Subjective norm, “would important others want me to perform the behaviour?”, determined by:
- normative beliefs about views of important others (‘referents’)
Perceived behavioural control, determined by:
- control beliefs about presence of facilitators of or barriers to behaviour
Direct pathway: perceived behavioural control --> behaviour?
- Actual control as common cause?
It is not clear from descriptions of the theory whether perceived behavioural control is assumed to have a direct causal effect on behaviour or whether the arrow represents an association between perceived behavioural control and behaviour that is induced by actual control as the common cause.
Regardless of interpretation:
Increasing actual behavioural control (by increasing skills or opportunities to perform the behaviour) safest bet to change behaviour.
TPB in observational studies
TPB explains between 35-50% of variance in intention
TPB explains between 26-35% of variance in behaviour
*verklaarde variantie: hoe goed kun je een uitkomst (intentie of gedrag) verklaren m.b.v. een model (of variabelen)
Using TPB to develop interventions
Applications have focused on:
- changing attitude (through behavioural beliefs)
- subjective norm (through normative beliefs)
- perceived behavioural control (through control beliefs)
… by changing the salient beliefs that are assumed to determine these constructs.
Three strategies:
1. Changing existing salient beliefs
2. Making existing non-salient beliefs salient
3. Creating new salient beliefs
NB. Salient = betekenisvol
Steps in the development of a TPB-based intervention (3)
Usually constitutes main study.
Second sample from target population.
Measure all TPB variables using structured questionnaire.
Examine whether intentions predicted by:
- attitude
- subjective norm
- perceived behavioural control
Examine whether behaviour predicted by:
- Intentions
- perceived behavioural control
Steps in the development of a TPB-based intervention (4&5)
Identify differences in beliefs between:
- intenders and non-intenders of behaviour
- those who do and do not engage in behaviour
5. Develop and evaluate intervention
Develop intervention to change key beliefs
- change existing salient beliefs
- create new salient beliefs
Evaluate intervention in other sample.
Examples changing beliefs (TPB)
Increase belief strength: not texting while driving decreases crash risk.
Increase outcome evaluation: emphasizing health and financial benefits of avoiding a crash.
Example changing Normative beliefs:
Increase belief strength: partner would approve of not texting while driving.
Increase motivation to comply: emphasize importance of not upsetting partner
(Normative beliefs refer to the perceived behavioural expectations of such important referent individuals or groups as the person's spouse, family, friends etc.)
Example changing Control beliefs:
Increase belief strength: there are many parking facilities available for texting.
Increase perceived power: texting while standing still is more convenient.
Complexities of designing a study according to TPB
- take the 10 most frequently mentioned beliefs
- include all beliefs mentioned by at least 10%
- Select 75% of all beliefs
Individual differences in salience of beliefs.
Some salient beliefs are more important than others in influencing intention.
TPB does not specify how to change beliefs (only that it requires exposure to ‘information’).
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