• Social Cognitive

Theory (SCT)

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 Theory of Planned Behavior (TPB)*:
Behavioral
Beliefs

Evaluations of
Behavioral Attitude Toward
Outcomes Behavior
Behavioral Behavior
Intention
Normative
Beliefs Subjective Norm
Perceived
Behavioral
Motivation Control
to Comply Coping skills/
resources

Perceived/ Actual
Barriers
*Slightly modified, and elaborated upon, by Vic Strecher
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 Social Cognitive Theory
 Efficacy expectations
 Outcome expectations

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 Social Cognitive Theory

Person Behavior Outcome

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 Social Cognitive Theory

Behavior Outcome

Outcome expectations:
The beliefs about a behavior leading to a certain outcome

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 Social Cognitive Theory
Efficacy expectations:
The beliefs about a person’s ability to perform a behavior

Person Behavior

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 Social Cognitive Theory
Efficacy expectations:
The beliefs about a person’s ability to perform a behavior

Person Behavior Outcome

Outcome expectations:
The beliefs about a behavior leading to a certain outcome

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 Social Cognitive Theory
Efficacy expectations:
High self-efficacy for eating less fat:
“Mr. Jones believes he is capable of changing his diet to include less fat.”

Mr. Jones Eat less fat Improved health

Outcome expectations:
Positive outcome expectation:
“Mr. Jones believes that eating less fat will lead to improved health.”

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 Social Cognitive Theory
 Efficacy expectations and outcome expectations are
beliefs, not necessarily truths

 Self-efficacy is not a global trait or personality

characteristic; it relates to specific behaviors in
specific settings

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 Self-efficacy: Why is it important?
In many studies, across a wide range of health-related
behaviors, persons with higher self-efficacy are more
likely to change behavior than those with lower self-
efficacy. This includes:

 initiation of new behaviors as well as maintenance

 putting forth greater effort

 greater persistence of effort

 performing behavior in a wider range of settings

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 Sources of efficacy information:
 Previous performance accomplishments

 Vicarious experience

 Verbal reinforcement

 Emotional arousal

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 Sources of efficacy information:

Which one source is the most important?

Previous performance accomplishments

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 Concepts related, but not the same
as, self-efficacy:
 Locus of Control
 Self-esteem
 Anxiety
 Depression
 Learned Helplessness
 Persistence
 Concentration (focus)

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 Measurement
 Efficacy Expectations
 “How confident are you that you can (change some
behavior)?”

 Example:
 “How confident are you that you can follow this low sodium
diet once you return home?”

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 Measurement
 Generality of self-efficacy:
 Efficacy beliefs for one type of activity will generalize to
other activities that are governed by similar skills, i.e. within
domains

 Distinct from “generalized self-efficacy”

 No empirical support that self-efficacy operates across all
situations and domains of functioning

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 Measurement
 Measure of self-efficacy must be specifically related to
the behavior in question
 Examples:
 self-efficacy for condom use
 self-efficacy for exercise
 self-efficacy to delay sex

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 Measurement
Please rate how confident you are that you can keep from smoking cigarettes in the following situations:
Not at all Extremely
confident confident
1 2 3 4 5
When I feel stressed O O O O O
After I have just finished a meal O O O O O
While drinking coffee with friends O O O O O
When I feel sad or lonely O O O O O
While talking on the telephone O O O O O
When I am around people who are smoking O O O O O
When I feel angry or frustrated O O O O O
When I am happy and feel like celebrating O O O O O
While driving O O O O O
When I feel nervous or anxious O O O O O
When I am bored O O O O O
When at a bar or a party O O O O O

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 Measurement
 Should include the behavior, the level of situational
demand

 Elicitation interviews or focus groups could be used to

identify those conditions that make performance of
desired behaviors difficult

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 Measurement
 Outcome Expectations
 “If you (change some behavior), how likely do you think it is
that (some specific outcome) will occur ?”

 Example:
 “If you eat less sodium in your food do you think it is likely
that your risk of serious health problems will be reduced?”

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 Research Findings
 Self-efficacy may be more important for those who
feel that their personal health actions control health
outcomes
 Efficacy perceptions can be manipulated: improved,
reduced

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 If efficacy expectations are low:

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 If efficacy expectations are low:
 Build self-efficacy by starting with simple, achievable tasks and provide positive
reinforcement for task accomplishment

 Focus on positive aspects of an incomplete performance

 Show your confidence in the person’s ability and provide sincere encouragement

 Identify similar others who have accomplished the task

 Teach specific skills to overcome problem areas

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 If outcome expectations are low:
 For health-related outcomes, focus on immediate and tangible
outcomes, not just long-term risk reduction

 Explain in “lay terms” the relationship between the desired

behavior and the outcome; where possible show models or
examples

 Focus on outcomes relevant to the person, not you; these may

include other, non-health related, outcomes

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 Efforts to enhance efficacy must:
 Demonstrate the person’s relative progress toward the target
behavior

 Attribute previous accomplishments to the person’s own abilities

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 Other methods for enhancing self-efficacy:
 Verbal reinforcements and encouragement to enhance efficacy

 Relaxation training to reduce anxiety during the behavior change

process

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 The Health Belief Model (HBM):

Individual Modifying Likelihood of Action

Perceptions Factors

Demographics, SES, Perceived benefits

Personality minus barriers

Susceptibility and Perceived threat

Severity of Disease of disease Likelihood of
behavior change

Cues to action

Social-Cognitive Theory (SCT):

Person Behavior Outcome

The Theory of Reasoned Action (TRA):

Efficacy Outcome
Behavioral
expectations expectations
Beliefs

Evaluations of
Behavioral Attitude Toward
Outcomes Behavior

Behavioral Behavior
Intention
Normative
Subjective
Beliefs
Norm Perceived
Behavioral
Motivation Control
Coping skills/
to Comply
resources

Perceived/ Actual
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 Overview of meta concepts shared by theories
Person Behavior Outcome

Efficacy Outcome

–Social Cognitive Theory

expectations expectations

–Health Belief Model

Perceived benefits

Demographics, Social
support, Personality Traits minus

Perceived barriers

–TRA/TPB Susceptibility and Severity of

Disease
Perceived threat
of disease
Likelihood of behavior change

Behavioral Cues to action

Beliefs

Evaluations of
Behavioral Attitude Toward
Outcomes Behavior

Behavioral Behavior
Intention
Normative
Beliefs Subjective Norm
Perceived
Behavioral
Control
Motivation
to Comply Coping skills/
resources
Perceived/ Actual
Barriers

Motivation Self-efficacy
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 Case Study 1
 Kate’s 51-year old mom found out she had a benign
breast lump 5 years ago and had biopsy for it. Although
now she knows having mammography yearly is really
important for her to find out early if she has breast
cancer, she insists that if there is something wrong,
she can find it from self-exam. she’s very confident
doing breast self exam every month.

 Plus, she says she doesn’t have a car now and Kate is
so far away from her. She really doesn’t feel it’s
necessary to bother someone else taking her to the
clinic when she feels good about her health.

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 Case Study 1-con’t
 Last month, Kate’s mom found out again she has another
breast lump.
 Knowing that the fear of finding cancer is the main concern
shared by every member in the family, include herself, Kate
said: “4 out of 5 breast lumps are benign. Also this may be a
good thing if you got it diagnosed in an early stage.”

 Now, Kate’s mom knows she has to see a doctor. This

reminds her that 5 years ago, she went through exactly
same things, having Clinical Breast Exam, ultra-sound, and
biopsy. She is ready to it.

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 Case Study 2
 Julia is a 3rd year doctoral student. She usually has to stay in
her lab all day until 9 pm. Although she knows eating more
fruits and vegetable will be very good for her health, she
just doesn’t have time to prepare healthy food.
 Actually, she enjoys much more the free pizza provided by
seminars at noon and KFC chicken. She thinks f & v are less
tasty.

 She was not considering to change her diet also because she
thinks she is still too young to worry about her health.

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 Case Study 2-con’t
 One day, Julia was invited by a friend to see a fortune
teller together. she got a crazy message: “You will die
from cancer when you’re 50.” This message really
scares her.

 After Julia’s best friend Sarah heard about the fortune

message, she told Julia an unhealthy diet is a much
stronger predictor of getting cancer than a fortune
teller’s prophecy. Sarah encouraged Julia to bring f
and v to school every day.

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 Case Study 2-con’t
 Sarah then told Julia:” It isn’t as hard as you think. It
takes me only 5 minutes to simply wash the fruits and
put them into a bag for next day. It not only prevents
cancer, but also helps my skin and weight. Actually,
You can still enjoy pizza and KFC in a smaller but
satisfying amount. I know you can do it!”

 Julia is now trying to include vegetable in her

breakfast, also bring fruits to school every day.

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