Behaviour Change - PowerPoint Presentation

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Behaviour Change

Past & current theories of how to get people from thinking to

doing

PART

1

Corinne Hodgson

Corinne S. Hodgson & Associates Inc.

2014Slide2

Part 1Traditional theories such as

Transtheoretical

Model, Model of Reasoned Action/Planned Behaviour, and Social Cognitive TheoryOpportunities from other areas of psychology: achievement theory, self theory, and self-determination theoryPart 2: Health Action Process Approach and Self-RegulationPart 3: New models from interactive health (Fogg, Eyal)

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OverviewSlide3

Webb TL et al. (

JMIR 2010 12(1):e 14) u

sed Michie & Prestwich coding scheme (Health Psychology 2010;29(1):1-8) to identify theory of behaviour changeTheories included:Transtheoretical model (12 studies)Social cognitive model (12 studies)Reasoned action/planned behaviour (9 studies)

Elaboration likelihood (2 studies) – communications theory of how attitudes are formed/people are persuaded1 study each:

Extended parallel process – 4 factors affect how people will respond to fear message: self-efficacy, response efficacy, perceived susceptibility, and severity of the threatSelf-regulation – how people monitor & manage their

behaviour

Precaution adoption process – 7 cognitive stages: unaware, unengaged, undecided, decided not to act or decided to act, acting, and maintenance Diffusion of innovationsHealth belief – belief in a personal threat + belief in effectiveness of proposed behaviour = likelihood of changing behaviourSocial norms – group-held beliefs about how people should behave

Online behaviour change tools: Systematic review of 85 RCTs

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Transtheoretical

Model

(Prochaska, 1977)Essence: change is a process and you can move closer to – or further away from – change depending uponSelf-efficacyDecisional balanceCSH Associates - From thinking to doing

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Three most commonly-used theoriesSlide5

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Transtheoretical

Model (Prochaska, 1977)

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Strengths & weakness of Transtheoretical

Model

StrengthsIf you know people’s stage, you can tailor messages so you meet them “where they are” & not alienate themLarge evidence baseCan work with any theory of behaviour change (hence “trans-theoretical)

Weaknesses

Good at telling you where people are but weak on process whereby they move between stages

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Theory

of Reasoned

Action (Fishbein & Ajzen 1975) / Theory of Planned Behaviour (Ajzen 1985)As name implies, infers people are making rational choices (“economic man”)

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Three most commonly-used theories of behaviour changeSlide8

Theory of Reasoned Action

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Behavioural

beliefs

Evaluation of behavioural outcomes

Normative beliefs

Motivation to comply

Attitude toward behaviour

Subjective norm

Behavioural intention

BehaviourSlide9

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Theory of Planned Behaviour

Behavioural

beliefs

Evaluation of behavioural outcomes

Normative beliefs

Motivation to comply

Attitude toward behaviour

Subjective norm

Behavioural intention

Behaviour

Control beliefs

Perceived power

Perceived behavioural controlSlide10

Strengths & Weaknesses of Theory of Reasoned Action/Planned Behaviour

Strengths

Well-established theories that have been used for years > lots of experimental and practical evidenceEasy to understandWeaknesses

Reality is that people often don’t make “rational” choices or “plan” their behaviour

Assumes that behaviour change naturally follows development of intention

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Social Cognitive Theory

What we think (cognition) influences our behaviour but is heavily influenced by what we learn from others (social)

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Three Most Commonly-used TheoriesSlide12

More holistic approach

Behaviour is the result of a combination of:

Social Cognitive Theory (Miller & Dollard 1941, Bandura 1980s)12

Personal Factors:

Beliefs

Self-efficacy

Self-controlExpectations

Social Factors:Environment

Observational learningSocial modellingReinforcement

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Social Cognitive Theory

Strengths

Well-established theoryAcknowledges the important role of environment and other peopleBecause it addresses environment, useful for issues such as smokingWeaknesses

Weak at understanding the process by which individuals decide to change – especially if they are “going against the flow”

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May be time to look at other theories and other areas of psychology to understand the complex process by which people move from just thinking about change to actually taking action

Few theories have yet to capitalize on learnings from:

Achievement Theory (Achievement Goal or Goal Orientation)Self Theory or MindsetSelf-Determination Theory

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Other theories

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Ego or performance orientation: focus is on doing well and demonstrating your competence to others

Problem: when tasks get difficult may feel anxious or helpless; afraid of failure so may quit or avoid harder tasks

Task or learning orientation: focus is on learning – enjoys the process & not worried about the outcome or outcome compared to othersAchievement Goal or Goal Orientation (Eisen, Nicholls, Elliott)

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Developed out of achievement literature

Two basic mindsets:

Fixed or Entity: belief that basic ability or talent are fixed traitsGrowth or Incremental: belief that people can develop their abilities through effort and persistenceElliot and Dweck 2005

Self Theory or Mindset (Dweck 2006)

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Mindset

Achievement Goal

BehaviourFixed/Entity (Dweck)Or

Performance/ Ego (focus on what you achieve)

ApproachAnxious to do well

to confirm you are “one of the smart ones”

AvoidanceFailure would show you aren’t smart so often avoid challenges (select easier tasks, quit when it gets hard)Growth/Incre-mental (Dweck

) Or Mastery/Task (focus on process of learning)

ApproachWill persist in even difficult tasks in order to “figure it out” and learn how to master the task

Avoidance

Goal is to avoid deterioration in performance or

skill

Mindset & Achievement Goals

Trichotomous

Achievement Goal Framework

Adapted from Elliott and McGregor 2001

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To date, Mindset or Self theory has been used primarily in education

Exciting aspect is that even simple changes can give people more of a “growth” mindset

Focus on level of effort not outcomePrime with messages or stories on how intelligence is malleable and can be improveSelf Theory Applications18

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Similar fixed/entity attitudes can be observed in health:

“I’m not the athletic type”

“I have no willpower” “I’ve always been fat” Application to health?19

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Motivation can stem from yourself (intrinsic) or outside yourself (extrinsic)

Intrinsic motivation stems from 3 basic universal psychological needs to feel:

Close to others (relatedness) << power of peers/social normsGood at something (competence)In control of your life (autonomy)Often simplified into “intrinsic motivation is good” and “extrinsic motivation is bad” but actually more complex

Self-Determination Theory (

Decci & Ryan 1970s)

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Type

of Motivation:

Amotivation(Lack self-efficacy or don’t value activity or outcome)

Extrinsic Motivation(Motivation is external but different degrees of internalization)

Intrinsic Motiva-

tion

Type of Behavioural Regulation:Non-regulationExternal(Reward or

punishmentexperienced as controlling) Introjected

(Some internalization so perform to avoid guilt or shame or to feel worthwhile)Identified

(More

internal locus of control & more conscious valuing as important)

Integrated

(Perform

to attain

personally-important outcomes

but not for their inherent interest & enjoyment)

Intrinsic

(self) regulation

(Find activity

interesting & enjoyable

; doing it enhances sense of relatedness, competency &/or autonomy)

Quality of Behaviour:

Nonself

-determined

Self-determined

Self-Determination Regulation

Financial

Incentives

Reasonable behaviour change goals?

Ultimate

goal

Decci

& Ryan. Handbook of Self-Determination Research (2002)

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A study of 175 people with type 2 diabetes measured self-determined motivation for exercise and stage

of change

at baseline, 3 months & 6 monthsProgressors: large increase in self-determined exercise motivation from baseline to 3 months and another, smaller increase from 3 to 6 monthsNon-progressors (n=37) had an initial large increase in self-determination from baseline to 3 months but then it declined over next 3-6 months Source: Fortier et al

J Health Psychology 2012

Relationship between stages of change & type of motivation

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Pre-contemplation:

extrinsic motives (appearance & weight) dominated over intrinsic (enjoyment & revitalization)

Contemplation: domination of extrinsic motivation not as strongPreparation: extrinsic motivation even weakerAction: extrinsic motives again dominant over intrinsicMaintenance: intrinsic motives more important than extrinsic

Markland and Ingeldew (2007)

Balance between internal & external motivators for physical activity may vary across stages

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Retrospective study of women’s motivation for physical activity:

Childhood: autonomously & intrinsically motivated – active because it was fun

Adolescence: combination of autonomous & non-autonomous – active because it is a form of socializingYounger adulthood or motherhood: mostly non-autonomous – to get back in shapeMiddle adulthood: combination of autonomous & non-autonomous – appearance, weight control & healthOlder adulthood: mostly autonomous – to be healthy

Source: Fortier & Kowal

, 2007Motivation may also vary across life stages

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Both extrinsic and intrinsic motives may be present at the same timeWhich one is dominant may vary at different stages of change and at different stages of life

Summary

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Theory of motivation so trying to get at why we behave the way we do & how we can changeLarge body of experimental research from different fields: education, physical activity, healthy eating, etc.

Validated questionnaires

Experiments in other countries showing it crosses cultureswww.selfdeterminationtheory.org Strengths

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Relationship to behaviours (outcomes)

Psychological mediators:

Autonomy

CompetenceRelatedness

MotivationIntrinsicIntegrated

IdentifiedIntrojected

ExternalAmotivation

Social Factors: autonomy support

(parents, peers, authority figures)

Outcomes

Well-being indices

Affective indices

Behavioural indices

Cognitive indices

Adapted from Standage & Treasure (2007)

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“Discuss with your family

and make a decision on how you want to proceed

to make improvements in your chosen activity.”Nurturing Motivation

Relatedness

Autonomy

Competence

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Support person’s sense of autonomy by giving choices & explaining rationale

Optimize relatedness by

Making users feel respected and cared for – give them opportunities to express their opinionsForm groups for relatedness & social supportBe empathetic – recognize that there are down sides to changeBoost feeling of competency by providing positive but realistic feedback and non-controlling guidance or information on how to attain health-related goals (avoid “you should do this…”)Emphasize working to improve yourself or your record rather than competing with others or being evaluated

Sheldon, William, Joiner.

Self-Determination Theory in the Clinic, Motivating Physical and Mental Health (2003)

Tactics

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Health Action Process ApproachSelf-regulation

For more information or for a consultation, email the principal at corinne@cshassociates.com.

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Coming up in Part 2Slide31

Bandura A.

Self-Efficacy in Changing Societies

. Cambridge University Press (1995)Decci EL, Ryan RM (eds). Handbook of Self-Determination Research. University of Rochester Press (2002)Elliot AJ, Dweck CS (eds). Handbook of Competence and

Motivation. Guildford Press (2005)Glanz K, Rimer BK, Lewis FM (

eds). Health and Behavior and Health Education, Theory, Research, and Practice (3

rd

ed). Jossey-Bass (2002)Haggar MS, NLD Chatzisarantis (eds). Intrinsic Motivation and Self-Determination in Exercise and Sport. Human Kinetics (2007)Heckhausen J,

Dweck CS (eds). Motivation and Self-Regulation Across the Life Span. Cambridge University Press (1998)

Sansone C, Harackiewicz JM (eds). Intrinsic and Extrinsic Motivation, The Search for Optimal Motivation and Performance.

Academic Press (2000

)

Michie

S, Prestwich A. Are interventions theory-based? Development of a theory coding scheme.

Health Psychology

2010;29:1-8

Sheldon KM, Williams G, Joiner T.

Self-Determination Theory in the Clinic, Motivating Physical and Mental Health.

Yale University Press (2003)

Stroebe

W.

Dieting, Overweight and Obesity, Self-Regulation in a Food-Rich Environment.

American Psychological Association (2008

)

Webb TL, Joseph J, Yardley L,

Michie

S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy.

JMIR

2010;12(1):

e4

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Short list of references