Session Seven – Behavioral Determinants and Theories
This session focuses on the initial planning process, including behavioral determinants and theories.
At the end of this session, participants should be able to:
· Describe five factors that influence behavior
· Describe how identification of doers and non-doers can influence decisions about influential determinants.
· List reasons why it is important to conduct research to identify behavioral determinants that intervention will address.
· Identify potential determinants relevant to their own intervention programs, that can be tested for importance.
As we move forward in this discussion, we start with two questions – What determines human behavior and how do we explain that behavior? For social marketers, this is generally the most helpful set of questions we can answer as we try to figure out what motivates people to change and what motivates them to accept the kinds of offerings we make. We also try to better understand their costs with the kinds of changes we are asking them to make.
There are several theories that help us with this. In this first portion we will discuss background models and theories that can be helpful.
The term theory is used very loosely here. Many of these are very useful working concepts, but not full formal theories that we might think of in logical philosophy or some of the more traditional social scientific disciplines. We will go through four of these principles.
The first set of useful components comes under the general heading “levels of influence.” There are different analysis levels under which we can think about how people and their behaviors are affected. The first area is individual factors, those differences that are unique to each person. These include a person’s knowledge, attitudes, beliefs, general personality style, and disposition. Psychologists would generally focus on these items to try to explain individual motivation. If we move up a level, there are a number of interpersonal factors that affect how people behave and feel. “Social identity” refers to how people see themselves with respect to other people. The level of social support they feel they have from people around them to make the kinds of changes we are offering. It also included the roles they have in their jobs. These can include the informal roles they take on as informal leaders, serving as sources of information for neighbors and friends. There is another level that has to do with the influence on human behavior that comes from institutions. These are the rules, regulations, and informal structures in the organizations where these people live and work. These can be their churches, synagogues, or work organizations. For example, we might ask people to incorporate physical activity into their job but because they work odd hours or have very little free time, they will be less inclined to adopt the kinds of suggestions or recommendations we make. Community factors involve all of those influences, issues, and structures, which are a part of the general neighborhood, the general social environment in which people live. These include their social networks of close family and personal friendships as well as what we call extended weak tie networks of acquaintances, familiar strangers, people they come in contact with in a looser informal way. Also included are community norms, which may play an enormous role in terms of encouraging or curbing changes in behavior that we as health professionals may advocate. Finally, there is the very important area of public policy. What are the regulations and laws that encourage people to wear seatbelts? When seatbelt usage is the law, it certainly is much easier for us to promote that behavior. However, if we encourage people to stop smoking and we especially want our teenagers to stop smoking, there are very few restraints on global merchants advertising cigarettes to teens. This creates a greater obstacle to overcome. All of these issues, individual factors, interpersonal factors, institutional factors, community issues, and public policy, play a role in affecting how people behave.
The next theoretical framework is the well-known “stages of change” model by Prochaska and his colleagues at the University of Rhode Island. This model has provided a great deal of insight and evidence regarding the process people go through when they are preparing to change and how this impacts what public health communicators say to people at each level of their readiness to change. Prochaska and his colleagues found evidence of five stages people go through when affecting change, whether it is to stop smoking, get screened for cancer, or any number of other kinds of health related tasks we put before them. The first stage is pre-contemplation, people are unaware of the problem and our task is to make them aware, give them information, and bring the problem and solution we are suggesting to their attention. Contemplation is the next stage. People are now aware of the dangers to their health or the consequences of not consuming calcium and how that can lead to osteoporosis. At this point, people are thinking about changing in the future, but they have not begun to change. A cognitive shift is occurring, but they haven’t adopted the behavior. The decision/determination stage is where people actually plan to change. As communicators, our task is to provide people with background information and help them determine what the behavioral steps are; for example, how they get screened, stop smoking, curb their appetite, increase their level of fruit and vegetable consumption, and so forth. The fourth stage of change is the action phase. People are engaging in the behavior or behaviors we’re advocating. They are implementing that specific action plan. That is why the decision/determination stage is so important. It has to be workable for people given the lives they lead and the complex challenges they face in today’s society. Finally, there is the maintenance stage. People are repeating the desired behavior they choose. It’s one thing to try the fruit and vegetable package for a week or so. It is another thing to keep that up or to seek a cancer screening every year according to national cancer institute guidelines, and, certainly, it is another thing to be able to stop smoking altogether and not relapse.
Our third model is the well known “social learning/social cognition” model, originally attributed to Albert Van Durra but embellished by a number of other social scientific researchers since first published. The strongest attributes of this model are six concepts that are helpful to check off as we think of the ways people learn to behave by watching others.
The first concept is behavioral capability. People watch others behave a certain way and find that behavior appealing. One of the first things they have to recognize, however, is that they also have the knowledge and skills to influence behavior. This means that we as public health change advocates need to provide information and training about any new behavior as Pochaska suggested.
The second concept to understand is that people have expectations or beliefs about what they think will happen to them and to others when they engage in the new behavior. It is important to discuss what the likely results of that behavior will be and provide encouragement. This will give people a sense of the effects that will result when they engage in the behavior.
The third concept is self-efficacy. Self-efficacy is defined as “the confidence that an individual has to take the action that is before them.” It is also known in some literature as the concept of locus of control. Put another way, it is the extent to which I can predict in advance the consequences of my behavior on the people around me and my environment. There are various levels of self-efficacy and personal control. Social scientists state that we should think about this in terms of three conventions. First, is the idea of internal/external, the locus of control for self-efficacy? Do I believe that my personal control or my confidence to take action in an efficacious sense is due to internal factors, to me as an individual? Or, do I suspect it is largely things in my environment? Of course, if it is things in my environment, I will feel less confident. The second convention is the globality/specificity function. If I believe my ability to take action covers a wide range of issues and areas of action, then it is fairly global and represents a fairly strong level of self-efficacy and control. If my ability to take action is more focused around specific areas, then it may mean I have less confidence to try some things than others. Finally, we ask how stable this sense of self-efficacy is. Do people feel this in a fairly constant way across time and situation, or is it somewhat unstable and not constant? In the latter case, our confidence is easily shaken, and the challenges people have to take, the actions that we are advocating, will be somewhat curtailed. Another aspect of self-efficacy that we know from research on social behaviors is that sometimes people take control, even when there is very little evidence that indicates they’re having a level of control. David Mechanic once said “if we all knew just how venerable we are, we wouldn’t get out of bed in the morning.” This is an interesting way to look at illusion control. Sometimes illusions are good for us. But we shouldn’t suggest that people take action in situations where they don’t have the control necessary to take those actions. This would set them up for failure. The important application of this notion of self-efficacy and its various dimensions, is that we need to help people succeed by pointing out their strengths. Where do they have a good track record? Where are they already doing things similar to what we are suggesting? Sometimes it is a good idea to try these things out in small groups were they can hear others talk about how they tried these things and what worked for them. This is the essence of what Van Durra was talking about and thinking of when we engage in social learning.
The next concept of social learning is that of observation learning. If I observe other people who are similar to me, and I see them behaving in ways that provide a visible, physical, tangible resource that I would like for myself, I am likely to find that appealing and feel that I could try that in my life. As health educators, we need to point out the experiences of others like them using stories and testimonies. We need to point out the specific physical changes others have experienced and give people realistic role models for them to emulate.
Reinforcement is a fifth concept of the social learning model. The responses that people get to their behavior are likely to effect whether they will engage in that behavior in the future. Positive reinforcement, as we know from conditioning model in psychology, gives people a sense of encouragement, and provides incentives or rewards to continue that behavior. Negative responses deter those changes. We have to think about the environment in which people live and whether or not this reinforcement will occur for them.
Finally, the concept of social support is extremely important. Albrecht and Adelman have described this “as the kind of communication process that occurs between people, between providers of support and recipients of support, that functions very specifically to help people reduce the uncertainty they face”. When that uncertainty is reduced or lowered to a more manageable level, particularly in situations of stress or a lack of confidence, then a sense of personal control results. That brings us back to the issue of self-efficacy because it is at that point that people feel they have the wear-with-all to engage in the kinds of change we are advocating.
Our fourth model is the diffusion model. It carries some very useful ways of thinking and a checklist for the kinds of things that help predict whether the change being considered is likely to succeed.
The first characteristic of a successful change process is whether or not people perceive a relative advantage. There is a well-worn phrase in the debate area that it is absolutely essential to first point out to people how the change advocated is preferable to either the status quo or any competing behaviors. We have to point out at the front what the relative advantage and the unique benefits of the change are. We want to point out how it is convenient, time saving, and ask some questions. Is there some prestige associated with it? What is the cost? Is there a cost savings here? How will people look and feel and think differently about themselves. Relative advantage gets people thinking about what could be better with the individual compared to where they currently are.
Compatibility is the second characteristic of a successful change program. The changes we are suggesting to people need to fit with their existing values, habits, experience, audience, and needs. We have to tailor these behaviors to the values and situations of the intended. For example, if change is incompatible with their religious beliefs, it is not likely to occur. This relates to a fundamental maxim in social marketing, “if the behavior we are offering is not the right behavior or is not suitable in its existing state, then we have to be willing to change that product, our offering, or behavior in ways that are compatible the communities and lifestyles of our target audience.”
Complexity is the third aspect of change. People are not likely to try if the change is too complex or difficult to understand or the behavior is seen as having too many parts. We have to create the behavior in an uncomplicated way. It has to be fairly easy to perform and understand. For example, if getting to the screening clinic will require transportation cost, child care, time, and a number of other factors that will simply interfere with the busy life of a young mother, she is not likely to engage in that behavior. However, if we can come up with something as creative as holding local screening in her neighborhood or having the mammogram mobile in the church parking lot on Sunday when she goes to church, then it is much easier for her to adhere to the suggested guidelines for screening.