behaviour change
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Behaviour ChangePast & current theories of how to get people
from thinking to doing
PART 1
Corinne HodgsonCorinne S. Hodgson & Associates Inc.
2014
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Part 1 Traditional theories such as Transtheoretical
Model, Model of Reasoned Action/Planned Behaviour, and Social Cognitive Theory
Opportunities from other areas of psychology: achievement theory, self theory, and self-determination theory
Part 2: Health Action Process Approach and Self-Regulation
Part 3: New models from interactive health (Fogg, Eyal)
Overview
3
Webb TL et al. (JMIR 2010 12(1):e 14) used Michie & Prestwich coding scheme (Health Psychology 2010;29(1):1-8) to identify theory of behaviour change
Theories 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 persuaded 1 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 threat
Self-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 innovations Health belief – belief in a personal threat + belief in effectiveness of proposed behaviour =
likelihood of changing behaviour Social norms – group-held beliefs about how people should behave
Online behaviour change tools: Systematic review of 85 RCTs
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1. Transtheoretical Model (Prochaska, 1977)
Essence: change is a process and you can move closer to – or further away from – change depending upon Self-efficacy Decisional balance
Three most commonly-used theories
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Transtheoretical Model (Prochaska, 1977)
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Strengths & weakness of Transtheoretical Model
Strengths
If you know people’s stage, you can tailor messages so you meet them “where they are” & not alienate them
Large evidence base Can 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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2. Theory of Reasoned Action (Fishbein & Ajzen 1975) / Theory of Planned Behaviour (Ajzen 1985)
As name implies, infers people are making rational choices (“economic man”)
Three most commonly-used theories of behaviour change
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Theory of Reasoned Action
Behavioural beliefs
Evaluation of behavioural outcomes
Normative beliefs
Motivation to comply
Attitude toward behaviour
Subjective normBehaviour
al intention
Behaviour
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Theory of Planned Behaviour
Behavioural beliefs
Evaluation of behavioural outcomes
Normative beliefs
Motivation to comply
Attitude toward behaviour
Subjective normBehavioural
intentionBehaviou
r
Control beliefs
Perceived power
Perceived behavioural
control
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Strengths & Weaknesses of Theory of Reasoned Action/Planned Behaviour
Strengths
Well-established theories that have been used for years > lots of experimental and practical evidence
Easy to understand
Weaknesses
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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3. Social Cognitive Theory
What we think (cognition) influences our behaviour but is heavily influenced by what we learn from others (social)
Three Most Commonly-used Theories
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More holistic approach Behaviour is the result of a combination of:
Social Cognitive Theory (Miller & Dollard 1941, Bandura 1980s)
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Personal Factors:Beliefs
Self-efficacySelf-control
Expectations
Social Factors:Environment
Observational learningSocial modellingReinforcement
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Social Cognitive Theory
Strengths
Well-established theory Acknowledges the
important role of environment and other people
Because it addresses environment, useful for issues such as smoking
Weaknesses
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 Mindset
Self-Determination Theory
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 others
Achievement 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 traits
Growth or Incremental: belief that people can develop their abilities through effort and persistence
Elliot and Dweck 2005
Self Theory or Mindset (Dweck 2006)
Mindset Achievement Goal
Behaviour
Fixed/Entity (Dweck)OrPerformance/ Ego (focus on what you achieve)
Approach Anxious to do well to confirm you are “one of the smart ones”
Avoidance Failure 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)
Approach Will 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 17 CSH Associates - From thinking to doing
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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 outcome Prime with messages or stories on how
intelligence is malleable and can be improve
Self Theory Applications
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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?
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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
norms Good 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-regulation
External
(Reward or
punishmentexperienced as
controllin
g)
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-determin
ed
Self-Determination Regulation Financial Incentives
Reasonable behaviour
change goals?
Ultimate goal
Decci & Ryan. Handbook of Self-Determination Research (2002)21
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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 months
Progressors: large increase in self-determined exercise motivation from baseline to 3 months and another, smaller increase from 3 to 6 months
Non-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 strong
Preparation: extrinsic motivation even weaker Action: extrinsic motives again dominant over
intrinsic Maintenance: 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 socializing
Younger adulthood or motherhood: mostly non-autonomous – to get back in shape
Middle adulthood: combination of autonomous & non-autonomous – appearance, weight control & health
Older adulthood: mostly autonomous – to be healthy
Source: Fortier & Kowal, 2007
Motivation may also vary across life stages
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Both extrinsic and intrinsic motives may be present at the same time
Which 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 change
Large body of experimental research from different fields: education, physical activity, healthy eating, etc.
Validated questionnaires Experiments in other countries showing it
crosses cultures www.selfdeterminationtheory.org
Strengths
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Relationship to behaviours (outcomes)
Psychological
mediators:Autonomy
CompetenceRelatedness Motivation
IntrinsicIntegratedIdentified
IntrojectedExternal
Amotivation
Social Factors:
autonomy support (parents,
peers, authority figures)
OutcomesWell-being
indicesAffective 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 opinions Form groups for relatedness & social support
Be empathetic – recognize that there are down sides to change
Boost 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 Approach Self-regulation
For more information or for a consultation, email the principal at
corinne@cshassociates.com.
Coming up in Part 2
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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 (3rd 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
Short list of references
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