Behaviour Change

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

PART 1

Corinne Hodgson Corinne S. Hodgson & Associates Inc.

2014

Overview

  

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) CSH Associates - From thinking to doing 2

Online behaviour change tools: Systematic review of 85 RCTs

  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 3

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Three most commonly-used theories

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 CSH Associates - From thinking to doing 4

Transtheoretical Model (Prochaska, 1977)

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Strengths & weakness of Transtheoretical Model

Strengths Weaknesses

   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)  Good at telling you where people are but weak on process whereby they move between stages CSH Associates - From thinking to doing 6

Three most commonly-used theories of behaviour change

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”) CSH Associates - From thinking to doing 7

Theory of Reasoned Action

Behavioural beliefs Evaluation of behavioural outcomes Normative beliefs Motivation to comply CSH Associates - From thinking to doing Attitude toward behaviour Subjective norm Behavioural intention Behaviour 8

Theory of Planned Behaviour

Behavioural beliefs Attitude toward behaviour Evaluation of behavioural outcomes Normative beliefs Subjective norm Behavioural intention Behaviour Motivation to comply Control beliefs Perceived power CSH Associates - From thinking to doing Perceived behavioural control 9

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 CSH Associates - From thinking to doing 10

Three Most Commonly-used Theories

3.

Social Cognitive Theory

 What we think (cognition) influences our behaviour but is heavily influenced by what we learn from others (social) CSH Associates - From thinking to doing 11

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

  More holistic approach Behaviour is the result of a combination of:

Personal Factors:

Beliefs Self-efficacy Self-control Expectations

Social Factors:

Environment Observational learning Social modelling Reinforcement 12 CSH Associates - From thinking to doing

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” CSH Associates - From thinking to doing 13

Other theories

 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

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Achievement Goal or Goal Orientation (Eisen, Nicholls, Elliott)

 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 CSH Associates - From thinking to doing 15

Self Theory or Mindset (Dweck 2006)

  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 CSH Associates - From thinking to doing 16

Mindset & Achievement Goals

Trichotomous Achievement Goal Framework Mindset

Fixed/Entity (Dweck) Or Performance/ Ego (focus on what you achieve) Growth/Incre mental (Dweck) Or Mastery/Task (focus on process of learning)

Achievement Goal

Approach Avoidance Approach Avoidance Adapted from Elliott and McGregor 2001

Behaviour

Anxious to do well to confirm you are “one of the smart ones” Failure would show you aren’t smart so often avoid challenges (select easier tasks, quit when it gets hard) Will persist in even difficult tasks in order to “figure it out” and learn how to master the task Goal is to avoid deterioration in performance or skill 17 CSH Associates - From thinking to doing

Self Theory Applications

 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 CSH Associates - From thinking to doing 18

Application to health?

 Similar fixed/entity attitudes can be observed in health:  “I’m not the athletic type”  “I have no willpower”  “I’ve always been fat” CSH Associates - From thinking to doing 19

Self-Determination Theory (Decci & Ryan 1970s)

 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 CSH Associates - From thinking to doing 20

Self-Determination Regulation

Financial Incentives Reasonable behaviour change goals?

Ultimate goal Type of Motivation:

Type of Behavioural Regulation:

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

Non regulation Quality of Behaviour: CSH Associates - From thinking to doing

Extrinsic Motivation (Motivation is external but different degrees of internalization) Intrinsic Motiva tion External

(Reward or punishment experienced as controlling) 21

Introjected

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

Nonself-determined 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)

Self determined

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

Relationship between stages of change & type of motivation

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 CSH Associates - From thinking to doing Source: Fortier et al J Health Psychology 2012 22

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

    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) CSH Associates - From thinking to doing 23

Motivation may also vary across life stages

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 CSH Associates - From thinking to doing 24

Summary

 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 CSH Associates - From thinking to doing 25

Strengths

 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

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Relationship to behaviours (outcomes)

Social Factors: autonomy support

(parents, peers, authority figures)

Psychological mediators:

Autonomy Competence Relatedness Adapted from Standage & Treasure (2007)

Motivation

Intrinsic Integrated Identified Introjected External Amotivation

Outcomes

Well-being indices Affective indices Behavioural indices Cognitive indices CSH Associates - From thinking to doing 27

Nurturing Motivation

Relatedness

“Discuss with your family

Autonomy

and make a decision on how you want to proceed

Competence

to make improvements in your chosen activity.” CSH Associates - From thinking to doing 28

Tactics

     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 CSH Associates - From thinking to doing Sheldon, William, Joiner. Self-Determination Theory in the Clinic, Motivating Physical and Mental Health (2003) 29

Coming up in Part 2

  Health Action Process Approach Self-regulation

For more information or for a consultation, email the principal at [email protected].

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Short list of references

           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 (2002) ed). Jossey-Bass 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 CSH Associates - From thinking to doing 31