Transcript Document

Self-Efficacy, Young People and ‘Risky
Behaviour’ ~ Evaluating the Merits of PsychoSocial Interventions
A Bi-lingual Workshop
Friday 10 September 2010 12:00 - 16:30 (GMT)
Woolf College, Seminar Rooms 4, 5 & 6, University of Kent,
Canterbury
Welcome and Introduction
Claire Martin and Jenny Billings
NHS Eastern and Coastal Kent
and
Centre for Health Service Studies
University of Kent
Upstream Approaches
We are standing by a swiftly flowing river. We
hear the cry of a drowning man. We jump in,
bring him to shore and revive him. We then
hear many more cries for help and continue to
pull drowning people to safety. Nearly
exhausted, it occurs to us that we are so busy
downstream saving people, we have not had
time to go upstream and find out why they’re
falling in.
Adapted from a story told by Irving Zola in an article by John B. McKinlay in A
Case for Refocusing Upstream: The Political Economy of Illness (1981)
Introduction
Catherine Huette
Médecin responsible de la prévention
prénatale
Conseil général de la Somme
From “Let’s talk about love” to the
“Self-efficacy, young people and ‘risky behaviour’”
project
• “Let’s talk about love” – a programme of teenage pregnancy prevention through
health education
– In Britain, including Kent: very high pregnancy rate among minors
– In the Somme: levels twice as high as the national average
– Developed within the framework of the France-UK cross-border European
co-operation programme Interreg III
• From the project conception (2002) to the closing conference (2007): several
years of work
– Overall assessment of health indicators, knowledge, structures
– Research enquiry centred on focus groups comprising teenagers and
professionals
– Strengthening of partnerships and networks
– Training initiatives
– Professional networks
– Development of reception units: e.g. ‘Leg up’
From “Let’s talk about love” to the
“Self-efficacy, young people and ‘risky behaviour’”
project
•
•
•
•
Need for further evaluation work on psycho-social interventions
Study of practice
Examination of theoretical underpinning
Involvement of large numbers of
– Conseil général (departmental council) professionals
– Relationship counsellors
– Midwives, doctors
– Family planning centres
– Social workers
• Work in partnership with
– the health services of the national education system
– Nursing schools
– with associations…..
University of Kent
Dr Jan Macvarish
Research Fellow
Centre for Health Services
Studies
Aims
• To look at the relationship between selfefficacy and changes in health behaviour
through an analysis of interventions with
young people.
• To identify what works.
Methods
• Search terms: Self-efficacy, perceived selfefficacy AND child, adolescent, young
people.
• Databases: PsycINFO abstracts, EBSCO
host, MEDLINE, SCOPUS, Cochrane,
Google Scholar.
Criteria for inclusion
• 1988 onwards.
• ‘Self-efficacy’ used in title, abstract or full
text.
• Age range 5-18 years.
• Article in English, but study could be from
anywhere.
• Self-efficacy either explicitly targeted or a
significant outcome measure.
• An intervention addressing ‘risky behaviour’
(STIs, HIV, pregnancy, drugs, alcohol,
smoking).
Before / After?
Main Findings: Quantitative Overview
25 studies included in the review.
• 19 US, 2 West African, 1 Italian, 3 international
reviews.
• 11 school-based, 5 community-based, others
included family planning clinic and residential
drug treatment facility.
• 12 HIV/AIDs, 8 another sex-related topic, 1
drugs-related, 1 alcohol-related, 1 both drugs
and sex, 2 physical activity.
• 5 reviews of other studies.
Main Findings
1.Use of self-efficacy:
• A few studies used ‘self-efficacy’ as a broad
concept describing a general outlook.
e.g. ‘there is little I can do to change many of
the important things in my life’.
• Most used it in relation to specific behaviour.
e.g. self-efficacy to use condoms, to say ‘no’ to
drugs, to delay sexual intercourse.
2. Only five studies used self-efficacy as a
central concept – 4 sex-related, 1 physical
activity.
3. In 20 studies, self-efficacy was used as
one of many measures in evaluating the
impact of an intervention.
4. Sample size ranged from 19 to over 2000.
5. Main uses:
• ‘Social modelling’ (role models) through peer
education, video presentations or computer
games.
• Reinforcement of safe behaviour through roleplay.
• Group work to identify risky situations.
• Interventions tailored to specific cultural
groups.
• Involving the target group in how the
intervention is developed.
1961 ‘Bobo Doll Experiment’
Conclusions
• Fewer studies than expected fitting our
criteria.
• Lack of consistency in the meaning of selfefficacy.
• Weak evidence of causal relationship
between self-efficacy and precise
behavioural changes.
• Are studies from other cultural contexts
applicable to UK populations?
Similarities and Differences from the
Kent/French Perspective
• Greater number of Anglophone studies,
especially US-based or US-led
interventions.
• Similar lack of conclusive evidence of
positive effects on behaviour change.
• Similar confusion with other concepts and
theories.
IREPS Picardie
Philippe Lorenzo
et
Anne-Sophie Bernin
Aims
• Collate studies in French concerning
interventions based on self-efficacy theory
and using tools to measure their effects
Method
• Key word search:
– Self-efficacy, perceived self-efficacy
– Child, adolescent, young people
– But also: self-esteem, psycho-social
skills, resilience, perceived behavioural
control
• Databases used: Medline, Pubmed,
BDSP, Sciencedirect, Popline, Persée
Main findings:
Statistical overview
• 13 studies included for 5-24 age range
• Countries: Quebec/Canada (5) Francophone
Africa (3)
Non-francophone Africa (1), Belgium (2),
France (2)
• Risks: HIV (7), Obesity (3), Sexual behaviour
(2), Cardio-vascular health (1)
• Locations:Schools (6), Communities (3),
Hospitals (3), Social Rehabilitation Centres (1)
Main findings
• Self-efficacy measures are used in conjunction
with measures of other types
• Wide variety of interventions, samples and
measures
• No evaluation of the concept itself: evaluation
of impact of intervention, evaluation of effects
on perceived self- efficacy
Main findings
• Improvement in perceived self-efficacy
• Limited impact on risky behaviours
• But: contradictory results in two studies!
Conclusions
• Use of self-efficacy as a learning technique
and not as social learning
• Recording of intention and not of
behavioural change
• No firm conclusions drawn from the
literature review
Differences
• Some anglophone studies focus on the
concept of self-efficacy itself; not so in the
French-speaking world.
• Few francophone studies address sexual
concerns. Those focused on HIV, however,
are linked to the question of condom use.
Similarities
• Application and use of the self-efficacy
concept in a wide range of different situations.
• Little evidence of link between beliefs and
behavioural change.
• Complexity of behaviours cannot be simplified
by a single explanatory theory.
The Practitioner’s Perspective
Jo Tonkin
Commissioning Manager, Young People’s
Service
Kent Drug and Alcohol Action Team
Kent County Council
Responses to the report
• Aspires to identify practice which is
theoretically driven and effective.
• Concludes that we are working with theoretical
perspectives that in fact are very hard to apply.
• Points to much that we have yet to understand
about adolescence, the role of risk taking and
the prevention of harmful behaviours.
How we are already using self efficacy to
influence behaviour change with young people in
Kent:
Interventions to reduce young people problematic use of drugs and
alcohol:
RisKit: a preventative initiative which uses a life skills approach to
build young people’s motivation to change harmful behaviours and
builds support through their family, school and engagement in their
community to make sure that their behaviour change is successful.
Specialist Community Treatment: a psycho-social intervention which
includes the development of a care plan. The plan includes goals
which young people agree and review, so demonstrating to them that
they have control over their lives.
How we are already using self efficacy to
influence behaviour change with young people in
Kent:
Service Improvement: Seeking the views of young people
about the service that they receive and using that knowledge
to improve services, providing them with feedback.
Service Development: Seeking out the experiences and views
of young people when we develop new services and let them
know how we have used that knowledge.
Participation of Young People: Underpinning the values of all
integrated children and young people’s services.
Scope for further development
• Build on learning from RCT.
• Development of a programme of work
which focuses on a life skills approach
to reduce risk taking behaviour.
Practioner’s Perspective
Séverine Verschaeve
IA-IPR
Amiens Educational Authority
Response to report
• Self-efficacy in health education in France:
– A concept understood but not made explicit: education for choice and
responsibility
– An apparently different philosophy: no attempt to define norms or apportion
blame
• Positive aspects underlined in the report:
– Importance of self-efficacy in learning processes generally
– Impact of self-efficacy concept on effectiveness of interventions, varying
according to the intervention domain
– This impact is more marked when the intervention is directed towards
increasing the skills of the target group
– Effectiveness of peer-led interventions, especially for peers themselves,
whose own self-efficacy is strengthened
• Limitations identified in the report:
– Transferability of outcomes and concepts to adolescents?
– Self-efficacy as a potential brake on behavioural change?
Possible use in practice
• More formalized integration of study outcomes in the design of
interventions directed at young people, and also at those with a
training role
– ‘Expert’ experience (role plays, simulating situations…)
– Delegated experience (“success story”, positive experiences)
– Social Persuasion (positive attitudes)
– Environment (physical and emotional states…)
• Skills work
– Decision making, thinking ahead
– Autonomy
– Know-how and lateral thinking, logic of interventions
Possible further developments
Areas for broader reflection :
• Teacher self-efficacy
– Belief in their ability to influence pupils’ learning (self-efficacy
and general effectiveness).
– Achievement of better outcomes and a more positive attitude
• Young people’s collective self-efficacy
– Exploiting studies undertaken in environment and sustainable
development education (acting against perceived impotence
in the face of environmental problems; underlining successes
achieved; maintaining positive thinking by avoiding the
‘doomsday’ mindset which leads to denial, despair, or
withdrawal; developing skills…)
Monolingual break out group
Discussion Points
• What are your reactions to the presentations
and reports?
• ‘Self-Efficacy’, ‘young people’ and ‘risky
behaviour’ – what does this all mean to you?
• What are the messages for practice?
• Five key points for the plenary
Break
Plenary Session