Behaviour Change

Behaviour ChangePast & current theories of how to get people

from thinking to doing

PART 1

Corinne HodgsonCorinne S. Hodgson & Associates Inc.

2014

CSH Associates - From thinking to doing 2

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

CSH Associates - From thinking to doing


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


Transtheoretical Model (Prochaska, 1977)


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


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


Theory of Reasoned Action

Behavioural beliefs

Evaluation of behavioural outcomes

Normative beliefs

Motivation to comply

Attitude toward behaviour

Subjective normBehaviour

al intention

Behaviour


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


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


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


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


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



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)


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


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


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?


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)


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


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

22


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


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


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


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

http://www.selfdeterminationtheory.org/


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)


“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


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


Health Action Process Approach Self-regulation

For more information or for a consultation, email the principal at

[email protected].

Coming up in Part 2


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

Behaviour Change

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