Attitude and Behaviour Change Flashcards
Describe the social ecological system
- Lewin’s field theory does not reduce phenomena to individual psychological processes
- Behaviours happen within a social ecological system
- Systems are ‘resilient’ - a system has the capacity to absorb disturbance, and to reorganise itself, simultaneously changing and retaining the same function, structure, identity, and feedbacks. Systems usually only change radically when faced with a crisis
- Behaviour is usually in a state of ‘quasi-stationary equilibrium (=flux around a steady state)
- Behaviour is part of an individual’s life space , subject to multiple forces acting to support or change the behaviour -there is a continuous state of tension around any behaviour
- Behaviour happens in a behaviour setting - self-regulating systems serving to regulate the expression of behaviour, leading to stable behavioural pattens (eg the operation of norms)
- Focus on channels - the social and economic structures through which events flow
- Changing behaviour requires changing the social ecological system that produces and reproduces that behaviour
- Forces on behaviour differ in intensity and direction. Changing one force with the intention of changing behaviour is likely produce changes in other forces too, possibly restoring the behaviour, or enhancing the behaviour change, or producing
unintended consequences elsewhere in the system - General 3-step sequence to changing a system:
– Unfreezing – destabilise the quasi-stationary equilibrium
– Moving – develop new sets of behaviours, supported by changes in motivational
forces
– Refreezing – facilitate other system changes (in beliefs, habits, infrastructure,
policies, regulations, services, norms, culture) to sustain overall system change.
Describe an attitude structure
○ Affective
§ Emotions/feelings about attitude object (eg fear, anger)
○ Behavioural
§ Interactions with attitude object (eg frequent use of X)
○ Cognitive
§ Beliefs about attitude object (eg X is goo for my health)
○ Social
§ Consensus, role-model (eg X is valued by others)
○ Most attitudes have the ABC bases, however different bases may carry more weight in determining the overall summary evaluation
Describe an attitude formation
○ Affective
§ Evaluative conditioning: pairing a positive stimulus with a neutral target
□ Eg celebrity endorsement, smells, images, music etc
§ Mere exposure - familiarity breeds liking
○ Behavioural
§ Self-perception (Bem’s work): We learn what we like by observing what we do
○ Cognitive
§ Reasoned inference: think through facts about the ‘object’ and draw evaluative inference
Describe an attitude function
○ Knowledge
§ Have/express attitudes to make sense of the world - to ‘summarise’ our experiences with attitude objects
○ Instrumental/utilitarian
§ Have/express attitudes to help guide behaviour; achieve rewards and avoid punishments
○ Social identity/social adjustive
§ Have/express attitudes to fit into groups or attitudes to fit into groups or relationships
○ Impression management/value expression
§ Have/expressive attitudes to express one’s values/ideologies
○ Self-esteem/defensive
§ Have/express attitudes that protect the self (from low self-esteem; anxiety)
○ Variation: object; group/culture, and individual differences
Describe attitude strength
○ Strong attitudes are:
§ Held with confidence, certainty
§ Usually based on lots of one-sided info (ABC, Social)
§ Persistent, resistant, and predictive of behavioural intentions and behaviour
○ Ambivalent attitudes
§ Contain positive and negative evaluative components and bases
Describe attitude change
○ Many processes result in attitude change
○ Social influence (conformity, obedience)
○ Perceived norms (descriptive, injunctive)
○ Cognitive dissonance reduction
○ Much research and application focuses on persuasion
§ Change of an attitude via processing of a message about an attitude object
○ Amount/nature of attitude change depends on attributes of each of these elements
○ In conjunction with depth of processing
Describe models of attitude change
○ Heuristic-Systematic Model (HSM; Chaiken et al., 1989) and Elaboration Likelihood Model (ELM; Petty & Cacioppo, 1986)
○ Two processing routes: deep or superficial (really a continuum)
○ Two important implications:
§ Amount and kind of attitude change depends on processing route
§ Factors influencing attitude change and manner of influence are contingent on processing route
Explain the elaboration likelihood model
- Attitudes can be modified by processes that involve more or less ‘attitude-object-relevant’ elaboration or thinking
○ Low elaboration characterises the peripheral route of persuasion
○ High elaboration characterises the central route of persuasion- Attitude change can occur via both routes via different processes
- Elaboration can result in pos or neg thoughts about the attitude object
- General thoughts can be trusted or not (ie validated)
- Strongest attitude change occurs when elaboration and validation are high
What is the central route of persuasion
○ Attitudes formed (or changed) based on more elaboration and validation are:
§ Stronger
§ More persistent over time (stable)
§ Resistant to further change
§ Predictive of intentions and behaviour
○ Compared to peripheral route persuasion
○ If you want to change behaviour, you need to change attitudes via the central route
Describe route selection in the elaboration likelihood model
○ What influences the adoption of processing route?
§ Motivation
□ Goal, value, or self relevance
□ Accountability
□ Need for cognition: desire and enjoyment of thinking
§ Capacity
□ Ability (prior knowledge, message comprehension)
□ Distraction
□ Repetition
○ Message characteristics
§ Central route
□ Because people are thinking deeply, argument quality matters
§ Peripheral route
□ Because people are thinking superficially, they rely on heuristics
® Message heuristics - argument quantity, not quality
® Source heuristics - credibility (expertise/knowledgable, trustworthiness), attractiveness, likeability, power
○ Matching
§ Source-recipient match (similarity)
□ Status/power
□ Ingroup/outgroup
§ Message-recipient match (eg between message content and attitude bases or general values)
§ Message-attitude base match (Fabrigar & Petty, 1999)
□ If the attitude is emotional, you want to change it with emotional bases
§ Message-attitude function match (eg Snyder & DeBono, 1989)
Explain the elements to the behaviour change model
- Taking action to change behaviour therefore involves a number of processes and skills. Many of these processes are within our control, and many of these skills can be taught. These include:
○ Motivation - desire/intention to engage in behvaiour
○ Self-efficacy - belief in one’s ability to execute the behaviours necessary to achieve a goal
○ Goal setting - setting a defined goal that will guide behaviour
○ Planning - determining how one intends to achieve their goal
○ Self-monitoring - examining and recording thoughts, feelings and/or behaviour in relation to the goal
○ Self-evaluation - assessing the extent to which one has succeeded in reaching a set goal
Goal review - reconsidering a goal in light of evaluation
Describe motivation and how is it significant for behaviour change?
○ What is motivation?
§ An individual’s desire/intention to engage in a behaviour
□ Do you/they want to do it?
○ Motivation is a prerequisite to behaviour change
○ It is a function of the extent to which we want to act in a certain way and believe we should act in a certain way
○ Behaviour change is challenging when there is a conflict between what we want to do and what we should do
§ For example, when what we want to do (smoke, drink, eat junk food) is not in our best interests
○ Determinants of motivation
§ Knowledge
§ Attitudes
§ Normative beliefs
§ Identities and values
§ Self-efficacy
○ Motivation is based on some form of story we have developed that includes some or all of the above
○ The motivation ‘story
How to increase motivation
§ Knowledge
□ Ensure people are aware of (and understand) relevant information
® What do people need to know about a new behaviour they need to enact or old behaviour they need to stop enacting?
® For example:
◊
§ Attitudes
□ People must believe the advantages/benefits of behaviour change outweigh the disadvantages/costs of performing the behaviour (ie they hold a pos attitude to behaviour change)
□ For example:
®
□ Increase personal relevance - what are the benefits of change for this person? What is their story?
□ Provide many arguments and repeat as needed
□ Provide people with substitutes or alternatives to behaviour if they are giving something up that gives them pleasure
§ Normative beliefs
□ Others’ approval/liking is a powerful motivator
□ Motivation will be higher if one perceives more social (normative) pressure to perform the behaviour than not to perform the behaviour or vice versa
® Eg eating fruit and veggies - there is more social pressure to consume than not to consume
□ Changing normative beliefs is difficult when the behaviour people need to enact contradicts the behaviour patterns of their ingroup
□ Work with people to overcome these norms
® When in the first weeks of behaviour change, can they avoid people who trigger old behaviour patterns?
® Can they shift the location of social events form the pub to a café
® Discuss with the client the concept pf ‘enabling’ and how others benefit from the status quo, which is of detriment to the client
§ Identities and core values
□ People perceive performance to be more consistent than inconsistent with self-image/their values
□ Core values and identities determine priorities
□ Weaken current wants/desires by explaining to people
□ What we want is not necessarily aligned with who we want to be
®
□ Values-based work can help clients to identify what their values are and
® How their current behaviour isn’t aligned with their values
® How behaviour change is aligned
Describe self efficacy and how it is important to behaviour change
○ What is self-efficacy?
§ An individual’s belief in their ability to execute the behaviours necessary to achieve a goal
○ Evidence from the following areas of research shows that the effects of an intervention on health behaviour are partially mediated by changes in perceived self-efficacy:
○ Four sources of efficacy information § Mastery experiences □ Learning through personal experience (most potent) □ Rationale: ® Achieving mastery over a difficult or previously feared task increases self-efficacy ® Success builds self-efficacy, failure undermines self-efficacy ® Successive mastery leads to refinement of skills + development of coping mechanisms to deal with problems □ Approaches for practice: ® Set challenging but achievable tasks ® Encourage practice ® Gradually increase the difficulty of tasks (graded steps) ® Attribute accomplishments to the person's abilities ® Psychoeducation on the difference between a lapse and a relapse ◊ Lapse is mistake - you acknowledge the mistake and then go back to the changed behaviour ◊ Relapse is falling back into the behaviour repeatedly ◊ Self-efficacy to deal with lapse too § Vicarious experiences □ Learning that occurs through observation of other people □ Rationale: ® Seeing others like ourselves succeed at a task can strengthen self-efficacy ® Seeing others like ourselves struggle may undermine self-efficacy □ Approaches for practice ® Ask clients: do you know anybody who has tried this before? ® Encourage clients to mix with peers who have succeeded ◊ If they don't know anyone personally, encourage clients to join peer support groups ◊ Encourage clients to discuss with peers what they did to succeed/how they succeeded ◊ Encourage clients to copy their peers ◊ Important to ensure that the peer/model overcame any difficulties through determined effort rather than with ease/luck § Verbal persuasion □ Communication of others about one's capabilities (most commonly used by health professionals) □ Rationale: ® Providing credible feedback/reinforcement can boost self-efficacy ® Effectiveness of this approach is dependent on client believing what they are told about their capabilities □ Approaches for clinical practice ® Give clients good (ie appropriate, constructive) feedback on their performance ® Feedback must be credible (ie not overly positive) § Emotional regulation □ People rely on information about their physiological state to determine their capabilities □ Rationale: ® Positive mood can boost self-efficacy ® Anxiety/high physiological arousal can undermine self-efficacy, especially if a person believes that arousal impairs performance □ Approaches for practice ® Normalise anxiety ® Reduce stressful elements of task performance by managing mood before and during performance ® Psychoeducation: teach clients about the Yerkes-Dodson Law: ◊ Evidence shows that optimal performance occurs when one is physiologically aroused ◊ Can be used to challenge client beliefs that they can't do something when they experience any anxiety
Describe goal setting and how it is important for behaviour change
○ What is goal setting
§ Defining a goal that will guide the behaviour
○ SMART goals - essential to behaviour change
§ Need to be clear and unambiguous
§ Specific
□ State exactly what you want to accomplish (who, what, when, where, how). Goal is clear, detailed, and well-defined
§ Measurable
□ Can you clearly and easily demonstrate and evaluate the extent to which the goal has been met?
§ Achievable
□ Ensure the goal is challenging but realistic
§ Relevant
□ How does the goal relate to the client’s overall objective?
§ Timed
□ Does the goal have a clear timeline
○ Once you have developed a SMART goal, you may need to develop smaller SMART goals that build up to the bigger one
What does taking action look like in behaviour change?
○ Step 1: assessment of skills
§ It is important to ensure someone has the skills required to engage in a particular behaviour before they attempt it
§ Attempting to take action and being unable to can undermine self-efficacy
§ Types of skills = motor; social; self-regulatory; self-care
○ Step 2: teaching skills
§ If your assessment concludes that one or more skills are lacking, the following can be used to develop these skills: instruction; demonstration; practice; feedback
What does action look like in behaviour change
If-then planning - a key cognitive skill and tool
After SMART goals are developed, it is time to implement the steps required to achieve these goals
These ‘implementation intentions’ specify when, where, and how the goal will be achieved and take the form of an ‘if-then’ plan
‘If’ identifies the cue to act. This might be time/place
‘Then’ identifies an effective goal-directed response
If-then planning can help your client identify situations that are usually associated with the behavoiur they are trying to change and then specify a response that is designed to overcome their usual habits in these situations
§ If-then planning can also help clients identify situations that they can link to engagement in a new behaviour
§ That is, it can help them seize opportunities/cues to act and remember these cues
If-then planning can be used to protect motivation from unhelpful thoughts/emotional arousal
Describe the steps of self-monitoring and self-regulation in the behaviour change model
○ It is important that your client monitors their attempts at behaviour change and evaluates progress
○ Why?
§ Without monitoring and evaluation, they are ‘driving blind’ and unable to determine:
□ Whether their behaviour really is changing (are they progressing towards their goal)
□ How much their behaviour is changing
□ Why their behaviour might not be changing
□ How behaviour change is making them feel
○ Things to self-monitor
§ Behaviour patterns in relation to the goal
§ Immediate reactions
§ Changes in well-being
○ Monitoring behaviour
§ What can be learnt?
□ Frequency of efforts required to resist old behaviour or instigate a new one
□ Perceived difficulty
□ Frequency of slips (failure to act as planned)
§ In addition, are each of the above declining over time?
□ If not, what strategies can be put in place to speed progress?
§ What has been the success of strategies used to date?
§ Requires good records
□ Digital apps/tools particularly useful here
® Habitica
§ Take appropriate actions
□ Rewards for achievements - make sure these are relevant
□ Remedial action if progress is inadequate
○ Monitoring reactions
§ Actual experiences while acting or resisting temptations
□ Link physiological responses to experiences - ‘what were you feeling?’
§ Challenge of noticing changes in levels of reactions
□ Mindfulness techniques can help here
§ Separate initial ‘automatic’ reactions from those that arise due to thoughts
§ Assess reactions to slow progress and potential diminishing self-efficacy
○ Monitoring changes in aspects of well-being
§ Monitor changes in well-being that might be related ot the behaviour change
□ From minutes after behaviour to days and weeks after
§ If positive, great! It shows:
□ Life can be better
□ Feared negatives have not occurred
§ If negative:
□ Work out whether linked to the behaviour change
□ Is the effect temporary? It usually is
□ What can you do to minimise the negatives?
○ Summative evaluation
§ Evaluate all three
§ Should be done regularly in the early days
§ Can also be triggered by a crisis
§ Celebrate successes (with rewards)
□ Use them to build self-efficacy
§ Learn from set-backs
□ Have a recovery plan ready
□ View them positively (ie teachable moments)
Describe the stage of goal review in the behaviour change model
○ If a goal wasn’t met, ask:
§ Was the goal too ambitious?
§ Was it not specific enough?
○ Amend goal if needed
○ If the goal was met, ask:
§ Can we make the goal slightly more challenging?
○ Avoid reviews when actively facing challenges
§ Need to be as objective as possible and reviewing a goal when feeling deflated will colour judgement
Explain the importance of equity with regards to behaviour change
- Social determinants of health are important to behaviour change
- Programs and interventions need to consider equity
- For example:
○ Affordability
§ Advantaged people can afford to go to the gym, access healthcare etc
§ Disadvantaged people cannot
○ Literacy
§ Information needs to be communicated in a way that reaches all groups
§ COVID-19 and migrant communities
○ Literacy levels
§ Presence of a translator for immigrant participants
§ Information materials suitable in content and length
§ Face-to-face approach
○ Access to course
§ Free and ample parking
§ Close to PTV
§ Disability-friendly
What are some types of evaluation
- Process (ie implementation)
○ Was the intervention implemented as intended?
§ Efficiency: are the intervention’s activities being produced with appropriate use of resources (eg budget and staff time?)- Outcome (ie effectiveness)
○ Did the intervention meet its objectives?
§ Cost-effectiveness: does the value or benefit of achieving the intervention’s objectives exceed the cost of producing the intervention?
- Outcome (ie effectiveness)
What is process evaluation
- Process evaluations focus on whether an intervention and its activities are operating and being implemented as planned
- Helps to identify intervention (not content) strengths, weaknesses, and areas for improvement
- Why do we need to do this?
○ It helps us answer the question: why was the intervention (un)successful?
○ The ‘black box’ - Always done in collaboration with stakeholders
- What to assess (from Saunders et al. 2005)
○ Fidelity
○ Dose delivered
○ Dose received
○ Reach
○ Recruitment
○ Context - Methods of evaluation (examples)
○ Activity records
○ Participation rates
○ Budgets
○ Reach
○ Impressions
○ Clicks
○ Engagement
Describe outcome evaluation
- Investigates whether, and to what extent, changes occur for participants in a program and if these changes are associated with the program
- Also done in collaboration with stakeholders
- The outcomes that are assessed in an evaluation will depend on the objectives of the program but usually include
○ Attitudes
○ Knowledge
○ Skills
○ Behavioural intentions
○ Behaviour/behaviour change (making sure these are within the scope) - Outcomes must be SMART
○ Specific
○ Measurable
○ Achievable
○ Relevant
○ Time-bound - Design of outcome evaluations
○ Experimental evaluations (ie randomised control trials)
§ Participants are randomised to a treatment group, which receives the program, or to a control group which does not
□ This design allows for conclusions to be drawn about the attribution
○ Quasi-experimental evaluations
§ Involves assessing outcomes over time (pre/pos program exposure) for a single group and comparing to a similar population, a comparison group, or national data
○ Before and after study
§ Involves assessing outcomes over time (pre/post program) for a single group but does not compare to a control group
§ Weakest design - Methods adopted by outcome evaluation
○ Qualitative
§ Focus groups
§ Interviews
§ Diaries
○ Quantitative
§ Surveys/questionnaires (that include validated measures)
○ Observation
○ A mixed methods approach is best practice - When to evaluate/collect data?
○ At all stages
○ Before implementation
§ Important to collect baseline data
○ Pilot-testing stage
§ Helps ensure that the outcomes are chosen for the evaluation are relevant, directly conntected to the program’s activities, and are in keeping with the program’s logic model
□ Provides early evidence of success or failure
○ After roll-out
§ Helps demonstrate to the funders the effectiveness of the program and make a case for the continued program funding or expansion
§ Helps to determine what works, for whom, and under what conditions
§ If the funding doesn’t allow for multi=stage testing, can ask a self-report if the program changed their behaviour - not ideal but is an option when necessary
What is a cost-effectiveness evaluation?
- Economic evaluation allows us to determine whether one intervention represents a better use of resources than another (or doing nothing)
- Demonstrates ‘value for money’ and possible cost savings for government by investing an intervention
- Cost-benefit analysis
○ Costs of the program (eg resources, staffing) are weighed against the costs of not running the program (eg hospitalisations) - Quality Adjusted Life year (QALY) is a very common cost-effectiveness measure
What is required for complex behaviour change?
- Complex change may take years from first efforts to sustained change
○ Periods of no action in between- What is required?
○ Goals that are sustained over attempts
○ Some stability of beliefs about reasons for change
○ Explanations of why determinants of change vary over quitting process
○ Complex model of self-regulation
○ Acceptance of multiple influences
- What is required?
What are the inadequacies of current behavioural theories?
- Social ecological theories
○ Cannot explain repeated failures- Expectancy values theories
○ Good for trying, hopeless for success
○ Good for decision making, not for behaviour change - Narrative theories
○ Explain, not predict - Self-protection theories
○ Only focus on avoiding harms - Self-regulation theories
○ Over focus on self-control - Learning theories
○ Struggle with the complexity
- Expectancy values theories
What are the issues in behaviour change?
- The importance of values and assumptions
- Centrality of desirability and achievability beliefs
- The relationship between conceptual and affective forces
- Deciding, implementing, and succeeding
What is the fundamental insight of CEOS theory?
- Human behaviour mirrors that of other animals in being in large part about adapting to the environment to maintain basic functions - operational processes
- But it can also be about pursuing conceptually generated goals which I refer to as being controlled by executive processes
- However, executive goal pursuit can only occur within the limitations of the more basic operational functioning
- Thus, we need to consider human behaviour, and thus behaviour change in terms of how operational processes both support and constrain executive plans
