Social Cognitive Theory
The social cognitive theory refers to a psychological model of behavior. It primarily was developed as the social learning theory from the work of the psychologist, Albert Bandura in Stanford University, California in the 1960s. The social learning theory really evolved into social cognitive theory in 1986, which emphasis on the acquisition of social behaviors and its external and internal social reinforcement. It regards the only way in which people acquire and maintain behavior, also considers the social environment in which people behave. We as nurses often encounter that social cognitive theory is utilized as a strategy in health promotion and disease prevention. The results of many current nursing researches have proved that the core set of determinants of social cognitive theory have a positive impact on translating the benefit and useful knowledge and information into effective health practices. The major determinants constructing the social cognitive theory described by Albert Bandura as “knowledge of health risks and benefits of different health practices, perceived self-efficacy that one can exercise control over one’ health habits, outcome expectations about the expected costs and benefits for different health habits, the health goals people set for themselves and the concrete plans and strategies for realizing them and perceived facilitator”.(p. 144) The social cognitive theory used in health promotion consider maintenance of behavior instead of initiating behavior. The goal of social cognitive theory is to explain how people regulate their behavior through control and reinforcement to achieve goal-directed behavior that can be maintained over time (“Using APA,” n. d. Social cognitive theory section. para, 2).
Each determinant is a necessary component of the social cognitive theory. Understanding each of them helps utilizing in an optimal way to achieve expected behavior change in health practice. Primarily, the knowledge of health risk and benefits affects whether people behave differently. If people have no idea how their usual lifestyle habits put them in poor health, it is difficult for them to change the lifestyle they usually enjoy. Only after receiving the appropriate knowledge of health risk and benefits, the people are motivated to overcome the challenges to adopting new health lifestyle habits. The belief of personal capacity as perceived self-efficacy is also important. The lifestyle habits are able to be changed if people believe they can produce desire effects because the belief is the foundation of human motivation and action.
Generally, people health behavior is also influenced by their expect outcomes. People anticipate the outcomes of their action before engaging the behavior, and these anticipated outcomes can affect successful completion of the behavior. Mainly, expect outcome is from previous experience. If people have a positive outcome with a similar previous healthcare experience, they expect the same outcome again while encountering the similar situation. Healthcare professional personnel must consulate with people who have a negative outcome from the previous experience in order to promote health behavior change. People regulate their behavior by their self-evaluative reactions; they do things only they think it is self-worth and self – satisfaction. As Albert Daudura emphasized “Motivation is increased by helping people to see how habit change in their self- interest and the broader goal they value highly”. (p.144)
The theorist also promotes behavior change with perceived facilitators. It is easy for people to adopt health habits if there is no obstruct factors they need to overcome. Some of these factors are personal things that measure performance of health behavior. As Albert Daudura states “They form an integral part of self – efficacy assessment. Self-efficacy belief must be measured against gradation of challenges to successful performance”.(p. 145) For instance, assessing any financial issue or physical problems such as chronic pain, disabilities or body weakness that hinder the people complied with behavior change. Before promoting change the poor health behaviors, these obstructions must be addressed by social workers or healthcare providers. If there is no obstruction to surmount, the behavior can be easy to perform.
In order to understand how the social cognitive theory works and promotes behavior change in detail in health practice. Two research articles have been chosen to discuss. One is “The Effect of a Garden-Based Nutrition Education Program on the Consumption of Fruits and Vegetables by Hispanic Children” (Megan Somerville . , et al 2012). It is identified as a one-group pretest-posttest design of within-subjects quasi-experiments. The 40 children who are 6 to 12 years and participant in the study were not assigned into different groups randomly. They only form an experimental group, which means there is not control group. Another main features of this kind of design is that a measurement of dependent variable is taken before and after a intervention such as Megan, Lisa, Kessler, Sharonda, Wallace and Bonny (2012) mentioned in the study “a previous validate survey to assess self-reported fruit and vegetable intake was administered before and after the intervention” (.p. 21), a weekly one hour session for 13 weeks.
The reason this research was conducted because lacked of recommend amount of fruit and vegetable has a negative impact in children growth and development. The increased rate of obesity, cardiovascular disease, diabetes and cancer is the reflex this condition. In fact, children consume less than the recommended amounts of fruit and vegetable in the United States. The higher level of acculturation and higher rates of food in security make this issue more serious in the Hispanic children. It is necessary to find a method to motivate this consuming fruit and vegetable behavior change in order to maintain the children’s healthy. The goal of the research is stated by Megan et al . , (2012) “was to develop, implement and evaluation a garden-based nutrition education program that would improve the fruit and vegetable snack eating behaviors of participating Hispanic children”(.p. 21).
The Hispanic children who participate into this research must be a member of Boys and Girls Club of Pomona and actively participated in the facility’s existing gardening program. In order to protect human subjects, Megan et al . , (2012) stated “the curricular and goals of this project were approved by the director of the Boys and Girl Club of Pomona, and the project procedures and consent form were approved by the Institutional Review Board of California State Polytechnic University, Pomona”(.P. 21). Spanish and English version of consent form were provided and signed by both children and their parents. And also children must be volunteered to participate.
The results of the research are significant. The children reported on their own that fruit servings consumed increased daily from 2.23 ± 4.18 to 4.13 ± 2.16 and vegetable serving consumed increased daily from 2.17±1.82 to 3.07±1.87. When the actual average number of serving consumed of each type of snack was counted before and after the intervention, researcher Megan et al., (2012) found that “average number of fruit and vegetable servings increased from 0.68 serving to 1.28 serving. Average number of chip servings decreased from 0.94 serving to 0.30 servings. These results reflect an upward trend in preference for fruit and vegetable snack and a downward trend in preference for chip snack”(.P. 23).
When asking what the study or research add to the literature, I would say that not all the component of the social cognitive theory have to be used to promote behavior. The theory would also work well if some determinants are used appropriate. In this study, the researchers only utilized the two major strategies: knowledge of health of risk and benefits of different health practices and perceived facilitator. For the knowledge of fruit and vegetable usage, the children were provided one-hour session weekly, for 13 weeks to learned knowledge of fruit and vegetable snack preparation. During the session, the children were given the chances to show their new knowledge and skills to both their peers and family members. According to Megan et al. (2013) “such interaction not only stimulated an increased interest in fruit and vegetable but also prompted continuing dialogue concerning produce in multiple setting” (.p.23). The motivation of behavior change increases while self-interest increases. Additionally, the source and location for the research to be implemented were considered a perceived facilitator. We often face lack of resource and appropriate location, which weakens changing the participants’ behavior. In this case, a variety of fruits and vegetables is available each week and the location of The Boys and Girls Club were provided to participants. Getting more practice on snack preparation in sessions and having a comfortable environment promote behavior changes also.
Another research article, “A Randomized Controlled Pilot Study of an HIV Risk-Reduction Intervention for Sub-Saharan Aferican University studys”, ( G.Anita Heeren. , et al 2012) is discussed also to better understand the social cognitive theory. This research study is utilized a qualitative randomized control trial, pretest – posttest experimental design. The researchers randomly assigned the students into one of two groups; both groups received either HIV risk reduction intervention or health-promotion control intervention. One researcher conducted the computer-generated random assignments; another researcher implemented the assignments; South African and Non-South African male and female students were randomly assigned separately to ensure that nationality and sex were balanced across the intervention (G. Anita Heeren. , et al 2012, p. 1107).
He “generalized HIV epidemic” trend has a high negative impact on public health in South Africa. Prevention of HIV spread required delivering intervention in high risk subpopulation. South African university students were believed as one of risk groups as they “reported a younger age at first sex, were less likely to report condom use at first sex, were more likely to report ever being forced to have sex, reported having sex with a greater number of lifetime sexual partners and more likely to report having multiple sexual partners compared with US students” (G. Anita Heeren . , et al 2012, p.1106). Only few students reported tests of the efficacy of university student designed HIV risk-reduction interventions. Because of high risk of HIV among the university student, the first year and second year university students became the target of peer-education HIV risk-reduction programs. This program created a study to test the efficacy of an intervention to reduce sexual risk behavior among this population in South Africa.
This research study was approved by the Institutional Review Board at the University of Pennsylvania and the Ethics Committee at the University of Fort Hare. For the confidential purpose, the students require to complete confidential questionnaires before and after the intervention and at 6 and 12 months. The eligibility criteria for participation was descript by G. Anita Heeren . , et al (2012) as “student aged 18 to 24 years who had been randomly selected and who planned to remain as students at the university for the next two academic years, which would allow for intervention implementation and 12 –month follow-up data collection” (.p. 1107).
After averaged over the 2 follow up assessment were taken and the collection data was analyzed; it determines several improvement on HIV risk-reduction. The students in HIV risk-reduction intervention group report fewer days on which they had unprotected sexual intercourse than did those in the health promotion intervention group. The students in intervention group were more likely to report more frequent condom use during sex than those in the health promotion control group. The non-South African students have greater reduction in unprotected intercourse when comparing with South African students. And students who received the HIV risk-reduction intervention scored high in condom-use expectancies, self-efficacy to use condoms, HIV risk-reduction knowledge and condom use knowledge.(G. Anita Heeren . , et al 2012, p.1113). The social cognitive theory was utilized indirectly in the HIV risk- reduction group. First, Researchers ask students in nine focus groups questions designed to elicit beliefs relevant to social cognitive theory constructs of outcome expectancy and self-efficacy. Activities as interactive exercise, games, brainstorming, role-playing, videos, and group discussions for the purpose of the intervention were designed “(a) to address condom-use outcome expectancies identified in the focus groups, (b) to increase skills and self-efficacy to address the things that the focus group participants said made it easy or hard to use condoms, and (c) to increase HIV risk-reduction knowledge, including condom use knowledge” ( G. Anita Heeren . , et al 2012, p.1108). Basically, the social cognitive theory was used in this study as it is in most researches. There is no any special strategy or creative method to manipulate the theory. So, it only supports the literature instead of adding any new thing.
Inclusion, no matter improving Hispanic children fruit or vegetable intake or reducing HIV infection related with risk sexual behavior among South African university students, it is proved that human poor health practice behaviors are able to be changed efficiently with social cognitive theory. The component of knowledge of health risks and benefits of different health practices in the theory seems more important when comparing both articles. All the participants in intervention groups in both studies received knowledge teaching, then get other interventions or not. Many human behavior changes, not necessary health practice can be explained by the social cognitive theory. It is sure that most people were motivated to change their poor behaviors at some points, and they just did not know this theory was using. For those who study theory, it is more helpful for them to understand and manipulate the theory. Also the theory helps to explain human behavior with respect to health seeking behavior. Of course, people have to have knowledge of health before seeking healthcare; and people begin to maintain health over time if they have expect goals of health, be confident to control their health and implement concrete plans. Basically, these are how the social cognitive theory motivates human behavior change.
Albert Bandura (2004). Health Promotion by Social Cognitive Means. Health Eudc Behav 2004, 144 – 145. Retrieved from http://people.oregonstate.edu/~flayb/MY%20COURSES/H671%20Advanced%20Theories%20of%20Health%20Behavior%20-%20Fall%202012/Readings/Bandura%2004%20HP%20by%20social%20cognitive%20means.pdf
G.Anita Heeren , John B. Jemmott III, Zolani Ngwane, Andrew Mandeya, & Joanne C. Tyler ( 2012 January 13). A Randomized Controlled Pilot Study of an HIV Risk-Reduction Intervention for Sub-Saharan African University Students. AID Behav (2013) 17, 1105-1115. Retrieved from http://eds.a.ebscohost.com.citytech.ezproxy.cuny.edu:2048/ehost/pdfviewer/pdfviewer?sid=f6e68533-5224-41d7-859d-c9b3534c57da%40sessionmgr4004&vid=10&hid=4208
Megan Somerville, Lisa A. Kessler, Sharlnda P., & Wallance, Bonny Burns-Whitmore (2012). The Effect of a Garden-Based Nutrition Education Program on the Consumption of Fruits and Vegetables by Hispanic Children. Californian Journal of Health Promotion 2012, volume 10, Special Issue: Obesity Prevention and Intervention, 20-25. Retrieved from http://eds.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=2e7e0a79-f501-4a85-8164-b6e59e89f76b%40sessionmgr111&vid=13&hid=115
“Using APA” (n. d. ). Behavioral Change Models. Retrieved from http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/SB721-Models/SB721-Models_print.html