Chapter 3: Methodology
3.8 Self-regulation
Self-regulation is framed within Social Cognitive Theory (Bandura 2004). Social Cognitive Theory is underpinned by the belief that human behaviour, motivation and well-being are regulated through the person’s belief in their own self-efficacy, goals and outcome expectations (Bandura 2004). Broadly speaking, self- regulation refers to the thoughts, feelings and actions that individuals adopt in order to attain their personal goals (Carver & Scheier 1998). It is achieved through the individual modifying his/her environment and making on-going behavioural changes, as necessary (Boekaerts et al. 2000, Maes & Karoly 2005, de Ridder & de Witt 2006). Self-regulatory theory views the individual as an
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active problem-solver, whose behaviour reflects an attempt to ameliorate the gap between current health status and a goal or ideal state (Carver & Scheier 1982).
3.8.1 Origins of self-regulation
One of the first self-regulatory theories was cybernetic control theory, which was developed by Carver and Scheier (1982). This theory originated from the mechanics of a machine and its chief mechanism of control is the operation of a cyclical feedback loop. With respect to humans, self-regulation is a far more complex process. However, the principles of the theory can also be applied to human behaviour (Carver & Scheier 1982). Unlike mechanistic processes, humans use the cyclical feedback loop process to appraise goal-setting, monitor progress towards the achievement of goals and take action to reduce discrepancies that arise between the individual’s current state and the standard needed to achieve their goals (Carver & Scheier 1982, de Ridder & de Wit 2006). The reduction of discrepancies between goal-setting and goal achievement is dependent on behaviour, such as compliance with a health recommendation and the person’s cognitive representation of their current status and the goal or plan that they have for changing it (Leventhal & Cameron 1987). In the presence of self-regulation, individuals become active decision-makers who determine their own outcomes and actions in terms of health behaviours, while in its absence, the person is helpless when faced with a health threat (Baumeister 2005).
The individual’s goals and their actions are contingent on the person’s context and characteristics (Carver 2004). Carver and Scheier (1982) theorised that in self-regulation, goals are organised hierarchically and altered in accordance with the individual’s sense of self and commitment to the goals. Self-awareness and self-monitoring are crucial to the understanding of self-regulation, as the individual’s interpretation of progress determines what further action is required and taken. Self-regulation is unique in that it involves regulation of the self, by the self, as opposed to the regulation of predominantly external influences (Leventhal et al. 2003).
72 3.8.2 Common characteristics
There are a number of theoretical approaches to self-regulation. These vary with respect to the principles that they emphasise or the mechanisms to which they subscribe (de Ridder & de Wit 2006). Irrespective of their focus, all theories share the two common characteristics of goal-setting and emotional and cognitive processes (Cameron & Leventhal 2003).
The first characteristic of goal-setting is initiated through the conscious or unconscious selection or activation of goals (Maes & Karoly 2005). In self- regulation, the individual chooses his or her own goals; a process known as autonomous regulation. These goals emanate from the individual and are set because they are of personal importance to them. Research reports suggest that individuals who are supported to engage in autonomous goal-setting tend to be more motivated to fulfil their goals (Williams et al. 1998). However, the development of autonomous regulation often requires the support of health care providers (Maes & Karoly 2005). The appraisal and revision of goals and strategies is determined by the feedback loop system that is characteristic of self- regulation.
The second common feature of self-regulation is concerned with the management of emotional responses (Carver & Scheier 1998). Emotional responses are intricately linked with cognitive processes in the attainment of goals and are central to motivation (Bandura 2005, de Ridder & de Wit 2006). The management of emotions plays a major role in determining and directing goal-setting strategies (de Ridder & de Wit 2006). Through the feedback loop system, goal-related outcomes are appraised cyclically and depending on these outcomes, new goals may be developed or previously developed goals revised.
While the literature does not readily explain the rationale for goal-setting, it has been suggested that the motivation to set goals in the first instance relates to the need for survival and a feeling of normality (sense of self) (Carver & Scheier 1996). The presence of ACS symptoms is an example of a goal-setting trigger. In
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this situation, the individual may view the illness experience (symptoms) as a threat to their health and therefore, their safety. Consequently, they may adopt a number of strategies to achieve their goal. The success or failure of these strategies is determined through the feedback loop system. If this adopted approach is successful, then the individual’s self-belief in their ability to deal with the threat is likely to increase. This self-belief is referred to as self-efficacy and is based on self-confidence (Bandura 1977, de Ridder & de Witt 2006). Self- efficacy is a component of self-regulation and according to Bandura (1977) it is an indicator for motivation to make behavioural change. Its presence strengthens the process of goal-setting and can influence an individual’s motivation and behaviour (Bandura 1986, Bandura 1999). Consequently, many self-regulatory models incorporate self-efficacy as a means of understanding or predicting goal focused behaviour (Leventhal et al. 1983, Brownlee et al. 2000).
Self-regulation therefore incorporates motivation, goal-setting, self-efficacy, cognition and emotion. As this study was focused on an intervention aimed at improving help-seeking behaviour, through improved knowledge, attitudes and beliefs about ACS, a model of self-regulation was considered appropriate. According to the social cognitive theory of self-regulation, individuals develop the capacity to successfully manage their behaviours by proceeding through a series of regulatory skill levels (Zimmerman 2000). Furthermore, self-regulatory models are thought to enhance the effectiveness of interventions designed to change health-related behaviour (Abraham et al. 1998).
Leventhal’s self-regulatory model of illness behaviour (1980) encompasses these important facets, together with an explicit devotion to the role of coping with emotions in the presence of a health threat (Leventhal et al. 1980). It was therefore felt that this could be a suitable framework to underpin the current intervention, as these were important and applicable issues in this study.
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