Social Cognitive Theory

Albert Bandura’s social cognitive theory (SCT) has been hugely influential in health promotion research and practice since his seminal publication of ‘Self-efficacy: Toward a unifying theory of bevavioural change’ (Bandura, 1977).

According to Bandura SCT is “founded on an agentic perspective” where individuals have the capacity to control their life, behaviour and environment (Bandura, 2001, 2012). SCT has a causal structure grounded in triadic reciprocal determinism where

“human functioning is a product of the interplay of intrapersonal influences, the behaviour individuals engage in, and the environmental forces that impinge upon them” (Bandura, 2012, p. 11). At the time, these concepts were novel compared to mainstream behavioural theory that understood personal and environmental factors to be unidirectional determinants of behaviour (Bandura, 2001). A schematic representation of this threefold structure of SCT is illustrated in Figure 2.4

Personal Determinants

Behavioural Determinants

Environmental Determinants

Figure 2.4. Schematic of Triadic Reciprocal Determinism (From Bandura, 2012, p. 12)

Central to SCT is the concept of self-efficacy. Perceived self-efficacy refers to

“beliefs in one’s capabilities to organize and execute the courses of action required to produce given levels of attainment” (Bandura, 1998, p. 624). In other words, the personal beliefs an individual holds about their capacity to organize and exercise control over behaviour and events. According to Bandura, self-efficacy beliefs provide the incentive to act, determine and regulate motivation and learning;

influence the strength of commitment to goals; affect perseverance and resilience to adversity and obstacles, and; determine confidence to use capabilities and skills effectively (Bandura, 1977, 1998). Self-efficacy beliefs are strengthened through personal mastery experiences (successful accomplishment), vicarious experience (seeing others model behaviour), social persuasion (verbal suggestion), and physical and emotional states (building physical strength and reducing anxiety and depression) (Bandura, 1977, 1998, 2012).

In SCT Bandura has described efficacy expectations as being different and distinct from outcome expectations (Bandura, 1977). Efficacy expectations are beliefs about the ability to perform a particular behaviour, whereas, outcome expectations are beliefs about the results of the behaviour. This is illustrated in Figure 2.5 below. Efficacy expectations vary in magnitude, generality and strength with implications for the performance of behaviour. Magnitude relates to how difficult a person finds it to adopt a particular behaviour; generality refers to how much a sense of efficacy extends beyond a specific behaviour to other behaviours, and strength refers to the level of efficacy belief about mastery of a behaviour (Bandura, 1977).

Bandura (Bandura, 2004, 2012) has described the concept of health promotion using social cognitive theory as comprising a group of core determinants that include: knowledge of health risks and benefits; perceived self-efficacy or belief about one’s control over health behaviour; outcome expectations about the benefits and costs of health behaviours; health goals and plans for realising them and perceived facilitators and impediments to changing behaviour. Structural paths of influence between these determinants where self-efficacy affects health behaviour both directly and through goals, outcome expectations and socio-structural factors is illustrated in Figure 2.6. below.

Person Behaviour Outcome

Efficacy expectations

Outcome expectations

Figure 2.5. Efficacy Expectations and Outcome Expectations (From Bandura, 1977, p. 193)

Outcome expectations Physical

Social Self-evaluative

Sociostructural factors Facilitators Impediments

Self-efficacy Goals Behaviour

Figure 2.6. Self-efficacy Structural Paths of Influence on Behaviour

Bandura (2004) asserts that self-efficacy beliefs are a crucial determinant of health behaviour, influencing an individual’s health goals and aspirations and also the outcomes that a person expects their efforts to produce. Using exercise as an example, those with high self-efficacy beliefs expect to realise positive outcomes from increasing physical activity while those with low self-efficacy expect poor outcomes. Positive outcome expectations may include physical fitness, improved health, social approval, improved mood and mental well-being. Self-efficacy beliefs also influence how obstacles or impediments are viewed; obstacles and impediments may include personal factors, social and economic factors and health system factors.

People with low self-efficacy will also be easily become discouraged by obstacles and difficulties and be more likely give up exercise. Bandura also posits that goals and aspirations for personal health are also influenced by self-efficacy beliefs, where people with stronger perceived self-efficacy beliefs are more likely to set higher goals and have a stronger commitment to achieving them (2004).

According to Bandura there are similarities and overlap between SCT and other psychosocial models of health behaviour (Bandura, 2004). He argues that models like the health belief model and the theory of planned behaviour have overlapping determinants under different names, but are in fact different types of outcome expectations. For example, perceived severity and susceptibility in the HBM are negative outcome expectations; while perceived benefits are positive outcome expectations, with perceived barriers equating to impediments to action. While other models of health behaviour are largely concerned with predicting behaviour, SCT theory provides not only predictors but also principles to inform, guide and motivate behaviour change (Bandura, 1997).

In SCT, the development of personal self-regulatory skills is essential for successful behaviour change (Bandura, 2004). Self-regulation depends on consistent self-monitoring of thoughts and behaviour. This self-observation provides information to allow evaluation of behaviour based on: personal standards;

comparison to others behaviour and social norms; past attainments and judgement about the value of the activity. Realistic goal setting helps to facilitate this self-reflective process and helps to motivate a person to take action, and to monitor progress towards achieving those goals (Bandura, 2004).

Interventions for developing and increasing self-efficacy need to include strategies to target mastery experiences, social modelling, verbal persuasion and improve physical and emotional states (Bandura, 1997, 1998, 2004). The ‘Women’s Wellness Program’ (Anderson, D. & Graham, 2007; Anderson, D., McGuire, &

Porter-Steele, 2013; Anderson, D. et al., 2006) is an example of an intervention that is based on SCT and includes these elements to promote health behaviour change.

(See Chapter 4 and Table 4.1).

Social cognitive theory, in its entirety, has been criticised for being overly broad and ambitious and for not being as comprehensively tested as some other health behaviour theories (McAlister, Perry & Parcel, 2008). However, there is extensive evidence from decades of research, that the self-efficacy construct is one of the most important predictors of health behaviours and health behaviour change. For example, self-efficacy and social cognitive theory has been used as the basis for chronic disease self-management programs (DeBusk et al., 1994; Lorig, 1996; Lorig, Sobel, Ritter, & Hobbs, 2001) and interventions to promote physical activity in adults with type 1 and type 2 diabetes (Plotnikoff, Lippke, Courneya, Birkett, &

Sigal, 2010; Plotnikoff, Lippke, Courneya, Birkett, & Sigal, 2008). There is strong

evidence that perceived self-efficacy is a determinant of physical activity and exercise across age groups and different populations (Bauman et al., 2012) including midlife Australian women (Anderson, R., Anderson, D. & Hurst, 2010).