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Health Promotion by Social Cognitive Means
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144 Health Education Behavior April 2004,Supply Side Versus Demand Side Approaches. Current health practices focus heavily on the medical supply side The growing pres. sure on health systems is to reduce ration and delay health services to contain health. costs The days for the supply side health system are limited People are living longer. This creates more time for minor dysfunctions to develop into chronic diseases Demand. is overwhelming supply Psychosocial factors partly determine whether the extended life. is lived efficaciously or with debility pain and dependence 2 3. Social cognitive approaches focus on the demand side They promote effective self. management of health habits that keep people healthy through their life span Aging. populations will force societies to redirect their efforts from supply side practices to. demand side remedies Otherwise nations will be swamped with staggering health costs. that consume valuable resources needed for national programs. SOCIAL COGNITIVE THEORY, This article focuses on health promotion and disease prevention by social cognitive. means 4 5 Social cognitive theory specifies a core set of determinants the mechanism. through which they work and the optimal ways of translating this knowledge into effec. tive health practices The core determinants include knowledge of health risks and bene. fits of different health practices perceived self efficacy that one can exercise control over. one s health habits outcome expectations about the expected costs and benefits for differ. ent health habits the health goals people set for themselves and the concrete plans and. strategies for realizing them and the perceived facilitators and social and structural. impediments to the changes they seek, Knowledge of health risks and benefits creates the precondition for change If people. lack knowledge about how their lifestyle habits affect their health they have little reason. to put themselves through the travail of changing the detrimental habits they enjoy But. additional self influences are needed for most people to overcome the impediments to. adopting new lifestyle habits and maintaining them Beliefs of personal efficacy play a. central role in personal change This focal belief is the foundation of human motivation. and action Unless people believe they can produce desired effects by their actions they. have little incentive to act or to persevere in the face of difficulties Whatever other factors. may serve as guides and motivators they are rooted in the core belief that one has the. power to produce desired changes by one s actions, Health behavior is also affected by the outcomes people expect their actions to pro. duce The outcome expectations take several forms The physical outcomes include the. pleasurable and aversive effects of the behavior and the accompanying material losses. and benefits Behavior is also partly regulated by the social reactions it evokes The social. approval and disapproval the behavior produces in one s interpersonal relationships is the. second major class of outcomes This third set of outcomes concerns the positive and neg. ative self evaluative reactions to one s health behavior and health status People adopt. personal standards and regulate their behavior by their self evaluative reactions They do. things that give them self satisfaction and self worth and refrain from behaving in ways. that breed self dissatisfaction Motivation is enhanced by helping people to see how habit. changes are in their self interest and the broader goals they value highly Personal goals. rooted in a value system provide further self incentives and guides for health habits. Long term goals set the course of personal change But there are too many competing. Bandura Health Promotion 145, influences at hand for distal goals to control current behavior Short term attainable goals.
help people to succeed by enlisting effort and guiding action in the here and how. Personal change would be easy if there were no impediments to surmount The per. ceived facilitators and obstacles are another determinant of health habits Some of the. impediments are personal ones that deter performance of healthful behavior They form. an integral part of self efficacy assessment Self efficacy beliefs must be measured. against gradations of challenges to successful performance For example in assessing. personal efficacy to stick to an exercise routine people judge their efficacy to get them. selves to exercise regularly in the face of different obstacles when they are under pressure. from work are tired feel depressed are anxious face foul weather and have more inter. esting things to do If there are no impediments to surmount the behavior can be easy to. perform and everyone is efficacious, The regulation of behavior is not solely a personal matter Some of the impediments to. healthful living reside in health systems rather than in personal or situational impedi. ments These impediments are rooted in how health services are structured socially and. economically,Primacy of Efficacy Belief in Causal Structures. Self efficacy is a focal determinant because it affects health behavior both directly and. by its influence on the other determinants Efficacy beliefs influence goals and aspira. tions The stronger the perceived self efficacy the higher the goals people set for them. selves and the firmer their commitment to them Self efficacy beliefs shape the outcomes. people expect their efforts to produce Those of high efficacy expect to realize favorable. outcomes Those of low efficacy expect their efforts to bring poor outcomes Self efficacy. beliefs also determine how obstacles and impediments are viewed People of low efficacy. are easily convinced of the futility of effort in the face of difficulties They quickly give up. trying Those of high efficacy view impediments as surmountable by improvement of. self management skills and perseverant effort They stay the course in the face of. difficulties, Figure 1 shows the paths of influence in the posited sociocognitive causal model. Beliefs of personal efficacy affect health behavior both directly and by their impact on. goals outcome expectations and perceived facilitators and impediments. Overlap in Health Belief Models, There are many psychosocial models of health behavior They are founded on the. common metatheory that psychosocial factors are heavy contributors to human health. For the most part the models include overlapping determinants but under different. names In addition facets of a higher order construct are often split into seemingly differ. ent determinants as when different forms of anticipated outcomes of behavioral change. are included as different constructs under the name of attitudes normative influences. and outcome expectations Following the timeless dictum that the more the better some. researchers overload their studies with a host of factors that contribute only trivially to. health habits because of redundancy Figure 2 shows the factors the various health models. select and their overlap with determinants in social cognitive theory. Most of the factors in the different models are mainly different types of outcome. expectations Perceived severity and susceptibility to disease in the health belief model. are the expected negative physical outcomes The perceived benefits are the positive out. 146 Health Education Behavior April 2004, Figure 1 Structural paths of influence wherein perceived self efficacy affects health habits both.
directly and through its impact on goals outcome expectations and perception of. sociostructural facilitators and impediments to health promoting behavior. come expectations In the theory of reasoned action and planned behavior attitudes. toward the behavior and social norms produce intentions that are said to determine behav. ior Attitude is measured by perceived outcomes and the value placed on those outcomes. As defined and operationalized these are outcome expectations not attitudes as tradi. tionally conceptualized Norms are measured by perceived social pressures and one s. motivation to comply with them Norms correspond to expected social outcomes for a. given behavior Goals may be distal ones or proximal ones Intentions are essentially. proximal goals I aim to do x and I intend to do x are really the same thing Perceived con. trol in the theory of planned behavior overlaps with perceived self efficacy Regression. analyses reveal substantial redundancy of predictors bearing different names 6 For exam. ple after the contributions of perceived self efficacy and self evaluative reactions to. one s health behavior are taken into account neither intentions nor perceived behavioral. control add any incremental predictiveness, Most of the models of health behavior are concerned only with predicting health hab. its But they do not tell you how to change health behavior Social cognitive theory offers. both predictors and principles on how to inform enable guide and motivate people to. adapt habits that promote health and reduce those that impair it 4. Threefold Stepwise Implementation Model, The social utility of health promotion programs can be enhanced by a stepwise imple. mentation model In this approach the level and type of interactive guidance is tailored to. people s self management capabilities and motivational preparedness to achieve desired. changes The first level includes people with a high sense of efficacy and positive out. come expectations for behavior change They can succeed with minimal guidance to. accomplish the changes they seek, Figure 2 Summary of the main sociocognitive determinants and their areas of overlap in different conceptual models of health behavior. 148 Health Education Behavior April 2004, Individuals at the second level have self doubts about their efficacy and the likely ben. efits of their efforts They make halfhearted efforts to change and are quick to give up. when they run into difficulties They need additional support and guidance by interactive. means to see them through tough times Much of the guidance can be provided through. tailored print or telephone consultation, Individuals at the third level believe that their health habits are beyond their personal.
control They need a great deal of personal guidance in a structured mastery program. Progressive successes build belief in their ability to exercise control and bolster their stay. ing power in the face of difficulties and setbacks Thus in the stepwise model the form. and level of enabling interactivity is tailored to the participants changeability readiness. The following sections are devoted to a more detailed consideration of how to enable peo. ple at these various levels of changeability to improve their health status and functioning. PUBLIC HEALTH CAMPAIGNS, Societal efforts to get people to adopt healthful practices rely heavily on public health. campaigns These population based approaches promote changes mainly in people with. high perceived efficacy for self management and positive expectations that the pre. scribed changes will improve their health Meyerowitz and Chaiken7 examined four pos. sible mechanisms through which health communications could alter health habits by. transmitting information on how habits affect health by arousing fear of disease by. increasing perceptions of one s personal vulnerability or risk or by raising people s. beliefs in their efficacy to alter their habits They found that health communications foster. adoption of healthful practices to the extent that they raise beliefs in personal efficacy. To help people reduce health impairing habits by health communications requires a. change in emphasis from trying to scare people into health to enabling them with the self. management skills and self beliefs needed to take charge of their health habits. In longitudinal analyses of community based health campaigns Rimal8 9 found that. perceived self efficacy governs whether individuals translate perceived risk into a search. for health information and whether they translate acquired health knowledge into health. ful behavioral practices Those of low self efficacy take no action even though they are. knowledgeable about lifestyle contributors to health and perceive themselves to be vul. nerable to disease Maibach and colleagues10 found that both people s preexisting self. efficacy beliefs that they can exercise control over their health habits and the self efficacy. beliefs instilled by a community health campaign contributed to adoption of healthy. eating habits and regular exercise Figure 3,Overprediction of Refractoriness. Our theories overpredict the resistance of health habits to change This is because they. are developed by studying mainly refractory cases but ignoring successful self changers. For example smoking is one of the most addictive substances It is said to be intractable. because it is compelled by biochemical and psychological dependencies Each puff sends. a reinforcing nicotine shot to the brain Prolonged use is said to create a relapsing brain. The problem with this theorizing is that it predicts far more than has ever been. observed More than 40 million people in the United States have quit smoking on their. own Where was their brain disease How did the smokers cure the disease on their own. Bandura Health Promotion 149, Figure 3 Paths of the influence of perceived self efficacy on health habits. 10 1177 1090198104263660Health Education amp BehaviorBandura Health PromotionARTICLE April 2004 312April Health Promotion by Social Cognitive Means

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