Attitude and Behaviour Change Flashcards
COM-B Model (Michie et al.)
Capability, Opportunity, Motivation –> Behaviour
Model of behaviour change
COM interact with each other and influence behaviour
Behaviour Change Wheel
Synthesis of 19 frameworks of behaviour change
Practical guide for designing and evaluating behaviour change
5 Aspects of Science Denial
FLICC
Fake experts
Logical fallacies
Impossible expectations
Cherry picking
Conspiracy theories
Parallel Argumentation
Way of explaining fallacy
Taking the flawed logic of a situation and extrapolating it out to another parallel
Types of Innoculation
Logic based - explaining the misleading techniques in misinformation
Fact based - showing how misinformation is false through factual explanation (more common)
Information Discernment
The ability to distinguish between misinformation and facts
Passive vs Active Innoculation
Passive - they are just receiving the information (most types from the seminar)
Active - they play an active role, actively engaging or generating answers (e.g. Crazy Uncle video game)
Attitude structure and definition
Structure: Affective, Behavioural, Cognitive, and Social
Evaluations of a social object
Lewin’s Behaviour Equation
Behaviour equation: B = f(P x E)
Behaviour = function of Person and Environment
Lewin’s Field Theory
A Social Ecological System
3-step sequence to change 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 (beliefs, habits, infrastructure, policies, etc.) to sustain overall system change
How to change a social ecological system
Systems are resilient - you must focus on the channels to a behaviour to know how to change it
Example: Levine convincing the US to eat organ meat during the war
- identified housewives as the gatekeepers (channel) to meal prep, so he targeted them
Deficit Model
People act like the problem is always a deficit of knowledge in the community – not true
o Usual approaches
Change the person (attitudes, identity, beliefs, values, etc.)
Disseminate knowledge, or at least make it available
Engage with community members/stakeholders via ‘action research’
All useful, but not necessary nor sufficient for science adoption, uptake, or influence
Standard Persuasion Frame
Source –> Message –> Recipient –> Context/Situation
Matching comes into play here
These factors, in conjunction with depth of processing (ELM)
Elaboration Likelihood Model
ELM - Petty & Cacioppo
Process occurs via central route (high message elaboration), or peripheral route (low message elaboration)
Path taken is influenced by Motivation (goal, accountability, need for cognition) and Capacity (ability, distraction, repetition)
Knowledge (BCM)
- Know relevant info
- ‘Taking this medication may reduce your cholesterol by X’
Attitudes (BCM)
- Must believe the advantages of changing outweighs the disadvantage/cost of not changing
o “It will feel good to quit smoking” - Emphasise personal relevance
- Provide many arguments and repeat them
- Provide substitutes/alternative behaviours (baby steps) if they are giving us something pleasurable
o E.g. no-sugar cokes
Normative Beliefs (BCM)
- Others’ approval is a strong motivator – social pressure
- “Others will approve if I quit smoking”
- Motivation is higher if there is more social pressure to perform the behaviour than not perform it
- Changing these is difficult when it contradicts the normative behaviours of a group
o E.g. hard to stop smoking if all of your friends smoke - Work with people to overcome these norms
o E.g. hang out at a café, not a pub
o Avoid people who trigger the behaviour – in the early days of change
Identities and Values (BCM)
- Make the behaviour consistent with their self-image/values
o These identify priorities - Highlight discrepancies in this dynamic
o “you want to be a present parent but your alcohol consumption prevents this” - Value-based work can help them identify theirs
o How the current behaviour isn’t aligned
o How behaviour change is aligned
Self-efficacy (BCM)
Belief in your ability to execute the necessary behaviours to achieve the goal
Critical to behaviour change
Four sources - mastery experiences, vicarious experiences, verbal persuasion, emotional regulation
Mastery experiences (self-efficacy)
o Achieving mastery over other things increases self-efficacy (best method) – refine skills, coping mechanisms
o Failure undermines it
o To build
Set achievable challenges
Practice, practice, practice
Graded steps
Attribute success to their abilities
Must be collaborative planning
Vicarious experiences (self-efficacy)
o Learn through observation of similar peopel
o Goes both ways – if others struggle it may reduce it
o To build
“Do you know anyone who…”, “How did they?”
Encouraging meeting people who have succeeded
Copy peers
* Important to ensure the peers overcame difficulties through effort not luck/ease
Support groups
Verbal persuasion (self-efficacy)
Most common used by health professional
o Provide critical feedback/reinforcement increases self-efficacy
o Only works if they believe
o To build
Give good feedback on performance
Give credible feedback
* “Well done, nearly there. Adding X to the plan might help achieve your goal”
* “You did X twice this week, how can we increase that?”
Emotional regulation (self-efficacy)
o Positive mood can boost self-efficacy
o Anxiety can undermine it, especially if they believe arousal will decrease performance
o To build
Normalise anxiety
Remove stressful elements by managing mood before and during performance
Psychoeducation – teach Yerkes-Dodson law
* Optimal performance occurs during physiological arousal
* Challenges their belief that they can’t do something when anxious
Goal Setting (BCM)
Define a goal to guide behaviour
Make it SMART
* May need smaller SMART sub-goals to get there
Action (BCM)
Assessment of skills
* Motor
* Social
* Self-regulatory
* Self-care
Teaching skills
* Instruction
* Demonstration
* Practice
o Roleplay potential scenarios
o Trying out behaviour (e.g. rehab exercises)
* Feedback
If-then planning
If-then planning (Action;BCM)
Key cognitive skill/tool
* ‘Implementation intentions’
o Specify when, where, and how the goal will be achieved
* IF identifies the cue to act. This might be a time/place
* THEN identifies an effective goal-directed response
o IF I find myself in X situation, THEN I will perform goal-directed response Y
* Helps
o Identify situations they can link to engagement with new behaviour
o Protect motivation from unhelpful thoughts and feeling
* Enhances goal-directed action by
o Facilitating cue identification
o Creating automatic association between context and action
o Leading to automation of behaviour – reduced effort
o Increase speed of response
o Mimicking the effects of previous practice
Self-monitoring (BCM)
Monitor behaviour
* Important – otherwise they are driving blind
o Is it really changing
o How much is it changing
o Why isn’t it changing
o Why is it changing
o How it is making them feel
* Things to monitor
o Behaviour patterns in relation to goal
o Immediate reactions
o Changes in wellbeing
Monitor reactions
* Actual experiences acting on or resisting temptation
* Challenge of noticing changes in levels of reaction
* Separate initial ‘automatic’ reactions from those that arise due to thoughts
* Assess reactions to slow progress and potential diminishing self-efficacy
Monitor changes in aspects of wellbeing
* From minutes after behaviour to days and weeks after
* If positive, great
* If negative
o Work out whether linked to the behaviour change
Is the effect temporary? (usually is)
How to minimise the negatives
Summative Evaluation
* Evaluate all 3
* Do regularly in the early days
* Can also be triggered by a crisis
* Celebrate success
o Builds self-efficacy
* Learn from set-backs
o Have a recovery plan
o View them positively (teachable moments)
Goal Review (BCM)
Was the goal too ambitious?
Not specific enough?
Amend goals if needed
Can we make it more challenging?
Avoid reviews when actively facing challenges – less objective then
Habits (BCM-adjacent)
Critical to behaviour change
Formed via repeated matching/associations over time between
* 1. A cue or situation and a behaviour
* 2. The behaviour and a reward (emotional or physiological)
More on this in lecture
Types of evalaution
Process (implementation) and Outcome (effectiveness)
Process evaluation
o Helps to identify intervention strengths, weaknesses, and areas for improvement
o Always done with stakeholders
o Assess
Fidelity
Dose delivered
Dose received
Reach
Recruitment
context
Outcome evaluation
o Cost-effectiveness
o Assess if change occurred, to what extent, and if the changes are associated with the program
o Also done with stakeholders
o Assess
Before implementation
Social-ecological theories
Changing the environment is the key
Cannot explain repeated failures
Expectancy value theories
Like theory of planned behaviour
Good for trying, hopeless for success
Narrative theories
Explain, don’t predict
Self-protection theories
Only focus on avoiding harms
Self-regulation theories
Over-focus on self-control
Learning theories
Struggle with complexity
Adult Learning Theory
AKA Andragogy
o Self-directed
o Goal orientated
o Practical
o Respect
o Relevancy orientated
Designing Behaviour Change Interventions (steps)
Stage 1 - understand the behaviour
- define the problem in behavioural terms
- select target behaviour
- specify the target behaviour
- identify what needs to change
Stage 2 - identify intervention option
- intervention functions
- policy categories
Stage 3 - identify content and implementation option
- behaviour change techniques
- mode of delivery
Characteristics of Science Denial
FLICC
Fake experts
Logical fallacies
Impossible expectations
Cherry picking
Conspiracy theories
Deconstructing Information Process
Construct argument –> Check validity (valid) –> Check premises (true) –> Claim succeeds; (false) –> Claim fails
Check validity (invalid) –> Hidden premise (remains invalid=claim false; restored validity –> Check premises)
Research Impact Pathway
Input –> Activities –> Outputs –> Outcomes –> Benefits
most academics stop at outputs, in practice you want to do the whole thing
Theory of Change
§ A method for planning how to translate research activity into social change with sets of stakeholders
§ Researchers almost never go through this process
Key steps
Focus on the high-level intended change
Identify what is needed for the change to happen
Establish and make explicit the related key assumption underpinning the theory of how change happens, and major risks that may affect it
Identify partners and actors who will be most relevant for achieving each result
Assess the model
- Plausibility
- Feasibility
- Testability
Co-design
o Community engagement has been broadly defined as involving communities in decision-making and in the planning, design, governance and delivery of services
Inform + educate (doing to)
Consult + involve (doing for)
Co-design + Co-produce (doing with)
Citizen led (doing by)
Generative Methods
Set of techniques and activities used to stimulate creativity, encourage idea generation, and facilitate the collaborative development of innovative solutions
Two categories of behaviour change approaches
Top-down
- driven by the agent deliberately acting upon their environment
Bottom-up
- driven by the environment, often circumventing the deliberation of the agent
Behaviour from top-down
most psych approaches - dominant perspective in behaviour change research and policy
o Agent is the unit of analysis and role of agency behaviour
o Behaviour as the result of conscious or unconscious cognitive processes
o Basically – aim to account for the “black box” between the agent and behaviour, often disembodied from concrete behavioural context
(e.g. Reasoned Action Approach)
Reasoned Action Approach (RAA; Model)
Background factors –> Beliefs (outcome, normative [injuctive/descriptive], control) –> Intentional Antecedents (attitudes, norms [descriptive, injunctive], -perceived behavioural control) –> Behavioural Antecedents (intentions, perceived behavioural control) –> Behaviour
Attitude theory
Dominant behaviour paradigm in the 70’s (composition and effects of attitudes)
Theory of Reasoned Action
Late 70’s, after attitude theory
Accounted for the fact that attitudes are poor predictors of behaviour
Predicted intentions using attitudes and norms (social pressure)
Followed by Theory of Planned Behaviour
Theory of Planned Behaviour
Followed Theory of Reasoned Action
Included perceived behavioural control to account for behaviours with low volitional control
Most common in the literature
Reasoned Action Approach (Info)
Current version following Theory of Planned Behaviour
Distinguishes between injunctive norms (what we think others think we should do) and descriptive norms (what we think others do)
o Arguably the best top-down model we have
o But at best still does not explain the majority of variance in behaviour
Intention-behaviour gap
Wording Measured in RAA
TACT
Target - an energy-efficient fridge
Action - I will install
Context - in my home
Time - in the next six months
Why RAA is good
Efficient - high amount of variance in behaviour using small number of variables
Standardised - prescriptive procedure and measures
Reliable - internal, test-retest
Flexible - designed for health behaviours but has been successfully applied to pretty much any behaviour you can think of, with consistent results
Effective - explains high amount of variance in intentions and behaviour
Empirically supported - literally hundreds (if not thousands) of studies now demonstrating consistent, effective results across suits of behaviour
BUT - it’s missing context
More Comprehensive Top-down Approaches than RAA
o Social psych models that formally account for context but in an arguably abstract and cognitive (top-down) way
o CEOS (Borland)
o Theory of Interpersonal Behaviour (Triandis)
Behaviour Approaches From the Bottom-Up
o Social Practice Theory (Shove), Nudge (Thaler & Sunstein)
o Behaviour is the result of the behavioural context in which it occurs
Concrete context as driver of behaviour, to the exclusion of cognitive processes
Social Practice Theory (Shove)
o Clearest and most systematised social practice approach
o Behaviour comprises 3 variables of context
Materials
* Physical objects involved in the behaviour
Meanings
* Mental activities associated with the behaviour
* E.g. associating an energy-efficient fridge with a sense of prestige
Competences
* Physical and mental skills involved
o Challenges the idea that motivation is a prerequisite for behaviour
Bypass cognition all together
Entirely concrete context
RAA Strengths
Predicts approximately:
* 30% to 60% of the variance in intentions
* 20% to 40% of the variance in behaviour
Interventions have medium effect sizes for changes in all constructs
Efficient
* Large amounts of variance with small number of variables measured
Standardised
Reliable
Empirically supported
Thorough account of more abstract context surrounding behaviour
RAA Limitations
Issues with sufficiency
* Can’t explain intention-behaviour gap
* Can’t explain why additional variables can increase the amount of variance in intention/behaviour explained
* Issues capturing concrete context that drives behaviour?
Social Practice Theory Strengths
Context as unit of focus and analysis provides a new complementary lens through which to view a behaviour, facilitates intervention innovation
Structural approach
* Reduces reliance on individual differences, potentially informing more universal behaviour change interventions
* Allows for upstream (structural, policy) points of intervention - don’t need to involve or persuade the individual
Social Practice Theory Limitations
Neglect of individual agency
* Cannot explain how some people are more readily recruited by practices than others
* Cannot explain individual variation in practice performance
Limits behaviour change innovation to upstream interventions only
* Ethical issues
* Behaviour change will likely only occur as long as altered contextual interventions are in place and unmodifiable
Using RAA and SPT Together
Social practice theory contextual beliefs predict intentions over and above reasoned action appraoch constructs
The reasoned action appraoch and social practice theory can be used side-by-side as dual lenses through which to predict behavioural intentions to a greater extent than either alone
Illusory Truth Effect
The more people that encounter misinformation and don’t challenge it, the more it seems true, and the more it sticks
Good Model for Misinformation Refutation
Fact –> Myth –> Fallacy –> Fact (again)
State the real fact, then the common myth, then explain why that is a fallacy, then finish on reinforcing the fact
What is Co-design?
○ A design process that involves:
§ Active participation and collaboration between designers, stakeholders, and end users
§ Integrating diverse perspectives, and iteratively refining ideas
§ A range of tools and exercise to optimise collaboration and generate insights and ideas
Mindsets of co-design (most important slide)
○ Elevate the lived experience
○ Value many perspectives
○ Curiosity
○ Hospitality
○ Learn through doing
Background Factors (RAA)
Not measured; e.g. Culture, education, knowledge
Form outcome, normative, and control belief
Beliefs (RAA)
o Outcome beliefs (beliefs about consequences of behaviour x likelihood that consequence will arise) predict attitudes
o Injunctive normative beliefs (whether we think important or similar others think we should perform the behaviour x motivation to comply with those others) predict injunctive norms
o Descriptive normative beliefs (whether we think important or similar others perform the behaviour x desire to be like those others) predict descriptive norms
o Control beliefs (beliefs about the specific barriers and facilitators of a behaviour x the power of the control factor) predict perceived behavioural control
Intentional Antecedents (RAA)
o Attitudes (evaluations of the behaviour), injunctive norms (what we think others think we should do), descriptive norms (what we think others do), and perceived behaviour control (how much or little control we think we have over a behaviour) predict intentions
Behavioural Antecedents (RAA)
o Intentions and sometimes perceived behavioural control predict behaviour
Self-Determination Theory
o Can be useful when looking at designing/evaluating interventions for people
o Autonomy, competence, relatedness
Example of the guy with the tech walking stick – no choice (autonomy), not really related, and he might not have been capable of doing all the steps
Social and Emotion Wellbeing (SEWB) Framework (description)
Strength-based approach:
The Social and Emotional Wellbeing diagram is a conceptual framework to organise your thinking about the social and emotional wellbeing of First Nations people and to inform the way you deliver services
SEWB Framework
4 determinants covering 9 guiding principles:
- Cultural determinants of SEWB (5)
- Social determinants of SEWB and mental health (1)
- Historical determinants of SEWB and mental health (1)
- Political determinants of SEWB and mental health (2)
Cultural Determinants of SEWB
Aboriginal and Torres Strait Islander health is viewed in a holistic context, that encompasses mental health and physical, cultural and spiritual health. Land is central to well being. Crucially, it must be understood that when the harmony of these interrelations is disrupted, Aboriginal and Torres Strait Islander ill health will persist.
Culturally valid understandings must shape the provision of services and must guide assessment, care and management of Aboriginal and Torres Strait Islander peoples health problems generally and mental health problems in particular.
The centrality of Aboriginal and Torres Strait Islander family and kinship must be recognised as well as the broader concepts of family and the bonds of reciprocal affection, responsibility and sharing.
It must be recognised that Aboriginal and Torres Strait Islander peoples have great strengths, creativity and endurance and a deep understanding of the relationships between human beings and their environment.
There is no single Aboriginal or Torres Strait Islander culture or group, but numerous groupings, languages, kinships, and tribes, as well as ways of living. Furthermore, Aboriginal and Torres Strait Islander peoples may currently live in urban, rural or remote settings, in urbanized traditional or other lifestyles, and frequently move between these ways of living.
Social Determinants of SEWB and Mental Health
Racism, stigma, environmental adversity and social disadvantage constitute ongoing stressors and have negative impacts on Aboriginal and Torres Strait Islander peoples’ mental health and
wellbeing
Historical Determinants of SEWB and Mental Health
It must be recognised that the experiences of trauma and loss, present since European invasion, are a direct outcome of the disruption to cultural wellbeing. Trauma and loss of this magnitude continues to have inter-generational effects.
Political Determinants of SEWB and Mental Health
The human rights of Aboriginal and Torres Strait Islander peoples must be recognized and respected. Failure to respect these human rights constitutes continuous disruption to mental health, (versus mental ill health). Human rights relevant to mental illness must be specifically addressed.
Self-determination is central to the provision of Aboriginal and Torres Strait Islander health
services
Equity
○ 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 often cannot
§ Literacy
□ Information needs to be
communicated in a way that
reaches all groups
□ COVID-19 and migrant
communities
Breaking Habits
○ Reframe potential losses as gains (e.g. “Doing this means I will be able to chase after my kids without losing my breath”)
○ Consciously rehearse self-regulatory plans (e.g. Engaging in controlled breathing when anxious)
○ Consciously focus on improving self-efficacy (e.g. Can-do self talk - “I can run the next 500m”, “I can order a coffee without a croissant”)
○ Focus on likely feelings of failure (i.e., anticipated regret) if client does not engage in a behaviour in which they planned to engage in or does engage in a behaviour in which they did not plan to engage (“I will feel guilty if I buy this doughnut when I didn’t plan to”, “I will feel awful if I don’t go to the gym when I had planned to”)
○ Set some absolute rules (e.g. “for the next 3 weeks I will not go to the coffee shop with the nice pastries”)
○ Learn competing thought (e.g. “This feeling of anxiety is normal and will pass, I need to ride it out like a wave” vs “this feeling is awful and I can’t stand it any longer, I must smoke a cigarette/have a drink”)
○ Over time, cue is reconceptualised and competing behaviours and thoughts become dominant
○ Help client unlearn emotional associations, which can strengthen the impulse to act in response to cue (e.g. When walking past the bakery: “that cake will taste delicious” vs “That cake will taste delicious for 5 mins but then I will feel guilty for the rest of the day”)
○ Seek social support (e.g. Share goals with others and ask them to help)
§ Help your client identify those who may not want them to change (e.g. If your client quitting smoking means there is only one smoker left in the group)
Co-Design Principles (working with young people)
- Have clear expectations
- Be flexible
- Involve more than one young person
- Value experience and skills
- Ensure there is mutual benefit
- Reimburse appropriately
- Support involvement
- Provide adequate feedback
- Avoid tokenism
