How can We Capitalize on Connections between Theory and Practice? Perspectives from the Study of Behavior Change Alex Rothman Department of Psychology University of Minnesota Center for Health, Intervention, and Prevention University of Connecticut November 2010

Does it Matter How We Think about the Interplay Between Theory and Practice? Why Construals/Metaphors Might Matter? Guide how investigators think about and conduct their work Guide the composition of research teams Guide how/where/to whom findings are communicated Guide how resources are allocated Guide where resources are allocated (e.g., the design and implementation of systems that support the efforts of investigators) All have implications for progress in theory and practice

Conceptualizing the Interplay Between Theory and Practice Social/Personality Psychology (Basic/Theory) Health (Applied/Practice)

Classic View of the Link between Theory and Practice Social/Personality Psychology (Basic/Theory) Health (Applied/Practice)

“…Many psychologists working today in an applied area are keenly aware of the need for close cooperation between theoretical and applied psychology. This can be accomplished in psychology, as it has been accomplished in physics, if the theorist does not look toward applied problems with highbrow aversion or with a fear of social problems, and if the applied psychologist realizes that there is nothing so practical as a good theory.” --Kurt Lewin ( ), “Problems of research in social psychology”

Classic View of the Link between Theory and Practice Social/Personality Psychology (Basic/Theory) Health (Applied/Practice) Weak/Passive Links

Re-conceptualizing the Link between Theory and Practice Basic/TheoryApplied/Practice Understanding (Social/Personality Psychology) Use (Health) Understanding and Use (Social/Personality & Health) Adapted from Stokes (1997), Pasteur’s Quadrant

“…if the theorist does not look toward applied problems with highbrow aversion or with a fear of social problems, and if the applied psychologist realizes that there is nothing so practical as a good theory.” --Kurt Lewin ( ), “Problems of research in social psychology” The pursuit of understanding and use provides the opportunity to transform a theory into a good theory (Rothman, 2004) (For further discussion, see Suls & Rothman, 2004; Weinstein & Rothman, 2005, Michie, Rothman, & Sheeran, 2008; Rothman, 2009)

InterventionBehavior Action Theory Conceptual Theory What Could a “Good Theory” Do? PredictorMediator

InterventionBehavior Moderator (action) What Could a “Good Theory” Do? Mediator For Whom (people)? For What (behavior)? Moderator (conceptual)

InterventionBehavior What Could a “Good Theory” Do? Mediator Timing: When does it matter? Specificity: What matters when? Behavior Mediator Initiation Maintenance

Pursuing Understanding and Use in Research at the Interface Between Social/Personality Psychology and Health 1. Initiation and Maintenance of Behavior Change (Rothman, 2000; Rothman et al., 2004, 2010) Specify the psychological processes that regulate the initiation and maintenance of behavior Design and test theory-based intervention strategies to promote healthy behavior 2. Framing Health Messages (Rothman & Salovey, 1997; Rothman et al., 2008; Rothman & Updegraff, in press) Specify the processes that mediate and moderate the influence of gain- and loss-framed messages Design and test theory-based communication strategies to promote healthy behavior

Model of Behavioral Initiation and Maintenance (Rothman, 2000; Rothman, Baldwin, & Hertel, 2004; Rothman, Hertel, Baldwin, & Bartels, 2008) Behavioral Initiation Guided by expectations about outcomes and process Optimistic expectations predict interest and initial success Motivated by desire to approach favorable goal (i.e., to be thin) Progress is marked by a change in discrepancy between current state and a goal state Behavioral Maintenance Guided by satisfaction with outcomes and process Satisfaction predicts long- term success Satisfaction based on comparison of experiences to expectations Motivated by a desire to avoid unfavorable goal (i.e., not be a smoker) Progress is marked by a sustained discrepancy between current state and a prior state

Intervention Initial Behavior Expectations/ Confidence Sustained Behavior Satisfaction Model of Behavioral Initiation and Maintenance (Baldwin et al., 2006, Health Psychology; Finch et al., 2005, Health Psychology; Hertel et al., 2008, Health Psychology) (Tested in a parallel set of community-based Interventions designed to promote either smoking cessation or weight loss)

Challenge Smoking Cessation Project: Expectation-Based Intervention 8 week group-based quit program Quit date between 4th and 5th session 529 Participants were randomly assigned to: (a) Optimistic treatment program –Focus on the benefits of quitting; Emphasize maintaining a positive view of cessation outcomes and process (b) Balanced treatment program –Focus on both benefits and costs of quitting; Emphasize maintaining a balanced view of cessation outcomes and process (Hertel et al., 2008, Health Psychology; see also Finch et al., 2005)

Effect of Intervention Condition on Smokers’ Quit Status at End of Active Treatment (Session 8) [Condition x Prior Abstinence Interaction: p <.05] Percent Smoke Free for last 7 days

Effect of Intervention Condition on Smokers’ Expectations and Confidence Longest Prior Quit Longest Prior Quit > 3 months < 3 months Optimistic Balanced Optimistic Balanced condition condition condition condition Beliefs assessed at Session 4 on 9 point scale ranging from –4 to +4 (expectations) and from 0 to 8 (self-efficacy) [Condition x Prior Abstinence Interaction: p’s <.05] Expectations about outcomes 4.80 (.14) 2.25 (.07) 2.19 (.08) 2.39 (.08) Confidence about ability to quit 5.21 (.14) 4.75 (.12) 2.42 (.08) 4.93 (.14)

Do Beliefs About Cessation Mediate the Interaction Effect on Smoking Status at Session 8? Intervention Condition X Prior Quit Length Self-Efficacy (session 4) Smoke Free at Session 8 (p >.10) =.77  =.77 [Direct effect: =.87, p <.05 ] [Direct effect:  =.87, p <.05 ] [Sobel test: z = 1.90, p <.05] Expectations (session 4)  =.65 (p<.05)  =.21 (p<.01)  =.38 (p<.05)  =.17 (p<.01) Action Theory Conceptual Theory

Effect of Intervention Condition on Smokers’ Quit Status after 6 Months and 18 Months Percent Smoke Free for last 7 days [Condition x Prior Abstinence Interaction: p’s <.05]

Specifying the Process: Did the Intervention Have a Direct or Indirect Effect on Smoking Status at 6 Months? Intervention Condition X Prior Quit Length Smoke Free at Session 8 Smoke Free at 6 Months (p >.20) =.72  =.72 [Direct effect: =1.05, p <.05] [Direct effect:  =1.05, p <.05] [Sobel test: z = 2.04, p <.05]  =.87 (p<.05)  =2.53 (p<.01)

Specifying the Process: Does Satisfaction with Behavior Change Underlie Sustained Behavior Change? Smoke Free at Session 8 Satisfaction with quit at Session 8 Smoke Free at 6 Months (p <.01) =1.53  =1.53 [Direct effect: =2.53, p <.01] [Direct effect:  =2.53, p <.01] [Sobel test: z = 2.36, p <.05]  =4.02 (p<.01)  =.23 (p<.05) (See also Baldwin et al., 2006)

Implications and Lingering Questions: I Integrating models of prediction and models of change: Action theory and conceptual theory (cf. Jeffery, 2004; Rothman, 2004) What are the determinants of people’s satisfaction? (Baldwin et al., 2009, Psychology & Health; in press, Annals of Behavioral Medicine) How can we design methods to enhance the satisfaction people derive from changes in their behavior?

Initial Behavior Behavioral Outcomes/ Experience What Could a “Good Theory” Do?: Subsequent Behavior Satisfaction Moderators of Output: Biological Factors Moderators of Input: Dispositional/Goal Factors What mediates the Mediator? What moderates the Mediator? Targets for Intervention

Do Initiation and Maintenance benefit from different self-regulatory strategies? Higgins (1998) proposed two styles of self-regulation: –Promotion-focus: Concern with accomplishments, hopes, aspirations; focus on eager approach-based strategies and positive outcomes. –Prevention-focus: Concern with safety, responsibility, obligations; focus on vigilant avoidance-based strategies and negative outcomes.

Intervention Initial Behavior Promotion Focus: Concern with accomplishments, hopes, aspirations; focus on eager approach-based strategies and positive outcomes Expectations/ Confidence Sustained Behavior Satisfaction Prevention Focus: Concern with safety, responsibility, obligations; focus on vigilant avoidance- based strategies and negative outcomes RFQ (regulatory focus questionnaire; Higgins et al., 2001) was completed at baseline in both the smoking cessation and weight loss interventions (Fuglestad et al., 2008)

Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology) H1: Participants who score higher on promotion-focus will have greater success losing weight

Challenge Study: Weight Loss Hypothesis 2: Participants who score higher on prevention-focus will have greater success maintaining weight that was lost  How do you operationalize maintenance?  5% weight loss maintained for at least 1 month  Discrepancy between weight and acceptable weight loss goal (assessed at base line) Small Discrepancy: Focus on maintaining weight loss Large Discrepancy: Focus on continuing to lose weight

Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

Challenge Study: Smoking Cessation Looking more closely at how promotion focus may help: Does a promotion-focus help people respond to a slip?

Challenge Study: Smoking Cessation Looking more closely at how promotion focus may help: Does a promotion-focus help people respond to a slip?

Challenge Study: Smoking Cessation Looking more closely at how promotion focus may help: Does a promotion-focus help people respond to a slip?

Challenge Study: Smoking Cessation

Implications and Lingering Questions: II Potential implications for practice Provide initiation/maintenance strategies that match people’s chronic focus Use RFQ scores to identify “vulnerable” actors and provide additional support (A few) Lingering questions: What does the RFQ measure? How do we integrate models of self-regulation with models of behavior change?

Pursuing Understanding and Use in Research at the Interface Between Social/Personality Psychology and Health? 1. Initiation and Maintenance of Behavior Change (Rothman, 2000; Rothman et al., 2004, 2010) Specify the psychological processes that regulate the initiation and maintenance of behavior Design and test theory-based intervention strategies to promote healthy behavior 2. Framing Health Messages (Rothman & Salovey, 1997; Rothman et al., 2008; Rothman & Updegraff, in press) Specify the processes that regulate the influence of gain- and loss-framed messages Design and test theory-based communication strategies to promote healthy behavior

Predicting the Impact of Gain and Loss Framed Messages: Two Perspectives Perspective #1: The impact of gain- and loss-framed messages depends on the match between the frame and the risk implications of the behavior promoted (e.g., Rothman & Salovey, 1997; Rothman et al., 2008; Bartels et al., 2010) Function of the behavior (e.g., detection/prevention) Construal of the behavior/health issue (e.g., risk) Perspective #2: The impact of gain- and loss-framed messages depends on the match between the frame and the motivational orientation of the recipient (e.g., Mann et al., 2004; Updegraff et al., 2007) BIS/BAS (Carver & White, 1994)

Rothman et al. (1999)Mann et al. (2004)

Message Framing Intervention to Promote Mammography: Testing Competing Moderators 355 women (40 and older, M=51) recruited at an inner city hospital (49% African American); all due for a mammogram Measured: (a) How mammography is construed (i.e., illness detecting vs. health affirming) (b) Perceived susceptibility for developing breast cancer (Champion, 1999) (c) Motivational orientation (BIS/BAS) Viewed 10 minute gain- or loss-framed video about mammography 3 month follow-up interview (mammography utilization) (Funded by NCI Grant R03-CA128468; Updegraff, PI)

Main Effect of Frame on Mammography Utilization Percent Screened at 3 Months (Gallagher, Updegraff, Rothman, & Sims (in press), Health Psychology)

Perceived Susceptibility of Developing Breast Cancer Moderated Effect of Message Frame on Screening Behavior (Gallagher, Updegraff, Rothman, & Sims (in press), Health Psychology)

Construal of Mammography Moderates Framing Effect: Women with Family History of Breast Cancer (N=63) Percent Screened at 3 months

Implications and Lingering Questions: III Implications for Theory and Practice (understanding and use): Provides an initial progress toward integrating current theoretical models (Rothman & Updegraff, in press) Better specification of the factors that moderate responses to gain- and loss-framed appeals Lingering questions: To what extent does the pattern of findings obtained generalize to other behavioral domains? Are there specific situations when the moderating effect of dispositional factors such as motivational orientation will be obtained? Are framed appeals effective because they persuade people to act or because they nudge people to act?

What can be done to promote the pursuit of understanding and use? Take our theories seriously We need to mindful of what our theories do and do not say We need to pursue opportunities to challenge our theories and discern what they can and cannot do. Need an environment that supports these efforts: NCI Theories Project ( Work by Susan Michie and colleagues Advanced Training Institute on Health Behavior Theory (2012), ( )

Promoting the Pursuit of Understanding and Use: Linking Social/Personality Psychology and Health Social Personality & Health Network ( Social Personality and Health Pre-conference prior to 2011 SPSP meeting

Contact Information Alex Rothman Department of Psychology University of Minnesota Phone:

RFQ Instructions: This set of questions asks you how frequently specific events actually occur or have occurred in your life. Please read each statement carefully. Using the scale below, indicate the number that best reflects your experience Never Seldom Sometimes Very often 1. Compared to most people, how often do you get what you want out of life? (Pro) 2. Growing up, how often did you “cross the line” by doing things that your parents would not like? (Pre R) 3. How often has succeeding at things inspired you to work even harder? (Pro) 4. How often did you get on your parents’ nerves when you were growing up? (Pre R) 5. Growing up, how often did you obey the rules that were made by your parents? (Pre) 6. Growing up, how often did you act in ways that your parents thought were not good? (PreR) 7. How often do you do well at different things you try? (Pro) 8. How often have you gotten into trouble because you were not being careful enough? (PreR) 9. When it comes to succeeding at things that are important to you, how often do you not do as well as you would like to? (Pro R) 10. How often do you feel like you have been successful in your life?(Pro) 11.How often have you found hobbies or activities in your life that you enjoy spending a lot of time doing? (Pro)

Correlation between RFQ and BFI Dimensions (n=200)

Relation between Prevention Focus and BFI Facets (n=200) Conscientiousness Agreeableness

Relation between Promotion Focus and BFI Facets (n=200) Extraversion Agreeableness Conscientiousness

Relation between Promotion Focus and BFI Facets (n=200) Neuroticism Openness

Challenge Study 1A: Smoking Cessation Hypothesis 1: Smokers who score higher on promotion-focus will be more likely to initiate cessation successfully Hypothesis 2: Smokers who score higher on prevention-focus will have greater success maintaining cessation  Differentiated between people who had quit smoking for 2 months and those who had not done so.

Challenge Study 1A: Smoking Cessation (Fuglestad et al. (2008) Health Psychology)

Challenge Study 1A: Smoking Cessation (Fuglestad et al. (2008) Health Psychology)