1. Social Cognitive Theory Caroline McNaughton Tittel Nutrition Education May 22, 2000

2. Social Cognitive Theory Mischel & Bandura SCT addresses –Psychosocial dynamics influencing health behavior –Methods of promoting behavior change Self-efficacy, self-confidence, and outcome expectations Reciprocal determinism –Behavior, personal factors & environment all interact

3. Reciprocal Determinism Bandura Person EnvironmentBehavior

4. Relevance of SCT to Health Education Comprehensive –Cognitive, emotional & behavioral explanations of behavior  Constructs provide avenues for behavioral research & health education practice Application of theoretical ideas developed in other areas of psychology to health behaviors & behavior 

5. Constructs of SCT Mischel & Bandura Environment Situation Behavioral capability Expectations Expectancies Self-control Observational learning Reinforcements Self-efficacy Emotional coping responses Reciprocal determinism

6. Use of SCT in Nutrition Predicting Influences –“Social cognitive model of fruit and vegetable consumption in elementary school children” -Resnicow K et al – “Social-cognitive predictors of fruit and vegetable intake in children” - Reynolds KD et al –“Examination of specific nutrition/health behaviors using a social cognitive model” -Lewis CJ et al Interventions –“Gimme 5 fruit, juice, and vegetables for fun and health: Outcome evaluation” -Baranowski T et al –“Development and evaluation of an intervention program: “Control on campus” -Wdowik MJ et al –“Changing fruit and vegetable consumption among children: The 5-a-Day Power Plus program in St. Paul, Minnesota” -Perry CL et al

7. Beverage Consumption Extent to which milk & soda consumption behaviors are influenced by SC variables has not been examined Justification –Current health concerns –consumption behaviors can be measured accurately –comparisons b/t whole/low-fat/skim & regular/diet soda Lewis et al (1989) J Am Diet Assoc; 89:194-202

8. Study Design Lewis et al Written questionnaire mailed in 2 phases –Phase 1: 39 items frequency of consumption, knowledge, attitudes & behavior as well as demog –Phase 2: 59 items differential association, social and non-social reinforcement, behavior modeling 457 adults mean age of 47 y, 58% female 709 college students mean age 21 y, 50% female

9. Model for Food Frequency Consumption Lewis et al Differential AssociationEvaluative Definitions Social Reinforcement Behavior modeling Frequency of food consumption behavior Non-social reinforcement

10. SCT Variables Lewis et al Differential association –perceptions of family, friends, health experts, media Attitude –“milk is important” & “soda is acceptable” Social reinforcement –positive feelings, belonging, pleasing others Nutrition knowledge –“true” & “false” & “don’t know”

11. SCT Variables Lewis et al Behavior modeling –frequency by mother, father, other adult, significant other, friend, & favorite media star Behavioral commitment –selection of beverages low in fat & sugar Taste enjoyment –“not at all” (1) to “very much” (5)

12. Results Lewis et al For both groups and for all 4 beverages, neither social reinforcement nor behavior modeling directly influence FOBC Milk –taste enjoyment, commitment, attitudes toward importance directly related to FOBC for both groups & both whole & low-fat/skim –taste enjoyment related to commitment & attitude –media, student, whole versus family, adult, whole

13. Results Lewis et al Soda –more variable than milk for consumption b/t groups & type of beverage –taste enjoyment & commitment were directly related to FOBC for both groups & both regular & diet

14. Conclusions Lewis et al “Best predictor of behavior is the person’s intention to perform the behavior” “Nutrition knowledge... may help to create an intervening variable, ‘behavioral intention,’ which in turn leads to the actual behavior” “... social beverages... more variable & easily changed... healthful beverages... steady & deeply rooted”

15. Gimme 5! Multi-component randomized school intervention in 4 th and 5 th graders to  FJV consumption Levels of FJV consumption in children range from 1.9 to 2.5 servings –  thru the elementary school years Focus groups conducted to determine environmental, personal & behavioral factors Baranowski et al (2000) Health Education & Behavior ; 27(1):96-111

16. Gimme 5! Baranowski et al 8 matched elementary school pairs 6-week intervention (12 sessions) –conducted by trained teacher –transparencies, handouts, worksheets, posters & weekly newsletters –Taste testing of snacks prepared by FSP –MTV-like video –Role-playing skits –Point-of-Purchase education

17. SCT Variables Baranowski et al Environment –  availability & accessibility Behavioral capability –asking skills, FaSST recipes Outcome expectancies –  performance w/o  acceptance by peers Self-control –Goals for FJV at meals & snacks

18. SCT Variables Baranowski et al Observational Learning –teacher, parents (?) Reinforcement –prizing for completing assignments, congratulations Self-efficacy –Role-play to bolster asking & shopping skills Reciprocal determinism

19. Results Baranowski et al 1,172 students provided 7-d food records for 3 y –15% African American, 85% Euro-American Curriculum implementation was 47% for all activities, w/ only 22% of crucial activities performed  participation in video & POP education activities Effect size of 0.2 servings comparable to other interventions  ’s in weekday FJV consumption –impacting home consumption is elusive

20. Results Baranowski et al

21. Future Directions Baranowski et al Better understanding of food choice More effectively impact mediating variables & processes Explorations of alternatives channels Teacher training which results in higher curriculum fidelity Higher dose of several intervention components

22. Control on Campus Based on SCT and EHBM Type I Diabetes knowledge, attitudes & behaviors assessed pre-, post- & at follow-up –3 intervention cohorts, 1 control –Reporting of HbA1C & knowledge  significantly for intervention groups –More support on campus, overcame fears associated with BG testing,  frequency of BG testing,  testing when BG felt to be low Abstract from Wdowik et al (2000) Diabetes Educ ; 26(1): 95-104

23. Limitations of SCT Too many constructs Limited in its ability to predict behavior No significant behavior  seen in large intervention studies Applied to a single behavior or not Additional influences Fails to address nonlinearities

24. References Baranowski T et al. (2000) Health Education and Behavior ; 27(1):96-111. Elder JP. Motivating Health Behavior. New York: Delmar, 1994. Glanz K. Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass, 1997. Lewis CJ et al. (1989) J Am Diet Assoc; 89:194-202. Perry CL et al. (1998) Am J Pub Health ; 88(4):603-609. Resnicow K et al. (1997) Health Psychology ; 16(3):272-276. Reynolds KD et al. J of Nutr Edu ; 31(1):23-30. Wdowik MJ et al. (2000) Diabetes Educ ; 26(1):95-104.