Behaviour Change
Past & current theories of how to get people from thinking
to doing
PART 1
Corinne Hodgson
Corinne S. Hodgson & Associates Inc.
2014
Overview
 Part 1
 Traditional theories such as Transtheoretical Model, Model
of Reasoned Action/Planned Behaviour, and Social Cognitive
Theory
 Opportunities from other areas of psychology: achievement
theory, self theory, and self-determination theory
 Part 2: Health Action Process Approach and Self-Regulation
 Part 3: New models from interactive health (Fogg, Eyal)
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Online behaviour change tools:
Systematic review of 85 RCTs
 Webb TL et al. (JMIR 2010 12(1):e 14) used Michie & Prestwich coding scheme (Health
Psychology 2010;29(1):1-8) to identify theory of behaviour change
 Theories included:




Transtheoretical model (12 studies)
Social cognitive model (12 studies)
Reasoned action/planned behaviour (9 studies)
Elaboration likelihood (2 studies) – communications theory of how attitudes are formed/people
are persuaded
 1 study each:
 Extended parallel process – 4 factors affect how people will respond to fear message: self-efficacy,
response efficacy, perceived susceptibility, and severity of the threat
 Self-regulation – how people monitor & manage their behaviour
 Precaution adoption process – 7 cognitive stages: unaware, unengaged, undecided, decided not to act
or decided to act, acting, and maintenance
 Diffusion of innovations
 Health belief – belief in a personal threat + belief in effectiveness of proposed behaviour = likelihood
of changing behaviour
 Social norms – group-held beliefs about how people should behave
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Three most commonly-used theories
1.
Transtheoretical Model (Prochaska, 1977)
Essence: change is a process and you can move closer
to – or further away from – change depending upon
 Self-efficacy
 Decisional balance
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Transtheoretical Model
(Prochaska, 1977)
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Strengths & weakness of
Transtheoretical Model
Strengths
Weaknesses
 If you know people’s stage,
you can tailor messages so you
meet them “where they are” &
not alienate them
 Large evidence base
 Can work with any theory of
behaviour change (hence
“trans-theoretical)
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 Good at telling you where
people are but weak on
process whereby they move
between stages
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Three most commonly-used theories
of behaviour change
2. Theory of Reasoned Action (Fishbein & Ajzen 1975) /
Theory of Planned Behaviour (Ajzen 1985)
 As name implies, infers people are making rational
choices (“economic man”)
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Theory of Reasoned Action
Behavioural beliefs
Evaluation of
behavioural
outcomes
Attitude toward
behaviour
Normative beliefs
Subjective norm
Motivation to
comply
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Behavioural
intention
Behaviour
Theory of Planned Behaviour
Behavioural beliefs
Attitude toward
behaviour
Evaluation of
behavioural outcomes
Normative beliefs
Subjective norm
Motivation to comply
Control beliefs
Perceived
behavioural control
Perceived power
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Behavioural
intention
Behaviour
Strengths & Weaknesses of Theory of
Reasoned Action/Planned Behaviour
Strengths
Weaknesses
 Well-established theories that
have been used for years > lots
of experimental and practical
evidence
 Easy to understand
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 Reality is that people often
don’t make “rational” choices
or “plan” their behaviour
 Assumes that behaviour
change naturally follows
development of intention
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Three Most Commonly-used Theories
3. Social Cognitive Theory
 What we think (cognition) influences our behaviour
but is heavily influenced by what we learn from
others (social)
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Social Cognitive Theory (Miller &
Dollard 1941, Bandura 1980s)
 More holistic approach
 Behaviour is the result of a combination of:
Personal Factors:
Beliefs
Self-efficacy
Self-control
Expectations
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Social Factors:
Environment
Observational learning
Social modelling
Reinforcement
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Social Cognitive Theory
Strengths
Weaknesses
 Well-established theory
 Acknowledges the important
role of environment and other
people
 Because it addresses
environment, useful for issues
such as smoking
 Weak at understanding the
process by which individuals
decide to change – especially if
they are “going against the
flow”
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Other theories
 May be time to look at other theories and other areas of
psychology to understand the complex process by which
people move from just thinking about change to actually
taking action
 Few theories have yet to capitalize on learnings from:
 Achievement Theory (Achievement Goal or Goal Orientation)
 Self Theory or Mindset
 Self-Determination Theory
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Achievement Goal or Goal
Orientation (Eisen, Nicholls, Elliott)
 Ego or performance orientation: focus is on doing
well and demonstrating your competence to others
 Problem: when tasks get difficult may feel anxious or
helpless; afraid of failure so may quit or avoid harder
tasks
 Task or learning orientation: focus is on learning –
enjoys the process & not worried about the outcome
or outcome compared to others
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Self Theory or Mindset (Dweck 2006)
 Developed out of achievement literature
 Two basic mindsets:
 Fixed or Entity: belief that basic ability or talent are
fixed traits
 Growth or Incremental: belief that people can develop
their abilities through effort and persistence
Elliot and Dweck 2005
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Mindset & Achievement Goals
Trichotomous Achievement Goal Framework
Mindset
Achievement Goal
Fixed/Entity
Approach
(Dweck)
Or
Avoidance
Performance/
Ego (focus on what
you achieve)
Growth/IncreApproach
mental (Dweck)
Or
Mastery/Task
Avoidance
(focus on process of
learning)
Adapted from Elliott and McGregor 2001
Behaviour
Anxious to do well to confirm you are
“one of the smart ones”
Failure would show you aren’t smart
so often avoid challenges (select easier
tasks, quit when it gets hard)
Will persist in even difficult tasks in
order to “figure it out” and learn how
to master the task
Goal is to avoid deterioration in
performance or skill
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Self Theory Applications
 To date, Mindset or Self theory has been used
primarily in education
 Exciting aspect is that even simple changes can give
people more of a “growth” mindset
 Focus on level of effort not outcome
 Prime with messages or stories on how intelligence is
malleable and can be improve
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Application to health?
 Similar fixed/entity attitudes can be observed in health:
 “I’m not the athletic type”
 “I have no willpower”
 “I’ve always been fat”
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Self-Determination Theory (Decci &
Ryan 1970s)
 Motivation can stem from yourself (intrinsic) or outside
yourself (extrinsic)
 Intrinsic motivation stems from 3 basic universal psychological
needs to feel:
 Close to others (relatedness) << power of peers/social norms
 Good at something (competence)
 In control of your life (autonomy)
 Often simplified into “intrinsic motivation is good” and
“extrinsic motivation is bad” but actually more complex
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Self-Determination Regulation
Financial
Incentives
Reasonable behaviour Ultimate
change goals?
goal
Type of
Motivation:
Amotivation
Extrinsic Motivation
(Lack self-efficacy
or don’t value
activity or
outcome)
(Motivation is external but different degrees of internalization)
Type of
Behavioural
Regulation:
Nonregulation
External
Introjected
Identified
Integrated
(Reward or
punishment
experienced
as
(Some
internalization
so perform to
avoid guilt or
shame or to
feel
worthwhile)
(More
internal locus
of control &
more
conscious
valuing as
important)
(Perform to
attain
personallyimportant
outcomes but
not for their
inherent
interest &
enjoyment)
controlling)
Quality of
Behaviour:
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Nonself-determined
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Intrinsic
Motivation
Intrinsic
(self)
regulation
(Find activity
interesting &
enjoyable; doing
it enhances
sense of
relatedness,
competency
&/or autonomy)
Selfdetermined
Decci & Ryan. Handbook of Self-Determination Research (2002)
Relationship between stages of
change & type of motivation
A study of 175 people with type 2 diabetes measured selfdetermined motivation for exercise and stage of change at
baseline, 3 months & 6 months
 Progressors: large increase in self-determined exercise
motivation from baseline to 3 months and another, smaller
increase from 3 to 6 months
 Non-progressors (n=37) had an initial large increase in selfdetermination from baseline to 3 months but then it declined
over next 3-6 months
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Source: Fortier et al J Health Psychology 2012
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Balance between internal & external
motivators for physical activity may vary
across stages
 Pre-contemplation: extrinsic motives (appearance & weight)
dominated over intrinsic (enjoyment & revitalization)
 Contemplation: domination of extrinsic motivation not as
strong
 Preparation: extrinsic motivation even weaker
 Action: extrinsic motives again dominant over intrinsic
 Maintenance: intrinsic motives more important than
extrinsic
Markland and Ingeldew (2007)
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Motivation may also vary across life
stages
Retrospective study of women’s motivation for physical activity:
 Childhood: autonomously & intrinsically motivated – active because it
was fun
 Adolescence: combination of autonomous & non-autonomous – active
because it is a form of socializing
 Younger adulthood or motherhood: mostly non-autonomous – to get
back in shape
 Middle adulthood: combination of autonomous & non-autonomous –
appearance, weight control & health
 Older adulthood: mostly autonomous – to be healthy
Source: Fortier & Kowal, 2007
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Summary
 Both extrinsic and intrinsic motives may be present at
the same time
 Which one is dominant may vary at different stages of
change and at different stages of life
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Strengths
 Theory of motivation so trying to get at why we
behave the way we do & how we can change
 Large body of experimental research from different
fields: education, physical activity, healthy eating, etc.
 Validated questionnaires
 Experiments in other countries showing it crosses
cultures
 www.selfdeterminationtheory.org
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Relationship to behaviours
(outcomes)
Social Factors:
autonomy
support
(parents,
peers,
authority
figures)
Psychological
mediators:
Autonomy
Competence
Relatedness
Motivation
Intrinsic
Integrated
Identified
Introjected
External
Amotivation
Adapted from Standage & Treasure (2007)
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Outcomes
Well-being indices
Affective indices
Behavioural indices
Cognitive indices
Nurturing Motivation
Relatedness
“Discuss with your family
Autonomy
and make a decision on how you want to proceed
Competence
to make improvements in your chosen activity.”
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Tactics
 Support person’s sense of autonomy by giving choices & explaining
rationale
 Optimize relatedness by
 Making users feel respected and cared for – give them opportunities to express
their opinions
 Form groups for relatedness & social support
 Be empathetic – recognize that there are down sides to change
 Boost feeling of competency by providing positive but realistic feedback
and non-controlling guidance or information on how to attain healthrelated goals (avoid “you should do this…”)
 Emphasize working to improve yourself or your record rather than
competing with others or being evaluated
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Sheldon, William, Joiner. Self-Determination Theory in the Clinic, Motivating Physical and Mental Health (2003)
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Coming up in Part 2
 Health Action Process Approach
 Self-regulation
For more information or for a consultation, email the
principal at corinne@cshassociates.com.
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Short list of references

Bandura A. Self-Efficacy in Changing Societies. Cambridge University Press (1995)

Decci EL, Ryan RM (eds). Handbook of Self-Determination Research. University of Rochester Press (2002)

Elliot AJ, Dweck CS (eds). Handbook of Competence and Motivation. Guildford Press (2005)

Glanz K, Rimer BK, Lewis FM (eds). Health and Behavior and Health Education, Theory, Research, and Practice (3rd ed). Jossey-Bass
(2002)
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Haggar MS, NLD Chatzisarantis (eds). Intrinsic Motivation and Self-Determination in Exercise and Sport. Human Kinetics (2007)
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Heckhausen J, Dweck CS (eds). Motivation and Self-Regulation Across the Life Span. Cambridge University Press (1998)
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Sansone C, Harackiewicz JM (eds). Intrinsic and Extrinsic Motivation, The Search for Optimal Motivation and Performance. Academic
Press (2000)
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Michie S, Prestwich A. Are interventions theory-based? Development of a theory coding scheme. Health Psychology 2010;29:1-8

Sheldon KM, Williams G, Joiner T. Self-Determination Theory in the Clinic, Motivating Physical and Mental Health. Yale University Press
(2003)

Stroebe W. Dieting, Overweight and Obesity, Self-Regulation in a Food-Rich Environment. American Psychological Association (2008)

Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis
of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. JMIR 2010;12(1):e4
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