Applying Social Cognitive Theory to planning and evaluation: why and how? March 2013

Transcription

1 Applying Social Cognitive Theory to planning and evaluation: why and how? March 2013

2 Introductions Presenters: Areeta Bridgemohan, MPH Health Promotion Field Support Specialist, Evaluation Ken Allison, PhD Senior Scientist, Health Promotion and Chronic Disease Prevention Associate Professor, Dalla Lana School of Public Health, University of Toronto Sarah Evason, MHSc RD Assisted by: Magdalena Wasilewska, MPH Health Promotion Coordinator 2

3 Webinar features Adobe Connect technology Chat function to ask questions or if you need help Webinar courtesy Polls istockphoto.com/adrian Assalve 3

4 Objectives of today s webinar To learn about: The benefits of applying theory The key elements of Social Cognitive Theory The application of Social Cognitive Theory Accessing our products and services istockphoto.com/erdosain 4

5 What is theory? Theory: set of interrelated concepts, definitions and propositions that explain or predict events or situations by specifying relations among variables. 1 Behavioural science theory draws on theoretical perspectives, research and practice tools of diverse disciplines. istockphoto.com/sodafish 5

6 Other terms 2 Concepts Constructs Variables Models istockphoto.com/mg 6

7 Characteristics of theory 2,3 Broad application abstract Testable Explanatory versus change theory Theories vary in terms of: Conceptual development Empirical testing istockphoto.com/jgi 7

8 Benefits of theory 3,4,5,6 Benefit Examples Provide guidance Help answer: why, what, and how health problems should be addressed Point towards indicators Strategic allocation of resources Capture most relevant program components Increased effectiveness Enable explanations Explain dynamics of health behaviours Offer insights into program planning and evaluation Form a basis for communication Contribution to knowledge base Persuade decision-makers of program merit Basis for clear communication of program intent and content Supports evidence-informed interventions Contributes to understanding of human nature and health Evaluation results can be used to modify existing theories 8

9 Social Cognitive Theory Bandura 7 istockphoto.com/bogdan Kosanovic 9

10 Social Cognitive Theory Bandura7

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12 Key concepts in Social Cognitive Theory 8 Outcome expectations - consequences of choices Observational learning - use of modeling Self-regulation - self-monitoring and goal-setting Incentive motivation - rewards and punishments Facilitation - providing support and resources Self-efficacy - confidence and ability to perform behaviours Collective efficacy - ability of a group to perform actions 12

13 Poll #1a: flu shots Did you get a flu shot this year? 1. Yes 2. No istockphoto.com/atnoydur 13

14 Poll #1b: flu Did you get the flu? 1. Yes 2. No istockphoto.com/atnoydur 14

15 Key concepts in Social Cognitive Theory 8 Outcome expectations - consequences of choices Observational learning - use of modeling Self-regulation - self-monitoring and goal-setting Incentive motivation - rewards and punishments Facilitation - providing support and resources Self-efficacy - confidence and ability to perform behaviours Collective efficacy - ability of a group to perform actions 15

16 Self-efficacy - central concept of SCT Most prominent component of SCT Empirical support for its importance Clear implications for health promotion and disease prevention Considered to be situation-specific 16

17 Poll #2: Social cognitive theory Do you currently use social cognitive theory in your programs? 1. Yes unintentionally 2. Yes intentionally 3. No istockphoto.com/atnoydur 17

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21 Social Cognitive Theory summary 8 Intuitively appealing Widely used as basis for health interventions Flexible Emphasis on modeling and self-efficacy Relevant to public health interventions and evaluations 21

22 Colour It Up Go for More Vegetables and Fruit Sarah Evason MHSc RD March 2013

23 Colour It Up overview An interactive six-week program that gives women the knowledge, skills and confidence to eat more vegetables and fruit Developed by Cancer Care Ontario as Take FIVE - 5 to 10 a day...your way! Extensive development and evaluation process The program name was changed to Colour It Up to accommodate recommendations in Canada's Food Guide 23

24 Colour It Up overview Uses elements of Social Cognitive Theory to help women make positive changes related to their vegetable and fruit intake Focus is on vegetables and fruit Why vegetables and fruit? Two-hour sessions for six weeks Why two hours? Why six weeks? Groups of nine to 15 participants Why small groups? Program for women ages 19 and up Why only women? 24

25 Colour It Up overview Participants gain knowledge and skills How to overcome barriers such as cost and preparation time Participants have group discussions and share experiences Examining attitudes, beliefs and perceptions about vegetables & fruit (v&f) Exploring barriers and negative thoughts Participants engage in group learning exercises Identifying situations that make it easier or more difficult to eat more v&f Participants provide social support to each other 25

26 Colour It Up overview Participants are guided in activities and discussions that inspire personal reflection, goal-setting and self-monitoring Participants are provided with skill-building opportunities and are encouraged to try a healthy vegetable or fruit snack at each session 26

27 How does Colour It Up differ from traditional healthy eating programs? Information-based programs Colour It Up Increase knowledge Enhance self-efficacy X Observational learning? Skill-building? Practicing new behaviours X Influencing thought processes, beliefs and values Addressing barriers X Social support X (if interactive) Positive reinforcement X 27

28 Behaviour change in action Behaviour change in action Example: If you watch someone else eat a vegetable or fruit and enjoy it, you are more likely to try it. If you do try it and find it enjoyable, you are more likely to eat it again. Our experiences and what we see others doing affect our expectations. Observational learning Colour It Up allows participants to learn from each other by sharing experiences and tasting vegetable and fruit recipes. Peer models Lively discussions and sharing Foods for veggie/fruit snack break 28

29 Behaviour change in action Behaviour change in action Example: Changing eating habits can be difficult. If you become frustrated or stressed about trying to eat more vegetables and fruit, you may feel that it is just too much and give up. Our thoughts and emotions can cloud or enhance how we think about changing our behaviour. Understanding thought processes Colour it Up helps participants be aware of thoughts that get in the way of eating more vegetables and fruit. Encourage participants to explore thoughts, beliefs and emotions. Address barriers. Help participants find solutions. 29

30 Behaviour change in action Behaviour change in action Example: If you believe in the benefits of eating vegetables and fruit (personal), you will stock your fridge with more vegetables and fruit (environment). This will lead to eating more vegetables and fruit (behaviour). Our thought processes, environment, and behaviour are constantly interacting. A change in one affects the others. Interaction of thought processes, environment and behaviour Colour It Up helps participants modify their thoughts and environments resulting in healthier eating behaviours. Help participants think in new ways about veg/fruit. Discuss ways to create healthier environments at home and work/school. 30

31 Behaviour change in action Behaviour change in action Example: The more confident you are about being able to eat vegetables and fruit, the more successful you will be. You will find ways to eat vegetables and fruit even when faced with challenges. The more success you have, the more your self-efficacy will grow. The more selfefficacy we have about doing things, the more likely we will find ways to do it. Self-efficacy Colour It Up encourages small steps to help participants overcome challenges and gain self-efficacy. Participants are encouraged to practice new behaviours Celebrate successes and examine challenges 31

32 Behaviour change in action Behaviour change in action Example: As you see the positive results that come from eating more vegetables and fruit (such as feeling better about yourself or getting praise), you are more likely to eat vegetables and fruit again. We are more likely to make a change if there is an incentive. Behaviours will continue if they are rewarded. Positive reinforcement Colour it Up provides incentives for attending the program and positive reinforcement for making changes. It also helps participants find ways to self-reward. Be consistent with incentives Be generous with praise Participants encouraged to set and follow through with self-rewards 32

33 Behaviour change in action Behaviour change in action Example: Setting a goal to eat more vegetables and fruit and using a food record to monitor progress increases awareness, keeps you focused and makes the behaviour your responsibility. The more strategies we learn to help control behaviour, the more likely we will be able to maintain the change. Goal setting and self-monitoring Colour It Up builds goal setting and self-monitoring into each session. Participants given time to set, review and share goals Participants complete the Veg/Fruit Checklist 33

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36 Applying Social Cognitive Theory to Colour It Up Sample activity Talking yourself into eating vegetables and fruits (Session 2) Identifying and barriers and finding solutions Enhancing self-efficacy Goal-setting 36

37 Sample Activity

38 Group discussion (self-talk): Ask participants to suggest ways they talk themselves OUT of and INTO making changes Ask them to reflect on past experiences.

39 Goal-setting and self-monitoring: Ask participants to write down one change they would like to make over the next week Encourage participants to notice how they deal with this change when they were successful and unsuccessful Participants share their experience at the next session (warm-up)

40 So, does Colour It Up really change behaviour? Evaluation Program evaluation in 12 Ontario communities (2003) Questionnaires administered Before program After last session Three months after last session 40

41 So, does Colour It Up really change behaviour? Results Vegetable and fruit consumption Before start of program At program end From literature review Difference Times per day, on average 3.8 times per day 5.6 times per day 0.6 times per day 1.8 times per day (3 times higher than expected) 3 months after program end 5.8 times per day, (3.5 times higher than expected) 41

42 So, does Colour It Up really change behaviour? Self-efficacy A five-point Likert scale was used to measure level of confidence in eating enough vegetables and fruits in relation to a variety of situational and emotional cues) How confident are you that you can: eat enough vegetables when eating alone? (Circle answer) Very Confident Somewhat Confident No opinion Somewhat Unconfident Very Unconfident 42

43 So, does Colour It Up really change behaviour? Participants showed increased confidence to maintain behaviour in a variety of situations as a direct result of participation in the program. Ongoing evaluation 43

44 Tips for applying theory to planning and evaluation 3 Think about the importance of evaluation early in planning, especially when considering objectives for health. Consider which theory(ies) are relevant to addressing the health problem/issue and to the factors influencing it. Use theory to help interpret and support intervention evaluation findings. Combine theory and evidence to inform action. Use intervention evaluations as opportunity to test theory. 44

45 Precede Proceed Model adapted from Green, et al.9

46 Poll #3: Your self-efficacy How confident are you that you can apply social cognitive theory to your programs? 1. Very confident 2. Somewhat confident 3. No opinion 4. Somewhat unconfident 5. Very unconfident istockphoto.com/atnoydur 46

47 Summary The importance of using theory to inform the planning and evaluation of program interventions in public health. Social Cognitive Theory, important features, and relevance to public health. Colour it Up - an example of a program based on Social Cognitive Theory Tips on applying theory to planning/evaluating an interventions 47

48 Health promotion capacity building services Free to those working on Ontario-focused projects Scope varies, depending on need: Brief, one-time advice Links to other sources of information and resources Review your work or product Consultations Training sessions/workshops Service request form: 48

49 Health promotion capacity building services Planning Evaluation Policy and by-law development Alcohol policy Health communication

50 PHO resources At a glance: ten steps to evaluating health promotion programs 10 Evaluating health promotion programs workbook 11 Program planning workbook 12 Online Health Program Planner 13 Health Promotion Resources are available in both English and French 50

51 Other recommended resources Theory at a glance: a guide for health promotion practice 5 The community health promotion handbook: action guides to improve community health 15 The guide to community preventive services 16 Planning health promotion programs: an intervention mapping approach 17 Health behavior constructs: theory, measurement and research 18 A practical approach for applying best practices in behavioural interventions to injury prevention 19 51

52 Questions? 52 istockphoto.com/rtimages

53 References 1. Kerlinger F.N. Foundations of Behavioral Research. (3 rd ed.) New York: Holt, Rinehart and Winston; In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research and Practice. 4th ed. San Francisco: Jossey Bass; p Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research and Practice. 4th ed. San Francisco: Jossey Bass; Glanz K, Rimer BK, Viswanath K. Theory, research and practice in health behavior and health education. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research and Practice. 4th ed. San Francisco: Jossey Bass; p Issel Michele. Health program planning and evaluation: a practical, systematic approach for community health. 2 nd edition. Massachusetts: Jones and Bartlett publishers;

54 References (continued) 5. National Cancer Institute. Theory at a Glance: a guide for health promotion practice. 2 nd edition. NIH Publication No ; Green Jackie. Editorial: the role of theory in evidence-based health promotion practice. Health Educ Res. 2000; 15(2): doi: /her/ Bandura A. Social foundations of thought and action: a social cognitive theory. Englewoods Cliffs, NJ: Prentice-Hall; McAlister AL, Perry CL, Parcel GS. How individuals, environments, and health behaviors interact: social cognitive theory. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education: Theory, Research and Practice. 4th ed. San Francisco: Jossey Bass; p Green Lawrence, Kreuter Marshall. Health promotion planning: an educational and ecological approach. 4 th Ed. Mountain View, CA : Mayfield Publishers; Public Health Ontario, Dalla Lana School of Public Health. At a glance: ten steps to evaluating health promotion programs. Toronto, ON: Queen s Printer for Ontario;

55 References (continued) 11. The Health Communication Unit, Centre for Health Promotion, University of Toronto. Evaluating health promotion programs workbook. Toronto, ON: University of Toronto; Public Health Ontario, Dalla Lana School of Public Health. Introduction to health promotion program planning. 4th ed. Toronto, ON: Queen s Printer for Ontario. In press Public Health Ontario and the National Collaborating Centre for Methods and Tools [document on the Internet]. Toronto: Queen's Printer for Ontario. Online Health Program Planner. [updated 2011; cited 2012 August 24]. Available from: Public Health Ontario, Dalla Lana School of Public Health [document on the Internet]. Toronto: Queen's Printer for Ontario. Health promotion 101. [cited 2012 December 3]. Available from: 55

56 References (continued) 15. Partnership for Prevention, Centers for Disease Control and Prevention [document on the internet]. The Community Health Promotion Handbook: action guides to improve community health c2012 [cited 2012 November 30]. Available from: Promotion-Handbook.aspx 16. Centers for Disease Control and Prevention (CDC) [homepage on the internet]. [cited 2012 December 5].The guide to community preventive services. Available from: Bartholomew LK, Parcel GS, Kok G, Gottlieb NH. Planning health promotion programs: an intervention mapping approach. San Fransico: Jossey-Bass; Schwarzer Ralf, Luszczynska Aleksandra. National Cancer Institute. Health behavior constructs: theory, measurement and research, Self-efficacy [document on the Internet]. [updated 2008 Apr 28; cited 2012 December 4]. Available from: Winston FK, Jacobsohn L. A practical approach for applying best practices in behavioural interventions to injury prevention. Injury Prevention 2010; 16: