Is the individuals belief that he or she can master a situation and produce positive outcomes?

One of the most widely used and robust health behavior change theories, SCT emerged from social learning theory, which identified that people learn from their own experiences and by observing the experiences of others.37 There are three major constructs in SCT that interact to influence behavior: personal factors (age, cognitions, previous experience with the behavior, etc.), environmental factors (access to resources, safety, support from family/friends, etc.), and aspects of the behavior itself (vigor of the behavior, outcomes achieved as a result of practicing the behavior, competence with the behavior, etc.). Successful efforts to change behavior depend on identification of the positive supports and the detractors in each of the three constructs. For example, if a therapist is managing the physical or occupational therapy services of a patient who has multiple sclerosis and this patient is motivated to be physically active yet does not have a safe place to walk or be physically active near home, the patient will likely not be able to consistently perform physical activity. If the same patient works for an employer who provides an onsite gym, the patient could negotiate with her supervisor to utilize the gym to be physically active a few days a week.

Of the multiple additional constructs in SCT, several are worth mentioning. Albert Bandura, the author of SCT, identified self-efficacy, the confidence a person has in his or her ability to perform a behavior, as having a significant influence on behavior change.39–41 Self-efficacy has been shown to predict the amount of effort an individual will expend to learn and practice a behavior, the persistence demonstrated in the process, and the effort expended to overcome barriers.42,43 Self-efficacy is behavior specific. Therapists are familiar with the importance of self-efficacy in neurological rehabilitation as patients learn and relearn movement strategies after neurological insults and the way in which repetition, small steps, verbal persuasion, and observational learning build confidence and thus competence in the movement. These same strategies enhance self-efficacy for behavior change related to enhancing wellness, and self-efficacy is key to the development of sustainable health habits.

Goal setting and social support are two additional useful constructs in SCT that fall into the broad category of self-regulation, an important skill to develop when adopting new health behaviors.41 The setting and achievement of goals can have a profound positive impact on learning new health behaviors, like the positive role goals play in physical and occupational therapy plans of care, with the additive effect of enhancing self-efficacy when goals are both challenging and achievable. When goals are not adequately challenging, they can decrease self-efficacy. Social support involves identifying others who will provide encouragement in the form of moral support, participation in the behavior, and accountability. For certain populations, social support has been shown to be significantly related to physical and mental health, pain, coping, adjustment, and life satisfaction.44

Social cognitive theory, the cognitive formulation of social learning theory that has been best articulated by Bandura [24, 25], explains human behavior in terms of a three-way, dynamic, reciprocal model in which personal factors, environmental influences, and behavior continually interact. Social cognitive theory synthesizes concepts and processes from cognitive, behavioristic, and emotional models of behavior change, so it can be readily applied to nutritional intervention for disease prevention and management. A basic premise is that people learn not only through their own experiences, but also by observing the actions of others and the results of those actions [14]. Key constructs of social cognitive theory that are relevant to nutritional intervention include observational learning, reinforcement, self-control, and self-efficacy [7].

Principles of behavior modification, which have often been used to promote dietary change, are derived from social cognitive theory. Some elements of behavioral dietary interventions based on social cognitive theory constructs of self-control, reinforcement, and self-efficacy include goalsetting, self-monitoring and behavioral contracting [7, 15].

Self-efficacy, or a person's confidence in his or her ability to take action and to persist in that action despite obstacles or challenges, seems to be especially important for influencing health behavior and dietary change efforts [25]. Health providers can make deliberate efforts to increase patients’ self-efficacy using three types of strategies: (1) setting small, incremental, and achievable goals; (2) using formalized behavioral contracting to establish goals and specify rewards; and (3) monitoring and reinforcement, including patient self-monitoring by keeping records [14]. In group nutrition programs, it is possible to easily incorporate activities such as cooking demonstrations, problem-solving discussions, and self-monitoring that are rooted in social cognitive theory.

The key social cognitive theory construct of reciprocal determinism means that a person can be both an agent for change and a responder to change. Thus, changes in the environment, the examples of role models, and reinforcements can be used to promote healthier behavior.

Causation

Several theories about the causes of intimate partner violence have been proposed over the years. Social learning theory suggests that intimate partner violence is a learned behavior. The fact that male perpetrators and female victims are more likely to report histories of exposure to violence in childhood supports this theory. However, most individuals exposed to violence in childhood do not go on to commit violence as adults, and not all abusers have violent upbringings. Furthermore, the link between poor parenting generally, including neglect, and subsequent intimate partner violence in adulthood suggests that the effect is not simply one of modeling abusive behavior. Exposure to rejecting or neglectful parenting is associated with adverse effects on intrapersonal (e.g., poor self-worth) and interpersonal development, which are associated with intimate partner violence.

A feminist perspective understands intimate partner violence against women as a form of coercive control rooted in society’s patriarchal structure, reflecting the persistent inequality in economic and social relationships between men and women. Lending support to this perspective is the finding that intimate partner violence appears to be less common in more democratic and less economically polarized societies. Although intimate partner violence occurs more often in contexts in which there is support for male authority in the family and women have less access to economic security, it is not clear why some individuals are more likely to be violent under such conditions than others.

With regard to psychological theory, there are conflicting views about the association between intimate partner violence and psychopathology. Some researchers argue that abusive males have deficits in one or more coping mechanisms, anger control, and communication skills, whereas others suggest that intimate partner violence results from dysfunctional interactional patterns between partners. Because types of intimate partner violence are not the same for all couples, there are likely multiple causes for its occurrence. Most of the research has focused on factors associated with increased risk of men abusing women (Table 228-1); however, we do not know to what extent these factors are causal from cross-sectional studies.

An explanatory framework that can guide etiologic and intervention research on intimate partner violence (and other public health problems) is the ecologic model. It attempts to integrate evidence on individual (genetic and life course), family, community, and socioeconomic structural factors. The ecologic model has recently been further developed to incorporate the impact of globalization on violence against women.6

Social Cognitive Theory, proposed by Bandura, focuses on an individual's learning through dynamic, reciprocal, and continuous interactions between the environment and themselves (Bandura, 1998). Essentially, behaviors are learned, and two cognitive processes are involved that influence adherence behaviors: self-efficacy and outcome expectation. Self-efficacy is an individual's belief in their ability to master a particular task or skill, whereas outcome expectancies are beliefs that a certain behavior will result in a particular outcome, which can be negative or positive. Aspects of Social Cognitive Theory have been examined extensively in the pediatric adherence literature, with many studies assessing self-efficacy. For example, in the context of pediatric obesity, a 2016 review of 16 studies using a Social Cognitive Theory framework found that higher self-efficacy was related to increased fruit and vegetable intake and lower fat, sugar, and sodium intake in youth who were obese (Rolling & Hong, 2016). Furthermore, cognitive and environmental factors also played a key role in adherence to dietary behaviors. This review highlights the application of Social Cognitive Theory to adherence in a specific pediatric population, but this theory can also be tested and applied to other chronic conditions, in which dietary adherence may be critical (e.g., inflammatory bowel disease, cystic fibrosis, food allergies).

Human Factors and Technical Considerations for Emerging Technologies

In anticipation of increased availability of OTC amplification and direct-to-consumer models of hearing health care, otolaryngologists must have an understanding of the factors, both from a design and technical perspective, that can influence an older adult's ability to use hearing technology, particularly new OTC devices currently on the market. Adequate amplification is only one aspect of addressing an older adult's hearing and communication needs. The field of human factors specializes in understanding and accounting for the unique human characteristics that influences an individual's ability to use and incorporate a piece of technology into his or her daily life.107 The primary focus is on enabling a user, an older adult, to interact with a piece of technology, an amplification device, comfortably, safely, and efficiently in an error-free manner in a dynamic environment.107 For older adults with hearing loss, the individual must learn a new technology and incorporate its use and maintenance into daily routine, while also augmenting what can be deeply entrenched communication behaviors.

Self-efficacy is an important aspect in managing any new technology, including hearing technology, and is defined as one'sperceived ability to execute a given behavior or task successfully.108 Approaches that enhance self-efficacy are associated with successful use of hearing aids among older adults.109 Bandura's Social Cognitive Theory delineates four strategies to enhance self-efficacy: performance accomplishments, vicarious experience, verbal persuasion and emotional arousal.108 These strategies may take the form of mastery experiences during device fitting and orientation through teach-backs, modeling steps or behaviors using the device, provision of immediate, specific, and positive feedback, and creating a supportive environment during training.108,110

Human characteristics, such as sensation, perception, cognition, and movement control, must be considered when designing a technology and its associated instructional materials.107 Aging affects each of these characteristics, and designs must account for these age-related changes. For example, age-related vision changes are highly prevalent. and older adults with both visual and hearing loss report lower rates of self-efficacy related to hearing aid uptake and use.109 The small buttons and batteries used in hearing aids, combined with the small font of hearing aid manuals, are often not suitable to older adults.110,111 Hearing technology can be made more suitable for older adults through the inclusion of rechargeable batteries that connect magnetically, larger buttons for volume control, and access to DVDs or online videos to supplement manuals.110 Besides accounting for changes in perception, these accommodations make devices more accessible to older adults experiencing age-related or disease-related changes in manual dexterity.107,110 Instructional materials that feature video tutorials support older adults with modeling of behaviors and reinforcement opportunities that can aid older adults experiencing changes in cognition.107,110

Social cognitive theory (SCT) is one of the most frequently applied theories of health behavior (Baranowski et al., 2002). SCT posits a reciprocal deterministic relationship between the individual, his or her environment, and behavior; all three elements dynamically and reciprocally interact with and upon one another to form the basis for behavior, as well as potential interventions to change behaviors (Bandura, 1977a, 1986, 2001). Social cognitive theory has often been called a bridge between behavioral and cognitive learning theories, because it focuses on the interaction between internal factors such as thinking and symbolic processing (e.g., attention, memory, motivation) and external determinants (e.g., rewards and punishments) in determining behavior.

A central tenet of social cognitive theory is the concept of self-efficacy – individuals’ belief in their capability to perform a behavior (Bandura, 1977b). Behaviors are determined by the interaction of outcome expectations (the extent to which people believe their behavior will lead to certain outcomes) and efficacy expectations (the extent to which they believe they can bring about the particular outcome) (Bandura, 1977b, 1997). For example, individuals may hold the outcome expectation that if they consistently use condoms, they will significantly reduce risk of becoming HIV-infected; however, they must also hold the efficacy expectation that they are incapable of such consistent behavioral practice. Behavior change would necessitate bringing outcome and efficacy expectations in alignment with one another. SCT emphasizes predictors of health behaviors, such as motivation and self-efficacy, perception of barriers to and benefits of behavior, perception of control over outcome, and personal sources of behavioral control (self-regulation) (Bandura, 1977a, 1977b). Another important tenet with respect to behavioral and learning is SCT's emphasis that individuals learn from one another via observation, imitation and modeling; effective models evoke trust, admiration and respect from the observer, and they do not appear to represent a level of behavior that observers are unable to visualize attaining for themselves. Thus, a change in efficacy expectations through vicarious experience may be effected by encouraging an individual to believe something akin to the following: “if she can do it, so can I”. SCT has been critiqued for being too comprehensive in its formulation, making for difficulty in operationalizing and evaluating the theory in its entirety (Munro et al., 2007). Moreover, some researchers using SCT as a theoretical basis have been criticized for using only one or two concepts from the theory to explain behavioral outcomes (Baranowski et al., 2002).

Social Cognitive Theory (SCT) proposes that the environment, behavior, and personal and cognitive factors all interact as determinants of each other [5,14]. According to this theory, human functioning is described in terms of a number of basic capabilities: symbolizing capability, forethought capability, vicarious capability (ability to learn through observation/imitation/modeling others’ behaviors and attitude), self-regulatory capability, and self-reflective capability.

The key concepts of SCT can be grouped into five major categories: (1) psychological determinants of behavior (outcome expectations, self-efficacy, and collective efficacy), (2) observational learning, (3) environmental determinants of behavior (incentive motivation, facilitation), (4) self-regulation, and (5) moral disengagement [5].

An important concept in SCT is self-efficacy, which represents a person’s belief in their capacity to perform a given behavior when faced with a variety of challenges [53]. According to SCT, self-efficacy may be developed in four ways: (1) personal experience of success, (2) social modeling (showing the person that others like themselves can perform/acquire a certain behavior, as well as the small steps taken by them), (3) improving physical and emotional states, and (4) verbal persuasion (encouragement by others to boost confidence) [5].

Another key concept is observational learning, which implies learning to perform new behaviors by exposure to interpersonal or media displays of that same behavior [5]. In this regard, peer modeling is a particularly relevant method for influencing behavior, because imitation occurs more frequently when observers perceive the models as similar to themselves [5].

Finally, according to SCT, self-regulation may be achieved in six different ways: (1) self-monitoring and systematic observation of one’s own behavior, (2) goal setting, (3) feedback on the quality of performance and how it might be improved, (4) self-reward, (5) self-instruction, and (6) social support from people who encourage a person’s efforts to exert self-control [5]. Social support, on the other hand, may be categorized into four types of supportive behaviors [5]: (1) emotional support, involving the provision of empathy, love, trust, and caring; (2) instrumental support, involving the provision of aid, resources, and services that directly assist a person in need; (3) informational support, meaning the provision of advice, suggestions, and information that a person can use to address problems; and (4) appraisal support or the provision of information that is useful for self-evaluation purposes (e.g., constructive feedback) [5].

Therefore, it seems logical that new technologies such as social media are particularly well suited for the application of SCT. Indeed, social media may serve as a source of modeling, verbal persuasion, feedback, and encouragement, as well as may contribute to address other aspects of SCT.

1 Bridging Social Cognitive Theory and Expectancy-Value Theory

Social cognitive theory and expectancy-value theory are two theories that address the development of human motivation. They share many similarities in their constructs and explanations. In addition, the two theories complement one another by each addressing certain processes in more depth than the other theory does.

When comparing the two theories, Bandura (1997) contrasted social cognitive theory's construct of self-efficacy with expectancy-value theory's construct of expectations for success. According to his interpretation, efficacy expectations refer to people's perceptions of their own abilities, whereas expectations for success in expectancy-value theory refer to people's beliefs regarding the effectiveness of particular actions (outcome expectancies). With regards to the latter type of belief, people might believe that certain actions will lead to success in a domain (outcome expectancy) but not necessarily consider themselves as being capable of that action. However, Wigfield and Eccles (2000) contested this interpretation. They viewed expectation for success as similar to self-efficacy.

The difference between self-efficacy and expectations for success lies in their respective time frames. Self-efficacy refers to a person's beliefs about her or his current ability in a particular domain (e.g., “I am good a math”). In contrast, expectations for success refer to how well one anticipates doing in a domain in the future (e.g., “I expect to do well at math”). This may be a distinction without a practical difference. Eccles and her colleagues have found in their own research that measures of the two constructs are highly correlated. Moreover, factor analyses have indicated that ability beliefs (i.e., self-efficacy) and expectations for success consistently load together (see Wigfield & Eccles, 2000). Nonetheless, Wigfield and Eccles (2000, p. 74) maintained that ability beliefs and expectations for success are “theoretically distinct” even though they “do not appear to be empirically distinguishable, at least as we have measured them.” If no empirical distinction has been found, however, it begs the question of whether there is discriminative validity between current ability beliefs and expected outcomes for success (Campbell & Fiske, 1959; Miller & Pollock, 1995). The fundamental similarity is that both theoretical models emphasize people's ability beliefs (either concurrent or expected). Further, if studies eventually find that the time frame (current vs. future ability expectations) matters in some meaningful way, this dimension could be incorporated as a moderator in an integrated theoretical model.

As I have previously argued, theoretical review papers typically highlight the differences between theories rather than seek to bridge potential similarities. As an exception to this general practice, Hyde and Durik (2005) underscored the similarities and potential areas for overlap between social cognitive theory and expectancy-value theory. The authors noted that both theories emphasize the importance of socialization, the role of individuals’ beliefs and choices in guiding their actions, and the impact of competence-related beliefs. They viewed the differences between expectancy-value theory and social cognitive theory as “subtle” matters of emphasis. In this regard, Hyde and Durik observed that the two theories “slightly differ” in how they characterize task value: Competence-related beliefs (expectations for success) and task value beliefs are independent processes that are both emphasized in expectancy-value theory, whereas competence-related beliefs (self-efficacy) receives much more emphasis in social cognitive theory. Although Bandura's research during the last two decades has focused primarily on the role of self-efficacy (e.g., see Bandura, 1997, 2001), social cognitive theory incorporates task value into its model. The theory explicitly addresses the impacts of incentives and judgmental processes. Bandura (1986, 1997) postulated that motivation is affected by self-incentives (similar to intrinsic value in expectancy-value theory), perceived disincentives (similar to cost in expectancy-value theory), personal standards (similar to attainment value in expectancy-value theory), and valuation of the activity (similar to utility value in expectancy-value theory). These different components are articulated somewhat differently in the two theoretical models, but that does not necessarily preclude formulating a synthesis. Indeed, when reviewing her own theory, Eccles has noted certain parts of the model that may need revising (e.g., see Eccles & Wigfield, 2002; Wigfield & Eccles, 2000).

The theoretical relationship between ability beliefs and task value may be similar in expectancy-value theory and social cognitive theory. As mentioned in the earlier summary of expectancy-value theory, research has found that competence-related beliefs tend to shape people's values (see Eccles & Wigfield, 2002; Wigfield & Eccles, 2000). However, it was also noted previously that task value tends to be a stronger predictor of sustained motivation (e.g., achievement-related choices) than do competence-related beliefs. Both theories highlight ways that competence-related beliefs and task values underlie people's motivation to pursue certain behaviors over others. Thus the causal relationship between ability expectations and values needs to be explored more fully in both theories; it is possible that there are multiple ways in which they may be related (e.g., the dual-pathway model in gender schema theory).

Besides highlighting similarities, Hyde and Durik (2005) suggested ways that social cognitive theory and expectancy-value theory might complement one another. First, the authors considered a relative strength of expectancy-value theory is its emphasis on both competence beliefs and task value. They saw social cognitive theory as focusing primarily on competence beliefs and paying little attention to values. (As I noted before, however, I find both theories acknowledge the impact of ability beliefs and task values—albeit configured in somewhat different ways in their respective models.) Second, Hyde and Durik considered it a relative strength of social cognitive theory that it identifies a fuller set of the processes linking socializers' beliefs and actions to children's development. Both theories include the role of socialization in their models, but social cognitive theory takes into account some of the specific parameters that influence when and how socialization agents affect children. For example, social cognitive theory addresses how characteristics about the socialization agents (e.g., salience, prevalence, functional value) and observer attributes (e.g., cognitive capabilities, expectations, preferences) guide the extent that children pay attention to particular models. Hyde and Durik (2005, p. 378) suggest “adding processes such as these to the expectancy-value framework should be helpful.”

In summary, I have reviewed a few ways that theory bridging involving social cognitive theory and expectancy-value theory might proceed. The two theories both address the influence of ability expectations and interests on children's motivation and behavior. The two theories may also complement one another with one theory addressing certain processes in more detail than the other theory.

2 Agentic Perspective

Social cognitive theory is rooted in an agentic perspective. People are self-organizing, proactive, self-reflecting, and self-regulating, not just reactive organisms shaped and shepherded by external events. Human adaptation and change are rooted in social systems. Therefore, personal agency operates within a broad network of sociostructural influences. In these agentic transactions, people are producers as well as products of social systems. Sociostructural and personal determinants are treated as co-factors within a unified causal structure rather than as rival conceptions of human behavior.

Social cognitive theory (SCT) serves to integrate behavioral and cognitive explanations for human behavior. Central to SCT is the notion that humans do not passively respond to past or current environmental influences but possess the ability to foresee the consequences of our actions. The cognitive outcome expectancies we form allow us to appraise potential consequences of engaging in any given behavior, and thus determine which behaviors we will engage in. Actions we expect will result in positive outcomes are readily adopted, while those that we believe will result in negative outcomes are avoided. This forethought allows us to predict events, set goals, and play an active role in achieving such goals. According to Bandura, self-efficacy is the key factor underlying the human agency central to SCT. Intention to act and a desired outcome are not sufficient to enact behavior; rather individuals must possess self-regulatory mechanisms that allow them to exert control over their behavior. Specifically, regardless of what other factors may affect behavior, unless someone believes they have the ability to perform a behavior or change their circumstances, they will not attempt to do so.

When examining the role of self-efficacy in drinking, researchers have most often studied the role of an individual's belief in their ability to resist drinking (refusal self-efficacy). Refusal self-efficacy is an important predictor of drinking and intention to drink alcohol in children and adolescents. Longitudinal designs have been used to predict teenagers' alcohol and drug use from cognitive and social variables, including refusal self-efficacy. Regardless of whether the participants had experience with alcohol use, refusal self-efficacy was predictive of alcohol use 9 months later. Research by Hasking and Oei has confirmed that in addition to demonstrated salience in clinical and adolescent samples, drinking refusal self-efficacy can discriminate problem and nonproblem drinkers and high- and low-risk drinkers in community samples.