Programas sanitarios en rumiantes

The Social Cognitive Theory (SCT) was first presented as the Social Learning Theory (SLT) in the 1960s by Albert Bandura (Bandura and Walters, 1963).

Over two decades later it was further developed into the SCT which depicts the influence of an individual’s experiences and environmental factors on behaviour (Bandura, 1986).This theory considers multilevel interactions and suggests that if you provide opportunity for social support through encouraging expectation, drawing upon self-efficacy and using observational learning and reinforcement that positive behaviour change can occur (Glanz, 2001, Nabi and Prestin, 2017). The primary purpose of the SCT is to explain why people engage in certain behaviours and to understand how people can regulate their behaviour through control and reinforcement in order to achieve goal-directed behaviour that can be maintained in the longer term (Bandura, 1998).

One issue which has arisen from behavioural intervention research is the lack of evidence to demonstrate long term effectiveness, in both the fields of treatment and prevention (Colquitt et al., 2016, Waters et al., 2011). The SCT, unlike some other models and theories, reflects on the maintenance of behaviour which is a key consideration when designing behaviour change interventions

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(Kwasnicka et al., 2016). Maintenance is an important factor to consider as once positive changes have been made there is a need to sustain them.

The core concepts of this theory are explained by Bandura through a

schematization of triadic reciprocal causation (Bandura, 1994). The schema shows how people acquire and maintain behaviour and how it is influenced by;

the environment, personal characteristics and personal experience. Figure 5 represents this schema and highlights how the relationship between each is mutual.

Figure 5: Schematic representation of the social cognitive theory

Adapted from (Bandura, 1994)

The SCT is built on six assumptions, sometimes referred to as ‘constructs’. The first five stem from the original SLT and they are; reciprocal determinism,

behavioural capability, observational learning, reinforcements and expectations.

The sixth, self-efficacy was included at a later date following progression of the SCT. In thinking how these constructs might apply to an intervention aimed at increasing fruit and vegetable consumption (via caregiver provision of fruit and vegetables), a description for each is provided, along with a supporting example (Table 1).

Behaviour

Environmental factors Personal

factors

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Table 1: Description of SCT constructs and supporting examples

Construct Description and example

Reciprocal determinism 1. This is the central concept of SCT (as depicted in the schema). This refers to the dynamic and

reciprocal interaction of person (individual with a set of learned experiences), environment (external social context), and behaviour (responses to stimuli to achieve goals).

This could refer to the interaction between a caregiver and their environment which may

potentially result in provision of healthier food (i.e.

fruit and vegetables).

Behavioural capability 2. This refers to a person's ability to perform a

behaviour through essential knowledge and skills.

In order to successfully perform a behaviour, a person must know what to do and how to do it.

This may refer to the caregiver having the

knowledge and skills that are necessary to prepare and provide fruits and vegetables for their child.

Observational Learning 3. This suggests that people can observe a behaviour asserted by others, and then mimic the behaviour themselves. This is often referred to as "behaviour modelling"

Caregivers could watch a video or attend a class to show them how to prepare fruits and vegetables.

They would then carry out this behaviour

themselves, in turn increasing provision to children.

Reinforcements This refers to the likelihood of a person continuing or discontinuing a particular behaviour.

Reinforcements can be positive or negative.

This may relate to the caregivers response to

providing fruits and vegetables. For example a child may refuse to eat the fruit the caregiver has

provided. This could result in the caregiver either refraining from serving that particular fruit again or motivate them to try serving it again, in hope that the child will eventually accept it.

Expectations 4. This refers to the anticipated consequences of a person's behaviour. It works on the premise that people anticipate the consequences of their actions before engaging in the behaviour. Expectations usually originate from previous experience and focus on the value that is placed on the outcome.

5.

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6. The caregiver may have beliefs about the likely outcomes of providing fruits and vegetables to their child. i.e. It will lead to positive health outcomes for the child.

Self-efficacy This refers to the level of a person's confidence in his or her ability to successfully perform a

behaviour. It is influenced by a person's capabilities and environmental factors.

This may relate to a caregivers ability to provide fruits and vegetables to their child.

Adapted from (Berlin et al., 2013)

In applying this within the context of fruit and vegetable provision, the schema may then be adapted and presented as depicted in Figure 6.

Figure 6: Application of the social cognitive theory to fruit and vegetable provision

Adapted from (Gaines and Turner, 2009)

Limitations of the SCT

There are several limitations of the SCT which should be considered when using this theory in public health. The theory itself does not determine how much impact each of the factors (within the schema) has on the behaviour.

Difficulties then arise when determining which behavioural element may be best

Fruit and vegetable provision

Availability, Accessibility, Family, Friends, Peers, Media Expectations,

Knowledge, Skills Self-efficacy

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targeted in order to achieve the best results (Carillo, 2010). There is also an assumption that if the environment is altered it will automatically result in a change to the individual, which in reality may or may not occur. As the theory also relies on the concept of learning it tends to dismiss those factors which occur due to an individual’s biological make-up which may also influence a change in behaviour (LaMorte, 2018). Moreover, it has also been suggested that this theory does not consider emotion and its impact, therein missing important contributory factors to behaviour (LaMorte, 2018). Finally, as with other theories, applicability of all the constructs of SCT to one public health problem may be difficult especially in developing focused public health programs (Godin et al., 2008).

Given that behaviour takes place within different social environments it is not only necessary to consider individual factors but also other wider social influences. In addition to this any attempts to change behaviour must also account for these extrinsic factors to maximise chance of intervention success (Kwasnicka et al., 2016). Therefore selecting a behaviour change approach can prove tricky as some focus primarily on individual factors, which although are essential cannot account for all changes that occur. For example, interventions to improve dietary behaviours may focus on individual behavioural

characteristics of those who would like to improve their eating habits but exclude thought for any extrinsic factors such as the influence of the food environment, other social influences and existing policy. However, this leads to the omission of factors that may be pivotal in driving the behaviour in question.

There is evidence which indicates that the effectiveness of a theory-based intervention may increase with the number of theories incorporated

(Bluethmann et al., 2017). Considering the complexities in capturing all associated factors with a particular behaviour, it becomes necessary to

contemplate other, more encompassing approaches. The theoretical domains framework is an approach which aims provide further scope to understand behaviour given that it has been designed to capture a multitude of behavioural theories. It was also designed with public health professionals in mind as a versatile and comprehensive tool that can be easily applied in practice (Michie et al., 2005).

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1.9.2 A framework approach to behaviour change: The Theoretical