Attribution Theory

Attribution theory speaks to how people answer questions that begin with “why?” It refers to the motivation that people have to explain and understand causality, particularly in situations that cannot be predicted. They make causal explanations about a variety of events, and those explanations (attributions) motivate their behavior. Causal attributions are beliefs about what caused something to happen. They may attribute the cause of an event to factors which they believe are outside of their own control (i.e., luck or fate) rather than to their own influence over a situation.

For example, a sexually active college student may believe that contracting a sexually transmitted disease (STD) is an uncertain event. The student may know that STDs are contracted only through sexual activity, but that being sexually active does not always cause one to contract an STD; that student is disease-free now. The student may attribute his/her disease-free state to events that are either within his/her control or to uncontrollable events. If the student attributes this state to steadfast condom use, then s/he may be likely to continue using condoms. If the student believes that this state is a matter of luck and caused by factors outside of the realm of personal control (i.e., partner, circumstances, fate) then the student is less likely to be conscientious about condom usage.

The implications of attribution theory for health behavior change are substantial, particularly where attributions can be changed or altered by education. Some attributions are rooted in personality traits and are not easily changeable, but most are perceptions and, as such, are receptive to change. Often causal attributions are found in more accessible, changeable beliefs and are motivated by incorrect attributions.

Diffusion of Innovation

Diffusion of innovation is a theory that analyzes, as well as explains, the adoption of a new innovation. It is a conceptual paradigm for understanding the process of social change.

Diffusion is the process by which an innovation is communicated through certain channels over time among the members of a social system. Thus, the four main elements of the theory are the innovation, communication channels, time, and the social system (target population).

An innovation is an idea, practice, or object that is perceived as new by an individual or group. The perceived newness of the idea for the individual determines the individual’s reaction to it. Additionally, whether the innovation is accepted depends upon whether the individual, or target population, perceives it as beneficial; sees it as in accordance with personal needs and values; finds it easy or difficult to understand or adopt; finds it possible to try the behavior; and feels that the results of the trial or acceptance of the innovation is viewed positively by the peer group.

The change agent or person introducing the innovation to the target population should take into consideration the following aspects:

·        Adopter categories: the characteristics of the target population;

·        Characteristics of the innovation or the change itself; and

·        Stages of adoption.

Each of these three categories should be analyzed and planned for when introducing and innovation or change.

It has been suggested that the mass media provides a quick and effective route for introducing new information or trying to influence attitudes, especially in the early stages of reaching audiences predisposed toward accepting new ideas. However, at the point of trial, or “adoption,” interpersonal channels are more influential. This means that a communications strategy might consist of using the mass media to introduce the message, provide knowledge, influence attitudes, and reinforce behavior. The introduction of the intervention itself – the teaching and encouraging of adoption of the behavior -- would then be done at the community or interpersonal level. A strategy such as this is especially important for groups known not to adopt new behaviors quickly.

The new idea of innovation typically moves slowly through a societal group as it is first introduced. Then, as the number of individuals trying the innovation (the adopters) increases, the diffusion of the new idea moves at a faster rate. The diffusion phenomenon initially follows an S-shaped curve. Such a curve denotes the slow rate of adoption of an innovation by the adopters at an early stage. The diffusion curve increases as the number of adopters also increases. Then, after the possible new adopters naturally decrease, so does the diffusion curve. Hence, the total diffusion of an innovation would follow, in reality, the normal curve. The diffusion is determined then by the social group, and each social group of adopters can be designated in the curve.

Characteristics of Adopter Categories

 ·        Innovators: venturesome, cosmopolitan, experimenters, risk-takers, information-seekers, with a higher financial status

·        Early Adopters: greatest degree of opinion leadership, respected by othedr members of social group. Strategies with a motivational emphasis may be most effective at getting them involved in the diffusion process.

·        Early Majority: Deliberate, adopt new ideas just before the averge member of a system.

·        Late Majority: Skeptical, adopt new ideas just after the average member of a system. Peer pressure is necessary to motivate adoption. Intervention strategies that help overcome barriers are needed to assist this group in adoption of the innovation.

·        Laggards: Traditional, last in a social system to adopt an innovation, pay little attention to the opinions of others.

Characteristics of an Innovation or Change

·        Relative Advantage: The degree to which an innovation is perceived as better than the idea it supersedes.

·        Compatibility: The degree to which an innovation is perceived as being consistent with existing values, past experiences, and the needs of potential adopters.

·        Complexity: The degree to which an innovation is perceived as difficulty to understand and use.

·        Trialability: The degree to which an innovation may be experimented with on a limited basis.

·        Observability: The degree to which the results of an innovation are visible to others.

Stages of Adoption

·        Awareness: The extent to which a target population is conscious of an innovation.

·        Interest: Personal intrigue about the innovation.

·        Trial: Experimentation with the adoption of the innovation

·        Decision: Adopter decides to continue, quit, or re-create the innovation.

·        Adoption: The continuation or integration of the innovation into the individual’s lifestyle.

 

Health Belief Model

The Health Belief Model was initially developed by a group of social psychologists at the U.S. Public Health Service in the 1950s to explain the failure of people to participate in various programs designed to prevent or to detect disease (Hochbaum, 1958; Rosenstock, 1960, 1966, 1974). Creating the model was a way to identify a few high-priority factors that might affect a person’s decision to be compliant with medical recommendations (Rosenstock, 1990). The model was later extended to include responses to symptoms (Kirscht, 1974) and to peoples behavior in response to diagnosed illness and compliance with medical regimens (Becker, 1974). Since its development, it has been one of the most often used psychosocial models of explaining health-related behavior (Rosenstock, 1990).   

Hochbaum (1958) studied over 1200 adults in three cities who participated in Public Health Service-sponsored free tuberculosis screening programs that were set up in various neighborhoods.  His primary focus was on why the participants did come in for screening, and so placed his emphasis on the forces that drive behavior rather than those that inhibit it.  His assessment included the participants' readiness to obtain x-rays, which included their beliefs that they were susceptible to tuberculosis and their beliefs in the benefits of early detection.  Their perceived susceptibility was comprised of two elements: (1) whether contracting tuberculosis was not only a mathematical possibility but a realistic possibility for the participants on a personal level; and (2) the extent that the participants believed that they could have the disease even with the absence of symptoms.  Perceived benefits also included two elements: (1) whether participants believed that x-rays could detect a disease that was not presenting symptoms; and (2) their belief that early detection and treatment would aid in the improvement of the prognosis.  Study results determined that four out of five participants who held both beliefs (perceived susceptibility and perceived benefits) took the predicted action of taking part in the tuberculosis screening program, while four out of five who held neither belief did not take part in the program.  Hochbaum therefore demonstrated that there was an association with two interacting variables -- perceived susceptibility and perceived benefits.

Further studies through the years (see Becker, 1974; Janz and Becker, 1984) have demonstrated that individuals will take action to ward off, screen for, or control ill health condition if they see themselves as susceptible to the condition (perceived susceptibility), if they believe it to have potentially serious health consequences (perceived severity), if they believe that an available course of action would either reduce their susceptibility to or the severity of the condition (perceived benefits), and if they believe that the anticipated barriers to taking the action are outweighed by the benefits (perceived barriers) (Rosenstock, 1990). 

Although the four key variables remain the most relevant components of the HBM, it is also believed that sociodemographic factors, particularly educational attainment, have an indirect effect on behavior by influencing the perception of susceptibility, severity, benefits, and barriers (Rosenstock, 1990, p.44).

The concept of efficacy expectation (Bandura, 1977) has also been considered as an addition to the HBM in order to increase its explanatory powers (Rosenstock, Strecher, and Becker, 1988).  As self-efficacy is "the conviction that one can successfully execute the behavior required to produce the outcomes" (Bandura, 1977a, p.79), it is comparable to the HBM concept of perceived benefits.  For example, if people want to quit smoking for health-related reasons, they must believe that smoking cessation will benefit their health (perceived benefits) and also that they are capable of quitting (efficacy expectation).  For the behavior change to succeed, they must feel threatened by their current behavior (perceived susceptibility and severity) and believe that a specific kind of change will have beneficial results at an acceptable cost (perceived benefits and barriers), but they must also feel competent enough (self-efficacious) to make that change.

Social Learning Theory/Social Cognitive Theory

Psychosocial theories contribute to the understanding of the effects of personal and environmental relationships on health behavior and health outcomes.  The most prominent theory in this perspective is Social Learning Theory which addresses both the psychosocial dynamics underlying health behavior and the methods of promoting behavior change.  Traced back to Stimulus-Response Theory (Watson, 1920) which states that a given stimulus elicits a given response, SLT incorporates the role of the organism into the model in attempts to deal with more complex phenomena.  It also includes such cognitive constructs as expectancy, imitation, covert rehearsal of events, self-efficacy, value, memory, and habits.

There are two main branches of Social Learning Theory -- one with a behaviorist bent and the other reliant on cognitive approaches.  Rotter developed his idea of "generalized expectancies of reinforcement" which contends that a person learns or is conditioned operantly on the basis of that person's history of positive or negative reinforcement.  The person also develops a sense of internal or external locus of control.  Those people with an internal orientation believe that reinforcers are subject to their own control and occur as a result of displaying their skills, while those with an external orientation see little or no connection between their behavior and reinforcers.  They perceive the occurrence of the reinforcers as result of fate, luck, or powerful others.  Those with an internal locus of control are more likely to self-initiate change; those with an external locus of control are more likely to be influenced by others (Rotter, 1966). 

Internally-oriented individuals have been found to be in better physical health than those who are externally-oriented (Ryckman, et al., 1982; Wallston and Wallston, 1981; Strickland, 1979).  Lau (1982) found that internals, as children, were encouraged by their parents to participate in preventive health behaviors such as following a proper diet, getting enough exercise, brushing their teeth properly, and having regular medical and dental checkups.  As a result of this early encouragement, internals learned to see themselves as responsible for the maintenance and improvement of their own physical health.  It would then follow that internals would have greater knowledge of the conditions that cause poor health and would take steps to maintain or improve their health.

Although other research is not completely consistent with these ideas (see Wallston and Wallston, 1982), there are studies which do support them.  In terms of smoking, studies have shown that internals are more likely than externals to reduce or quit smoking (Strickland, 1978, pp. 1193-1194; Wallston and Wallston, 1982, p.78).  There is a general association between those with an internal locus of control and good health, preventive health care, and more adequate coping with illness once it does occur (Ryckman, 1989, pp. 474-475).  

The second branch of SLT employs cognitive concepts to explain behavioral phenomena.  Bandura's concept of self-efficacy (1977), which is the confidence a person feels about performing a particular behavior, is perhaps the most important prerequisite for successful behavior change.  Efficacy expectations are the beliefs or convictions that individuals have which enable them to execute the behaviors that are required to produce certain outcomes (Bandura, 1977a).  These expectations influence people's choices of activities and environmental settings.  Having high or low self-efficacy also determines how much effort people will expend on activities and how long they will persist in challenging tasks in the face of aversive experiences.  The acquisition of high or low levels of efficacy expectations has four major sources which are performance accomplishments, vicarious experiences, verbal persuasion, and emotional arousal.

Performance accomplishments are related to personal mastery experiences; success experiences tend to create high expectations and failure expectations create low expectations.  This is further reinforced by the belief that once strong, high efficacy expectations have been created and reinforced by a number of success experiences, occasional failures are likely to have little impact on the individual's judgment of his/her capabilities.  At the same time, once low expectations have been created and reinforced, occasional successes are likely to have little impact on self-judgment.  Low expectations can be changed, however, by a pattern of repeated successes fueled by an increased and determined effort to affect change by the individual.  Through these determined efforts, people can eventually overcome and master the most difficult obstacles (Bandura, 1981, p.203).