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Chapter 7

Health Sciences 4202A/B Chapter Notes - Chapter 7: Social Cognitive Theory, Social Learning Theory, Procedural Knowledge

Health Sciences
Course Code
HS 4202A/B
Tamara Thompson

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Chapter 7 Social Cognitive Theory Applied to Health Behavior
Social cognitive theory (SCT), one of the most valuable assets in the field of health behavior, asserts
in general terms that the environment (social, physical, economic, legal/policy) and the personal
characteristics of the individual interact with behavior in a reciprocal fashion
SCT evolved from Albert Bandura’s social learning theory
He suggested that learning occurs within a social context and involves observing the behaviors of
others, modeling those behaviors, being reinforced for performing these behaviors, and basic
cognition pertaining to the behaviors
- In essence, social learning theory suggests that people learn new behaviors through observing
others, imitating their behavior, and then being reinforced by the observed outcomes of the
Bandura later expanded social learning theory to suggest that the social context, the larger
environmental factors, the individual, and the individual’s behavior are intertwinedthis expansion
was termed social cognitive theory.
SCT was not developed specifically to explain health behaviors per se, although it has been applied
effectively to a range of health behaviors
The elegance of SCT in the context of the new public health lies in its inherent assumption that nearly
all human behavior is influenced by the immediate social environment in which the behavior occurs
Obesity as a Socially Generated Form of Disease
Key Concepts
Five Key Constructs of Social Cognitive Theory
SCT has its origins in social learning theory (a theory used in education and psychology), but the two
theories are not the same
- The key difference is that SCT is predicated on the concept that the social environment is a central
influence on behavior, making personal characteristics alone an inadequate explanation of health
However, it is important to know that these five constructs (knowledge, perceived, self-efficacy,
outcome expectations, goal formation, and social structural factors) stem from a landmark article
authored by Bandura, which specifically examined SCT in the context of health promotion
Knowledge is a precondition for behavior change
Knowledge is viewed as a “gateway” that must be passed before more complex personal and social
issues come into play
An old adage in health behavior is that “knowledge is a necessary, but not sufficient, basis for
behavior change.”
One good way of thinking about knowledge acquisition is as a fundamental starting point for all
health-promotion programs
- Bandura also distinguishes different types of knowledge
- In the context of health promotion, content knowledge involves understanding the advantages
and drawbacks of a given health behavior, though this represents a minimal awareness only
- The more advanced type of knowledge, procedural knowledge, involves understanding how to
engage in a given health behavior.
Perceived Self-Efficacy
The next step is to provide people with the confidence and ability they need to actually adopt the
health-protective behavior, known as perceived self-efficacy
Perceived self-efficacy is perhaps the most widely known theoretical construct in the field of health

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Perceived self-efficacy is a person’s perception of his or her ability to perform a specific behavior
It is vital to understand that self-efficacy is task-specific
It is also worth noting that self-efficacy is indeed a perception
- Perceptions that people hold may or may not mirror reality
It is important for health-promotion programs to accommodate differences in self-efficacy levels
because the range in a population is likely to be broad
As you can see, the construct of perceived self-efficacy is extremely relevant to the adoption and
maintenance of health behaviors that may not always be easy to perform
In essence, strong self-efficacy is a belief that an individual can perform a health-protective behavior
even under adverse circumstances
- Sometimes referred to as resilient self-efficacy, the concept of perseverance even when conditions
are not ideal is vital simply because so many health-protective behaviors occur under difficult
Here are several other examples of health behaviors that may be difficult to maintain under certain
challenging circumstances: consuming a low-sodium diet, consuming a diet low in refined sugars,
consuming a diet low in saturated fats, smoking cessation, reduced consumption of alcohol, engaging
in regular aerobic exercise routines, eating a high-fiber diet to prevent colorectal cancer, avoiding food
additives that may cause cancer, and using nonhormonal contraceptives
It is critical to note that any given health behavior may require several distinct skills, and thus
perceived self-efficacy may not be uniform across these various skill requirements.
The utility of self-efficacy as SCT construct is that it is very amenable to intervention efforts.
According to SCT, people can and do increase their perceptions of self-efficacy based on four
methods of learning
- Bandura suggests that these efforts will have their “greatest impact on people who have some
reason to believe that they can produce effects through their actions,” meaning that verbal
persuasion will be more effective when a person can easily modify self- efficacy
Bandura also warns that verbal persuasion beyond a person’s actual ability will quite
likely be counterproductive.
- People learn by watching others perform a given behavior; if the given behavior is performed
successfully, feedback to the observer may inform their self-efficacy perceptions
Vicarious learning is especially influential on self-efficacy perceptions when people are
unsure about their ability
This form of learning is maximized when people observe someone quite similar to
themselves successfully performing (or not successfully performing) a given health-
protective behavior
Indeed, this theoretical premise is the basis for the use of peer-to-peer teaching models in
health-promotion efforts and also health-promotion interventions utilizing media
Another effective approach, if possible, would be to have a student who successfully
performed this delicate behavior describe the experience to the other students (a form of
peer teaching)
Unfortunately, this is often not possible in connection with so many health- protective
behaviors (e.g., condom application, sexual negotiations).
- The final and most effective method is enactive attainment.
Enactive attainment is physically guiding or coaching someone through the behavior
People’s self-efficacy perceptions are naturally shaped by their experience of effort followed by
success or effort followed by failure
- Here, however, it is important to note that success and failure are also perceptions
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