Behavioural change theories

Self-efficacy[2] is an individual's impression of their own ability to perform a demanding or challenging task such as facing an exam or undergoing surgery. This impression is based upon factors like the individual's prior success in the task or in related tasks, the individual's physiological state, and outside sources of persuasion. Self-efficacy is thought to be predictive of the amount of effort an individual will expend in initiating and maintaining a behavioural change, so although self-efficacy is not a behavioural change theory per se, it is an important element of many of the theories, including the health belief model, the theory of planned behaviour and the health action process approach.

In 1977, Albert Bandura performed two experimental tests on the self-efficacy theory. The first study asked whether systematic desensitization could effect changes in avoidance behavior by improving people's expectations of their personal efficacy. The study found that "thorough extinction of anxiety arousal to visualized threats by desensitization treatment produced differential increases in self-efficacy. In accord with prediction, microanalysis of congruence between self-efficacy and performance showed self-efficacy to be a highly accurate predictor of degree of behavioral change following complete desensitization. The findings also lend support to the view that perceived self-efficacy mediates anxiety arousal." In the second experiment, Bandura examined the process of efficacy and behavioral change in individuals suffering from phobias. He found that self-efficacy was a useful predictor of the amount of behavioral improvement that phobics could gain through mastering threatening thoughts.[3]

According to the social learning theory[4] (more recently expanded as social cognitive theory[5]), behavioural change is determined by environmental, personal, and behavioural elements. Each factor affects each of the others. For example, in congruence with the principles of self-efficacy, an individual's thoughts affect their behaviour and an individual's characteristics elicit certain responses from the social environment. Likewise, an individual's environment affects the development of personal characteristics as well as the person's behavior, and an individual's behaviour may change their environment as well as the way the individual thinks or feels. Social learning theory focuses on the reciprocal interactions between these factors, which are hypothesised to determine behavioral change.

The theory of reasoned action[6][7] assumes that individuals consider a behaviour's consequences before performing the particular behaviour. As a result, intention is an important factor in determining behaviour and behavioural change. According to Icek Ajzen, intentions develop from an individual's perception of a behaviour as positive or negative together with the individual's impression of the way their society perceives the same behaviour. Thus, personal attitude and social pressure shape intention, which is essential to performance of a behaviour and consequently behavioural change.

In 1985, Ajzen expanded upon the theory of reasoned action, formulating the theory of planned behaviour,[8] which also emphasises the role of intention in behaviour performance but is intended to cover cases in which a person is not in control of all factors affecting the actual performance of a behaviour. As a result, the new theory states that the incidence of actual behaviour performance is proportional to the amount of control an individual possesses over the behaviour and the strength of the individual's intention in performing the behaviour. In his article, Further hypothesises that self-efficacy is important in determining the strength of the individual's intention to perform a behaviour. In 2010, Fishbein and Ajzen introduced the reasoned action approach, the successor of the theory of planned behaviour.

According to the transtheoretical model[9][10] of behavior change, also known as the stages of change model, states that there are five stages towards behavior change. The five stages, between which individuals may transition before achieving complete change, are precontemplation, contemplation, preparation for action, action, and maintenance. At the precontemplation stage, an individual may or may not be aware of a problem but has no thought of changing their behavior. From precontemplation to contemplation, the individual begins thinking about changing a certain behavior. During preparation, the individual begins his plans for change, and during the action stage the individual begins to exhibit new behavior consistently. An individual finally enters the maintenance stage once they exhibit the new behavior consistently for over six months. A problem faced with the stages of change model is that it is very easy for a person to enter the maintenance stage and then fall back into earlier stages. Factors that contribute to this decline include external factors such as weather or seasonal changes, and/or personal issues a person is dealing with.

The health action process approach (HAPA)[11] is designed as a sequence of two continuous self-regulatory processes, a goal-setting phase (motivation) and a goal-pursuit phase (volition). The second phase is subdivided into a pre-action phase and an action phase. Motivational self-efficacy, outcome-expectancies and risk perceptions are assumed to be predictors of intentions. This is the motivational phase of the model. The predictive effect of motivational self-efficacy on behaviour is assumed to be mediated by recovery self-efficacy, and the effects of intentions are assumed to be mediated by planning. The latter processes refer to the volitional phase of the model.

The BJ Fogg Behavior Model. The different levels of ability and motivation define whether triggers for behavior change will succeed or fail. As an example trying to trigger behavior change through something difficult to do (low ability) will only succeed with very high motivation. In contrast, trying to trigger behavior change through something easy to do (high ability) may succeed even with average motivation.

The Fogg Behavior Model (FBM)[12] is a design behavior change model introduced by BJ Fogg. This model posits that behavior is composed of three different factors: motivation, ability and a prompt. Under the FBM, for any person (user) to succeed at behavior change needs to be motivated, have the ability to perform the behavior and needs a trigger to perform this behavior. The next are the definitions of each of the elements of the BFM:

BJ Fogg does not provide a definition of motivation but instead defines different motivators:

• Pleasure/Pain: These motivators produce a response immediately and although powerful these are not ideal. Boosting motivation could be achieved by embodying pain or pleasure.
• Hope/fear: Both these motivators have a delayed response and are the anticipation of a future positive outcome (hope) or negative outcome (fear). As an example people joining a dating website hope to meet other people.
• Social acceptance/rejection: People are motivated by behaviors that increase or preserve their social acceptance.

This factor refers to the self-efficacy perception at performing a target behavior. Although low ability is undesirable it may be unavoidable: "We are fundamentally lazy," according to BJ Fogg. In such case behavior change is approached not through learning but instead by promoting target behaviors for which the user has a high ability. Additionally BJ Fogg listed several elements or dimensions that characterize high ability or simplicity of performing a behavior:

• Time: The user has the time to perform the target behavior or the time taken is very low.
• Money: The user has enough financial resources for pursuing the behavior. In some cases money can buy time.
• Physical effort: Target behaviors that require physical effort may not be simple enough to be performed.
• Brain cycles: Target behaviors that require high cognitive resources may not be simple hence undesirable for behavior change.
• Social deviance: These include behaviors that make the user socially deviant. These kind of behaviors are not simple.
• Non-routine: Any behavior that incurs disrupting a routine is considered not simple. Simple behaviors are usually part of routines and hence easy to follow.

Triggers are reminders that may be explicit or implicit about the performance of a behavior. Examples of triggers can be alarms, text messages or advertisement, triggers are usually perceptual in nature but may also be intrinsic. One of the most important aspects of a trigger is timing as only certain times are best for triggering certain behaviors. As an example if a person is trying to go to the gym everyday, but only remembers about packing clothing once out of the house it is less likely that this person will head back home and pack. In contrast if an alarm sounds right before leaving the house reminding about packing clothing, this will take considerably less effort. Although the original article does not have any references for the reasoning or theories behind the model, some of its elements can be traced to social psychology theories, e.g., the motivation and ability factors and its success or failure are related to Self-efficacy.

Tailoring refers to methods for personalizing communications intended to generate higher behavior change than non personalized ones.[15] There are two main claims for why tailoring works: Tailoring may improve preconditions for message processing and tailoring may improve impact by altering starting behavioral determinants of goal outcomes. The different message processing mechanisms can be summarized into: Attention, Effortful processing, Emotional processing and self-reference.

• Attention: Tailored messages are more likely to be read and remembered
• Effortful processing: Tailored messages elicit careful consideration of persuasive arguments and more systematic utilization of the receivers own schemas and memories. This could also turn out damaging because this careful consideration does increase counterarguing, evaluations of credibility and other processes that lessens message effects.
• Peripheral emotion/processing: tailoring could be used to create an emotional response such as fear, hope or anxiety. Since positive emotions tend to reduce effortful processing and negative emotions enhance it, emotion arousal could elicit varying cognitive processing.
• Self-reference: This mechanism promotes the comparison between actual and ideal behaviors and reflection.

Behavioral determinants of goal outcomes are the different psychological and social constructs that have a direct influence on behavior. The three most used mediators in tailoring are attitude, perception of performance and self efficacy. Although results are largely positive they are not consistent and more research on the elements that make tailoring work is necessary.