Section 4.2: Cognitive Psychology Theories of Change
Alison Hutchinson, PhD
Postdoctoral Fellow, Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta
Carole A. Estabrooks, PhD
Professor and CIHR Canada Research Chair in Knowledge Translation, Faculty of Nursing, University of Alberta
Cognitive psychology theories
- Focus on behavior of the individual
- Are helpful in identifying cognitions amenable to change
- Claim that interventions to influence cognitive characteristics can mediate/moderate behavior (Conner & Norman, 2005)
- In the study of KT, such theories have been used to inform:
- o research design
- o intervention development
- o evaluation of KT interventions
Assumption of Cognitive Psychological Theories
Most cognitive psychological theories assume that individuals make decisions in a rational manner; following a systematic review of all available information
(Conner & Norman, 2005)
Cognitive psychology theories influential in the field of KT
|Related to motivation||Social cognitive theory|
Theory of planned behaviour
|Related to action||Implementation intentions|
Theory of operant conditioning
|Related to stages of change||Transtheoretical model of change|
|Related to decision making||Cognitive continuum theory|
Theories related to motivation
- Claim that motivation determines and predicts behavior
- Social cognitive theory assumes incentives and expectations related to outcomes and self efficacy determine behavior (Bandura, 1977,1982; Azjen, 1991)
- Self efficacy is hypothesized to be influenced by 4 sources of information – performance accomplishment (most influential), vicarious experience, verbal persuasion and physiological feedback (Bandura, 1977, 1982)
Theories related to motivation
- According to the theory of planned behavior intention to engage and perceived control over the behavior are determinants and predictors of behavior (Azjen, 1991)
- Intention relates to attitudes, subjective norms and behavioral control
Theories related to action
- Focus on individuals who are motivated to change
- The theory of implementation intentions relates to the behavioral logistics (when, where and how) that are necessary to achieve the intended goal (Gollwitzer, 1999)
- The theory of planned behavior suggests that planning and preparation will facilitate adoption of specific behavior
- According to operant conditioning theory, positive feedback will encourage repetition of the respective behavior, while negative feedback is likely to discourage certain behavior (Blackman, 1974)
- Interventions underpinned by operant conditioning theory may include feedback mechanisms to encourage or discourage behavior
Theories related to stages of change
- The transtheoretical model of change comprises 5 stages:
- Precontemplation – no plan to adopt in foreseeable future
- Contemplation – intends to adopt within next 6-months
- Preparation – intends to adopt within next month
- Action – has been using behavior for the past 6-months
- Maintenance – actively working to maintain the behavior
- It is claimed that an individual progresses through the stages over time (Prochaska & Velicer, 1997)
Theories related to stages of change
- Strategies to enhance progression from precontemplation to contemplation include:
- o Continuing education; Educational outreach; Performance feedback
- Strategies to enhance progression to preparation and action stages include:
- o Provision of resources and support
- Strategies to promote progression from action to maintenance include:
- o Reminders and prompts; Provision of appropriate equipment
Theories related to decision making
- The cognitive continuum theory claims that the cognitive mode for decision making exists on a continuum – analysis and intuition are at opposite poles on the continuum
- Characteristics of the individual decision determine the point on the continuum that is adopted
- Six modes of healthcare decision making have been identified, based on cognitive mode (intuition – analysis) and the structure of the task (potential for manipulation, visibility of the process, time required) (Hamm, 1988)
- Cognitive continuum theory can help explain and justify health professionals' decisions
(Hammond, 1980, 1981; Hamm, 1988)
Limitation of Cognitive Psychology Theories
Such theories do not:
- consider external factors
- take into account the social construction of knowledge
Evidence for cognitive psychology theories
- There is some evidence for the value of the theory of planned behavior in guiding development of interventions to influence behavior (Perkins et al., 2007; Eccles et al., 2007)
- An expanding body of evidence suggests operant conditioning is useful in predicting health professionals' behavior (Eccles et al., 2007; Bonetti et al., 2007)
- There is limited evidence to support stages of change (Bonetti et al., 1994; Weinstein, 1998) and the cognitive continuum theories (Lauri et al., 2001; Hamm, 1989)
- We recommend that future research be programmatic; undertaken systematically and incrementally to test theory-based interventions and their theoretical assumptions
- Research methodology and interventions should be reported in detail to enable replication studies and fidelity to the intervention
- Conner M, Norman P. Predicting health behaviour: a social cognition approach. In: Conner M, Norman P, editors. Predicting Health Behaviour. New York, USA: Open University Press; 2005.
- Bandura A. Self-efficacy: towards a unifying theory of behaviour change. Psychological Review 1977;84:191-215.
- Bandura A. Self-efficacy mechanism in human agency. American Psychologist 1982;37:122-147.
- Azjen I. The theory of planned behavior. Organizational behavior and human decision processes 1991;50:179-211.
- Gollwitzer PM. Implementation intentions: strong effects of simple plans. American Psychologist 1999;54:493-503.
- Blackman D. Operant conditioning: an experimental analysis of behaviour. London: Methuen; 1974.
- Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. American Journal of Health Promotion 1997;12(1):38-48.
- Hammond KR. The integration of research in judgment and decision theory (Report 226). Boulder, CO: University of Colorado, Center for Research on Judgment and Policy; 1980.
- Hammond KR. Principles of organization in intuitive and analytical cognition (Report 231). Boulder, CO: University of Colorado, Center for Research on Judgement and Policy; 1981. Report No.: 231.
- Hamm RM. Clinical intuition and clinical analysis: Expertise and the cognitive continuum. In: Dowie J, Elstein A, (Ed.) Professional Judgment: A Reader in Clinical Decision Making. Cambridge, UK: Cambridge University Press; 1988.
- Perkins MB, Jensen PS, Jaccard J, Gollwitzer P, Oettingen G, Pappadopulos E, et al. Applying theory-driven approaches to understanding and modifying clinicians' behavior: What do we know? Psychiatric Services 2007;58(3):342-348.
- Eccles MP, Johnston M, Hrisos S, Francis J, Grimshaw J, Steen N, et al. Translating clinicians' beliefs into implementation interventions (TRACII): A protocol for an intervention modeling experiment to change clinicians' intentions to implement evidence-based practice. Implementation Science 2007 [Accessed 7 February 2008]; 2 (27).
- Bonetti D, Pitts NB, Eccles M, Grimshaw J, Johnston M, Steen N, et al. Applying psychological theory to evidence-based clinical practice: Identifying factors predictive of taking intra-oral radiographs. Social Science & Medicine. 2006;63:1889-1899.
- Weinstein ND, Lyon JE, Sandman PM, Cuite CL. Experimental evidence for stages of health behavior change: The Precaution Adoption Process Model applied to home radon testing. Health Psychology 1998;17(5):445-453.
- Lauri S, Salantera S, Chalmers K, Ekman S-L, Kim HS, Kappeli S, et al. An exploratory study of clinical decision-making in five countries. Journal of Nursing Scholarship 2001;33(1):83-90.
- Hamm RM. Moment-by-moment variation in experts' analytic and intuitive cognitive activity. IEEE Transactions on Systems, Man, and Cybernetics 1989;18(5):757-776.
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