Social Learning Theory (Bandura)

Summary: Bandura’s Social Learning Theory posits that people learn from one another, via
observation, imitation, and modeling. The theory has often been called a bridge between
behaviorist and cognitive learning theories because it encompasses attention, memory, and
motivation.

Originator: Albert Bandura

Key Terms: Modeling, reciprocal determinism

Social Learning Theory (Bandura)

People learn through observing others’ behavior, attitudes, and outcomes of those behaviors.
―Most human behavior is learned observationally through modeling: from observing others, one
forms an idea of how new behaviors are performed, and on later occasions this coded
information serves as a guide for action.‖ (Bandura). Social learning theory explains human
behavior in terms of continuous reciprocal interaction between cognitive, behavioral, and
environmental influences.

Necessary conditions for effective modeling:

1. Attention — various factors increase or decrease the amount of attention paid. Includes
distinctiveness, affective valence, prevalence, complexity, functional value. One’s
characteristics (e.g. sensory capacities, arousal level, perceptual set, past reinforcement)
affect attention.
2. Retention — remembering what you paid attention to. Includes symbolic coding, mental
images, cognitive organization, symbolic rehearsal, motor rehearsal
3. Reproduction — reproducing the image. Including physical capabilities, and self-
observation of reproduction.
4. Motivation — having a good reason to imitate. Includes motives such as past (i.e.
traditional behaviorism), promised (imagined incentives) and vicarious (seeing and
recalling the reinforced model)

Bandura believed in ―reciprocal determinism‖, that is, the world and a person’s behavior cause
each other, while behaviorism essentially states that one’s environment causes one’s behavior,
Bandura, who was studying adolescent aggression, found this too simplistic, and so in addition
he suggested that behavior causes environment as well. Later, Bandura soon considered
personality as an interaction between three components: the environment, behavior, and one’s
psychological processes (one’s ability to entertain images in minds and language).

Social learning theory has sometimes been called a bridge between behaviorist and cognitive
learning theories because it encompasses attention, memory, and motivation. The theory is
related to Vygotsky’s Social Development Theory and Lave’s Situated Learning, which also
emphasize the importance of social learning.
PRECEDE-PROCEED MODEL

The PRECEDE-PROCEED model provides a comprehensive structure for assessing health and
quality-of-life needs and for designing, implementing, and evaluating health promotion and other
public health programs to meet those needs. PRECEDE (P redisposing, R einforcing, and E
nabling C onstructs in E ducational D iagnosis and E valuation) outlines a diagnostic planning
process to assist in the development of targeted and focused public health programs. PROCEED
(P olicy, R egulatory, and O rganizational C onstructs in E ducational and E nvironmental D
evelopment) guides the implementation and evaluation of the programs designed using
PRECEDE.

PRECEDE consists of five steps or phases (see Figure 1). Phase one involves determining the
quality of life or social problems and needs of a given population. Phase two consists of
identifying the health determinants of these problems and needs. Phase three involves analyzing
the behavioral and environmental determinants of the health problems. In phase four, the factors
that predispose to, reinforce, and enable the behaviors and lifestyles are identified. Phase five
involves ascertaining which health promotion, health education and/or policy-related
interventions would best be suited to encouraging the desired changes in the behaviors or
environments and in the factors that support those behaviors and environments.

PROCEED is composed of four additional phases. In phase six, the interventions identified in
phase five are implemented. Phase seven entails process evaluation of those interventions. Phase
eight involves evaluating the impact of the interventions on the factors supporting behavior, and
on behavior itself. The ninth and last phase comprises outcome evaluation—that is, determining
the ultimate effects of the interventions on the health and quality of life of the population.

In actual practice, PRECEDE and PROCEED function in a continuous cycle. Information

gathered in PRECEDE guides the development of program goals and objectives in the
implementation phase of PROCEED. This same information also provides the criteria against
which the success of the program is measured in the evaluation phase of PROCEED. In turn, the
data gathered in the implementation and evaluation phases of PROCEED clarify the relationships
examined in PRECEDE between the health or quality-of-life outcomes, the behaviors and
environments that influence them, and the factors that lead to the desired behavioral and
environmental changes. These data also suggest how programs may be modified to more closely
reach their goals and targets.

Among the contributions of the PRECEDE-PROCEED model is that it has encouraged and
facilitated more systematic and comprehensive planning of public health programs. Sometimes
practitioners and researchers attempt to address a specific health or quality-of-life issue in a
particular group of people without knowing whether those people consider the issue to be
important. Other

Figure 1

times, they choose interventions they are comfortable using rather than searching for the most
appropriate intervention for a particular population. Yet, what has worked for one group of
people may not necessarily work for another, given how greatly people differ in their priorities,
values, and behaviors. PRECEDE-PROCEED therefore begins by engaging the population of
interest themselves in a process of identifying their most important health or quality-of-life
issues. Then the model guides researchers and practitioners to determine what causes those
issues—that is, what must precede them. This way, interventions can be designed based not on
speculation but, rather, on a clear understanding of what factors influence the health and quality-
of-life issues in that population. As well, the progression from phase to phase within PRECEDE
allows the practitioner to establish priorities in each phase that help narrow the focus in each
subsequent phase so as to arrive at a tightly defined subset of factors as targets for intervention.
This is essential, since no single program could afford to address all the predisposing, enabling
and reinforcing factors for all of the behaviors, lifestyles, and environments that influence all of
the health and quality-of-life issues of interest.

Applications of the PRECEDE-PROCEED model in the public health field are myriad and
varied. The model has been used to plan, design, implement, and/or evaluate programs for such
diverse health and quality-of-life issues as breast, cervical, and prostate cancer screening; breast
self-examination; cancer education; heart health; maternal and child health; injury prevention;
weight control; increasing physical activity; tobacco control; alcohol and drug abuse; school-
based nutrition; health education policy; and curriculum development and training for health care
professionals. A searchable bibliography of hundreds of published applications is available on
the World Wide Web. Also available is an interactive software training program entitled
EMPOWER, which illustrates how the model can be used to plan a breast cancer detection
program.

Cognitivism

The cognitivist revolution replaced behaviorism in 1960s as the dominant paradigm. Cognitivism
focuses on the inner mental activities – opening the ―black box‖ of the human mind is valuable
and necessary for understanding how people learn. Mental processes such as thinking, memory,
knowing, and problem-solving need to be explored. Knowledge can be seen as schema or
symbolic mental constructions. Learning is defined as change in a learner’s schemata.

A response to behaviorism, people are not ―programmed animals‖ that merely respond to
environmental stimuli; people are rational beings that require active participation in order to
learn, and whose actions are a consequence of thinking. Changes in behavior are observed, but
only as an indication of what is occurring in the learner’s head. Cognitivism uses the metaphor of
the mind as computer: information comes in, is being processed, and leads to certain outcomes.

Behaviorism

Behaviorism is a worldview that assumes a learner is essentially passive, responding to

environmental stimuli. The learner starts off as a clean slate (i.e. tabula rasa) and behavior is
shaped through positive reinforcement or negative reinforcement. Both positive reinforcement
and negative reinforcement increase the probability that the antecedent behavior will happen
again. In contrast, punishment (both positive and negative) decreases the likelihood that the
antecedent behavior will happen again. Positive indicates the application of a stimulus; Negative
indicates the withholding of a stimulus. Learning is therefore defined as a change in behavior in
the learner. Lots of (early) behaviorist work was done with animals (e.g. Pavlov’s dogs) and
generalized to humans.

Behaviorism precedes the cognitivist worldview. It rejects structuralism and is an extension of

Logical Positivism.

Radical behaviorism

Developed by BF Skinner, Radical Behaviorism describes a particular school that emerged

during the reign of behaviorism. It is distinct from other schools of behaviorism, with major
differences in the acceptance of mediating structures, the role of emotions, etc.

Connectionism (E. Thorndike)

The learning theory of Thorndike represents the original S-R framework of behavioral
psychology: Learning is the result of associations forming between stimuli and responses. Such
associations or "habits" become strengthened or weakened by the nature and frequency of the S-
R pairings. The paradigm for S-R theory was trial and error learning in which certain responses
come to dominate others due to rewards. The hallmark of connectionism (like all behavioral
theory) was that learning could be adequately explained without refering to any unobservable
internal states.

Thorndike's theory consists of three primary laws: (1) law of effect - responses to a situation
which are followed by a rewarding state of affairs will be strengthened and become habitual
responses to that situation, (2) law of readiness - a series of responses can be chained together to
satisfy some goal which will result in annoyance if blocked, and (3) law of exercise -
connections become strengthened with practice and weakened when practice is discontinued. A
corollary of the law of effect was that responses that reduce the likelihood of achieving a
rewarding state (i.e., punishments, failures) will decrease in strength.

The theory suggests that transfer of learning depends upon the presence of identical elements in
the original and new learning situations; i.e., transfer is always specific, never general. In later
versions of the theory, the concept of "belongingness" was introduced; connections are more
readily established if the person perceives that stimuli or responses go together (c.f. Gestalt
principles). Another concept introduced was "polarity" which specifies that connections occur
more easily in the direction in which they were originally formed than the opposite. Thorndike
also introduced the "spread of effect" idea, i.e., rewards affect not only the connection that
produced them but temporally adjacent connections as well.

Scope/Application:

Connectionism was meant to be a general theory of learning for animals and humans. Thorndike
was especially interested in the application of his theory to education including mathematics
(Thorndike, 1922), spelling and reading (Thorndike, 1921), measurement of intelligence
(Thorndike et al., 1927) and adult learning (Thorndike at al., 1928).
Example:

The classic example of Thorndike's S-R theory was a cat learning to escape from a "puzzle box"
by pressing a lever inside the box. After much trial and error behavior, the cat learns to associate
pressing the lever (S) with opening the door (R). This S-R connection is established because it
results in a satisfying state of affairs (escape from the box). The law of exercise specifies that the
connection was established because the S-R pairing occurred many times (the law of effect) and
was rewarded (law of effect) as well as forming a single sequence (law of readiness).

Principles:

1. Learning requires both practice and rewards (laws of effect /exercise)

2. A series of S-R connections can be chained together if they belong to the same action
sequence (law of readiness).

3. Transfer of learning occurs because of previously encountered situations.

4. Intelligence is a function of the number of connections learned.

What Is the Health Belief Model

The Health Belief Model (HBM) is a tool that scientists use to try and predict health behaviors.
Originally developed in the 1950s, and updated in the 1980s, it is based on the theory that a
person's willingness to change their health behaviors is primarily due to the following factors:

 Perceived Susceptibility
People will not change their health behaviors unless they believe that they are at risk.
Those who does not think that they are at risk of acquiring HIV from unprotected
intercourse are unlikely to use a condom.
 Perceived Severity
The probability that a person will change his/her health behaviors to avoid a consequence
depends on how serious he or she considers the consequence to be.
If you are young and in love, you are unlikely to avoid kissing your sweetheart on the
mouth just because he has the sniffles, and you might get his cold. On the other hand, you
probably would stop kissing if it might give you Ebola.
 Perceived Benefits
It's difficult to convince people to change a behavior if there isn't something in it for
them.
Your father probably won't stop smoking if he doesn't think that doing so will improve his
life in some way.
 Perceived Barriers
One of the major reasons people don't change their health behaviors is that they think that
doing so is going to be hard. Sometimes it's not just a matter of physical difficulty, but
social difficulty as well. Changing your health behaviors can cost effort, money, and
time.
 If everyone from your office goes out drinking on Fridays, it may be very difficult to cut
down on your alcohol intake.

The Health Belief Model, however, is realistic. It recognizes the fact that sometimes wanting to
change a health behavior isn't enough to actually make someone do it, and incorporates two more
elements into its estimations about what it actually takes to get an individual to make the leap.
These two elements are cues to action and self efficacy.

Cues to action are external events that prompt a desire to make a health change. They can be
anything from a blood pressure van being present at a health fair, to seeing a condom poster on a
train, to having a relative die of cancer. A cue to action is something that helps move someone
from wanting to make a health change to actually making the change.

In my mind, however, the most interesting part of the Health Belief Model is the concept of self
efficacy -- an element which wasn't added to the model until 1988. Self efficacy looks at a
person's belief in his/her ability to make a health related change. It may seem trivial, but faith in
your ability to do something has an enormous impact on your actual ability to do it. Thinking
that you will fail will almost make certain that you do. In fact, in recent years, self efficacy has
been found to be one of the most important factors in an individual's ability to successfully
negotiate condom use.

The Transtheoretical Model of Behavior Change assesses an individual's readiness to act on a

new healthier behavior, and provides strategies, or processes of change to guide the individual
through the stages of change to action and maintenance.
Processes of change:

 Precontemplation: Unaware of problem, not thinking of or wanting to change.

 Contemplation: Aware of problem and thinking about taking action.

 Preparation: Getting emotionally ready. Intending to act.
 Action: Taking the necessary action.
 Maintenance: Keeping up the necessary action. Not backing out or slowing down.
 Termination: Ending at the appropriate point. Not becoming 'institutionalized'.

This model is particularly applicable for such as addiction and health, where the person is not
likely to be easily willing to change.
What is health promotion?

Health promotion is the process of enabling people to exert control

over the determinants of health and thereby improve their health. As
a concept and set of practical strategies it remains an essential guide
in addressing the major health challenges faced by developing and
developed nations, including communicable and non-communicable
diseases, and issues related to human development and health.

Health promotion is a process directed towards enabling people to

take action. Thus, health promotion is not something that is done on
or to people; it is done by, with and for people either as individuals
or as groups. The purpose of this activity is to strengthen the skills
and capabilities of individuals to take action and the capacity of
groups or communities to act collectively to exert control over the
determinants of health and achieve positive change.

Role and relevance of health promotion

In tackling the determinants of health, health promotion will include
combinations of the strategies first described in the Ottawa charter,
namely developing personal skills, strengthening community action,
and creating supportive environments for health, backed by healthy
public policy. Special attention is also given to the need to reorient
health services towards health promotion.

Thus, health promotion will include actions directed at both the

determinants of health that are outside the immediate control of
individuals, including social, economic and environmental
conditions, and the determinants within the more immediate control
of individuals, including individual health behaviours.

Health promotion is a powerfully relevant strategy for social

development -
in particular as an important set of strategies to address the factors
influencing inequalities in health. Health promotion also
encompasses the principles that underlie a series of strategies that
seek to foster conditions that allow populations to be healthy and to
make healthy choices. The range of strategies draws upon multiple
fields of thought including anthropology, epidemiology, sociology,
psychology and other behavioural sciences, public health, political
science, education and communication, to name a few, and their
respective methodologies.

Health promotion and determinants of health

Health is a resource for life that enables people to lead individually,
socially and economically productive lives. It is a positive concept
emphasising social and personal resources (physical, mental and
spiritual).

It has long been acknowledged that there are certain prerequisites

for health that include peace, adequate economic resources (and
their distribution), food and shelter, clean water, a stable ecosystem,
sustainable resource use, and access to basic human rights. The
challenge to meet these fundamental needs must remain a core goal
for all action directed towards health, social and economic
development.

Recognition of these prerequisites highlights the inextricable links

between social and economic conditions, structural changes, the
physical environment, individual lifestyles and health. These links
provide the key to an holistic understanding of health, and are
meaningful to people's lives as they experience them.

There are obvious inherent challenges in achieving the goal of

reduced inequities. Virtually all societies struggle with this problem.
Achieving complete equality in health status among all who live in
Northern Ireland could be viewed as an unrealistic goal. But
achieving 'equitable' or fair access to the opportunities and
supportive environments all people need to be healthy is both a
laudable and achievable goal in a caring, civilized society. The
United Nations report on human development suggests that efforts
to reduce relative poverty, and to increase opportunities in
education, employment, wages and participation in political and
economic spheres are the key strategies for reducing inequities and,
therefore, improving the health and wellbeing of those who live
here.

Challenges for health promotion

The fact that health promotion refers to a collection of strategies that
can be applied to many health and development issues also means
that these strategies must operate within the context of something
else. 'Empowerment', 'advocacy', 'communications', 'education',
'social mobilisation', 'community participation', and so on, all buzz-
words of health promotion adherents, have little meaning in a
vacuum. Nor are these components of health promotion ends in
themselves, but means to achieve healthier and fuller lives.