Page - 147 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

1. Introduction to behaviour change theories Health behaviour and behaviour change theories aim to explain the mechanisms by which (health) behaviours change, with a focus on harnessing those mechanisms to promote change [1]. These theories trace their roots to early work in the field of psychology, and B.F. Skinner’s work in operant conditioning. Miller and Dollard’s 1941 work on “social learning and imitation” can be considered the first behaviour change theory, asserting that people develop behavioural patterns through social interaction and reinforcement, including observing the actions and consequences experienced by others. This work formed the basis of the modern Social Learning and Social Cognitive theories. 1.1. Social Learning and Social Cognitive Theory Social Learning Theory sought to combine the behaviourist and cognitive theories of learning, by positing that people learn through an interaction between cognitive factors, environmental influences, and behaviour. Observational learning occurs with four processes: attention (observing the modelled behaviour), retention (remembering the modelled behaviour), reproduction (attempting to imitate the behaviour), and motivation (anticipating the consequences of performing the behaviour, including social consequences). Reinforcement (external consequences) and self-control also play a role. In 1986 the theory was extended into the Social Cognitive Theory, an extensive theory of human motivation and action. In this theory, cognitive, environmental, and behavioural determinants all interact and influence one another [2]. People live and act within a social structure, which is in turn influenced by its members. Human agency can be exercised by taking action, directing others, or acting as part of a group. It encompasses intention and forethought, self-regulatory, and self-reflective mechanisms. The latter includes the important psychological construct of self-efficacy – an individual's belief that their actions can effect the desired change; that is, that they are capable of being effective in a particular task. The Social Cognitive Theory is a general theory of behaviour, not specific to health or behaviour change. Nonetheless, it is one of the most-used theories in behaviour- change interventions, including internet-based interventions [3]. A shortcoming of the model is that it ignores the role of emotions, neurology, and physiology on behaviour. For example, behaviour often shifts as people age, without any corresponding shift in social, cognitive, or environmental influences. 1.2. The Health Belief Model Work in the field progressed in the 1950’s, as researchers sought to understand why tuberculosis screening programs had failed. The factors they elucidated formed the basis of the Health Belief Model (Figure 1). S.MedlockandJ.C.Wyatt /HealthBehaviourTheory inHealth Informatics 147