Health Education & Behavior31 April 2 (April 2004)
Health Promotion by Social Cognitive Means
Albert Bandura, PhD
This article examines health promotion and disease prevention from the perspective of social cognitive theory. This theory posits a multifaceted causal structure in which self-efficacy beliefs operate together with goals, outcome expectations, and perceived environmental impediments and facilitators in the regulation of human motivation, behavior, and well-being. Belief in one’s efficacy to exercise control is a common pathway through which psychosocial influences affect health functioning. This core belief affects each of the basic processes of personal change—whether people even consider changing their health habits, whether they mobilize the motivation and perseverance needed to succeed should they do so, their ability to recover from setbacks and relapses, and how well they maintain the habit changes they have achieved. Human health is a social matter, not just an individual one. A comprehensive approach to health promotion also requires changing the practices of social systems that have widespread effects on human health. Keywords: social cognitive theory; self-efficacy; self-regulation; collective efficacy; self-management model
I am deeply honored to be a recipient of the Healthtrac Award. It is a special honor to be recognized by a foundation that promotes the betterment of human health in the ways I value highly. In comparing myself to the figure Larry so generously described, I feel like a Swiss yodeler following Pavarotti. The field of health is changing from a disease model to a health model. It is just as meaningful to speak of levels of vitality and healthfulness as of degrees of impairment and debility. Health promotion should begin with goals, not means.1 If health is the goal, biomedical interventions are not the only means to it. A broadened perspective expands the range of health-promoting practices and enlists the collective efforts of researchers and practioners who have much to contribute from a variety of disciplines to the health of a nation. The quality of health is heavily influenced by lifestyle habits. This enables people to exercise some measure of control over their health. By managing their health habits, people can live longer and healthier and retard the process of aging. Self-management is good medicine. If the huge health benefits of these few habits were put into a pill, it would be declared a scientific milestone in the field of medicine.
Albert Bandura, Department of Psychology, Stanford University, Stanford, California. Address reprint requests to Albert Bandura, Department of Psychology, Stanford University, Stanford, California 94305-2130; e-mail: email@example.com. A major portion of this article was presented as the Healthtrac Foundation Lecture at the convention of the Society for Public Health Education in Philadelphia, November 9, 2002. Health Education & Behavior, Vol. 31 (2): 143-164 (April 2004) DOI: 10.1177/1090198104263660 © 2004 by SOPHE
Health Education & Behavior (April 2004)
Supply-Side Versus Demand-Side Approaches Current health practices focus heavily on the medical supply side. The growing pressure on health systems is to reduce, ration, and delay health services to contain health costs. The days for the supply-side health system are limited. People are living longer. This creates more time for minor dysfunctions to develop into chronic diseases. Demand is overwhelming supply. Psychosocial factors partly determine whether the extended life is lived efficaciously or with debility, pain, and dependence.2,3 Social cognitive approaches focus on the demand side. They promote effective selfmanagement of health habits that keep people healthy through their life span. Aging populations will force societies to redirect their efforts from supply-side practices...