Bandura / Health Promotion 10.1177/1090198104263660 ARTICLE
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: firstname.lastname@example.org. 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...
References: 1. Nordin I: The limits of medical practice. Theor Med Bioeth 20:105-123, 1999.
Bandura / Health Promotion
2. Fries JF, Crapo LM: Vitality and Aging: Implications of the Rectangular Curve. San Francisco, Freeman, 1981. 3. Fuchs V: Who Shall Live? Health Economics and Social Choice. New York, Basic Books, 1974. 4. Bandura A: Self-Efficacy: The Exercise of Control. New York, Freeman, 1997. 5. Bandura A: Psychological aspects of prognostic judgments, in Evans RW, Baskin DS, Yatsu FM (eds.): Prognosis of Neurological Disorders (2nd ed.). New York, Oxford University Press, 2000, pp. 11-27. 6. Dzewaltowski DA, Noble JM, Shaw JM: Physical activity participation: Social cognitive theory versus the theories of reasoned action and planned behavior. J Sport Exerc Psychol 12:388-405, 1990. 7. Meyerowitz BE, Chaiken S: The effect of message framing on breast self-examination attitudes, intentions, and behavior. J Pers Soc Psychol 52:500-510, 1987. 8. Rimal RN: Closing the knowledge-behavior gap in health promotion: The mediating role of self-efficacy. Health Commun 12:219-237, 2000. 9. Rimal RN: Perceived risk and self-efficacy as motivators: Understanding individuals’ longterm use of health information. J Communic 8:633-654, 2001. 10. Maibach E, Flora J, Nass C: Changes in self-efficacy and health behavior in response to a minimal contact community health campaign. Health Commun 3:1-15, 1991. 11. Carey MP, Kalra DL, Carey KB, Halperin S, Richards CS: Stress and unaided smoking cessation: A prospective investigation. J Consult Clin Psychol 61:831-38, 1993. 12. Robins LN: The Vietnam drug user returns. Special Action Office Monograph. Ser. A, No. 2. Washington, DC, Government Printing Office, 1974. 13. Vaillant GE: The Natural History of Alcoholism Revisited. Cambridge, MA, Harvard University Press, 1995. 14. Granfield R, Cloud W: The elephant that no one sees: Natural recovery among middle-class addicts. J Drug Iss 26:45-61, 1996. 15. Bandura A: Social cognitive theory in cultural context. J Appl Psychol 51:269-290, 2002. 16. Bandura A: Social cognitive theory of mass communications, in Bryant J, Zillman D (eds.): Media Effects: Advances in Theory and Research (2nd ed.). Hillsdale, NJ, Lawrence Erlbaum, 2001, pp. 121-153. 17. Taylor CB, Winzelberg A, Celio A: Use of interactive media to prevent eating disorders, in Striegel-Moor R, Smolak L (eds.): Eating Disorders: New Direction for Research and Practice. Washington, DC, American Psychological Association, 2001, pp. 255-270. 18. Bandura A: Environmental sustainability by sociocognitive deceleration of population growth, in Schmuck P, Schultz W (eds.): The Psychology of Sustainable Development. Dordrecht, the Netherlands, Kluwer, 2002, pp. 209-238. 19. Rogers EM, Vaughan PW, Swalehe RMA, Rao N, Svenkerud P, Sood S: Effects of an entertainmenteducation radio soap opera on family planning behavior in Tanzania. Stud Fam Plann 30:11931211, 1999. 20. Vaughan PW, Rogers EM, Swalehe RMA: The Effects of “Twende Na Wakati,” an EntertainmentEducation Radio Soap Opera for Family Planning and HIV/AIDS Prevention in Tanzania. Unpublished manuscript, University of New Mexico, Albuquerque, 1995. 21. Vaughan PW, Rogers EM, Singhal A, Swalehe RM: Entertainment-education and HIV/AIDS prevention: A field experiment in Tanzania. J Health Communic 5:81-100, 2000. 22. DeBusk RF, Miller NH, Superko HR, Dennis CA, Thomas RJ, Lew HT, Berger WE III, Heller RS, Rompf J, Gee D, Kraemer HC, Bandura A, Ghandour G, Clark M, Shah RV, Fisher L, Taylor CB: A case-management system for coronary risk factor modification. Ann Intern Med 120:721-729, 1994. 23. West JA, Bandura A, Clark E, Miller NH, Ahn D, Greenwald G, DeBusk RF: Self-Efficacy Predicts Adherence to Dietary Sodium Limitation in Patients With Heart Failure. Unpublished manuscript, Stanford University, Stanford, CA, 1999. 24. Haskell WL, Alderman EL, Fair JM, Maron DJ, Mackey SF, Superko HR, Williams PT, Johnstone IM, Champagne MA, Krauss RM, Farquhar JW: Effects of intensive multiple risk factor
Health Education & Behavior (April 2004)
reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. Circulation 89:975-990, 1994. 25. Lieberman DA, Brown SJ: Designing interactive video games for children’s health education, in Morgan K, Satava RM, Sieburg HB, Mattheus R, Christensen JP (eds.): Interactive Technology and the New Paradigm for Healthcare. Amsterdam, IOS Press and Ohmsha, 1995, pp. 201210. 26. Brown SJ, Lieberman DA, Gemeny BA, Fan YC, Wilson DM, Pasta DJ: Educational video game for juvenile diabetes care: Results of a controlled trial. Med Inform 22:77-89, 1997. 27. Lieberman DA: Interactive video games for health promotion: Effects on knowledge, selfefficacy, social support, and health, in Street RL, Gold WR, Manning T (eds.): Health Promotion and Interactive Technology: Theoretical Applications and Future Directions. Hillsdale, NJ, Lawrence Erlbaum, 1997, pp. 103-120. 28. Bruvold WH: A meta-analysis of adolescent smoking prevention programs. Am J Public Health 83:872-880, 1993. 29. Connell DB, Turner RR, Mason EF: Summary of findings of the school health education evaluation: Health promotion effectiveness, implementation, and costs. J School Health 55:316-321, 1985. 30. Perry CL, Kelder SH, Murray DM, Klepp K: Communitywide smoking prevention: Long-term outcomes of the Minnesota heart health program and the class of 1989 study. Am J Publ Health 82:1210-1216, 1992. 31. Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ, Webber LS, Elder JP, Feldman HA, Johnson CC, Kelder SH, Wu M: Outcomes of a field trial to improve children’s dietary patterns and physical activity: The child and adolescent trial for cardiovascular health (CATCH). JAMA 275:768-776, 1996. 32. Holman H, Lorig K: Perceived self-efficacy in self-management of chronic disease, in Schwarzer R (ed.): Self-Efficacy: Thought Control of Action. Washington, DC, Hemisphere, 1992, pp. 305-323. 33. Lorig K, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, Gonzalez VM, Laurent DD, Holman HR: Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: A randomized trial. Med Care 37:5-14, 1999. 34. Bandura A: Exercise of human agency through collective efficacy. Curr Dir Psychol Sci 9:7578, 2000. 35. Bandura A: Social cognitive theory: An agentic perspective. Annu Rev Psychol 52:1-26. Palo Alto, CA, Annual Reviews Inc., 2001. 36. McAlister AL, Puska P, Orlandi M, Bye LL, Zbylot P: Behaviour modification: Principles and illustrations, in Holland WW, Detels R, Knox EG (eds.): Oxford Textbook of Public Health (2nd ed.), Vol. 3. Applications in Public Health . Oxford, UK, Oxford University Press, 1991, pp. 316. 37. Lorig K: Self-Efficacy: Its Contributions to the Four Year Beneficial Outcome of the Arthritis Self-Management Course. Paper presented at the meeting of the Society for Behavioral Medicine, Chicago, April 1990. 38. Public Citizen Health Research Group: Health Letter 9(11), 1993.
Please join StudyMode to read the full document