This month, we’re wrapping up our summer series exploring some of the most widely used public health theories that help explain why people make the health decisions they do.
Over the past two months, we’ve looked at the Transtheoretical Model, which focuses on the stages people move through as they change behavior, and the Health Belief Model, which examines how perceptions of risk, benefits, and barriers influence health decisions.
For our final theory, we’re looking at Social Cognitive Theory, a model that takes a broader view of health behavior by considering not only what people think and do, but also the environments in which they live.
What Is Social Cognitive Theory?
Created by Stanford University psychologist Albert Bandura, Social Cognitive Theory (originally called Social Learning Theory) proved that internal thoughts and beliefs actively shape behavior alongside the external environment.
His theory emphasizes the relationship between three factors:
- Personal factors: beliefs, thoughts, and personality traits
- Behavior: actions and skills
- Environment: social surroundings, the built environment, and policies
One of the most important concepts within Social Cognitive Theory is self-efficacy: an individual’s belief that they are capable of performing a behavior successfully.
We’ve mentioned self-efficacy in our previous newsletters. It appears across several health behavior theories, and for good reason.
People need to believe that change is possible and that they are capable of making that change.
Let’s look at how Social Cognitive Theory can help us understand something as important as cancer screening.
Understanding the Theory Through Cancer Screening
Getting screened for cancer might seem like a straightforward decision: if screening can detect cancer earlier, why wouldn’t someone make an appointment?
But the decision is rarely that simple.
Social Cognitive Theory helps us see the many factors that can influence whether someone actually goes to get screened.
Personal Factors
Personal factors include the thoughts, beliefs, and characteristics that influence how someone approaches a health behavior.
When it comes to cancer screening, these might include:
- Beliefs about their personal risk of developing cancer
- Feelings about medical screenings, such as fear of pain or discomfort
- Previous experiences with healthcare
- Beliefs about whether screening is worthwhile
Someone who believes they are unlikely to develop cancer may not see screening as necessary.
Someone else may understand the importance of screening but feel anxious about making an appointment or worry about what the screening might find.
These personal factors can influence whether someone is ready or willing to take action.
But willingness is only one part of the equation.
Behavior
Social Cognitive Theory also considers the behaviors and skills required to complete a health behavior.
Getting a cancer screening isn’t one single action. It can involve making an appointment, arranging transportation, taking time off work, getting to the healthcare center, completing paperwork, and following through with the screening itself.
Even making an appointment can be a barrier.
For some people, calling a doctor’s office creates enough anxiety that they avoid making the call altogether. Others may not know how to find a provider, schedule an appointment online, or navigate the healthcare system.
These are behavioral challenges, but they don’t exist in isolation.
They are closely connected to the environment around us.
Environment
The environment includes the physical, social, and policy environments that can make a health behavior easier or harder to accomplish.
Consider someone who is ready and willing to get a cancer screening: if there isn’t a health center nearby, getting screened becomes much more difficult. If the available healthcare providers don’t accept their insurance, cost may become a barrier. If there is no reliable transportation, getting to the appointment may not be possible.
And the environment isn’t only physical.
Our social environment can influence health behaviors, too.
If cancer screening is something people openly discuss with their family and friends, it may feel more normal and less intimidating. Hearing someone say, “I just had my screening last week,” can make the behavior seem like a routine part of taking care of your health.
The opposite can also be true.
If no one in someone’s social circle talks about healthcare, if screening is viewed as unnecessary, or if conversations about health are considered taboo, a person may be more likely to avoid or fear the process.
Policies are another part of the environment.
Policies that expand access to affordable healthcare, support preventive services, or make screening easier to access can reduce barriers and make healthy behaviors more achievable.
The Three Factors Work Together
Personal factors, behavior, and environment aren’t independent of one another.
Someone who believes cancer screening is important and wants to get screened may have the knowledge and motivation to make an appointment, but if they don’t have transportation, their environment creates a barrier.
Or perhaps a health center is nearby, but they’ve never made a medical appointment on their own and don’t feel confident navigating the process. Their skills and self-efficacy become barriers.
Maybe they have access to a health center and feel confident making an appointment, but everyone around them dismisses cancer screening as unnecessary. Their social environment may influence their decision to delay.
The Importance of Self-Efficacy
Self-efficacy is an individual’s belief in their ability to engage in the behaviors necessary to achieve a particular health outcome.
It is a central concept in Social Cognitive Theory and, as we’ve seen throughout this series, it also appears in other theories of health behavior.
Why is it so important?
Because knowing what to do is different from believing you can do it.
Someone may know that cancer screening is recommended but still feel incapable of navigating the healthcare system, making the appointment, getting to the health center, or following through with the screening.
Building self-efficacy might mean breaking a complicated behavior into smaller, manageable steps, providing practical support, or helping someone complete the behavior for the first time.
What This Means for Our Work at CHIRP
Social Cognitive Theory highlights an important lesson from the health behavior theories we’ve explored this summer, one that we have mentioned time and again: health behaviors don’t happen in a vacuum.
What people believe and how they behave matters. The environments in which people live, work, and access healthcare matter, too.
At CHIRP, this broader perspective helps us think about public health programs as more than simply delivering information or asking people to change their behavior.
Effective programs consider the factors that shape whether change is actually possible.
When we understand the personal, behavioral, and environmental factors influencing a health behavior, we can better identify where support is needed and design programs that make meaningful change more achievable.
