As social marketers and change agents, our theories drive how we understand and describe problems and propose and test different solutions to them. What is a theory? In science, it is a way in which we think about how the world works - what are the problems, what questions do we ask in our research, what interventions do we design, how do we evaluate outcomes (either positive or negative), and do the expected outcomes really make a difference in the big picture? While there are many theories to choose from, many change agents have only the slightest idea about a few of them if they had a survey course of ‘behavioral theories.’ If they haven’t had a such a course, the use of any commonly agreed upon, and research-tested, framework to think about and change the world plummets. If every social entrepreneur and change agent has their own “theory of change” - good luck with that. Innovation in tackling wicked problems also suffers from unfamiliarity with theories of change as people simply repeat what others have done: there is little exploration of insights that different theories can guide us towards. Learning about other ways of thinking about the world, call them ‘theories,’ can help us adopt different points-of-view about a problem, provide different analogies for thinking through possible solutions, weigh the benefits and risks of selecting one strategy over another, and broaden our perspective (Ness, 2015). And perhaps the bottom line is the conclusion reached by Hornik (2002) that the use of the wrong theory to define and solve a problem is one of the key sources for program failure.
Let’s look at the evidence for using theory in solving problems. Hornik & Yanovitsky (2003) argue that designing interventions and evaluations of complex interventions such as social marketing are extremely difficult without a theory of change to guide what variables to measure/change and how to attribute success to the intervention. I suggest you consider that social change is so complex that, without a theory of change (with the caveat that it has research evidence to support it), you are wandering in the wilderness of what and how to develop interventions. Noar et al (2012) reported that only 15/34 (44%) of HIV/AIDS mass communication campaigns reported using theory on which to ground their approach - an improvement from <20% of interventions in the previous decade. Yet, the use of theories in social marketing is largely unexplored despite several systematic reviews of its application. The key reason is that creators of benchmark criteria for social marketing did not include use of theory. Thus, reviews of social marketing interventions by Stead et al. (2007), Fujihira, et al. (2015), Carins & Rundle-Thiele (2014) and Xia et al. (2016) are silent on this basic scientific question - are social marketing interventions based on explicitly stated theories or just made up? I found one review of the use of branding in social marketing programs. Evans et al (2015) found that of 69 articles they reviewed that used branding, 77% of them contained enough information to identify one or more theories that were used in the design and implementation of the branding effort. In one study that did not use benchmark criteria to qualify 155 articles of “social marketing effectiveness,” Helmig & Thaler (2010) found that nearly 2/3rds did not explicitly reference a theory on which the intervention was based. So are theories being applied in social marketing programs? So far most reviewers don’t consider them important when asking the question ‘what makes social marketing effective?’ Perhaps the new definition of social marketing that includes “[an integration of] research, best practice, theory, audience and partnership insight, to inform the delivery of competition sensitive and segmented social change programs that are effective, efficient, equitable and sustainable” may lead more program designers and researchers to consider this element of intervention effectiveness when designing and reviewing them.
This post is not a review of all the possible theories that could be used in social marketing [see my chapter of theories in social marketing], but the only one I believe can add a broad and valuable lens in your research and practice. And thanks to a recent article in Translational Behavioral Medicine (Riley et al, 2016), a road map for social cognitive theory (SCT) has finally appeared. The article is the first to present SCT graphically. The authors’ purpose is to create a model for testing dynamic computational modeling of SCT hypotheses. You might not be interested in those details, so ignore the math in the figure below. But the key pieces of the theory, and how they relate to behavior, is what I’m focusing on here. We’re going to walk through it in a moment.
First the disclaimers: I am an ardent social cognitive theorist and practitioner. My ‘academic grand-father’ is Albert Bandura, the formulator of the theory who consulted on my PhD dissertation that was under the guidance of one of his students, Dave Rimm. I have been quoted as saying that if every public health person read Bandura’s Social Foundations of Thought and Action the world would already be a better place (but as friends have pointed out, it’s a really thick book - the best ones always are). But enough qualifications: this is the approach that encompasses a broad perspective to learning and behavior change that should be the hallmark of social marketing; not some isolated ideas about benefits and costs, increasing intentions to act, nudges or changing peer and social norms.
As shown in the figure (reprinted by permission of the publisher, and you can click on it to see an enlarged version), the key variables in SCT that are important for both intervention and evaluation actions are:
Self-efficacy: how confident someone is that they can perform a given behavior is the central issue. Self-efficacy for a given behavior will vary over time, and in different situations. the behavior must also be specifically described. For example, how confident are you that you can eat a fruit with breakfast this morning? Yes, the context is breakfast, and if you don’t eat breakfast, your efficacy is likely zero. But what if you do eat breakfast, what kind of fruit are you confident you could eat - a banana, a papaya, a pomegranate? I don’t know about you, but the differences in my confidence for eating some fruits over others at breakfast is pretty dramatic. Ask me to eat the wrong fruit, in the wrong context, and I’m likely to say “pass.” Confidence in ability to perform the behavior = self=efficacy —> behavior.
Self-efficacy can be influenced by several different variables shown on the left; the most important may be by observing other people’s behavior (or vicarious learning). Every time you, or someone else, sees someone do something (and that ‘seeing’ may be through directly watching them in real life, through an audio-visual media such as television or YouTube, hearing about it on a radio or podcast, or reading about it in a book or blog), that person becomes a model for a behavior you might decide to avoid, try, maintain or change. Several factors influence whether you imitate the behavior or not, not least of which is whether you see that person experience positive or negative outcomes.
Another important contribution to self-efficacy is a person’s prior experience with the behavior. If I’ve never eaten a pomegranate (as opposed to bananas and papayas), or even tried to prepare one to eat, asking me to eat one for breakfast is going to get you many quizzical looks and questions. Do you peel it? Wash it? Cook it? Slice it? Of course, once I’ve done it a few times - or even watched a video of someone else doing it, my confidence (self-efficacy) for eating one goes up. And then the consequences for my engaging in the behavior, positive or negative, also contribute to my sense of self-efficacy (I’m told a pomegranate stain is difficult to remove, are they as tasty as a banana or papaya?). Also,it’s important to remember that what I define as ’success’ may be different from how someone else defines it for themselves (or me!).
Then there are things like obstacles and barriers - variables that inexplicably receive laser focus from social marketers and other change agents but which, in the scheme of things, are really nuisances. If a person has a high sense of self-efficacy, more times than not they do not need our help to remove or overcome most of the barriers and obstacles to eating a pomegranate (or banana or papaya) for breakfast. Yes, they may need a Price (affordable to purchase) and Place (access and availability to purchase them) intervention to assist them at key steps. Other than that, we don’t give people enough credit for being resourceful if they truly want to eat pomegranates for breakfast - or do almost anything else they believe that they can do - and want to.
The last point, that they are motivated to do something, can come from an array of internal factors that the model lumps together as physical, mental and emotional interpersonal states. There are too many possible variables that exist in this space to review them all here. To continue the example of the pomegranate though, if I wake up tired and late, have a major presentation to give first thing when I arrive at the office, the dog decides it’s a nice day to smell the flowers rather than get her business done, and all that is churning up more frustration and anxiety (“Will I get to the office in time for the presentation?”)… then no, I’m probably not having a pomegranate for breakfast. If I’m preparing Sunday brunch for some friends, then there may be a another set of motivations to be sure to include pomegranates (show off some culinary curiosity and talents and wait for the applause?).
Then there’s the issue of perceived social support and/or persuasion. If other people in my social networks (for example, family members, peers or colleagues) talk about and practice eating five servings of fruits and vegetables a day and say “You can do it, we’ll help,” then I may be more inclined to believe I can do it too. If they are encouraging me, so much the better for my confidence level. If one of them is an aficionado of pomegranates, I have it made.
Now I have to have the self-management skills: can I make the changes necessary to eat more fruits and vegetables - and especially pomegranates? The questions here are: Can I monitor, at least somewhat accurately, how many servings of fruits and vegetables I eat each day (maybe use a camera to photograph them if necessary)? Can I set a goal - is it to increase what I eat by one serving a day, try a pomegranate at least once a week? Will I set up some kind of reinforcement or reward system up for eating fruits and vegetables? If I can do this, my confidence level shoots up again, as opposed to feeling too busy and frantic to pull it all together.
Exiting from the self-efficacy box (yes, I see others doing it, I sense social support for it, I can manage it and tackle the barriers, and I am motivated), then I wonder what the payoff will be? Positive effects on my health, status among my foodie friends, or energy level? Negative effects on my enjoyment of meals, bank account, or family members who have to eat what I eat? These, and others, are the Outcome Expectancies - what do I expect to happen if I start changing and adopt new eating behaviors?
Now, will someone or something remind me to eat a fruit or vegetable - or more specifically a pomegranate? Can I create some internal cues that do the same thing - Think: “always have pomegranate juice with my cereal.” How about some environmental cues: pomegranates are always on my shopping list and on a shelf in my refrigerator. These are the cues to action. If the cues are there - whether it is a person telling me, a sign at the grocer or my own reminders to myself - then I’m more likely to do it. If the cues aren’t there, or worse, even contradictory to eating fruits and vegetables (“New health alert: pomegranates may be dangerous to your health”), then guess what? Not even thinking about eating that!
These are the key factors that influence whether I adopt or learn new behaviors - I hate the word “change!” - as do most people. And if I try a pomegranate, and it tastes bad and takes too long to prepare, these negative Behavioral Outcomes make it less likely I’ll try it again. But maybe having it in a restaurant (environmental context) is easier and better than doing it at home. OK, order more pomegranates when I’m out eating. Or try different fruits and vegetables. Maybe one of my dear social supporters will show me a way to buy and prepare them more easily - or I’ll search and find recipes on the internet. Those actual experiences of trying the new behavior influence my Outcome Expectations, my Self-Efficacy and my future behaviors.
In summary, social cognitive theory is the road map I always trust to give me a large picture of helping people learn new behaviors (NOT change them). When I hear people talk about focusing on nudges (cues to action), or social support, or peer and social norms, or barriers to ‘change,’ I always cringe. If you look at social cognitive theory, you will see all of those variables are important - including environmental constraints to, and facilitators for, action. Learning new behaviors is the service we are providing for people when we talk about 'behavior change.' There are many factors that go into learning. Map out for yourselves what your priority group currently does, and what they could do, and use this graphic as your roadmap. I suggest that you will be surprised at the insights and interventions it may help you discover.
The SCT Questions You Need to Answer for Helping People Learn New Behaviors
Have I seen or heard about other people doing it?
Have I done it before (or something like it)?
Am I motivated to do it?
Are there obstacles or barriers in the way for doing it?
Do I have support from others to try it?
Do I have the skills to try and practice the new behavior?
AND - How confident am I that I can do the behavior?
What do I expect to happen (positively or negatively)?
Are there reminders or cues to do it?
Is the environmental context right for making that choice?
OK - now I’m ready to try something new.
Which answers are most important for your priority group is your formative research question. How many answers you line up and address is your intervention design issue. Whether it leads to desired individual and social change is your evaluation question. The more deliberate you are when thinking through what theory to use, the more likely your are to have an effective social marketing intervention.
Carins, J.E. & Rundle-Thiele, S.R. (2014). Eating for the better: A social marketing review (2000-2012). Public Health Nutrition; 17(7):1628-1639.
Evans, W.D., Blitstein, J., Vallone, D., Post, S. & Nielsen, W. (2015). Systematic review of heath branding: Growth of a promising practice. Translational Behavioral Medicine; 5:24-36.
Fujuhira, H., Kubacki, K., Ronto, R., Pang, B & Rundle-Thiele, S. (2015). Social marketing physical activity interventions among adults 60 years and older: A systematic review. Social Marketing Quarterly; 21(4):214-229.
Helmig, B. & Thaler, J. (2010). On the effectiveness of social marketing - What do we really know? Journal of Nonprofit and Public Sector Marketing; 22(4):264-287.
Hornik, R.C. & Yanovitzky, I. (2003). Using theory to design evaluations of communication campaigns: The case of the National Youth Anti-Drug Media Campaign. Communication Theory; 13(2):2014-224.
Ness, R.B. (2015). Promoting innovative thinking. American Journal of Public Health; (105; Suppl 1): S114-118.
Noar, S.M., Palmgreen, P., Chabot, M., Dobransky, N. & Zimmerman, R.S. (2009). A 10-Year systematic review of HIV/AIDS mass communication campaigns: Have we made progress? Journal of Health Communication: International Perspectives; 14(1):15-42.
Riley, W.T., Martin, C.A., Rivera, D.E et al. (2016). Development of a dynamic computational model of social cognitive theory. Translational Behavioral Medicine; 6:483-495. doi: 10.1007/s13142-015-0356-6
Stead, M., Gordon, R., Angus, K. & McDermott, L. (2007). A systematize review of social marketing effectiveness. Health Education; 107(2):126-191.
Xia, Y, Deshpande, S. & Bonates, T. (2016). Effectiveness of social marketing interventions to promote physical activity among adults: A systematic review. Journal of Physical Activity and Health; 13:1263-1274.