This glossary collects the key concepts, people, and ideas you will meet in this lesson. Use it as a reference while you work through the material, or as a review before assessments. Type in the search box to filter entries.

The same thing from a different vantage point

Lesson 3 covered theories that focus on the individual, and even there we kept returning to the blurred line between a person and his or her surroundings. This lesson crosses that line on purpose. It reviews theories that focus primarily on the social/environmental context and the way it interacts with individuals: the same thing, but from a different vantage point. This section sets up that vantage point and introduces the lesson's first and best-known theory, Social Cognitive Theory, by following how it grew out of the study of learning.

Internal and external: an arbitrary line

One way to sort theories is to say that individual theories address internal factors while social/environmental theories address external ones. The distinction is worth offering and withdrawing in the same breath: given the blurred lines, it is clearly not an adequate way to characterize the difference. There is no definitive way to make the separation, so we make do with arbitrary terms like internal/external or individual/social in order to position our thinking. The labels are filing categories, and the theories reach across them. Social Cognitive Theory contains constructs that live inside the person and constructs that live in the environment, and its central claim is about the traffic between them.

How far out do we go?

Talking about context raises questions that have taken up more writing space than a hundred sets of encyclopedias. What counts as a meaningful definition of context, and how far out from the individual do we go? Different disciplines answer differently, and their answers preview the theories of this lesson and the next.

What is a social/environmental context?

The most useful answer is a life story rather than a definition, and each stage of the story names a layer that a later theory will try to work with. Open the layers below; each pairs a general description with a Canadian illustration.

The story ends with the practical question that drives this lesson: if you are trying to understand what influences behaviour, how on earth do you untangle all of this, much less do something about it? Each theory in the lesson is one answer, and each chooses a piece of the onion to work on.

Social Cognitive Theory: origins and evolution

This lesson starts close to the individual and works outward, so it begins with Social Cognitive Theory, perhaps the most well known and productive theory of its kind in public health because of its specific focus on the interaction between individuals and their immediate environment. Its evolution matters, because the theory as it stands integrates constructs added at different times. Click each card to follow the sequence.

Bandura himself is a Canadian story: born in 1925 in Mundare, a small town east of Edmonton, he did his undergraduate degree at the University of British Columbia before a career at Stanford (Bandura biography). His 1977 paper introducing self-efficacy remains among the most cited in psychology (Bandura, 1977).

Reciprocal determinism as a working diagram

Later writers often draw reciprocal determinism as a triangle whose corners are the person, the behaviour, and the environment, with influence running along every edge in both directions. The same cycle can be described in prose: a person acts on individual factors and social/environmental cues, receives a response, adjusts, and acts again. Click the corners and edges to see what each means, illustrated with a first-year student deciding whether to join an intramural team.

A case to carry into the next section

Hold that case. The next section lays out the full set of constructs in a single table, follows a 16-year-old named Theresa through the cycle, and builds an intervention from the pieces. The origins you have just traced explain why the list is as long as it is: nothing was ever removed.

What Social Cognitive Theory says happens

Section 1 followed the theory's growth. This section takes the theory as it stands and asks what it claims. After the history it may not be clear how the constructs relate together, so it helps to cluster them: changing a behaviour is a function of individual characteristics, environmental factors, and the interactive process that links them. The table lists all ten constructs with their definitions, and a third column shows how a program would work on each construct, drawn from the intervention proposed later in this section for Theresa.

The ten constructs

How does each factor weigh in during the process of behaving? The candid answer is that it is not clear in the sense of precise science. Many of these relationships are still being investigated, and the role of self-efficacy and observational learning is better understood than the rest. That candour is the seed of the critiques at the end of this section.

Theresa: a case from field research

A sound answer emphasizes self-efficacy, behavioural capability, and vicarious learning, and keeps Theresa's goal intact: popularity and peer approval motivated her risky behaviour, so the program gives her tools to reach the same goal in less damaging directions. Open each component to see the construct it targets.

Where self-efficacy comes from

Because programs lean so heavily on self-efficacy, it helps to know Bandura's own account of its sources. His 1977 paper named four: mastery experiences (past success at the behaviour or something like it), vicarious experiences (seeing someone like you succeed), verbal persuasion (being told credibly that you can), and physiological and emotional states (reading your own nerves as readiness or as inability). The bicycle box is a mastery story; the mentor is a vicarious one. The picker turns each source into a program tactic for three behaviours.

Three published programs, and a Canadian one

Three published studies used elements of the theory. Read them as evidence about which constructs carry weight, because they do not all point the same way.

Things to think about: two critiques

Treat the critiques as a practitioner's warning rather than a reason to abandon the theory; the studies above show programs that worked. They mean that you, the designer, must choose which constructs to emphasize and justify the choice, because the theory will not choose for you. The Theresa intervention did exactly that. The next section moves one step further out, to a theory in which the unit of analysis is no longer the person but the ties between people.

Relationships, not characteristics

Social Cognitive Theory kept the individual in view and added the immediate environment. Social Network Theory takes the next step out and changes the unit of analysis. Its key claim is that the specific or unique characteristics of individuals, their attitudes, beliefs, or gender, are not so important, because the focus is on relationships between and among individuals and on how the nature of those relationships influences beliefs and behaviour. That is a real departure from Lesson 3. The Health Belief Model asks what a person perceives; network theory asks whom the person is tied to, how often, in how many ways, and who else those people are tied to.

Origins and basic elements

Social Network Theory is a broad area whose applications run from sociology and health to communications, political opinion, and mathematical and systems theory. It first surfaced in theoretical form among sociologists in the 1950s, in John Barnes' study of a Norwegian island parish, and has since expanded in many directions, including social network analysis handbooks and research on communication networks. By relationships the theory means the sets of relationships an individual participates in: family and kin networks, work networks, and any other social group of which the person is a member. These are usually drawn as a social network diagram, or sociogram. The simplest sociogram places a focus individual, called the ego, in the centre, with lines to the other people in the network, called alters.

Concerning health, networks can play an important role in whether someone acts in a risky way (smoking, no exercise) or a healthy way (eating well, exercising), in what health information a person is exposed to, and in what social support is available for adhering to treatment, coping with a difficult condition, or quitting smoking. A network can be looked at with respect to health risks, such as a group of injection drug users who, by sharing needles, create a shared situation of high risk for HIV, hepatitis, and tuberculosis, or with respect to its supportive role, such as a smoking cessation group that meets regularly and socializes together.

A worksite network you can explore

To use the theory you need research on the network of interest. Take exercise at a worksite as an example, where you would want to know the people in the network, the frequency of their interactions, the types of interaction (only work, or social and exercise too, such as a group that jogs or plays basketball at lunch), differences in relational roles (who organizes things, who belongs to several kinds of interaction), and whether there are cliques. The diagram below is a made-up worksite built to that description. Click any person to see his or her ties.

The lesson of the worksite is about a person like Ed. Suppose Ed is an important member of the subgroup that jogs at lunch and also belongs to several of the subgroups that socialize outside work. Ed is then "a real gold mine in terms of influence." If you worked with Ed and asked him to help, he could bring others into the jogging network or distribute information about obesity prevention to every network he belongs to. The diagram tells you something about social influences on exercise, and also about channels of communication and channels of influence if you wanted to change it.

Ego-centred and full relational networks

There are many types of network. The most common in health research and interventions is the ego-centred network, a map of the social relations surrounding one individual, built from that person's perspective. A full relational network includes reciprocal information from the other members. The difference matters for cost and for what you can see.

Six network qualities

Six qualities are worth looking for in assessing a network's role in the health behaviour of its members. Click each card. Each definition is paired with the feature of the worksite diagram that shows it.

Using Social Network Theory

The theory is most useful as a strategy for relatively limited or defined groups. It is not a mass or large population intervention. Using it involves two steps, not counting evaluation. First, research to identify the important characteristics of the network: for an ego-centred network, identify one or more individuals around an activity where a network seems to be involved, interview them, and build a map; for a full relational network, interview all or a significant number of members. Second, develop an intervention that works with the network as a facilitator. That could mean using the network to distribute information. Consider the example of blues musicians and smoking cessation: the musicians appeared to be a network, and information might be best and most credibly disseminated through one of them. Or, combining the theory with the modeling construct of Social Cognitive Theory, you could work with influential members to introduce risk-reducing behaviour by modeling it to the others, as when the lunchtime joggers begin recruiting the rest of their social network.

Open the three program examples.

A Canadian case: peers, kits, and ties

Things to think about: two critiques

Notice how the two theories so far divide the work. Social Cognitive Theory explains what a person learns from the people around her; Social Network Theory explains who those people are, how they are tied, and which of them can carry a message or a model to the rest. Both are built for groups you can name. The next section turns to two approaches designed for the opposite situation, where the goal is to move a behaviour or a technology through a whole population that no one can interview.

How behaviour moves through a population

The first two theories in this lesson are built for groups you can name. The last two are built for populations. This section reviews diffusion of innovations and social marketing together because both are less theory driven and more a description of a process for how behaviour tends to change in groups of people or communities. Neither gives you constructs inside a person; both describe how something new travels, and both borrow from earlier theories, self-efficacy, vicarious learning, perceived costs and benefits, wherever it helps.

Diffusion of innovations: origins

Diffusion approaches have roots in rural sociology, in studies such as Ryan and Gross' account of hybrid seed corn spreading among Iowa farmers, and in the 1920s and 1930s anthropology of how cultural practices diffuse. Everett M. Rogers set out the general theory in 1962 in a book revised through several editions that remains a classic (Rogers, 1962). Its concern is the process by which a behaviour or technology makes its way into a population and is, or is not, adopted. In Rogers' definition, "diffusion is the process by which an innovation is communicated through certain channels over time among members of a social system," with a goal of maximizing exposure and reach. The innovation is whatever the target population perceives as new. Note the resemblance to stage models, because dissemination has a chronological element built in. Open the five key processes.

Adopter categories and the S-curve

Innovations are adopted in stages by different categories of adopters: early adopters, early majority, late majority, and laggards. Rogers' full scheme adds a small group of innovators in front and estimates each category's share of a population; the shares produce the S-shaped curve of cumulative adoption. Identifying the categories lets you plan a strategy for each. Consider getting fine-restaurant chefs to introduce low-fat dishes: the early adopters might be up-and-coming chefs trying to make a name, so you target them first and let publicity about their adoption spur the rest. Move the slider to watch the process unfold.

Two further concepts complete the picture. The diffusion context is the complex of factors in the target population and in the program itself that may facilitate or hinder diffusion: a centralized state that forces dissemination through one gateway, or local political and social structures that inhibit a new behaviour. Then there are the product attributes that determine the speed and extent of diffusion. The table lists the five most often cited and several additional attributes, applied to a real Canadian innovation: in January 2024 British Columbia became the first province to offer at-home HPV self-screening in its cervix screening program. Notice that many attributes are really about barriers to adoption.

Social marketing

Social marketing applies the principles of marketing to health aims. It treats behaviour change as a "product" that you, the health promotion professional, are trying to market, and the target population as consumers weighing it like any other product choice. The goal is voluntary adoption because people come to see the behaviour as in their interest, so the word marketing can mislead: what is borrowed is the voluntary choice and the need to present it as attractive in its costs and benefits. Notice the resemblance to diffusion of innovations and even to the Health Belief Model. Kotler and Zaltman introduced the approach in the late 1960s and early 1970s (social marketing); it has since been used widely, especially in reproductive health and HIV/AIDS programs internationally. Canada's landmark is ParticipACTION, founded in 1971, whose advertising and later Body Break segments made physical activity a marketed product for a generation (ParticipACTION). The principles are summarized as the four Ps, given here with a running example of smoking cessation among pregnant women.

Two further terms come from marketing. Market segmentation divides a target population into meaningful subgroups so that messages and campaigns can be channelled appropriately; messages and channels for expectant teen mothers may differ significantly from those for adult expectant mothers. Targeting develops campaigns closely tailored to the needs, attitudes, beliefs, and behaviours of a specific segment. Use the planner to work the four Ps and segmentation through three Canadian campaigns.

Using both approaches: bikers and helmets

Two published examples follow the same logic. A diffusion project to increase Internet use among family physicians found heavy patient volume was the barrier, so it focused on use at unconstrained times; as physicians used it then, they gained confidence and skill and their usage rose. And the National Cancer Institute's "5 A Day for Better Health" campaign, with the Produce for Better Health Foundation, repeated one message, eat five or more servings of vegetables and fruit daily, through produce bags, in-store displays, packaging, recipe cards, brochures, magazines, news, Internet and social media, radio and television, billboards, schools, health fairs, cookbooks, and more, increasing knowledge of the product and of how to fit it into daily life.

Things to think about: the evaluation critique

That completes the lesson's four approaches: a theory of learning from others, a theory of the ties along which learning travels, and two descriptions of how something new moves through a population. The final review asks you to hold all four at once and choose among them.

Bringing It All Together

This lesson crossed the blurred line that Lesson 3 kept pointing at. The opening admission set the terms: there is no definitive way to separate an individual from his or her social/environmental context, so internal/external and individual/social are arbitrary labels that help us position our thinking. That context includes the family and meanings a person is born into, friendship and work networks, the physical space, the political-economic space with its rules and products, and the person's own experience of interacting with all of it, the layers of an onion that Bronfenbrenner called a person's ecology. The lesson then worked outward from the individual. Social Cognitive Theory began as an offshoot of behaviourism when Bandura showed in the 1960s that reinforcement directed at other people also teaches the observer (vicarious learning). Self-efficacy and agency were added in 1977, the cycle of reciprocal determinism followed, and the theory was renamed in the mid-1980s. Its ten constructs sort into individual characteristics, environmental factors, and the process that links them; the Theresa case showed the cycle in motion and the intervention built from three chosen constructs; the published programs showed which constructs carried weight, and the critiques, the grab-bag and the old clothes, showed why a designer must choose.

Social Network Theory changed the unit of analysis from the person to the tie. Individual characteristics are not so important to it; what matters is who is connected to whom, how often, in how many ways, and with what credibility. Its tools are the sociogram, the distinction between ego-centred and full relational networks, and six qualities: centrality, reciprocity, complexity or intensity, homogeneity, subgroups and linkages, and communication patterns. Its practice is two steps, map the network and then work through it, as the Bangladesh opinion leaders, the Flagstaff relational subsets, the Black Churches natural helpers, and Canadian peer-based naloxone distribution all illustrate. Its limits are the mirror of its strengths: it suits groups you can name, and mapping them is labour intensive and raises confidentiality concerns.

Diffusion of innovations and social marketing are built for populations and describe a process rather than a set of constructs. Rogers defined diffusion as the communication of an innovation through certain channels over time among members of a social system; the five key processes run from innovation development through dissemination, adoption, implementation, and maintenance, and adoption itself has stages that parallel the stage models. Adopter categories allow a strategy for each group, diffusion context can help or hinder, and attributes such as relative advantage, compatibility, complexity, trialability, and observability set the speed of spread. Social marketing packages a behaviour as a product with a price, a place, and a promotion, segments the market, and targets each segment, aiming at voluntary adoption because people come to see the behaviour as in their interest. The bikers and their helmets showed the two approaches overlapping almost completely, and the closing critique reminded you that a behaviour is harder to count than a kit.

Final Knowledge Assessment

This assessment covers all material from this lesson. You must score 100% to complete the lesson. Review the feedback for any incorrect answers and try again.