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Alex Rothman Department of Psychology University of Minnesota

How can We Capitalize on Connections between Theory and Practice? Perspectives from the Study of Behavior Change. Alex Rothman Department of Psychology University of Minnesota Center for Health, Intervention, and Prevention University of Connecticut November 2010.

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Alex Rothman Department of Psychology University of Minnesota

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  1. How can We Capitalize on Connections between Theory and Practice?Perspectives from the Study of Behavior Change Alex Rothman Department of Psychology University of Minnesota Center for Health, Intervention, and Prevention University of Connecticut November 2010

  2. Does it Matter How We Think about the Interplay Between Theory and Practice? Why Construals/Metaphors Might Matter? Guide how investigators think about and conduct their work Guide the composition of research teams Guide how/where/to whom findings are communicated Guide how resources are allocated Guide where resources are allocated (e.g., the design and implementation of systems that support the efforts of investigators) All have implications for progress in theory and practice

  3. Conceptualizing the Interplay Between Theory and Practice Social/Personality Psychology (Basic/Theory) Health (Applied/Practice)

  4. Health (Applied/Practice) Social/Personality Psychology (Basic/Theory) Classic View of the Link between Theory and Practice

  5. “…Many psychologists working today in an applied area are keenly aware of the need for close cooperation between theoretical and applied psychology. This can be accomplished in psychology, as it has been accomplished in physics, if the theorist does not look toward applied problems with highbrow aversion or with a fear of social problems, and if the applied psychologist realizes that there is nothing so practical as a good theory.” --Kurt Lewin (1943-44), “Problems of research in social psychology”

  6. Health (Applied/Practice) Social/Personality Psychology (Basic/Theory) Weak/Passive Links Classic View of the Link between Theory and Practice

  7. Understanding (Social/Personality Psychology) Understanding and Use (Social/Personality & Health) Use (Health) Re-conceptualizing the Link between Theory and Practice Basic/Theory Applied/Practice Adapted from Stokes (1997), Pasteur’s Quadrant

  8. “…if the theorist does not look toward applied problems with highbrow aversion or with a fear of social problems, and if the applied psychologist realizes that there is nothing so practical as a good theory.” --Kurt Lewin (1943-44), “Problems of research in social psychology” • The pursuit of understanding and use provides the opportunity to transform a theory into a good theory (Rothman, 2004) (For further discussion, see Suls & Rothman, 2004; Weinstein & Rothman, 2005, Michie , Rothman , & Sheeran, 2008; Rothman, 2009)

  9. What Could a “Good Theory” Do? Intervention Behavior Predictor Mediator Conceptual Theory Action Theory

  10. What Could a “Good Theory” Do? Intervention Behavior Mediator Moderator (action) Moderator (conceptual) For Whom (people)? For What (behavior)?

  11. What Could a “Good Theory” Do? Intervention Behavior Behavior Initiation Mediator Mediator Maintenance Timing: When does it matter? Specificity: What matters when?

  12. Pursuing Understanding and Use in Research at the Interface Between Social/Personality Psychology and Health 1. Initiation and Maintenance of Behavior Change (Rothman, 2000; Rothman et al., 2004, 2010) Specify the psychological processes that regulate the initiation and maintenance of behavior Design and test theory-based intervention strategies to promote healthy behavior 2. Framing Health Messages (Rothman & Salovey, 1997; Rothman et al., 2008; Rothman & Updegraff, in press) Specify the processes that mediate and moderate the influence of gain- and loss-framed messages Design and test theory-based communication strategies to promote healthy behavior

  13. Behavioral Initiation Guided by expectations about outcomes and process Optimistic expectations predict interest and initial success Motivated by desire to approach favorable goal (i.e., to be thin) Progress is marked by a change in discrepancy between current state and a goal state Behavioral Maintenance Guided by satisfaction with outcomes and process Satisfaction predicts long-term success Satisfaction based on comparison of experiences to expectations Motivated by a desire to avoid unfavorable goal (i.e., not be a smoker) Progress is marked by a sustained discrepancy between current state and a prior state Model of Behavioral Initiation and Maintenance(Rothman, 2000; Rothman, Baldwin, & Hertel, 2004; Rothman, Hertel, Baldwin, & Bartels, 2008)

  14. Model of Behavioral Initiation and Maintenance (Baldwin et al., 2006, Health Psychology; Finch et al., 2005, Health Psychology; Hertel et al., 2008, Health Psychology) Intervention Initial Behavior Sustained Behavior Expectations/ Confidence Satisfaction (Tested in a parallel set of community-based Interventions designed to promote either smoking cessation or weight loss)

  15. Challenge Smoking Cessation Project:Expectation-Based Intervention • 8 week group-based quit program • Quit date between 4th and 5th session • 529 Participants were randomly assigned to: (a) Optimistic treatment program • Focus on the benefits of quitting; Emphasize maintaining a positive view of cessation outcomes and process (b) Balanced treatment program • Focus on both benefits and costs of quitting; Emphasize maintaining a balanced view of cessation outcomes and process (Hertel et al., 2008, Health Psychology; see also Finch et al., 2005)

  16. Effect of Intervention Condition on Smokers’ Quit Status at End of Active Treatment (Session 8) Percent Smoke Free for last 7 days [Condition x Prior Abstinence Interaction: p < .05]

  17. Effect of Intervention Condition on Smokers’ Expectations and Confidence Longest Prior Quit Longest Prior Quit > 3 months < 3 months Optimistic Balanced Optimistic Balanced condition condition condition condition Beliefs assessed at Session 4 on 9 point scale ranging from –4 to +4 (expectations) and from 0 to 8 (self-efficacy) [Condition x Prior Abstinence Interaction: p’s < .05] 2.42 (.08) 2.25 (.07) 2.19 (.08) 2.39 (.08) Expectations about outcomes Confidence about ability to quit 5.21 (.14) 4.75 (.12) 4.80 (.14) 4.93 (.14)

  18. Do Beliefs About Cessation Mediate the Interaction Effect on Smoking Status at Session 8? Conceptual Theory • =.38 (p<.05) Expectations (session 4) • =.17 (p<.01) Intervention Condition X Prior Quit Length Smoke Free at Session 8 b =.77 (p > .10) • =.21 (p<.01) Self-Efficacy (session 4) • =.65 (p<.05) Action Theory [Direct effect: b =.87, p < .05 ] [Sobel test: z = 1.90, p < .05]

  19. Effect of Intervention Condition on Smokers’ Quit Status after 6 Months and 18 Months Percent Smoke Free for last 7 days [Condition x Prior Abstinence Interaction: p’s < .05]

  20. Specifying the Process:Did the Intervention Have a Direct or Indirect Effect on Smoking Status at 6 Months? Intervention Condition X Prior Quit Length Smoke Free at 6 Months b =.72 (p > .20) • =2.53 (p<.01) Smoke Free at Session 8 • =.87 (p<.05) [Direct effect: b =1.05, p < .05] [Sobel test: z = 2.04, p < .05]

  21. Specifying the Process:Does Satisfaction with Behavior Change Underlie Sustained Behavior Change? Smoke Free at Session 8 Smoke Free at 6 Months b =1.53 (p < .01) • =.23 (p<.05) Satisfaction with quit at Session 8 • =4.02 (p<.01) [Direct effect: b =2.53, p < .01] [Sobel test: z = 2.36, p < .05] (See also Baldwin et al., 2006)

  22. Implications and Lingering Questions: I Integrating models of prediction and models of change: Action theory and conceptual theory (cf. Jeffery, 2004; Rothman, 2004) What are the determinants of people’s satisfaction? (Baldwin et al., 2009, Psychology & Health; in press, Annals of Behavioral Medicine) How can we design methods to enhance the satisfaction people derive from changes in their behavior?

  23. What Could a “Good Theory” Do?: Moderators of Output: Biological Factors Targets for Intervention Initial Behavior Subsequent Behavior What mediates the Mediator? Satisfaction Behavioral Outcomes/ Experience What moderates the Mediator? Moderators of Input: Dispositional/Goal Factors

  24. Do Initiation and Maintenance benefit from different self-regulatory strategies? Higgins (1998) proposed two styles of self-regulation: Promotion-focus: Concern with accomplishments, hopes, aspirations; focus on eager approach-based strategies and positive outcomes. Prevention-focus: Concern with safety, responsibility, obligations; focus on vigilant avoidance-based strategies and negative outcomes.

  25. Promotion Focus: Concern with accomplishments, hopes, aspirations; focus on eager approach-based strategies and positive outcomes Prevention Focus: Concern with safety, responsibility, obligations; focus on vigilant avoidance-based strategies and negative outcomes Intervention Initial Behavior Sustained Behavior Expectations/ Confidence Satisfaction • RFQ (regulatory focus questionnaire; Higgins et al., 2001) was completed at baseline in both the smoking cessation and weight loss interventions (Fuglestad et al., 2008)

  26. H1: Participants who score higher on promotion-focus will have greater success losing weight Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

  27. How do you operationalize maintenance? • 5% weight loss maintained for at least 1 month • Discrepancy between weight and acceptable weight loss goal (assessed at base line) • Small Discrepancy: Focus on maintaining weight loss • Large Discrepancy: Focus on continuing to lose weight Challenge Study: Weight Loss Hypothesis 2: Participants who score higher on prevention-focus will have greater success maintaining weight that was lost

  28. Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

  29. Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

  30. Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

  31. Challenge Study: Weight Loss (Fuglestad et al. (2008) Health Psychology)

  32. Looking more closely at how promotion focus may help: Does a promotion-focus help people respond to a slip? Challenge Study: Smoking Cessation

  33. Looking more closely at how promotion focus may help: Does a promotion-focus help people respond to a slip? Challenge Study: Smoking Cessation

  34. Looking more closely at how promotion focus may help: Does a promotion-focus help people respond to a slip? Challenge Study: Smoking Cessation

  35. Challenge Study: Smoking Cessation

  36. Challenge Study: Smoking Cessation

  37. Challenge Study: Smoking Cessation

  38. Implications and Lingering Questions: II Potential implications for practice Provide initiation/maintenance strategies that match people’s chronic focus Use RFQ scores to identify “vulnerable” actors and provide additional support (A few) Lingering questions: What does the RFQ measure? How do we integrate models of self-regulation with models of behavior change?

  39. Pursuing Understanding and Use in Research at the Interface Between Social/Personality Psychology and Health? 1. Initiation and Maintenance of Behavior Change (Rothman, 2000; Rothman et al., 2004, 2010) Specify the psychological processes that regulate the initiation and maintenance of behavior Design and test theory-based intervention strategies to promote healthy behavior 2. Framing Health Messages (Rothman & Salovey, 1997; Rothman et al., 2008; Rothman & Updegraff, in press) Specify the processes that regulate the influence of gain- and loss-framed messages Design and test theory-based communication strategies to promote healthy behavior

  40. Predicting the Impact of Gain and Loss Framed Messages: Two Perspectives • Perspective #1: The impact of gain- and loss-framed messages depends on the match between the frame and the risk implications of the behavior promoted (e.g., Rothman & Salovey, 1997; Rothman et al., 2008; Bartels et al., 2010) • Function of the behavior (e.g., detection/prevention) • Construal of the behavior/health issue (e.g., risk) • Perspective #2: The impact of gain- and loss-framed messages depends on the match between the frame and the motivational orientation of the recipient (e.g., Mann et al., 2004; Updegraff et al., 2007) • BIS/BAS (Carver & White, 1994)

  41. Rothman et al. (1999) Mann et al. (2004)

  42. Message Framing Intervention to Promote Mammography:Testing Competing Moderators • 355 women (40 and older, M=51) recruited at an inner city hospital (49% African American); all due for a mammogram • Measured: (a) How mammography is construed (i.e., illness detecting vs. health affirming) (b) Perceived susceptibility for developing breast cancer (Champion, 1999) (c) Motivational orientation (BIS/BAS) • Viewed 10 minute gain- or loss-framed video about mammography • 3 month follow-up interview (mammography utilization) (Funded by NCI Grant R03-CA128468; Updegraff, PI)

  43. Main Effect of Frame on Mammography Utilization Percent Screened at 3 Months (Gallagher, Updegraff, Rothman, & Sims (in press), Health Psychology)

  44. Perceived Susceptibility of Developing Breast Cancer Moderated Effect of Message Frame on Screening Behavior (Gallagher, Updegraff, Rothman, & Sims (in press), Health Psychology)

  45. Construal of Mammography Moderates Framing Effect: Women with Family History of Breast Cancer (N=63) Percent Screened at 3 months

  46. Implications and Lingering Questions: III Implications for Theory and Practice (understanding and use): Provides an initial progress toward integrating current theoretical models (Rothman & Updegraff, in press) Better specification of the factors that moderate responses to gain- and loss-framed appeals Lingering questions: To what extent does the pattern of findings obtained generalize to other behavioral domains? Are there specific situations when the moderating effect of dispositional factors such as motivational orientation will be obtained? Are framed appeals effective because they persuade people to act or because they nudge people to act?

  47. What can be done to promote the pursuit of understanding and use? Take our theories seriously We need to mindful of what our theories do and do not say We need to pursue opportunities to challenge our theories and discern what they can and cannot do. Need an environment that supports these efforts: NCI Theories Project (http://cancercontrol.cancer.gov/brp/theories_project/) Work by Susan Michie and colleagues Advanced Training Institute on Health Behavior Theory (2012), (http://cancercontrol.cancer.gov/workshop/ )

  48. Promoting the Pursuit of Understanding and Use: Linking Social/Personality Psychology and Health Social Personality & Health Network (www.sphnetwork.org) • Social Personality and Health • Pre-conference prior to 2011 SPSP meeting

  49. Contact Information Alex Rothman Department of Psychology University of Minnesota Phone: 612-625-2573 Email: rothm001@umn.edu

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