Section 4.2: Cognitive Psychology Theories of Change

[ Table of Contents ]

Alison Hutchinson, PhD
Postdoctoral Fellow, Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta

Carole A. Estabrooks, PhD
Professor and CIHR Canada Research Chair in Knowledge Translation, Faculty of Nursing, University of Alberta

Cognitive psychology theories

  • Focus on behavior of the individual
  • Are helpful in identifying cognitions amenable to change
  • Claim that interventions to influence cognitive characteristics can mediate/moderate behavior (Conner & Norman, 2005)
  • In the study of KT, such theories have been used to inform:
    • o research design
    • o intervention development
    • o evaluation of KT interventions

Assumption of Cognitive Psychological Theories

Most cognitive psychological theories assume that individuals make decisions in a rational manner; following a systematic review of all available information

(Conner & Norman, 2005)

Cognitive psychology theories influential in the field of KT

Related to motivation Social cognitive theory
Theory of planned behaviour
Related to action Implementation intentions
Theory of operant conditioning
Related to stages of change Transtheoretical model of change
Related to decision making Cognitive continuum theory

Theories related to motivation

  • Claim that motivation determines and predicts behavior
  • Social cognitive theory assumes incentives and expectations related to outcomes and self efficacy determine behavior (Bandura, 1977,1982; Azjen, 1991)
  • Self efficacy is hypothesized to be influenced by 4 sources of information – performance accomplishment (most influential), vicarious experience, verbal persuasion and physiological feedback (Bandura, 1977, 1982)

Theories related to motivation

  • According to the theory of planned behavior intention to engage and perceived control over the behavior are determinants and predictors of behavior (Azjen, 1991)
  • Intention relates to attitudes, subjective norms and behavioral control

Theories related to action

  • Focus on individuals who are motivated to change
  • The theory of implementation intentions relates to the behavioral logistics (when, where and how) that are necessary to achieve the intended goal (Gollwitzer, 1999)
  • The theory of planned behavior suggests that planning and preparation will facilitate adoption of specific behavior
  • According to operant conditioning theory, positive feedback will encourage repetition of the respective behavior, while negative feedback is likely to discourage certain behavior (Blackman, 1974)
  • Interventions underpinned by operant conditioning theory may include feedback mechanisms to encourage or discourage behavior

Theories related to stages of change

  • The transtheoretical model of change comprises 5 stages:
    • Precontemplation – no plan to adopt in foreseeable future
    • Contemplation – intends to adopt within next 6-months
    • Preparation – intends to adopt within next month
    • Action – has been using behavior for the past 6-months
    • Maintenance – actively working to maintain the behavior
  • It is claimed that an individual progresses through the stages over time (Prochaska & Velicer, 1997)

Theories related to stages of change

  • Strategies to enhance progression from precontemplation to contemplation include:
    • o Continuing education; Educational outreach; Performance feedback
  • Strategies to enhance progression to preparation and action stages include:
    • o Provision of resources and support
  • Strategies to promote progression from action to maintenance include:
    • o Reminders and prompts; Provision of appropriate equipment

Theories related to decision making

  • The cognitive continuum theory claims that the cognitive mode for decision making exists on a continuum – analysis and intuition are at opposite poles on the continuum
  • Characteristics of the individual decision determine the point on the continuum that is adopted
  • Six modes of healthcare decision making have been identified, based on cognitive mode (intuition – analysis) and the structure of the task (potential for manipulation, visibility of the process, time required) (Hamm, 1988)
  • Cognitive continuum theory can help explain and justify health professionals' decisions

(Hammond, 1980, 1981; Hamm, 1988)

Limitation of Cognitive Psychology Theories

Such theories do not:

  • consider external factors
  • take into account the social construction of knowledge

Evidence for cognitive psychology theories

  • There is some evidence for the value of the theory of planned behavior in guiding development of interventions to influence behavior (Perkins et al., 2007; Eccles et al., 2007)
  • An expanding body of evidence suggests operant conditioning is useful in predicting health professionals' behavior (Eccles et al., 2007; Bonetti et al., 2007)
  • There is limited evidence to support stages of change (Bonetti et al., 1994; Weinstein, 1998) and the cognitive continuum theories (Lauri et al., 2001; Hamm, 1989)

Future research

  • We recommend that future research be programmatic; undertaken systematically and incrementally to test theory-based interventions and their theoretical assumptions
  • Research methodology and interventions should be reported in detail to enable replication studies and fidelity to the intervention


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