Theories of behaviour

1. Presented by: DINA YOUSSEF
Instructor of Dental Public Health
Alexandria University

2. SELF-EFFICACY
OBJECTIVES:
 Introduce & define self-efficacy theory
 Apprehend the judgment scales and the sources of
self-efficacy
 Know the development of self-efficacy over lifespan
 Recognize role of self-efficacy in oral health
 List its different advantages & limitations

3. SELF-EFFICACY
Bandura (1977) observed that individuals have the
following two expectations when they act
Outcome Expectation Efficacy Expectation
Expectation of a certain desirable
outcome by taking an action
Expectation of self-efficacy or
having the ability to take an action

4. SELF-EFFICACY

5. SELF-EFFICACY
There are two levels of self-efficacy
General self-efficacy Task-specific self-efficacy
Reflected in an individual’s
general tendency
Individual’s efficacy in
relation to a certain task

6. SELF-EFFICACY
 Self-efficacy is a construct of the Social Cognitive Theory
proposed by Bandura
 Social Cognitive Theory, a revision of Social Learning
Theory, states that individuals do not learn or change
behavior in a linear fashion

7. SELF-EFFICACY
 Rather, changes take place bidirectionally
Environment
BehaviourInformation

8. SELF-EFFICACY
 Beliefs in one's capabilities to organize & execute the
course of action required to produce given attainments
(Bandura, 1977)
 Once formed, self-efficacy beliefs influence not only
the courses of action pursued, but also the effort
expended, perseverance in the face of difficulties, the
nature of thought patterns

9. SELF-EFFICACY
Perceived Self-Efficacy:
 People's beliefs about their capabilities to
produce designated levels of performance that
exercise influence over events that affect their lives

10. SELF-EFFICACY
People with Low
Self-Efficacy
People with High
Self-Efficacy
Vs.
• Avoid challenging tasks • View challenging problems
as tasks to be mastered
• Believe that difficult tasks
are beyond their capabilities
• Develop deeper interest in
activities they participate in

11. SELF-EFFICACY
People with Low
Self-Efficacy
People with High
Self-Efficacy
Vs.
• Focus on personal failings • Form a stronger sense of
commitment to their interests &
activities
• Quickly lose confidence
in personal abilities
• Recover quickly from setbacks
& disappointments

12. SELF-EFFICACY
Mastery
Experience
Vicarious
Experience
Verbal
Persuasion
Emotional
State
Sources of Self-Efficacy

13. SELF-EFFICACY
Sources of Self-Efficacy
1- Mastery Experience:
 “The most effective way of
developing a strong sense of efficacy
is through mastery experiences”
Bandura explained (1994)

14. SELF-EFFICACY
Sources of Self-Efficacy
1- Mastery Experience:
Performing a task successfully strengthens our
sense of self-efficacy
 However, failing to adequately deal with a task
or challenge can undermine & weaken self-
efficacy

15. SELF-EFFICACY
Sources of Self-Efficacy
1- Mastery Experience:
 Providing opportunities for people to gain mastery is the
reason of workshops, training programs, internships &
clinical experiences are offered

16. SELF-EFFICACY
Sources of Self-Efficacy
2- Vicarious Experience (Social Modeling):
 Witnessing other people successfully completing a task
is another important source of self-efficacy
 According to Bandura, “Seeing people similar to oneself
succeed by sustained effort raises observers beliefs that
they too possess capabilities master comparable activities
to succeed”

17. SELF-EFFICACY
Sources of Self-Efficacy
2- Vicarious Experience (Social Modeling):
 Individuals do not have to experience effects of poor
health choices if they can learn from others' experiences
To be most effective, models should be personally liked
and are seen as having similar attributes (e.g. age, gender
and ethnicity)

18. SELF-EFFICACY
Sources of Self-Efficacy
2- Vicarious Experience (Social Modeling):
 Also, the model should be seen by individual as someone who
struggled imperfectly, but succeeded in similar task

19. SELF-EFFICACY
Sources of Self-Efficacy
2- Vicarious Experience (Social Modeling):

20. SELF-EFFICACY
Sources of Self-Efficacy
3- Verbal Persuasion (Social Persuasion):
 Act to telling or convincing a
person to perform a task or
action to change a behavior or
put into action a set of events to
achieve an objective

21. SELF-EFFICACY
Sources of Self-Efficacy
3- Verbal Persuasion (Social Persuasion):
 Bandura also asserted that people could be persuaded to
belief that they have the skills & capabilities to succeed
 Getting verbal encouragement from others helps people
overcome self-doubt & instead focus on giving their best
effort to the task at hand

22. SELF-EFFICACY
Sources of Self-Efficacy
3- Verbal Persuasion (Social Persuasion):
Positive appraisals
strengthen self-efficacy
Negative appraisals
weaken self-efficacy

23. SELF-EFFICACY
Sources of Self-Efficacy
3- Verbal Persuasion (Social Persuasion):

24. SELF-EFFICACY
Sources of Self-Efficacy
4- Somatic & Emotional State:
 The individual’s physiological &/or emotional state
influencing her/his judgment of self-efficacy
Stress, anxiety, worry & fear all negatively affect self-efficacy
& lead to self-fulfilling prophecy of failure (Pajares, 2002)

25. SELF-EFFICACY
Sources of Self-Efficacy
4- Somatic & Emotional State:
 A classic example of how emotional state affects self-
efficacy & ultimately health behaviour is fear of dentist

26. SELF-EFFICACY
Sources of Self-Efficacy
4- Somatic & Emotional State:
Thought of going to
dentist associated with
pain & anxiety
Delay appointments
for even routine,
preventive care
Deterioration in
dental health
Avoidance Behaviour
Need for more
extensive treatment
or even tooth loss

27. SELF-EFFICACY
Sources of Self-Efficacy
4- Somatic & Emotional State:
 So, emotional arousal affects self-efficacy which affects
the decisions people make
Emotional state
improves
Emotional arousal
or stress
Self-efficacy
change is expected

28. SELF-EFFICACY
Sources of Self-Efficacy
Example:
 A 42 year old male presents with severe generalized gingivitis &
isolated 4 mm pockets. The patient had a family history of type 2
diabetes and hypertension although the patients has neither of
them
 Upon questioning, the provider learns that patient’s father
experienced loose teeth, resulting in need for full dentures at an
early age. The patients wants to keep his teeth

29. SELF-EFFICACY
Sources of Self-Efficacy
Example:
 In this case the dentist can use vicarious learning to
explain about PDL disease & to teach patient about proper
oral hygiene measures & treat him

30. SELF-EFFICACY
Sources of Self-Efficacy
Example:
 In subsequent appointment, patient
experienced improved gingival health because
of his oral hygiene efforts
 Verbal persuasion will attribute improved
oral status to the patient’s practices

31. SELF-EFFICACY
Sources of Self-Efficacy
Example:
The dentist here allowed the patient to experience
success through his own effort (enactive attainment),
allowed him to learn of poor outcomes through his fathers
experience (vicarious learning) & pointed out that the
results are a direct result of his efforts (verbal persuasion)

32. SELF-EFFICACY
Dimesnions of Self-Efficacy
Magnitude
Strength

33. SELF-EFFICACY
Dimesnions of Self-Efficacy
1- Magnitude of Self-Efficacy Expectations:
 Refers to the level of task difficulty that a person
believes she/he is capable of executing

34. SELF-EFFICACY
Dimesnions of Self-Efficacy
2- Strength of Self-Efficacy Expectations:
 Refers to whether the judgment about magnitude is
- Strong: Perseverance in coping efforts despite
disconfirming experiences
- Weak: Easily questioned in the face of difficulty

35. SELF-EFFICACY

36. SELF-EFFICACY
Cognitive
Processes
Motivational
Processes
Affective
Processes
Selection
Processes

37. SELF-EFFICACY
1- Cognitive Processes:
 Personal goal setting is influenced by self-appraisal
of capabilities
Stronger perceived
self-efficacy
Higher goal challenges
Firmer commitment

38. SELF-EFFICACY
1- Cognitive Processes:
 Most courses of action are initially organized in
thought
 People's beliefs in their efficacy shape types of
anticipatory scenarios they construct & rehearse
Self-efficacy Success scenarios Positive guides & supports
Self-efficacy Failure scenarios Negative guides

39. SELF-EFFICACY
1- Cognitive Processes:
 Thinking processes involved in:
- Acquisition of information
- Organization of information
- Use of information

40. SELF-EFFICACY
2- Motivational Processes:
 3 different forms of cognitive motivators around
which different theories built
Attribution theoryAttributions
Outcome expectancies Expectancy-value theory
Cognized goals Goal theory

41. SELF-EFFICACY
2- Motivational Processes:
 Activation to action
 Level of motivation is reflected in:
- Choice of courses of action
- Intensity and persistence of effort

42. SELF-EFFICACY
3- Affective Processes:
 People's beliefs in their coping capabilities affect how
much stress and depression they experience in threatening
or difficult situations, as well as their level of motivation
 Perceived self-efficacy to exercise control over stressors
plays a central role in anxiety arousal

43. SELF-EFFICACY
3- Affective Processes:
 People who believe they can exercise control over
threats do not conjure up disturbing thought patterns
 But those who believe they cannot manage threats
experience high anxiety arousal

44. SELF-EFFICACY
3- Affective Processes:
 Processes regulating emotional states & elicitation of
emotional reactions
Affect can alter perceptions of situations as well as
outcomes of cognitive effort, it can also fuel, block, or
terminate cognition and behavior

45. SELF-EFFICACY
4- Selection Processes:
 We all select to pursue activities we can manage in
environments within our capabilities,
- Low self-efficacy
- High self-efficacy
Selection of non challenging activities in familiar environments
Selection of challenging activities in novel environments

46. SELF-EFFICACY
The newborn comes without any sense of self
 Infants exploratory experiences in which they
see themselves produce effects by their actions
provide initial basis for developing a sense of
efficacy
Self-Efficacy over Lifespan
A. Origins of a Sense of Personal Agency:

47. SELF-EFFICACY
 The initial efficacy experiences are centered in the
family
Self-Efficacy over Lifespan
B. Familial Sources of Self-Efficacy:

48. SELF-EFFICACY
 Parents who are responsive to their infants' behavior &
create opportunities for efficacious actions by providing
enriched physical environment & permitting freedom of
movement for exploration, have infants who are
accelerated in their social and cognitive development
Self-Efficacy over Lifespan
B. Familial Sources of Self-Efficacy:

49. SELF-EFFICACY
 As the growing child's social
world rapidly expands, peers
become increasingly important in
children's developing self-
knowledge of their capabilities
Self-Efficacy over Lifespan
C. Broadening through Peer Influences:

50. SELF-EFFICACY
 Age-mates provide highly informative
comparisons for judging & verifying one's
self-efficacy
 Peer relationships broaden self-
knowledge of their capabilities
Self-Efficacy over Lifespan
C. Broadening through Peer Influences:

51. SELF-EFFICACY
 School is the place where children
develop cognitive competencies & acquire
the knowledge and problem-solving skills
essential for participating effectively in
larger society
Self-Efficacy over Lifespan
D. School as an Agency for Cultivating Cognitive
Self-Efficacy:

52. SELF-EFFICACY
As adolescents approach demands of adulthood, they
must learn to assume full responsibility for themselves in
almost every dimension of life
This requires mastering many new skills & the ways of
adult society
Self-Efficacy over Lifespan
E. Growth through Transitional Experiences of
Adolescence:

53. SELF-EFFICACY
Self-Efficacy over Lifespan
E. Growth through Transitional Experiences of
Adolescence:

54. SELF-EFFICACY
Self-Efficacy over Lifespan
F. Self-Efficacy Concerns of Adulthood:
 Young adulthood is a period when people have to learn
to cope with many new demands
 A firm sense of self-efficacy is an important contributor
to attainment of further competencies & success

55. SELF-EFFICACY
Self-Efficacy over Lifespan
F. Self-Efficacy Concerns of Adulthood:
 Those who enter adulthood poorly
equipped with skills and plagued by
self-doubts find many aspects of
their adult life stressful & depressing

56. SELF-EFFICACY
Self-Efficacy over Lifespan
G. Reappraisals of Self-Efficacy With Advancing Age:
 Self-efficacy issues of the elderly
center on reappraisals &
misappraisals of their capabilities
 Biological conceptions of aging
focus extensively on declining
abilities

57. SELF-EFFICACY
Self-Efficacy over Lifespan
G. Reappraisals of Self-Efficacy With Advancing Age:
Many physical capacities do
decrease as people grow older,
thus, requiring reappraisals of
self-efficacy for activities in
which the biological functions
have been significantly affected

58. SELF-EFFICACY
 Self-efficacy has been an accurate predictor of oral health
in both cross sectional & longitudinal studies
 Qualitative analysis of dental attitudes indicated that
cognitive experiences, supportive and emotional
dimensions & childhood experiences influence dental
attitudes and behaviors
Self-Efficacy & Oral Health

59. SELF-EFFICACY
 Dental self-efficacy was found to be a determinant in oral
health and oral hygiene among diabetes patients and for
general oral health in elderly patients
 Self-efficacy has shown to be consistent with
improvements in oral hygiene over time, but benefit may be
short term only
Self-Efficacy & Oral Health

60. SELF-EFFICACY
 Periodontal patients showed improvements in oral
hygiene and dental self-efficacy six months after the initial
intervention but differences were lost over time
 Self-efficacy was found to be protective against ECC.
Researchers have proposed that self-efficacy may be a
useful part of a multidimensional model to predict ECC
Self-Efficacy & Oral Health

61. SELF-EFFICACY
 The theory differs from other theories addressing personal
agency or control, in that self-efficacy is domain specific
That is, an individual can have high expectations that oral
health is attainable through personal oral hygiene
professional care. The same individual may have low self
efficacy in other areas of health
Self-Efficacy & Oral Health

62. SELF-EFFICACY
Sources of Dental Self-Efficacy in Oral Health
Behavior:
 Syrjälä et al in 2001 described 5 sources:
1st source: knowledge about oral health behavior
2nd source: Experience in caring for one’s own oral health
Self-Efficacy & Oral Health

63. SELF-EFFICACY
Sources of Dental Self-Efficacy in Oral Health
Behavior:
 Syrjälä et al in 2001 described 5 sources:
3rd source: Support received from the dentist
4th source: Emotional arousal
5th source: Model received in childhood, from home or school
Self-Efficacy & Oral Health

64. SELF-EFFICACY
Examples of Self-Efficacy Scales in Dental
Practice:
 Self-efficacy scale for self- care (SESS) in
periodontal patients
 Self-efficacy scale for maternal oral-care (SESMO)
Self-Efficacy & Oral Health

65. SELF-EFFICACY
 High levels of self-efficacy enhance one's
accomplishments & feelings of personal well being
(Pajares, 1996)
 Self-efficacy helps one to remain calm when
approaching challenging tasks (Pajares, 1996)
Advantages

66. SELF-EFFICACY
 High self-efficacy increases one's willingness to
experiment with new ideas (Ormrod, 2008)
 Self-efficacy encourages one to set higher
expectations for future performances (Ormrod, 2008)
Advantages

67. SELF-EFFICACY
 High self-efficacy beliefs do not always guarantee
positive outcome expectations (Pajares, 1996)
 Self-efficacy beliefs vary greatly between
individuals, which makes them very difficult for
researchers to assess (Pajares, 1996)
Limitations

68. SELF-EFFICACY
 High self-efficacy can sometimes lead to an
individual applying less effort to a particular task.
This is because high self-efficacy can sometimes
lead to overconfidence (Ormrod, 2008)
 Basing one's self-efficacy for a new task on
results of previous tasks may be misleading
(Bandura, 1986)
Limitations

70. SENSE OF COHERENCE
Objectives:
 Apprehend the origin & concept of SOC theory
 Understand what is salutogenesis
 List the different components of SOC
 Recognize impact of SOC on oral health

71. SENSE OF COHERENCE
 The concept of sense of coherence (SOC) was put
forward by Aaron Antonovsky in 1979 to explain why
some people become ill under stress & others stay
healthy
 It arose from the salutogenic approach

72. Salutogenesis
Salus
=
Health
Genesis
=
Origin
Origins of Health
SENSE OF COHERENCE

73. SENSE OF COHERENCE
 The study of health rather than the study of disease
 The salutogenic approach to healthcare looks at origins
of health as oppose to pathogenic approach to healthcare
which looks at origin (or causes) of disease (pathos)
 Salutogenic theory looks for root of unhealthiness rather
than just treating the disease

74. SENSE OF COHERENCE
 Antonovsky's objection to the study of
pathogenesis is that it tends to
dichotomize people into either a "healthy"
or "ill" state
 He contends there is a continuum of
"ease to dis-ease" state for most people.

75. SENSE OF COHERENCE
ILLNESS
SICKNESS
“HEALTH-EASE”“DIS-EASE”
SALUTOGENESIS
PATHOGENSIS
HEALTH PROMOTION
DISEASE PREVENTION, CURE & CARE

76. SENSE OF COHERENCE

77. SENSE OF COHERENCE
Pathogenesis Salutogenesis
What causes diseases? What causes Health?
About Avoiding Problems
Disease/Illness an anomaly
Reactive - Absence Disease
Against pain or Loss
Prepares one to live
About reaching Potential
Inherently flawed
Proactive - Presence Health
For Gain or Growth
Discover how to live fully
Vs.

78. SENSE OF COHERENCE
Pathogenesis SalutogenesisVs.
Clinician will diagnose a
condition and work to
cure it
Clinician will work with a
patient on goal-oriented
behavior that will strengthen
SOC & thereby move patient
toward "ease" end of ease to
dis-ease continuum

79. SENSE OF COHERENCE
 Salutogenesis model closely examines role of stressors
& tension as contributing factors for health and dis-ease
 A stressor is defined as a source of disturbance that
upsets a sense of equilibrium
 This may come from external or internal sources such
as illness, heredity, job stress, or lack of personal control

80. SENSE OF COHERENCE
Antonovosky’s way of explaining the health continuum & salutogenic direction

81. SENSE OF COHERENCE
Cognitive
Perceptual
Social

82. SENSE OF COHERENCE
 The extent to which one has a pervasive, enduring
though dynamic, feeling of confidence that one’s
environment is predictable and that things will work
out as well as can reasonably be expected
 In other words, it’s a mixture of optimism & control

83. SENSE OF COHERENCE
Salutogenesis and Health Promotion (WHO, 1986:1)
“Is the process of enabling individuals and
communities to increase control over, and to
improve their health”

84. SENSE OF COHERENCE
Comprehensibility
(Cognitive)
Meaningfulness
(Motivational)
Manageability
(Behavioral)
SOC Components

85. SENSE OF COHERENCE
 Extent to which a person perceives the
stimuli that confront them as making
cognitive sense, as information, that is
ordered, consistent & structured
SOC Components
1- Comprehensibility (Cognitive Component):

86. SENSE OF COHERENCE
 Extent to which individuals perceive
they are able to manage the situation on
their own or through significant others in
their social network
2- Manageability (Behavioral Component):
SOC Components

87. SENSE OF COHERENCE
 Extent to which a person feels that life
makes sense emotionally, that things are
really worth it and that there is good reason
or purpose to care about what happens
3- Meaningfulness (Motivational Component):
SOC Components

88. SENSE OF COHERENCE

89. SENSE OF COHERENCE
Resources
Its worth it
Meaningful
It makes sense
Manageable
Comprehensible

90. SENSE OF COHERENCE
 According to Antonovsky’s theory of salutogenesis, a
strong SOC promotes good health
 SOC reflects a person’s view of life and capacity to respond
to stressful situations in a health promoting manner.
 SOC has been suggested to be highly applicable in the
public health area, since it is directed not only towards cure,
but also towards prevention (Geyer 1997)

91. SENSE OF COHERENCE
 The resources used to respond to stimuli are called
“general resistance resources” GRR
 These resources are essential to the movement toward
health promotion & are classified as:
- Biological
- Material
- Psychosocial

92. SENSE OF COHERENCE
 Typical GRR are financial resources,
knowledge/intelligence, experience, self-esteem, healthy
behavior, commitment, social support, traditions,
religion/philosophy/art, and preventive guidance in health
 However, the essential aspect of GRR is not the availability
of resources, but also each individual’s ability to use his or
her GRR for the intended purpose, which is based on the SOC

93. SENSE OF COHERENCE
 GRRs are shaped by life experiences
characterized by consistency, participation
in shaping outcome & balance between
underload and overload
 Thus, when these resources are available
or in the immediate surroundings, the
person has a better chance of dealing with
life’s challenges

94. SENSE OF COHERENCE
 So, people with a strong SOC are more likely to identify
a wider range of available resources
o Weak SOC: Anticipate things will go wrong, difficulty
expecting needs to be fulfilled, lack hope
o Strong SOC: Life is complicated, but understood & in
the end things will work out

95. SENSE OF COHERENCE
 The Orientation to Life Questionnaire was developed
as a cross-cultural tool for measuring SOC
 Most commonly used in two forms, with either 29, or
13 items
Measuring SOC

96. SENSE OF COHERENCE
 Jarno Savolainen et al in 2005
 Study verified SOC as a determinant of oral & general health
behaviour & oral health-related quality of life
 The cross-sectional data was collected via home interviews,
self- administered questionnaires, or clinical examinations
A Salutogenic Perspective to Oral Health

97. SENSE OF COHERENCE
 SOC was positively associated with oral health behaviours,
such as dental attendance & tooth-brushing frequency
 SOC was positively associated with level of oral hygiene
 A strong SOC was strongly associated with a positive oral
health-related quality of life (OHIP)
A Salutogenic Perspective to Oral Health

98. SENSE OF COHERENCE
 Researchers found that mothers' SOC is significantly
associated with several oral health indicators in adolescents
 Strong maternal SOC was associated with gingival health,
overall caries rate, anterior caries, and professional dental
visits
A Salutogenic Perspective to Oral Health

99. SENSE OF COHERENCE
CONCLUSION:
1- Challenges pathogenic approach, since it focuses on
pathways and mechanisms leading to health
2- Addresses the “upstream” underlying social determinants of
population oral health, instead of focusing mainly on changing
health behaviors

100. SENSE OF COHERENCE
CONCLUSION:
3- To reduce oral health inequities, salutogenic orientation
seems to be a promising framework for interventions based on
an understanding of what sustains health in conditions of
chronic adversity
4- In a challenging global world, the way people are able to
perceive structures, create coherence and keep everything
together has a central impact on health

101. REFERENCES
 Sense of coherence: definition and explanation, Martin Olsson, Kjell Hansson, Ann-
Marie Lundblad, Marianne Cederblad, INTERNATIONAL J O F SOCIAL WELFARE, 2006.
 A salutogenic approach to oral health promotion, ndréa Neiva da Silva Maria Helena
Magalhães de Mendonça Mario Vianna Vettore, 2008.
 Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of
human behavior (Vol. 4, pp. 71-81). New York: Academic Press. (Reprinted in H.
Friedman [Ed.], Encyclopedia of mental health. San Diego: Academic Press, 1998).
Health Behavior Models and Oral Health: A Review. Journal of Dental Hygiene, Vol. 78,
No. 3, Summer 2004
Application of self-efficacy theory in dental clinical practice. Oral Diseases (2010) 16,
747–752

102. THANK YOU !