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Effective Modelling requires:

Increased ATTENTION to task (minimise distractions, make clear what the important bits are, etc)

Improved RETENTION strategies (such as use of memory aids, dosset boxes, mnemonic strategies, mantras etc)

REPRODUCTION through imitation and practice (allowing people to practice small bits of the overall task before attempting it all, grading approaches, etc)

Maximising MOTIVATION to carry out the task (use it or lose it - working with people on why this is important, the benefits, what it means for them etc)

Ongoing Sources of Self-efficacy: how to boost it

All of us, at some point (even/especially when we don't realise it!) act as role models for those around us.

As clinicians, this is also true, whether we are modelling tasks (such as self administering injections for example) or behaviours (such as 'therapeutic eating' on eating disorder wards).

Realising that people learn through imitation of role models, and that we are those role models should set our minds to thinking - 'how can we maximise our role modelling for best effect'...

'External' Locus of Control

3 - SOCIAL LEARNING THEORY

Take 5-10 minutes to make a quick mind map about how you could use these four sources of self-efficacy to help boost a patients' self-efficacy about whatever health-related change that interests you.

Now - spend 5 minutes or so drawing up a mind map or list of health behaviours that can be learned through observation, from whom, and when in life this may be the case.

e.g. learning to smoke through watching/being influenced by peers (teenage years)

Try and think of a mix of healthy/unhealthy behaviours

A theory developed by Bandura (again!) (e.g. 1977, 1995)

The key facet of which is that the majority of learning - including the learning of health behaviours - takes place BETWEEN people.

People observe role models, and imitate what they see. There's a continuous interaction between a persons thoughts, behaviour, and environment.

See the 'Bobo doll experiment in the next slide' for an example of learning through observation. although this experiment is about aggression, it applies to health behaviours too.

Positive reinforcement is key to success with modelling - either experiencing this first hand (e.g. how much better it feels to have stopped an unhealthy behaviour)...

... or through observation (seeing how much happier/fitter/healthier someone else is as a result of these behaviours)

Those with strong self-efficacy...

  • View challenges as tasks to be mastered
  • Develop a deeper interest in the area
  • Have a strong sense of commitment to the task at hand
  • Recover quickly from setbacks

Self-efficacy can be improved by the following four means...

  • Mastery (or 'doing' - e.g. making small changes to build confidence before making bigger changes)

  • Social Modelling (or 'seeing' - being around others who are doing the same thing, e.g. weight loss groups/AA etc)

  • Social Persuasion (or 'hearing' - encouragement from others, esp about the positive outcomes of behaviour change)

  • Psychological Responses (or 'feeling' - learning how to minimise stress about a certain task can boost S.E.)

What is 'Strong' Self-efficacy?

A recent study by Lawson & Beggs (2013) called 'Self-efficacy in nursing students' stated that high levels of self-efficacy in final year students had a direct link to how well liked they are by patients in their care.

Those with an 'external' locus of control...

  • Blame others when things go wrong

  • Credit any successes to luck or chance

  • Raise expectations unrealistically after failure

  • Less likely to fully commit to a task

  • More prone to anxiety and depression

  • Are prone to experience 'learned helplessness'. See this link for more info on this: http://psychology.about.com/od/lindex/f/earned-helplessness.htm

Click on for the answer...

2: Riddle me this...

Self-efficacy - a theory which was developed by the social psychologist Albert Bandura (1977, 1994)

It is, according to him, "the belief in your capability to manage certain situations."

In other words, self-efficacy is really another word for 'confidence'. People with 'strong self efficacy', for example, have high levels of confidence in acheiving a certain goal.

This links you to an efficacy questionnaire, to see the sort of stuff psychologists consider to be important:

http://www.excelatlife.com/questionnaires/self-efficacy.htm

A man parks his car outside a hotel.

He realises that he is bankrupt.

Explain this situation: You have 3 minutes to write down a feasible explanation for what is going on.

Your next task...

To start, some exercises...

Before we get started on the theory,

it's important you try and complete the

following tasks.

I'll explain the relevance a bit later!

First: Connect the Dots

So what was the point of all that?

Draw 9 dots on your paper,

like the picture here.

Connect the dots, using just

four lines. The lines must be

straight, and connected:

don't lift your pen off once

you start.

You have 3 minutes.

We'll cover 3 core psychological principles which apply to how people learn:

  • Self-efficacy
  • Locus of Control
  • Social Learning Theory

We'll also link this with clinical skills and health promotion, because healthy behaviours, medication management etc. are all skills that need to be learned.

It doesn't actually matter if you got the 'right' answers at all. The important thing to reflect on was how you approached the tasks.

So, spend the next 5-10 minutes reflecting on how you approached the exercises. Hold in mind the following points:

What were your initial thoughts - did you think 'what is the point', 'I can't be bothered', or were you more positive in your approach?

How confident were you at it? What influenced your confidence levels - past experiences of similar things, feeling 'good' or 'bad' at doing these sort of things etc?

Did you assume you could get it right or did you think you'd never get there?

Really try and think about what influenced your approach - even if you gave up or didn't even try to complete them: your experiences are just as relevant as those people who found the tasks easy.

The last bit, before the theory!

The two exercises required you to do something a little outside of your normal experience (unless you are a logic puzzle geek, in which case this is your normal experience).

Either way, this has important consequences, which should set the theory segment of this tutorial into some sort of context. Read on...

Overview of session

What your reflection should now show you, is that when faced with a new task, or when given instructions about doing something, our response to that is influenced by many different variables. Some of these we are aware of, some we are not.

Now, let's transpose this onto our patients. Let's assume we are not asking them to join the dots or solve a riddle, but we are asking them to change their health behaviour: give up drinking/eat healthier/take medication at the right times, whatever it may be.

The way they will respond to these instructions, the way they will learn these new skills and behaviours, are based on much the same feelings as you just experienced in the tasks. Like with you, these feelings may help them succeed, or contribute to them giving up or failing.

By knowing what influences these thoughts and behaviours, we can anticipate how people will respond to our health promotion strategies, and we can attempt to boost people's abilities to respond well to them!

1: SELF EFFICACY

Theoretical models and the real world

Think of a clinical example, in an area of your interest, in which a change in behaviour is needed.

What aspects of these three theories could be used in practice to help your patient 'learn' this new behaviour and the reasons for it?

How could you promote change and what sources for observation and modelling could there be?

Make some notes on this - 10-15 minutes should do it!

Improving peoples' Locus of Control

One more thing...

I'm a bit naughty and

one of these slides is

entirely made up, and

therefore, wrong.

I'd double check the

slides, and go through

your notes, do a spot of extra reading etc if I were you.

Those with 'weak' self-efficacy...

  • Avoid challenging tasks...

  • Believing they are beyond their capabilities

  • Focus on any personal failings

  • Quickly lose confidence

And the answer is...

2: LOCUS OF CONTROL

Locus of control is something that gets formulated from a young age, but we can help boost the sense of someone's internal locus by:

  • Modelling self control

  • Providing warm and supportive encouragement

  • Highlighting examples in which they have taken control/responsibility for things

  • Getting them involved in exercise (provides evidence that we have control over what we do)

It's important to recognise that nobody is either completely 'internal' or 'external' regarding this, but rather they are on a continuum or scale between the two extremes.

Think back to the tasks at the beginning of the tutorial. Make some notes on the following:

Where would you say your efficacy was with regard to these? How did it effect your performance?

Now transpose this onto patients you may work with. How would their levels of self-efficacy interplay with the things you were asking them to do?

Monopoly.

'Internal' Locus of Control

Those with an internal LoC:

  • Feel in control of things
  • Are more likely to assume success in tasks
  • Are more likely to shift their expectations realistically if they 'fail' at something
  • Can set long term goals and delay gratification
  • Tend to be healthier and happier than those without an internal LoC (Ng, 2006)

In summary - you should now have a basic understanding of three core theories which examine how people learn new behaviours: self-effiacy, locus of control, and social learning theory.

You should have looked at a couple of questionnaires which would have shown you the constructs which make up these theories, as well as carried out a few exercises which enabled you to transpose theories onto practice.

Your own experience of attempting the logic puzzles should also put into context how these theories work in practice when faced with a new thing to do...

Weak Self-efficacy

Not to be confused with Locusts, which are an entirely different matter.

'Locus of Control' is a concept developed by a psychologist called Julian Rotter in 1966

It's easier to understand if you replace 'locus' with 'location'...

It is whether you feel control of your life is located within yourself, or whether that control is external - i.e. other people/factors have control over you.

Also note that self efficacy is not a fixed variable...

That is, we can become more or less confident over time

And, we can be confident at one thing, whilst simultaneously being unconfident about something else

Self efficacy is, as a result, always in a state of flux.

Click the link to take the locus of control test: http://www.psych.uncc.edu/pagoolka/LocusofControl-intro.html

To get a deeper understanding

any basic psychology text book

should do - this is a good one

in my opinion.

Have a search around and see

what there is.

Individual Strategies to Health Promotion:

self-efficacy, locus of control, social learning theory

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