In this appendix, we briefly describe key theories that address psychosocial contributions to decision-making and behavior change. Section 1 describes health behavior theories, Section 2 describes behavioral economics theory, and Section 3 presents psychological and developmental theories pertaining specifically to fatherhood.
A. Health Behavior Change Theories and Concepts
Glanz and colleagues (2008) reviewed decades of research in public health and found the following theories most often examined by health behavior change researchers:
· Theory of Reasoned Action/Theory of Planned Behavior (TRA/TPB; Ajzen and Fishbein 1980). These individual-focused theories view the individual as a rational decision maker. According to TRA/TPB, an individual's intention to engage in a behavior is the best predictor of whether he actually will. Behavioral intention is born of the individual's assessment of the desirability of the perceived outcome, social pressures and norms regarding acceptable behavior, and the individual's perceived control over enacting the behavior (Montaño and Kasprzyk 2008).
· Health Beliefs Model (HBM; Rosenstock 1966). Like TRA/TPB, this individual-focused model assumes individuals act rationally, but this model focuses specifically on why individuals fail to engage in healthy behaviors. It was developed to help explain why individuals do and do not participate in health prevention programs (Hochbaum 1958) and to understand individuals' responses to symptoms (Kirscht 1974) and, therefore, focuses on such psychosocial factors as an individual's perceived susceptibility to an adverse outcome (for example, contracting a disease); the perceived severity or the expected consequences of the adverse outcome (for example, pain or death); the perceived benefits or beliefs about the extent to which adopting new behaviors will reduce the adverse outcome and its consequences; confidence in one's ability (efficacy) to adopt the new behavior; and the perceived barriers and costs of engaging in the new behavior (Champion and Skinner 2008).
· Transtheoretical Model (TTM)/Stages of Change (Prochaska et al. 1992). This model posits that behavior change is a process that occurs in a series of five stages: (1) the Pre-contemplation stage, in which individuals are unaware of the problem; (2) the Contemplation stage, in which individuals are aware of the problem, are thinking about changing, but have not committed to doing do; (3) the Preparation stage, in which individuals have committed to change and may have already made small alterations in their behavior in preparation for more substantial changes; (4) the Action stage, in which individuals substantially modify the undesired behavior over a period of months; and (5) the Maintenance stage, in which individuals work to prevent relapse and sustain the behavior achieved in the Action stage (Prochaska et al. 1992).
· Social Learning/Social Cognition Theory (SCT; Bandura 1977). A central tenet of SCT is that behavior is affected by factors both within and external to individuals. Individuals learn behaviors by watching others; behaviors that are more closely linked to desirable expected outcomes are particularly salient. Ultimately, a behavior is more likely to be performed if individuals are confident of their capacity for doing so (McAlister et al. 2008).
· Social Networks and Social Supports (see Heaney and Israel 2008). Social networks are the "web" of social ties, with immediate and extended family members, peers, and "important others" surrounding an individual. Social support refers to the emotional, instrumental, informational, and appraisals provided by these social relations, which can serve to enhance or impede an individual's efforts to change (Heaney and Israel 2008).
· Transactional Model of Stress and Coping (Lazarus and Cohen 1977). Stressors are internal and external demands that cause stress in an individual, and coping refers to strategies for addressing the stressor and for managing emotional reactions to it. This model posits that reactions to stressors depend on individuals' evaluation of the potential threat posed and whether they have the psychological, social, and cultural resources to counter it. The more threatening and less controllable a stressor is perceived to be, the less likely individuals will act upon it, and so behavior change is less likely. Coping styles and mechanisms-for example, information seeking, adopting positive dispositions (such as optimism, hope, future orientation, and perseverance), and accessing social support-can counteract the effects of stressors and facilitate behavior change (Glanz and Schwartz 2008).
· Ecological Models (Bronfenbrenner 1977). Ecological models view the developing individual as embedded in and influenced by a variety environments, both proximal and distal: families; neighborhoods; the workplace; schools; community service agencies; and federal, state, and local policy environments, for example. These environments can support or hinder behavior change. One ecological model of parenting, for example-a "Dynamic Model of Paternal Influences on Children" (Cabrera et al. 2007)-posits that fathers' biological, cultural, and rearing history, together with family characteristics and contextual circumstances, affects fathers' involvement with their children. Ecological models suggest that behavior change is more likely when both individual and environmental factors are supportive of the change.
· Social Marketing (see Storey, Saffitz, and Rimón 2008). Social marketing aims to influence individual behavior by fostering knowledge, attitudes, and skills that support desired outcomes (Andreasen 1994, 2006). Social marketing "facilitates the acceptance, rejection, modification, abandonment, or maintenance of particular behaviors by…the target audience" (Grier and Bryant, 2005). Social marketing is relevant to the design and implementation of public media campaigns as well as knowledge- and skills-based educational health and educational interventions. A key principle of social marketing is audience segmentation-targeting health promotion messages and programs to distinct subgroups based on such characteristics as goals, lifestyles, current behavior, future intentions, and readiness to change. These characteristics are important because they influence the salience of the desired behavior and individuals' receptivity to behavior change interventions (Grier and Bryant 2005).
Below, we summarize key concepts from these major health behavior change theories.
· Factual knowledge and awareness, such as health facts, the preventability or treatability of a condition, and effective strategies improving outcomes and reducing risks (Slater and Flora, 1991)
· Perceived risk, including the perceived susceptibility to negative outcomes and the perceived need to change
· Positive outcomes expectancies, including the benefits of engaging certain behaviors
· Salience/importance placed on the expected outcome, such as the importance placed on being healthy (Slater and Flora 1991)
· Psychological readiness to change, for example, whether one is even aware of the need for change and, if so, whether s/he is simply considering making changes or has already taken the necessary steps toward change (Prochaska et al. 1992)
· Willingness to change, such as the willingness to purchase healthier foods even if pricier than less healthy foods (Slater and Flora 1991)
· Motivation to change, including both intrinsic (such as enjoyment from an activity, and the desire to master a skill) and extrinsic (external rewards and punishments inducing behavior change)
· Self-efficacious beliefs about change, such as confidence in one's ability to eat a healthy diet and exercise regularly (Slater and Flora, 1991), and confidence in following health screening procedures (BeLue et al. 2011)
· Intentions to change, both in terms of stated goals ("I plan to change") as well as specific, actionable plans ("I have made plans to change") (Rose et al. 2007)
· Perceived barriers to change, including psychological barriers (such as fear) and perceived logistical barriers (lack of time, lack of resources perceived as necessary to support change)
· Social norms, including expectations of one's culture, peers, and/or other "important others," actual behaviors of these important others (for example, number of friends who smoke; Rose et al. 2007), and the perceived prevalence of risky behavior in the community
· Social support, including the amount, source, type (instrumental, emotional), and nature of support (for example, positive or negative)
· Kin and social networks, including the overall size, density, and composition
· Interpersonal relationships, including expectations of important others, appraisals by important others, and relationship quality
B. Behavioral Economics Theory
Behavioral economics extends traditional economic theory of human behavior to ground it in "more realistic psychological foundations" (Camerer and Lowenstein 2004). As in economic theory, decision making is still theorized to be a rational process, but behavioral economics acknowledges that individuals' decisions are not simply the result of straightforward calculations of costs and benefits by a rational actor with perfect information. Rather, behavior results from both logical and psychological processes within the individual, as well as from the complex interplay between individuals and their environment.
In describing the key tenets of behavioral economics, Bertrand et al. (2004) posit that behavior change requires:
· Reducing psychological barriers. Individuals may not engage in a behavior even if it is sensible to do so. Psychological factors such as feelings of inadequacy or beliefs that they cannot change their behavior can prevent individuals from engaging in more positive behavior, even if they acknowledge that these are behaviors they should adopt.
· Strengthening identity salience. Behaviors that are congruent with aspects of an individual's identity that are most salient to him or her are more likely to occur.
· Triggering positive feelings. Behaviors that trigger positive feelings, such as a sense of confidence or self-efficacy, are more likely to occur.
· Making the desired behavior the default behavior by changing norms. Individuals' decisions and behaviors are influenced by their environments, so if social norms are supportive of a particular behavior, it is more likely to occur.
· Paying attention to "channel factors." These are small details that can impede or facilitate adoption of desired behaviors. For example, health researchers may provide a map to a doctors' office. Fatherhood programs may choose to co-locate with services fathers need, such as employment services.
C. Psychological and Developmental Theories Relevant to Father Behavior and Behavior Change
Psychological and developmental theories speak to individual, interpersonal, and contextual factors that influence fathering behavior and, as such, are also worth considering as theoretical anchors for identifying predictors of fathering behavior. Family scholars draw from a variety of perspectives, including psychoanalytic and developmental psychology, sociology, and economics (Tanfer and Mott 1998). The following briefly describes key theoretical perspectives used to study fatherhood:
· Personality Theories (see reviews in McRae and John 1992; Mischel and Shoda 1995). Personality characteristics predispose individuals to behave in certain ways, and certain personality characteristics may make behavior change more and less difficult. The five dimensions of personality validated over decades of research are openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism.
· Attachment Theory (Bowlby 1979; Ainsworth 1991). Children form attachments to their parents and other primary caregivers, and these attachments have lasting consequences for the development of close relationships and responsive parenting into adulthood.
· Life Course/Life Stage Theory (Bengston and Allen, 1993). Life transitions shape how men experience fatherhood and perform as fathers, and this affects their fathering behavior (Marsiglio 1995). Normative life transitions could include the start or end of a romantic relationship, residential moves, and job changes or loss of a job; such changes can affect a father's physical and emotional availability to his children.
· Developmental/Generativity Theory (Erickson 1982). As adults develop, they increasingly orient themselves toward the care and well-being of the next generation, which involves biological generativity (procreation), parental generativity (parenthood), and societal generativity (broader contributions to a better world) Correspondingly, men can be biological fathers, child-rearing fathers, and/or social fathers (Tanfer and Mott 1998).
· Identity Theory (Kuhn, 1960)/Role Occupancy Theories (Fox and Bruce 2001; Pleck and Pleck 1997). How an individual perceives himself in various roles-for example, as a parent, provider, worker, spouse/partner-can influence his behavior. The more salient and central the role of "father" to a man's identity, the more he will engage in a variety of fatherhood-related behaviors.
· Motivation Theory (Dweck 1999). Behavior depends on an individual's performance goals, which are driven by self-theories about change. Individuals who believe that intelligence and skills are fixed are not motivated to persevere in the face of adversity, whereas individuals who believe intelligence and skills are malleable will persevere when faced with challenges. The former will therefore tend to be resistant to change, preferring instead to "prove" what they already know, whereas the latter will seek to "improve" and are more open to change.
· Parental Investment Theory (PIT; Daily and Wilson 1980). Parents make decisions about how much time, energy, and financial resources to invest in their children, and, to some extent, these decisions are based on the likelihood that these investments will pay off for the child and/or for the father (Fox and Bruce 2001).
· Social Scripting Theory (Simon and Gagnon 1987). Men receive and internalize cultural norms and messages about what it means to be a father, and this affects their fathering behavior (Doherty et al. 1998).