Levels of Causation • Earlier interpretation: • Proximal – Biological • Distal – Social • Later 19th Century – Levels: • Levels ranging from Individual to Institutional • Difference between how and why biologically • Space – Time Causal pathways
Public Health and Levels • Multifactorial approach to disease causation – agent, host, & environment • Move beyond the web of causation – Z Axis • Proximal-Distal Terminology • Gene-environment interaction • Social determinants of health • Space, Time, Distance, Levels and Causal Potency (association)
THE THEORY OF TRIADIC INFLUENCE Levels of Causation Ultimate CULTURAL SOCIAL BIOLOGY/ Causes ENVIRONMENT SITUATION PERSONALITY 1 2 3 4 5 6 a f Social/ Personal Nexus c d e b Sense of Information/ Interpersonal Others’ Social Interactions w/ Self/Control Opportunities Bonding Beh & Atts Competence Social Instit’s Distal Influences 7 8 9 10 11 12 g r p i q h k n m l j o Expectancies & Evaluations Self Skills: Motivation Perceived Values/ Knowledge/ Determination Social+General to Comply Norms Evaluations Expectancies 13 14 15 16 17 18 s x ATTITUDES SOCIAL SELF-EFFICACY u w v t Affect and Cognitions TOWARD THE NORMATIVE BEHAVIORAL BEHAVIOR BELIEFS CONTROL Proximal 19 20 21 Predictors Decisions A G B H C I D E F 22 K Experiences 23 Related Behaviors J Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream Biological/Nature Nurture/Cultural DECISIONS/INTENTIONS Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological 4
Why use theories? • Help target causal determinants of behavior • Theoretically informed evaluations • Improved future theories • But how…? • Wide range of theories • Range of techniques to modify behavior • Basis of selecting specific theory to change specific behavior
Causal Modeling Approach • Identify behavioral determinants • Develop methods to clarify list of behavior change techniques • Identify links between the behavior change technique and behavior determinants
Results • 53 Techniques (examples): • Setting goals • Providing rewards/incentives • Improve coping skills • Increasing skills (problem-solving, decision-making) • Feedback etc. • 71% Agreement in mapping technique on theoretical constructs.
List of Determinants • Social/Professional role and identity • Knowledge • Skills • Beliefs about capabilities • Beliefs about consequences • Motivation and goals • Memory, Attention, Decision Process • Environmental Context and Resources • Social Influences • Emotion • Action Planning
Conclusions • This exercise makes theories more accessible to researchers. • Need to move forward and keep adding to the list • Improve replicability of interventions in different populations because the basic construct is the same • Conservation of resources due to clarity about determinant-technique relationship
Question… • Do we agree with this approach? • The mapping and relationship are opinions of researchers.