How does the social learning theory approach explain human Behaviour?

Social Learning Theory

Social learning theory proposes that individuals learn by observing the behaviors of others (models). They then evaluate the effect of those behaviors by observing the positive and negative consequences that follow. Social learning theorists assert that members of the adolescent's social network who use substances serve as models for adolescents. If adolescents see role models, such as parents or friends, using substances with positive consequences, they are more likely to develop positive expectations of substance use, which increases the likelihood that the adolescent will use substances. Learning not to use substances occurs in a similar fashion when adolescents who observe negative consequences of use expect negative outcomes and are less likely to use substances. Self-efficacy, an individual's confidence in their own capabilities, is also thought to be learned socially. Self-efficacy to obtain and use or, alternately, to refuse substance use, may also be learned by observing a model. If an individual perceives that he/she can efficaciously obtain and use substances, he/she is more likely to use them.

Social Learning Theory and Social Cognitive Theory

Social Learning Theory applies to several human behavior theories in which the acquisition and maintenance of behaviors such as addictive behaviors depend on the connections between personal factors, environmental factors, and the behavior. Social Learning/Cognitive Theory, to which Albert Bandura greatly contributed, focuses on several key constructs including differential reinforcement, vicarious learning, cognitive processes, and reciprocal determinism.

Differential reinforcement takes place when a behavior results in positive or negative consequences received from the environment or the self. This helps explain why behaviors may change with the environment. Note that consequences to behavior are often social consequences. For example, a teenager using cocaine with peers at a party may receive social approval; however, the same behavior, if observed or discovered by parents or other authorities would likely result in strong disapproval and additional unwanted consequences for the teenager. The likelihood that this teenager will engage in cocaine use is greater if he or she has a positive perception and has less disapproving attitudes toward cocaine use.

Vicarious learning, or modeling, occurs by observation of others' behavior, attitudes, and outcomes of the behavior and can increase the likelihood of the observer engaging in the behavior. Role models such as peers and parents affect expectancies, evaluations, and self-efficacy related to the observed behavior. Thus, even as the consequences we associate with our own behavior shape our future behavior, observing others' consequences associated with their behavior can also shape our behavior (see below for more detail).

Cognitive processes include encoding, organizing, and retrieving information, and these are postulated to regulate behavior and environmental events. An individual cognitively processes information from the environment and determines their behavioral response. Self-regulation can be defined as the ability to arrange environmental incentives and apply consequences. Thus, self-regulation need not be limited to one's ability to choose how to respond in specific situations but can also be applied to one's ability to make choices that affect the degree of exposure to specific influences. For example, if Clyde does not want to smoke marijuana and realizes that he has difficulty saying no to Paul or Mike, he can avoid Paul and Mike as a means of regulating his behavior. A related construct is self-efficacy, which can be defined as the belief that one can engage in a specific behavior and/or produce a specific desired outcome. Self-efficacy can be thought of as context-specific confidence. The extent to which Clyde believes he will be able to resist an offer to smoke marijuana is an example of self-efficacy. Self-efficacy effects and is affected by behavior. The more confidence Clyde has in his ability to resist peer influence, the more successful he will be in doing so. In turn, successful instances of resistance will increase self-efficacy to resist in the future. Furthermore, seeing a peer resist influence can boost one's self-efficacy in resisting peer influence.

Reciprocal determinism describes the associations between behavior and environmental and personal factors, each of which is affected by the other two factors. For example, peers and social environments affect subsequent smoking behaviors, and vice versa.

Modeling

SLT assumes that vicarious or observation learning also exerts a unique influence on adolescent drinking patterns and can be as important as first-hand experience with the effects of alcohol (i.e., direct learning). Prior to their first drink, children learn about alcohol through the drinking behavior and attitudes of their parents and family (Cumsille et al., 2000), and the larger culture (MacAndrew and Edgerton, 1969). Webb and Baer (1995) also found that adolescents with heavy drinking parents drank more, and that this relationship was not mediated by the adolescents’ social skills. Parents influence adolescent substance use directly by overt modeling and indirectly through poor supervision, inconsistent disciplinary practices, a poor parent–child relationship, and family conflict (Duncan et al., 1997).

Norms regarding when and how much to drink, how to behave under the influence, etc., are later reinforced or altered by peer groups, which assume increasing influence in later adolescence (Cumsille et al., 2000). There is some evidence that the influence of parental drinking is most prominent during early adolescence, and that peer drinking becomes more influential in later adolescence. In a longitudinal study of 4200 California adolescents (Ellickson et al., 2001), risk factors for drinking in the 12th grade were measured in the 7th and 10th grade. Significant grade-7 predictors included early drinking onset, parental drinking, future intentions to drink, cigarette offers, difficulty resisting pressures to smoke, having an older sibling, being male, deviant behavior, and poor grades. By grade 10, however, parental drinking was no longer a significant predictor, but peer alcohol and marijuana use, difficulty resisting pressure to drink, and coming from a disrupted family did predict alcohol consumption (Ellickson et al., 2001). Seminal experiments by Alan Marlatt and colleagues clearly demonstrated that social modeling can alter drinking behavior. Using a mock bar laboratory, Caudill and Marlatt (1975) assigned undergraduates to a drinking situation that involved a heavy, light, or non-drinking confederate. Despite similar baseline drinking patterns, participants who drank with a heavy drinking confederate drank significantly more than participants who drank with a light drinking or abstaining confederate. This social modeling effect has been replicated (Collins et al., 1985) and appears to be most pronounced when the drinker and the heavy drinking model are male, and among individuals with a family history of alcohol problems (Chipperfield and Vogel-Sprott, 1988). These experiments suggest that affiliating with a heavy drinking peer group can be a significant risk factor for heavy drinking.

Several studies have further demonstrated that the mere number of alcohol-using friends is the best predictor of alcohol use (Wills et al., 1998). Having friends who use alcohol or who encourage substance use also predicts earlier onset of use, a higher initial level of use, and a higher rate of increase in use over time (Curren et al., 1997).

In summary, both parents and peers play a major role in the onset and escalation of adolescent alcohol use. Parental influence can be direct (via overt modeling) or indirect (via poor monitoring). Peer influence is also significant and appears to increase in prominence later in adolescence.

Conclusion

The importance of IPE in preparing undergraduates for a world of work where co-ordinated collaborative practice is the norm should not be underestimated. By engaging in IPE students are able to experience, in a safe environment, the complexity of joint working and the ways in which individual professional sensitivities can, and do, get in the way of decision-making, as well as culminating in a less linked and more fragmented experience for patients. IPE is a useful precursor to improved collaborative working; today's practitioners need to be capable of working across boundaries and providing seamless holistic patient care with colleagues. In 1988, the WHO called for IPE on the basis that learning together translates into improved working together (WHO 1998).

This chapter has sought to provide the reader with an overview of the current thinking around IPE within the context of contemporary health and social care practice, as well as instil in the reader a sense of its importance in the preparation of graduate health and social care practitioners.

As the historical perspective shows, IPE is not a new concept and yet there is still much work to be done on securing a robust evidence base to support the investment both educators and practitioners put into its ongoing inclusion in education programmes, which both prepares new graduates and supports the ongoing professional development of the health and social care workforce.

The authors of this chapter have highlighted the importance of IPE in the undergraduate curriculum to help prepare graduates for a world of work where collaborative practice is becoming increasingly the norm. The publication of the most recent NHS white paper: ‘Liberating the NHS’ (DH 2010a) reinforces the requirement for collaborative practice in health and social care. For all practitioners this means that every opportunity to develop those skills required for effective collaborative practice should be seized.

For undergraduates concerned with learning to be a particular type of professional with all the inherent uni-professional requirements this demands, the inclusion of IPE can sometimes be viewed as less valuable than those uni-professional aspects. The authors of this chapter hope to convince readers that IPE is an important aspect of their undergraduate education. It is possible to learn to be a particular type of professional within an interprofessional learning context.

Learning to be an effective physiotherapist in the twenty-first century necessitates active engagement in IPE. IPE provides opportunities to practise and experience collaborative working in a safe environment. Learning is a process not performed in isolation from others. As Wenger (1998) asserts, learning involves collaboration and engagement between learners, each influencing and, in turn, being influenced by each other; learning outcomes become shared by communities of practice. IPE is a natural place for this to occur.

Social learning theories (Wenger 1998) suggest that learning with, and through, interaction with others builds communities of practice. This chapter has tried to highlight the importance of interprofessional education as a way of developing the knowledge skills required for collaborative working. It can be argued that building communities of learning through engagement in IPE is the best way to develop such knowledge and skills. IPE communities of learning provide a safe environment where undergraduates can test out their own professional role and identity alongside peers from other professional groups doing the same. Collaborative learning, practice and work are never easy, and are difficult to negotiate on a daily basis. However, it is imperative that today's practitioners are able to practise such professional negotiation on a daily basis if they are to practise person-centred health and social care. IPE offers a vehicle to support this and through collaboration between professionals lead to:

improved services;

improved health outcomes;

effecting change.

The importance of working closely with other professionals to provide care that is truly focussed upon people and their families cannot, and should not, be underestimated (DH 2000b; Wilcock et al. 2009). Being an effective physiotherapist means being equipped with the knowledge, skills and values distinctive to physiotherapy, and recognising, understanding and valuing the knowledge skills and values distinctive to other professional groups. Physiotherapists who are confident in their own professional knowledge, skills and values will be able to recognise when they are the best professional for the job and when it is more appropriate for another professional to do the job. IPE as a mechanism for promoting more effective collaboration and team-working can help to prepare graduates for the daily negotiation of professional boundaries as an integral part of work in order to provide patient-centred care.

The benefits of IPE are well documented and this chapter has introduced readers to the history, drivers, key concepts and practices of IPE alongside an exploration of some of the complexities inherent in any collaborative endeavour (including IPE). The authors acknowledge the need for more evidence to substantiate the benefits of IPE as a precursor to effective collaborative work practices; however, the growing evidential base (Horder 2004; Bokhour 2006; Stone 2006; Lennox and Anderson 2007; Clarke 2006; Cooper and Spencer-Dawe 2006) is testament to the enduring interest in IPE. Current political and societal drivers (DH 2010a, 2010b) continue to ensure that IPE and interprofessional working remain a high priority in health and social care. As West et al. (2006) assert, more positive patient outcomes are realised through greater and more effective collaboration between professionals. IPE that puts patients at the centre promotes collaboration between professionals, reinforces professionals' collaborative competence and relates collaborative learning to collaborative practice (Horder 2004; Hendrick and Khaleel 2008; Wilcock, 2009).

Weblinks

Australasian Interprofessional Practice and Education Network (AIPPEN): http://aippen.net/index.html

Canadian Interprofessional Health Collaborative (CIHC): www.cihc.ca

Centre for the Advancement of Interprofessional Education (CAIPE): www.caipe.org.uk

European Interprofessional Education Network (EIPEN): www.eipen.eu

Global Health Workforce Alliance: www.who.int/workforcealliance/en

Health Professions Global Network: http://hpgn.org/

International Association for Interprofessional Education and Collaborative Practice (InterEd): www.interedhealth.org

Japan Interprofessional Working and Education Network (JIPWEN): http://jipwen.dept.showa.gunma-u.ac.jp/

Journal of Interprofessional Care: http://informahealthcare.com/jic

National Health Sciences Students' Association (NaHSSA): http://nahssa.ca/en/gateway

Nordic Interprofessional Network (NIPNet): http://nipnet.org/

The Network: Towards Unity for Health: www.the-networktufh.org

World Health Organization (WHO): www.who.int/en

London Deanery: Interprofessional Education http://www.faculty.londondeanery.ac.uk/e-learning/interprofessional-education/Interprofessional%20education.pdf

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