Social Cognitive Theory and Exercise of Control over HIV Infection

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Social Cognitive Theory and Exercise of Control over HIV Infection
Albert Bandura
Stanford University
(Note: This manuscript is provided without a reference list)
Bandura, A. (1994). Social cognitive theory and exercise of control over HIV infection. In R. J.
DiClemente and J. L. Peterson (Eds.), Preventing AIDS: Theories and methods of
behavioral interventions (pp. 25-59). New York: Plenum.

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Prevention of infection with the AIDS virus requires people to exercise influence over
their own behavior and their social environment. Societal efforts designed to control the spread
of AIDS have centered mainly on informing the public on how the human immunodeficiency
virus (HIV) is transmitted and how to safeguard against such infection. It is widely assumed that
if people are adequately informed about the AIDS threat they will take appropriate self-
protective action. Heightened awareness and knowledge of health risks are important
preconditions for self-directed change. Unfortunately, information alone does not necessarily
exert much influence on refractory health-impairing habits. To achieve self-directed change,
people need to be given not only reasons to alter risky habits but also the behavioral means,
resources, and social supports to do so. Effective self- regulation of behavior is not achieved by
an act of will. It requires certain skills in self-motivation and self-guidance (Bandura, 1986).
Moreover, there is a major difference between possessing self-regulative skills and being able to
use them effectively and consistently under difficult circumstances. Success, therefore, requires
strong self-belief in one's efficacy to exercise personal control
Perceived self-efficacy is concerned with people's beliefs that they can exert control over
their own motivation, thought processes, emotional states and patterns of behavior. People's
beliefs about their capabilities affect what they choose to do, how much effort they mobilize,
how long they will persevere in the face of difficulties, whether they engage in self- debilitating
or self-encouraging thought patterns, and the amount of stress and depression they experience in
taxing situations. When people lack a sense of self-efficacy, they do not manage situations
effectively even though they know what to do and possess the requisite skills. Self-doubts
override knowledge and self-protective action.
Numerous studies have been conducted linking perceived self-efficacy to health-
promoting and health-impairing behavior (Bandura, 1991a; O'Leary, 1985). The results show
that perceived self-efficacy can affect every phase of personal change -- whether people even
consider changing their health habits, how hard they try should they choose to do so, how much
they change, and how well they maintain the changes they have achieved. In addition to
influencing health habits, a low sense of efficacy in coping with stressors activates autonomic,
catecholamine, and endogenous opioid systems that can impair immune function (Bandura,
1991a; Maier, Laudenslager, & Ryan, 1985).
Translating health knowledge into effective self-protection action against AIDS
infection requires social and self-regulative skills and a sense of personal power to exercise
control over sexual and drug activities, the two major transmitter modes of the AIDS virus. As
Gagnon and Simon (1973) have correctly observed, managing sexuality involves managing
interpersonal relationships. Thus, risk reduction calls for enhancement of interpersonal efficacy
rather than simply targeting a specific infective behavior for change. The major problem is not
teaching people safer sex guidelines, which is easily achievable, but equipping them with skills
and self-beliefs that enable them to put the guidelines consistently into practice in the face of
counteracting influences. Difficulties arise in following safer sex practices because self-
protection often conflicts with interpersonal pressures and sentiments. In these interpersonal
situations the sway of coercive threat, allurements, desire for social acceptance, social pressures,
situational constraints, fear of rejection and personal embarrassment can override the influence
of the best of informed judgment. Women have the lowest assurance in their efficacy to exercise
control over pressures by a desirable partner to engage in unprotected intercourse that potentially
places them at risk of infection (Kasen, Vaughan, & Walter, 1992). Experiences of forced

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unwanted intercourse, which are not uncommon, lower women's sense of efficacy to negotiate
safer sex (Heinrich, in press). The weaker the perceived self-efficacy, the more such social and
affective factors can increase the likelihood of risky sexual behavior.
Exercise of personal control over sexual behaviors that carry risk of infection calls on
skills and self-efficacy in communicating frankly about sexual matters and protective sexual
methods and ensuring their use. Some of the people who perceive a personal risk of sexually
transmitted disease are reducing the number of sexual partners and are more wary of engaging in
sex with casual partners. Ignorance of a partner's sexual and drug activities has become a new
risk factor. However, to rest self- protection on partners' reports of their sexual and drug history
is a hazardous safeguard. Sexual ardor and impression management can readily expurgate risky
histories in personal disclosures. Most people in steady relationships see little need for protective
measures through belief in their partner's monogamousness and negative serostatus. However,
youth often go through a series of relationships resulting in exposure to multiple partners,
usually of unknown serostatus. Moreover, survey studies reveal that a majority of
"monogamous" relationships are so in name rather than in actual practice. Because the AIDS
virus is transmittable heterosexually, occasional sex with partners outside a monogamous
relationship, especially those who have had bisexual or drug involvements, expands the range of
potential risk for heterosexuals as well.
Subjective risk appraisal for AIDS infection is highly unreliable because infected
individuals remain asymptomatic for a long time and their sexual and drug history often remain a
private matter. Lacking knowledge of the behavioral history and serostatus of sexual partners,
people tend to make their risk appraisals on the basis of social and physical appearances, which
can be highly misleading. Given evidence that most males would lie about their sexual history to
gain sex (Keeling, 1989), seeking protection through probing inquiry provides illusory safety.
Indeed, the stronger people believe in their personal efficacy to assess by inquiry the risk status
of a new partner, the more likely they are to engage in unprotected intercourse (O'Leary,
Goodhart, Jemmott, & Boccher-Lattimore, 1992). Hence, the development of communicative
efficacy should center on skills for negotiating safer sex practices rather than for history taking
of highly suspect reliability.
Even people who are well informed on safer-sex guidelines often err in their subjective
appraisal of the extent to which they are putting themselves at risk of HIV infection. Bauman
and Siegel (1987) found that gay men practicing hazardous sex underestimate the riskiness of
their behavior as judged against epidemiologically established linkage to seropositivity.
Misappraisals of riskiness of one's sexual practices tend to be associated with underestimation of
personal susceptibility to infection, with misbeliefs that risky sex with a few regular partners is
safe, and erroneous beliefs that behavioral precautions that actually have no protective value
(showering before and after sexual contact, healthful regimens, inspecting partners for lesions)
will render risky sex safe. Such findings underscore the need for risk-reduction messages not
only to describe risky sexual practices but to correct common misbeliefs about irrelevant factors
that invest risky practices with false safety.
In managing sexuality and intravenous drug use, people have to exercise influence over
themselves as well as over others. This requires self-regulative skills in motivating and guiding
one's actions. Self-regulation operates through internal standards, affective reactions to one's
own conduct, use of motivating self incentives and other forms of cognitive self- guidance
(Bandura, 1986, 1991b). Self-regulative skills thus form an integral part of risk-reduction
capabilities. They partly determine the social situations into which people get themselves, how

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well they navigate through them, and how effectively they can resist social inducements to
potentially risky behavior. It is not often that people deliberately set out to entangle themselves
in highly risky activities. Rather, they make a series of seemingly innocuous choices that
eventually culminates in risky involvements. Effective self-regulation, therefore, requires self-
monitoring skills for recognizing and aborting potential entanglement scenarios early in the
chain of portentous decisions. It is easier to wield control over preliminary choice behavior
likely to lead to troublesome social situations than to try to extricate oneself from such situations
while enmeshed in them. This is because the antecedent phase involves mainly anticipatory
motivators which are amenable to cognitive control; the entanglement phase includes stronger
social inducements to engage in high-risk behavior which are less easily manageable.
In some countries, such as Africa, Latin America and the Caribbean, AIDS is almost
exclusively a heterosexually transmitted disease, with untreated venereal diseases increasing
susceptibility to HIV infection. In Europe and the United States, the route of heterosexual
transmission is mainly via bisexuals and intravenous drug users infected by sharing
contaminated needles. Southern Asian countries are witnessing a rapid spread of infection
among intravenous drug users which then spreads to heterosexual partners and their newborns
(Des Jarlais & Friedman, 1988b). Control of the spread of the AIDS virus by intravenous drug
users requires risk-reduction strategies aimed at both drug and sexual practices. Relatively little
effort has been devoted to developing interventions to prevent infection among intravenous drug
users. This is a serious neglect because infected drug users are transmitting the virus
heterosexually to their female sexual partners who, in turn, run a high chance of infecting their
infants through perinatal transmission. As a result, AIDS is taking an increasingly heavy toll on
women and children, especially among ethnic minorities in impoverished environs where drug
use is prevalent. Those who continue to inject drugs intravenously, despite cognizance of the
threat of AIDS infection, need access to sterile needles and knowledge on how to disinfect
needles to safeguard against transmission of the virus. They need to be taught protective sexual
practices to avoid infecting their sexual partners and be persuaded to use them consistently.
Perceived Self-Efficacy and Adoption of Health Practices
People's beliefs that they can motivate themselves and regulate their own behavior plays
a crucial role in whether they even consider altering habits detrimental to health. They see little
point to even trying if they believe they cannot exercise control over their own behavior and that
of others. Even people who believe their detrimental habits may be harming their health achieve
little success in curtailing their behavior unless they believe they have sufficient efficacy to resist
the instigators to it. This observation is corroborated in a longitudinal study conducted by
McKusick, Wiley, Coates, and Morin (1986) of gay men's sexual behavior. Several
psychological factors that could influence sexual risk-taking behavior were assessed. These
included perceived threat that one is potentially at risk of exposure to the AIDS virus; degree of
peer support for adopting safer sexual behavior; social skills necessary to negotiate protective
sexual behavior; level of self-esteem; and perceived self-efficacy that one can take protective
actions that lessen the risk of AIDS infection. Belief in one's personal efficacy to exercise
control over one's sexual behavior emerged as the best predictor of sexual risk-taking behavior.
The lower the perceived self-efficacy, the higher the likelihood of engagement in sexual
practices that carry a high risk of AIDS infection. Men who frequented bars and bath houses had
a lower sense of efficacy than those who were committed to a monogamous relationship. Social

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skill in negotiating self-protective sexual activity was also associated with low-risk sexual
practices.
The role of perceived self-efficacy in the adoption and maintenance of self-protective
behavior is corroborated in other lines of research. Even though individuals acknowledge that
safer sex practices reduce risk of infection, they do not adopt them if they believe they cannot
exercise control in sexual relations (Siegel, Mesagno, Chen, & Christ, 1989). Perceived self-
efficacy to negotiate condom use predicts safer sex practices in adolescents (Basen-Engquist &
Parcel, 1992; Jemmott, Jemmott, & Fong, 1992; Jemmott, Jemmott, Spears, Hewitt, & Cruz-
Collins, 1991; Kasen, et al., 1992) and adults (Brafford & Beck, 1991; Henrich, in press;
O'Leary, et al., 1992). Alcohol and drug use in the context of sexual activity foster sexual
behaviors at high risk of infection. Drugs and alcohol lower perceived self-efficacy to adhere to
safer sex practices (Kasen, et al., 1992; Rosenthal, Moore, & Flynn, 1991). Among drug users,
perceived self-efficacy predicts success in regular use of clean needles and condoms with sexual
partners (Kok, deVries, Mudd & Strecker, 1991). Perceived self-efficacy is related to self-
protective behavior both concurrently and longitudinally.
The spreading threat of AIDS has produced substantial changes in sexual practices in the
gay community as shown in reduction of high-risk sexual acts and number of sexual partners. In
the study of longitudinal predictors, McKusick and his colleagues found that a strong sense of
efficacy to exercise self-protective control, association with groups that made safer sex the norm,
and knowledge of serostatus were the significant predictors of enduring reductions in high-risk
sexual practices (McKusick, Coates, Morin, Pollack, & Hoff, 1990) The reductions in high-risk
practices accompanying each of these three sources of influence are summarized in Figure 1.
These longitudinal predictors underscore the importance of self-efficacy enhancement through
skill development and alterations of subcommunity norms in programs designed to produce
long-term behavior change.
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Insert Figure 1 about here
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COMPONENTS OF EFFECTIVE SELF-DIRECTED CHANGE
Social cognitive theory explains human functioning in terms of triadic reciprocal
causation (Bandura, 1986). In this causal model, which is summarized schematically in Figure 2,
(1) personal determinants in the form of cognitive, affective and biological factors, (2) behavior,
and (3) environmental influences all operate as interacting determinants of each other. An
effective program of widespread change in detrimental health practices includes four major
components aimed at altering each of the three classes of interacting determinants. The first is
informational, designed to increase people's awareness and knowledge of health risks. The
second component is concerned with development of the social and self-regulative skills needed
to translate informed concerns into effective preventive action. The third component is aimed at
skill enhancement and building resilient self-efficacy by providing opportunities for guided
practice and corrective feedback in applying the skills in high- risk situations. The final
component involves enlisting and creating social supports for desired personal changes. Let us
consider how each of these four components would apply to self- directed change of behaviors
that pose high risk of AIDS infection.

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Insert Figure 1 about here
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Informational Component
Efforts to encourage people to adopt health practices rely heavily on persuasive
communications in health education campaigns. In such health messages, appeals to fear by
depicting the ravages of disease are often used as motivators, and recommended preventive
practices are provided as guides for action. People need enough knowledge of potential dangers
to warrant action, but they do not have to be scared out of their wits to act, any more than
homeowners have to be terrified to insure their households. Rather, what people need is sound
information on how AIDS is transmitted, guidance on how to regulate their behavior, and firm
belief in their personal efficacy to turn concerns into effective preventive actions. Responding to
these needs requires a shift in emphasis from trying to scare people into healthy behavior to
empowering them with the tools for exercising personal control over their health habits.
The influential role of people's beliefs in their personal efficacy in adopting preventive
health practices is shown by Beck and Lund (1981). They studied the persuasiveness of health
communications in which the seriousness of a disease and susceptibility to it were varied.
Patients' perceived self- efficacy that they could stick to the required preventive behavior was a
good predictor of whether they adopted the preventive practices. Fear arousal had little effect on
whether or not they did so. Analyses of the mechanisms through which mass media health
campaigns exert their effects similarly reveal that perceived self-efficacy plays an influential role
in the adoption of health practices (Maibach, Flora, Nass, 1991; Slater, 1989). The stronger the
preexisting perceived self-efficacy, and the more the media campaigns enhance people's self-
regulative efficacy, the more likely they are to adopt the recommended practices. The
relationship remains even when multiple controls are applied for a host of other possible
influences.
To be most effective, health communications should instill in people the belief that they
have the capability to alter their health habits and should instruct them on how to do it.
Communications that explicitly do so increase people's determination to modify habits
detrimental to their health (Maddux & Rogers, 1983). Entrenched habits rarely yield to a single
attempt at self-regulation. Success is usually achieved through renewed effort following failed
attempts. To strengthen the staying power of self-beliefs, health communications should
emphasize that success requires perseverant effort, so that people's sense of efficacy is not
undermined by a few setbacks to the point where they get discouraged and give up. Faultless
self-regulation is not easy to come by even for pliant habits, let alone for addictive and sexual
behavior. A strong sense of controlling efficacy is built by overcoming setbacks through
perseverant effort. Unfortunately, the possibility that the AIDS virus is transmittable to the
immunologically vulnerable through a few sexual contacts with infected partners or sharing a
few contaminated needles does not leave much room for carelessness or occasional reversions to
risky habits.
An increased research effort is needed to determine how preventive health
communications should be framed to maximize their impact on perceived self-regulative
efficacy. Self- efficacy theory provides one set of guidelines (Bandura, 1986). I shall consider
later how symbolic modeling influences should be structured to maximize their psychosocial

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impact. Decision theory regarding risk perception and risky decisions provides other suggestions
(Tversky & Kahneman, 1981). For example, people interpret information regarding risky
activities in terms of potential gains and potential losses. There is some evidence to suggest that
health communications are more persuasive if framed in terms of health losses to get people to
check for maladies, but in terms of health benefits to get them to adopt preventive behavior
(Rothman, Salovey, Antone, Keough, & Drake, in press). Meyerowitz and Chaiken (1987) found
that health communications framed in terms of health benefits had less impact on perceived self-
efficacy and behavior designed to detect maladies than communications framed in terms of
health losses. They examined four alternative mechanisms through which health
communications could alter health habits -- by transmission of factual information, fear arousal,
change in risk perception and enhancement of perceived self-efficacy. The health
communications fostered adoption of preventive health practices mainly by their effect on
perceived self-efficacy. National education campaigns need to exploit more fully our knowledge
of social-influence processes, and the cognitive and affective mechanisms governing human
motivation and behavior.
The preconditions for change are created by increasing people's awareness and
knowledge of the profound threat of AIDS. They need to be provided with a great deal of factual
information about the nature of AIDS, its modes of transmission, what constitutes high risk
sexual and drug practices, and how to achieve protection from infection. This is easier said than
done. Our society does not provide much in the way of treatment of drug addiction, nor is about
to provide refractory drug users with easy access to sterile needles and other drug paraphernalia.
It has little experience in how to reach and educate drug users on how to disinfect needles to
reduce the risk of AIDS infection.
In the sexual domain, our society has always had difficulty talking frankly about sex and
imparting sexual information to the public at large. Because parents generally do a poor job of it
as well, most youngsters pick up their sex education from other, often less trustworthy and
reputable, sources outside the home or from the consequences of uninformed sexual
experimentation. To complicate matters further, some sectors of the society lobby actively for
maintaining a veil of silence regarding protective sexual practices on the belief that such
information will promote indiscriminate sexuality. In their view, the remedy for the spreading
AIDS epidemic is a national celibacy campaign for unweds and gays and faithful monogamy
among the wedded. They oppose educational programs in the schools that talk about sex
methods that provide protection against AIDS infection.
The net result is that many of our public education campaigns regarding AIDS are
couched in desexualized generalities that leave some ignorance in their wake. To those most at
risk, such sanitized expressions as "exchange of bodily fluids" is not only uninformative but can
be misinformative by investing safe bodily substances with perceived infective properties. Even
those more skilled in deciphering medical locutions do not always know what the preventive
messages are talking about. For example, an intensive campaign spanning a full week, conducted
at a university campus, included public lectures, numerous panel discussions, presentations in
dormitories, and condom distribution, all of which were widely reported in the campus
newspaper. A systematic assessment of students' beliefs and sexual practices conducted several
weeks later revealed that more than a quarter of the students did not know what constitutes "safer
sex," and some of them had misconceptions of safer sex practices that, in fact, would present
high risk of infection (Chervin & Martinez, 1987). Other findings of this study, which will be

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reviewed later, document the severe limitations of efforts to change sexual practices by
information alone.
The informational component of the model of self-directed change includes two main
factors--the informational content of the health communications and the mechanisms of social
diffusion. Detailed factual information about AIDS must be socially imparted in an
understandable, credible, and persuasive manner. Social cognitive theories provide a number of
guidelines on how this might be best accomplished (Bandura, 1986; McGuire, 1984; Zimbardo,
Ebbesen, & Maslach, 1977). However, developing effective AIDS prevention programs is only
the first step. They must also be disseminated. Unlike other health risk-reduction campaigns
which involve relatively prosaic habits, the risky habits for AIDS infection are laden with
matters of illegalities and judged immoralities.
Informative health messages, however well designed, cannot have much social impact
without effective means of dissemination. Because of their wide reach and influence, the mass
media, especially television, can serve as a major vehicle of social diffusion of information
regarding health guidelines. However, a variety of diffusion vehicles must be enlisted in a public
health campaign for several reasons. High costs and restricted access to television limit its
availability. Moreover, television networks typically adopt a conservative stance on
controversial matters. They have resisted getting into the act for fear that talk of protective sex
practices will jeopardize advertising revenue by arousing the wrath of some sectors of their
viewing audience. This resistance would have weakened if the AIDS virus had spread rapidly
heterosexually across all sectors of society, thus making it a general societal problem rather than
one confined to gays and drug users. However, it is unlikely that the television industry will
offer much help as long as AIDS remains mainly a disease of poor minorities. Existing social,
religious, recreational, occupational, and educational organizations can serve as highly effective
disseminators of preventive health guidelines. Wide cultural diversity requires that the messages
of risk-reduction campaigns for AIDS be tailored to socioeconomic, racial and ethnic differences
in value orientations and disseminated through multiple sources to ensure adequate exposure
(Mantell, Schinke, & Akabas, 1988).
Nontraditional social networks must be enlisted for high- risk groups who are beyond the
reach of the usual community organizations. For example, in outreach programs, "street-wise"
counselors have been highly successful in reaching drug populations (Watters, et al., 1990).
After they become known in the social circles of drug users, the counselors help them with
referrals to drug treatment programs. They offer them explicit instruction in safer sex practices.
They teach intravenous drug users how to reduce the risk of AIDS by disinfecting needles with
ordinary household bleach which kills the HIV virus. The disinfection procedure, which had
been rarely used before, was widely adopted and consistently applied. Although this outreach
program also increased the use of condoms, the drug users were much more conscientious in
disinfecting needles than in protecting their sexual partners against sexually transmitted
infection. Such findings underscore the need for sexual partners to exercise personal control in
protecting their own health.
A comprehensive national program regarding the growing AIDS threat must address
broader social issues as well as risky health practices. This is because the AIDS epidemic has
far-reaching social repercussions. One of these issues concerns the widespread public fear of
AIDS infection. Many people continue to believe that the AIDS virus can be transmitted by
casual contact or by insect transmission and food handling despite evidence to the contrary.
Efforts by health professionals to dispel misapprehensions are discounted by many of those who

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are alarmed on the grounds that what is proclaimed safe currently may be discovered to be risky
later. Recurrent disputes among researchers in the public media regarding risk factors for other
diseases have eroded some of the credibility of medical expertise. Widespread public fear gets
translated into advocacy of laws requiring sweeping mandatory blood testing and identification
and social restriction of those with antibodies to the HIV virus.
In public perceptions of the AIDS threat, risky behavior gets transformed to risky
groups. As AIDS imposes mounting financial burdens on society and strains medical and social
service systems, members of high-risk groups tend to become targets of growing public hostility.
Once entire groups get stigmatized because some of its members behave in risky ways, those
who do not also become the objects of fear and hostility. The way in which they are treated
socially may be dictated more by group identity than by their personal characteristics. Public
alarm fueled by many misbeliefs enhances such stigmatization. Policy debates on how to control
the spread of AIDS have become highly politicized. Prohibitionists argue that public health
campaigns promote indiscriminate sex. Their critics argue that knowledge does not foster
sexuality and that prohibitionists are intent at curtailing sex practices they find morally
objectionable rather than at increasing the safety of sex. Uninformed public reactions to the
AIDS threat require serious attention as do the risky health practices themselves, because they
help to shape public policies and impose constraints on health education programs. Even
societies that possess the necessary scientific knowledge, resources and expertise can be
immobilized by conflicts of values and morals from establishing psychosocial programs that can
help to stem the tide of infection.
Development of Self-Protective Skills and Controlling Self-Efficacy
It is not enough to convince people that they should alter risky habits. Despite a high
level of knowledge, many continue risky sexual and drug practices. People also need guidance
on how to translate their concerns into efficacious actions. In the campus survey mentioned
earlier (Chervin & Martinez, 1987), after exposure to the intensive educational campaign less
than half of the students who were sexually active used safer sex methods designed to prevent
infection with sexually transmitted diseases. Most of them even avoided talking about the matter
with their sexual partners. Studies conducted on other campuses similarly reveal that most
sexually active students who are knowledgeable about AIDS do not adopt safer sex practices
(Edgar, Freimuth, & Hammond, 1988). Among inner-city youth, neither a high level of factual
knowledge about HIV transmission nor even knowing someone who was infected or had died of
AIDS reduce behaviors that carry high risk of infection (Stiffman, Earls, Dore, & Cunningham,
1992). McKusick, Horstman and Coates (1985) similarly found that gay men were uniformly
well informed about safer sex methods for protecting against AIDS infection, but those who had
a low sense of efficacy that they could manage their behavior and sexual relationships were
unable to act on their knowledge.
The ability to learn by social modeling provides a highly effective method for increasing
human knowledge and skills. A special power of modeling is that it can simultaneously transmit
knowledge and valuable skills to large numbers of people through the medium of videotape
modeling. Knowledge of modeling processes identifies a number of factors that can be used to
enhance the instructive power of modeling (Bandura, 1986). Applications of modeling principles
to AIDS prevention would focus on how to manage interpersonal situations and one's own
behavior in ways that afford protection against infection with the AIDS virus. Both self-

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regulative and risk-reduction strategies for dealing with a variety of situations that promote risky
behavior should be modeled to convey general guides that can be applied and adjusted to fit
changing circumstances.
We saw earlier that human competency requires not only skills but also self-belief in
one's capability to use those skills well. Indeed, results of numerous studies of diverse health
habits and physical dysfunctions reveal that the impact of different methods of influence on
health behavior is partly mediated through their effects on perceived self-efficacy (Bandura,
1992). The stronger the self-efficacy beliefs they instill, the more likely are people to enlist and
sustain the effort needed to change habits detrimental to health. Modeling influences should,
therefore, be designed to build self-assurance as well as to convey strategies for how to deal
effectively with coercions for risky practices. The influence of modeling on beliefs about one's
capabilities relies on comparison with others. People judge their own capabilities, in part, from
how well those whom they regard as similar to themselves exercise control over situations.
People develop stronger belief in their capabilities and more readily adopt modeled ways if they
see models similar to themselves solve problems successfully with the modeled strategies, then
if they see the models as very different from themselves (Bandura, 1986). To increase the impact
of modeling, the characteristics of models such as their age, sex, and status, the type of problems
with which they cope, and the situation in which they apply their skills, should be made to
appear similar to the people's own circumstances.
Enhancement of Social Proficiency and Resiliency of Self-Efficacy
Proficiency requires extensive practice and this is no less true of managing the
interpersonal aspects of sexuality. After people gain knowledge of new skills and social
strategies, they need guidance and opportunities to perfect those skills. Initially, people practice
in simulated situations where they need not fear making mistakes or appearing inadequate. This
is best achieved by role-playing in which they practice handling the types of situations they have
to manage in their social environment. They receive informative feedback on how they are doing
and the corrective changes that need to be made. The simulated practice is continued until the
skills are performed proficiently and spontaneously.
Not all the benefits of guided practice are due to skill improvement. Some of the gains
result from raising people's beliefs in their capabilities (Bandura, 1988b). Experiences in
exercising control over social situations serve as self-efficacy builders. This is an important
aspect of self-directed change because if people are not fully convinced of their personal efficacy
they undermine their efforts in situations that tax capabilities and readily abandon the skills they
have been taught when they fail to get quick results or suffer reverses. The important matter is
not that difficulties rouse self-doubts, which is a natural immediate reaction, but rather the
degree and speed of recovery from setbacks. It is resiliency in perceived self-efficacy that counts
in maintenance of changes in health habits. The higher the perceived self-efficacy, the greater is
the success in maintenance of health-promoting behavior (Bandura, 1992).
The influential role played by perceived self-efficacy in the management of sexual
activities is documented in studies of contraceptive use by teenage women at high risk because
they often engage in unprotected intercourse (Kasen, et al., 1992; Levinson, 1986). Such
research shows that perceived self- efficacy in managing sexual relationships is associated with
more effective use of contraceptives. The predictive relation remains when controls are applied
for demographic factors, knowledge and sexual experience.

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