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Teori Perilaku Kesehatan

The Precede-Proceed model is a framework for designing, implementing, and evaluating public health programs. It consists of two parts - PRECEDE (phases 1-5) which works backward from the desired health outcome to identify behavioral and environmental factors influencing it. PROCEED (phases 6-9) works forward to implement interventions targeting those factors and evaluate their impact on behaviors, quality of life, and health outcomes. The model emphasizes that health is influenced by multiple interrelated factors and requires multisectoral interventions. It has been used to plan programs in diverse areas like cancer screening, heart health, and tobacco control.
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0% found this document useful (0 votes)
220 views22 pages

Teori Perilaku Kesehatan

The Precede-Proceed model is a framework for designing, implementing, and evaluating public health programs. It consists of two parts - PRECEDE (phases 1-5) which works backward from the desired health outcome to identify behavioral and environmental factors influencing it. PROCEED (phases 6-9) works forward to implement interventions targeting those factors and evaluate their impact on behaviors, quality of life, and health outcomes. The model emphasizes that health is influenced by multiple interrelated factors and requires multisectoral interventions. It has been used to plan programs in diverse areas like cancer screening, heart health, and tobacco control.
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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2.

2 Health Behavior Theory


1. Lawrence Green Theory
The Precede-Proceed model of health planning and evaluation, developed
for the public health sector by a prestigious team led by Lawrence W. Green, is a
model that is aimed at preventing disease thereby increasing an individual's
overall health and quality of life (QOL) and that incorporates social, cultural and
individual factors that affect the outcome of a person's overall health and
incidence of disease (Green LW and Shawna LM, 2002).
Two fundamental propositions are emphasized: (1) health and health risks
are caused by multiple factors and (2) because health and health risks are
determined by multiple factors, efforts to effect behavioral, environmental, and
social change must be multidimensional or multisectoral, and participatory(Green
LW and Shawna LM, 2002).
The Precede-Proceed model provides a structure for assessing health and
quality-of-life needs by "designing, implementing, and evaluating health
promotion and other public health programs to meet those needs" (Green,
Encyclopedia of Public Health,Gale). "PRECEDE" is actually an acronym that
stands

for Predisposing, Reinforcing,

in Educational Diagnosis

and Enabling Constructs

and Evaluation. Diagnosis and

evaluation are

incorporated functions within Precede; it outlines a means for accurately


diagnosing and planning (diagnostic planning) a process to be used to
development a targeted and focused public health program for a targeted
community (Green LW and Shawna LM, 2002)..
"PROCEED"
is
also
an
acronym

for Policy, Regulatory,

and Organizational Constructs in Educational and Environmental Development.


The social and cultural features of education and environment are incorporated
functions within Proceed; it facilitates the programs designed as a result of
the Precede process

by guiding

the

implementation

and

evaluation

of

those Precede programs. While Precede works backward from the desired end
result, attained through the diagnostic process, to the beginning point (the point(s)
that preceded the end result) of the assessment process, Proceed works forward to

implement the designed plan and to evaluate its effectiveness(Green LW and


Shawna LM, 2002).
PRECEDEs five phases move logically backward from the desired
result to where and how you might intervene to bring about that result, to the
administrative and policy issues that need addressing in order to mount an
intervention successfully (Green LW and Kreuter MW, 2005).
Precede's five phase or steps:
1. Phase one requires determining the health and quality of life, needs, the
social problems, and/or the cultural needs of a given population.
2. Phase
two requires identifying all determinants
of health of

these problems and needs.


Determinants of Health:
Biology and genetics. Examples: sex and age (internal)
Individual behavior. Examples: alcohol use, injection drug use (needles),

unprotected sex, and smoking (internal)


Social environment. Examples: discrimination, income, and gender

(external)
Physical environment. Examples: where a person lives and crowding

conditions (external)
Health services. Examples: Access to quality health care and having or not

having health insurance (external)


3. Phase three requires analyzing the determinants of health for the
behavioral determinants (internal factors of behavioral choices) and
environmental determinants (external factors of local environment) of the
health problems (quality of life is defined as physical and mental health).
Predisposing factors are intellectual and emotional
givens that tend to make individuals more or less likely to
adopt healthful or risky behaviors or lifestyles or to approve of
or accept particular environmental conditions. Some of these
factors can often be influenced by educational interventions.
They include:
Knowledge. Youre more likely, for instance, to avoid
sunburn if you know it can lead to skin cancer than if you
dont.

Attitudes. People who have spent their youth as athletes often


come to see regular exercise as an integral part of life, as

necessary and obvious as regular meals.


Beliefs. These can be mistaken understandings believing that
anything low in fat is also low in calories or closely held beliefs
based on religion or culture the Bible says Spare the rod and
spoil the child, so its important to physically punish your

children for mistakes or misdeeds.


Values. A value system that renounces violence would make a
parent less likely to beat a child, or to be physically abusive to a

spouse or other family member.


Confidence. Many people fail to change risky behavior simply
because they dont feel capable of doing so.

Enabling

factors are

those

internal

and

external

conditions directly related to the issue that help people adopt


and maintain healthy or unhealthy behaviors and lifestyles, or
to embrace or reject particular environmental conditions.
Among them are:

Availability of resources. People with mental health problems, for


instance, are much more likely to get help if services are readily

available.
Accessibility of services. Services do no good if they have
waiting lists that run into years, or arent physically accessible to

those who need them.


Community and/or government laws, policies, priority, and
commitment to the issue. Government laws and policies can
both force changes in behavior or environment, and underline

the importance of those changes.


Issue-related skills. People who start out with a work ethic and
an understanding of the workplace, for instance, are apt to benefit from

job placement programs (Green LW and Kreuter MW, 2005).


Reinforcing factors, are the people and community
attitudes that support or make difficult adopting healthy
behaviors or fostering healthy environmental conditions.

These are largely the attitudes of influential people: family,


peers,

teachers,

employers,

health

or

human

service

providers, the media, community leaders, and politicians and


other decision makers. An intervention might aim at these
people and groups because of their influence in order to
most effectively reach the real target group(Green LW and Kreuter
MW, 2005).

4. Phase four requires identifying the individual determining factors that


predispose to, reinforce, and enable behaviors and lifestyles (i.e., choice
within environments).
5. Phase five ascertains interventions--health promotion intervention, health
education intervention and/or policy-related intervention--best suited to
encouraging needed changes (1) in behaviors or environments and (2) in
factors supporting the behaviors and environments (behavioral reactions to
environments result in lifestyles).
PROCEED has four phases that cover the actual implementation of the
intervention and the careful evaluation of it, working forward to the original
starting point, which is the ultimate desired result of the process.
Proceed's additional four phases or steps:
6. Phase six implements (puts into effect) the interventions identified in
phase five.
7. Phase seven requires process evaluation of the implemented interventions.
8. Phase eight involves the impact of (the effect produced by) the
interventions: impact evaluation requires evaluating the impact of the
interventions on (1) the identified factors that support behavior and on (2)
the behavior itself (evaluating the impact of intervention on both external
behavioral support factors and internal choice-related behavior).
9. Phase nine, the last phase, comprises desired-results outcome evaluation,
that is, phase nine determines the end-result effects of the interventions on

the quality of life, i.e., health, and socio-cultural support factors of the
population or community.

Figure Generic Representasion of the Precede-Proceed Model (Green LW and


Kreuter, 2005)
In

actual

practice, Precede and Proceed function

in

a continuous

cycle.

The cyclical mature of this model encourages more systematic and comprehensive
planning of public health programs so that the programs match what the
community identifies as its needs with the result that programs are participated in
with goals and objectives more often reached. This model encourages recognition
of differing goals, priorities and values in different communities of populations.
As a result the real-world applications of the Precede-Proceed model have been
myriad and varied. The model has been used to plan, design, implement, and/or
evaluate programs for such diverse health and quality-of-life issues as breast,
cervical, and prostate cancer screening; breast self-examination; cancer education;
heart health; maternal and child health; injury prevention; weight control;
increasing physical activity; tobacco control; alcohol and drug abuse; school-

based nutrition; health education policy; and curriculum development and training
for health care professionals(Green LW and Shawna LM, 2002).
References:
Lawrence W.

Green

and

Shawna

L.

Mercer.

"Precede-Proceed

Model."Encyclopedia of Public Health. Ed. Lester Breslow. Vol. 3. Gale Cengage,


2002.
Green, L.W. and Kreuter, M.W. Health Program Planning: An Educational and
Ecological Approach. 4th edition. NY: McGraw-Hill Higher Education, 2005.

2. Health Belief Model


a. Orientation
The Health Belief Model (HBM) is a psychological model that
attempts to explain and predict health behaviors. This is done by
focusing on the attitudes and beliefs of individuals. The HBM was first
developed in the 1950s by social psychologists Hochbaum, Rosenstock
and Kegels working in the U.S. Public Health Services. The model was
developed in response to the failure of a free tuberculosis (TB) health
screening program. Since then, the HBM has been adapted to explore a
variety of long- and short-term health behaviors, including sexual risk
behaviors and the transmission of HIV/AIDS.
b. Core Assumptions and Statements
The HBM is based on the understanding that a person will take a
health-related action (i.e., use condoms) if that person:

feels that a negative health condition (i.e., HIV) can be avoided,

.
2

has a positive expectation that by taking a recommended action, he/she

will avoid a negative health condition (i.e., using condoms will be


effective at preventing HIV), and

believes that he/she can successfully take a recommended health action

(i.e., he/she can use condoms comfortably and with confidence).

The HBM was spelled out in terms of four constructs representing the perceived
threat and net benefits: perceived susceptibility, perceived severity, perceived
benefits, and perceived barriers. These concepts were proposed as accounting for
people's "readiness to act." An added concept, cues to action, would activate that
readiness and stimulate overt behavior. A recent addition to the HBM is the
concept of self-efficacy, or one's confidence in the ability to successfully perform
an action. This concept was added by Rosenstock and others in 1988 to help the
HBM better fit the challenges of changing habitual unhealthy behaviors, such as
being sedentary, smoking, or overeating. Table from Theory at a Glance: A Guide
for Health Promotion Practice" (1997)

Concept

Definition

Application

Define population(s) at risk, risk


Perceived
Susceptibility

One's

opinion

of levels; personalize risk based on

chances of getting a a person's features or behavior;


condition

heighten

perceived

susceptibility if too low.

Perceived
Severity

One's opinion of how


serious a condition and
its consequences are

One's

belief

in

the

Perceived

efficacy of the advised

Benefits

action to reduce risk or


seriousness of impact

Specify consequences of the


risk and the condition

Define action to take; how,


where,

when;

clarify

the

positive effects to be expected.

Perceived

One's opinion of the Identify and reduce barriers

Barriers

tangible

and through reassurance, incentives,

psychological costs of
the advised action

Cues to Action

Self-Efficacy

Strategies

to

activate Provide

"readiness"

Confidence

assistance.

how-to

information,

promote awareness, reminders.

in

one's Provide training, guidance in

ability to take action

c. Conceptual Model

Reference: Glanz et al, 2002, p. 52

performing action.

3. The Transtheoretical Model (TTM)


The Transtheoretical Model (TTM) uses the Stages of
Change to integrate the most powerful principles and processes
of change from leading theories of counseling and behavior
change (Prochaska JO et al, 2008).
The Transtheoretical Model (Prochaska & DiClemente,
1983;

Prochaska,

DiClemente,

&

Norcross,

1992)

is

an

integrative, biopsychosocial model to conceptualize the process


of intentional behavior change. Whereas other models of
behavior change focus exclusively on certain dimensions of
change (e.g. theories focusing mainly on social or biological
influences), the TTM seeks to include and integrate key
constructs from other theories into a comprehensive theory of
change

that

can

be

applied

to

variety

of

behaviors,

populations, and settings (e.g. treatment settings, prevention


and

policy-making

settings,

etc.)hence,

the

name

Transtheoretical (Prochaska JO et al, 2008).


The Stages of Change
Stages of Change lie at the heart of the TTM. Studies of change have
found that people move through a series of stages when modifying behavior.
While the time a person can stay in each stage is variable, the tasks required to
move to the next stage are not. Certain principles and processes of change work
best at each stage to reduce resistance, facilitate progress, and prevent relapse.
Those include decisional balance, self-efficacy, and processes of change. Only a
minority (usually less than 20%) of a population at risk is prepared to take action
at any given time. Thus, action-oriented guidance misserves individuals in the
early stages. Guidance based on the TTM results in increased participation in the
change process because it appeals to the whole population rather than the minority
ready to take action (Prochaska JO et al, 2008).
The stage construct represents a temporal dimension. Change implies
phenomena occurring over time. Surprisingly, none of the leading theories of

therapy contained a core construct representing time. Traditionally, behavior


change was often construed as an event, such as quitting smoking, drinking, or
overeating. TTM recognizes change as a process that unfolds over time, involving
progress through a series of stages. While progression through the Stages of
Change can occur in a linear fashion, a nonlinear progression is common. Often,
individuals recycle through the stages or regress to earlier stages from later ones
(Prochaska JO et al, 2008).

Figure Stages of change in the modification of problem behaviors.


(Prochaska JO and DiClemente CC, 1992)

Precontemplation.
People in the Precontemplation stage do not intend to take action in the
foreseeable future, usually measured as the next six months. Being uninformed or
under informed about the consequences of ones behavior may cause a person to
be in the Precontemplation stage. Multiple unsuccessful attempts at change can
lead to demoralization about the ability to change. Both the uninformed and under

informed tend to avoid reading, talking, or thinking about their high-risk


behaviors. They are often characterized in other theories as resistant, unmotivated,
or unready for help. The fact is, traditional programs were not ready for such
individuals and were not designed to meet their needs (Prochaska JO et al, 1994).

Contemplation.
Contemplation is the stage in which people intend to change in the next six
months. They are more aware of the pros of changing, but are also acutely aware
of the cons. In a meta-analysis across 48 health risk behaviors, the pros and cons
of changing were equal. This weighting between the costs and benefits of
changing can produce profound ambivalence that can cause people to remain in
this stage for long periods of time. This phenomenon is often characterized as
chronic contemplation or behavioral procrastination. Individuals in the
Contemplation stage are not ready for traditional action-oriented programs that
expect participants to act immediately (Prochaska JO et al, 1994).

Preparation.
Preparation is the stage in which people intend to take action in the
immediate future, usually measured as the next month. Typically, they have
already taken some significant action in the past year. These individuals have a
plan of action, such as joining a health education class, consulting a counselor,
talking to their physician, buying a self-help book, or relying on a self-change
approach. These are the people who should be recruited for action-oriented
programs (Prochaska JO et al, 1994).

Action.
Action is the stage in which people have made specific overt modifications
in their lifestyles within the past six months. Because action is observable, the
overall process of behavior change often has been equated with action. But in the
TTM, Action is only one of six stages. Typically, not all modifications of behavior

count as Action in this Model. In most applications, people have to attain a


criterion that scientists and professionals agree is sufficient to reduce risk of
disease. For example, reduction in the number of cigarettes or switching to low-tar
and low-nicotine cigarettes were formerly considered acceptable actions. Now the
consensus is clearonly total abstinence counts (Prochaska JO et al, 1994).

Maintenance.
Maintenance is the stage in which people have made specific overt
modifications in their lifestyles and are working to prevent relapse; however, they
do not apply change processes as frequently as do people in Action. While in the
Maintenance stage, people are less tempted to relapse and grow increasingly more
confident that they can continue their changes. Based on self-efficacy data,
researchers have estimated that Maintenance lasts from six months to about five
years (Prochaska JO et al, 1994).
References:
Prochaska, JO; DiClemente, CC. Stages of change in the
modification

of

problem

behaviors.

Prog

Behav

Modif

1992;28:183218.
Prochaska, J.O., Butterworth, S., Redding, C.A., Burden, V., Perrin,
N., Lea, Michael, Flaherty, Robb M., and Prochaska, J.M. (2008).
Initial efficacy of MI, TTM tailoring, and HRIs in multiple
behaviors for employee health promotion. Preventive Medicine,
46, 226-231.
Prochaska, JO; Norcross, JC; DiClemente, CC. Changing for good:
the revolutionary program that explains the six stages of change
and teaches you how to free yourself from bad habits. New York:
W. Morrow; 1994
4. Theory of Planned Behavior/ Reasoned Action

a. History and Orientation


Ajzen and Fishbein formulated in 1980 the theory of reasoned action
(TRA). This resulted from attitude research from the Expectancy Value
Models. Ajzen and Fishbein formulated the TRA after trying to estimate
the discrepancy between attitude and behavior. This TRA was related to
voluntary behavior. Later on behavior appeared not to be 100% voluntary
and under control, this resulted in the addition of perceived behavioral
control. With this addition the theory was called the theory of planned
behavior (TpB). The theory of planned behavior is a theory which predicts
deliberate behavior, because behavior can be deliberative and planned.
b. Core Assumptions and Statements
Theory of Reasoned Action suggests that a person's behavior is determined
by his/her intention to perform the behavior and that this intention is, in
turn, a function of his/her attitude toward the behavior and his/her
subjective norm. The best predictor of behavior is intention. Intention is
the cognitive representation of a person's readiness to perform a given
behavior, and it is considered to be the immediate antecedent of behavior.
This intention is determined by three things: their attitude toward the
specific behavior, their subjective norms and their perceived behavioral
control. The theory of planned behavior holds that only specific attitudes
toward the behavior in question can be expected to predict that behavior.
In addition to measuring attitudes toward the behavior, we also need to
measure peoples subjective norms their beliefs about how people they
care about will view the behavior in question. To predict someones
intentions, knowing these beliefs can be as important as knowing the
persons attitudes. Finally, perceived behavioral control influences
intentions. Perceived behavioral control refers to people's perceptions of
their ability to perform a given behavior. These predictors lead to
intention. A general rule, the more favorable the attitude and the subjective

norm, and the greater the perceived control the stronger should the
persons intention to perform the behavior in question.
c. Conceptual Model

Source: Ajzen, I. (1991). The theory of planned behavior. Organizational


Behavior and Human Decision Processes, 50, p. 179-211.

5. Social Learning Theory


His theory added a social element, arguing that people can learn new
information and behaviors by watching other people. Known as, this type
of learning can be used to explain a wide variety of behaviors.
Bandura explained:
"Learning would be exceedingly laborious, not to mention hazardous, if
people had to rely solely on the effects of their own actions to inform them
what to do. Fortunately, most human behavior is learned observationally
through modeling: from observing others one forms an idea of how new
behaviors are performed, and on later occasions this coded information
serves

as

guide

for

action."

-Albert Bandura, Social Learning Theory, 1977


a. Basic Social Learning Concepts
There are three core concepts at the heart of social learning theory. First is
the idea that people can learn through observation. Next is the notion that
internal mental states are an essential part of this process. Finally, this
theory recognizes that just because something has been learned, it does not
mean that it will result in a change in behavior.
Let's explore each of these concepts in greater depth.
1) People can learn through observation.
Observational Learning
In his famous, Bandura demonstrated that children learn and
imitate behaviors they have observed in other people. The children
in Banduras studies observed an adult acting violently toward a
Bobo doll. When the children were later allowed to play in a room
with the Bobo doll, they began to imitate the aggressive actions
they had previously observed.

Bandura identified three basic models of observational learning:

A live model, which involves an actual individual


demonstrating or acting out a behavior.

A verbal instructional model, which involves descriptions


and explanations of a behavior.

A symbolic model, which involves real or fictional


characters displaying behaviors in books, films, television
programs, or online media.

2) Mental states are important to learning.


b. Intrinsic Reinforcement
Bandura noted that external, environmental reinforcement was not the only
factor to influence learning and behavior. He described intrinsic
reinforcement as a form of internal reward, such as pride, satisfaction, and
a sense of accomplishment. This emphasis on internal thoughts and
cognitions helps connect learning theories to cognitive developmental
theories. While many textbooks place social learning theory with
behavioral theories, Bandura himself describes his approach as a 'social
cognitive theory.
c. Learning does not necessarily lead to a change in behavior.
While behaviorists believed that learning led to a permanent change in
behavior, observational learning demonstrates that people can learn new
information without demonstrating new behaviors.
d. The Modeling Process
Not all observed behaviors are effectively learned. Factors involving both
the model and the learner can play a role in whether social learning is
successful. Certain requirements and steps must also be followed. The
following steps are involved in the observational learning and modeling
process:

Attention:
In order to learn, you need to be paying. Anything that distracts
your attention is going to have a negative effect on observational
learning. If the model interesting or there is a novel aspect to the
situation, you are far more likely to dedicate your full attention to
learning.

Retention:
The ability to store information is also an important part of the
learning process. Retention can be affected by a number of factors,
but the ability to pull up information later and act on it is vital to
observational learning.

Reproduction:
Once you have paid attention to the model and retained the
information, it is time to actually perform the behavior you
observed. Further practice of the learned behavior leads to
improvement and skill advancement.

Motivation:
Finally, in order for observational learning to be successful, you
have to be motivated to imitate the behavior that has been modeled.
and play an important role in motivation. While experiencing these
motivators can be highly effective, so can observing other
experience some type of reinforcement or punishment. For
example, if you see another student rewarded with extra credit for
being to class on time, you might start to show up a few minutes
early each day.

e. Final Thoughts
In addition to influencing other psychologists, Bandura's social learning
theory has had important implication in the field of eduction. Today, both
teachers and parents recognize the importance of modeling appropriate

behaviors. Other classroom strategies such as encouraging children and


building are also rooted in social learning theory.
References
Bandura, A. (1965). Influence of models' reinforcement contingencies on the
acquisition of imitative responses. Journal of Personality and Social Psychology,
1, 589-595.
Bandura, A., Ross, D. & Ross, S.A. (1961). Transmission of aggression through
imitation of aggressive models. Journal of Abnormal and Social Psychology, 63,
575-82.
Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall.

6. Behaviorist Theory & Language Learning


Core to all of behaviorism is the assumption that human and animal
behaviors are determined by learning and reinforcement. Whether by
classical conditioning or operatant conditioning, species acquire new
skills, deepening on the effects these skills have on the specie's
environment. If an action proves to have a positive outcome (e.g., if by
pressing a button, a rat receives food), the organism is more likely to
continue to repeat this behavior. However, if the outcome is negative (e.g.,
if by pressing a button, a rat rat receives a shock), the organism is less
likely to repeat the behavior.
Skinner, and Stimulus-Response (S-R) adherents, believed that behaviorist
theory could be used to infer a learning history. They held that one could
take an animal or person, observe its/his/her behavior, and figure out what
had been reinforced previously.

Behaviorist reduced all responses to

associations, to a pattern of positive and negative reinforcement that


establishes links between stimuli and their environmental antecedents and
consequences. Responses that were reinforced would be repeated, and
those that were punished would not. Thus, if a dog brought its human a
ball and the human pet it, the dogs behavior would be reinforced, and it
would be more apt to getting the ball in the future. Likewise, if the dog
brought its human a ball and the human kicked it, the dogs behavior
would be punished, and it would be less likely to do it.
These associations between stimuli, actions, and responses could explain
virtually every aspect of human and animal behavior and interaction, but
one seemed particularly problematic for the behaviorist theory: language.
In 1957, Skinner published his book, Verbal Behavior, in which he
attempted to apply his form of operant conditioning to language learning.
A basic assumption of his was that all language, including private, internal
discourse, was a behavior that developed in the same manner as other
skills. He believed that a sentence is merely part of a behavior chain,
each element of which provides a conditional stimulus for the production
of the succeeding element (Fodor, Bever, & Garrett, p25).

The

probability of a verbal response was contingent on four things:

reinforcement, stimulus control, deprivation, and aversive stimulation.


The interaction of these things in a childs environment would lead to
particular associations, the basis of all language.
Skinner proposed that language could be categorized by the way it was
reinforced. He claimed that there were four general types of speech:
echoic behavior, mand, tact, interverbals and autoclitic.
Echoic behavior is the primary form of verbal behavior of language
learners. These verbalizations include repeated utterances, as in:
1. PARENT: [pointing to cookie] Thats a cookie. Can you say
cookie?
CHILD: Cooookie
Mands (short for deMANDS) are defined as utterances that are
reinforced by the elevation of deprivation. So for instance, if a
child were hungry or cold, her requests (as in (2)
2. Cookie
Directives such as Stop, Go, and Wait also count as mands.
However, in (3), the child may be simply naming the object or
stating what she likes.
3. Cookie
Utterances that are produced when the speaker is not deprived are
called tact (short for conTACT). Tacts are verbalizations that the
speaker produces to provide information instead of attending to
states of deprivation. While on the surface, tacts and mands may
seem similar, their underlying motivations (stimuli) and their
reinforcements are different. When a mand is reinforced, the need
is sated. When a tact is reinforced, there is no need to sate.
The fourth type of utterance is the interverbals. These include such
things as Please and Thank you. These utterances are not
necessary to provide information. Rather, they are used in
discourse situation and pertain to the interactive nature of dialog.
So for example, in (4), the second utterance, the response to the
question, is an interverbal. Likewise, the associative response in
number (5) is also an interverbal.
4. SPEAKER A: Whos your favorite graduate student?
SPEAKER B: You
5. WORD: CAT RESPONSE: Dog

With the final category, autoclitics, Skinner attempted to deal with


internal speech, or thought. Autoclitics, by his account, are subject
to the same effects of reinforcement as verbalized speech and that
previously reinforced internal, or thought behaviors, will influence
not only current and future thought but also current and future
verbal behavior.
Whether the speech was internal or dialogic, reinforced positively
or negatively, all language can be considered behavior that is
conditioned and learned. When Skinner wrote Verbal Behavior he
attempted to explain the most complex human behavior:
communication.

This

included

all

forms

of

language

comprehension, from dialog to thought.


Though a tribute to the behaviorist paradigm, Skinners book
generated more questions and concerns than it explained. After his
book was published and critiqued by Noam Chomsky, Skinner
failed to respond immediately to the issues and problems raised.
His slow response coupled with both a growing disdain for the
behaviorist paradigm and the influence of technology, computers,
and information processing led to the strengthening of the
cognitive movement in psychology and other social sciences.

References & Resources


Fodor, JA; Bever, TG; & Garrett, MF. (1975) The Psychology of Language: An
Introduction to Psycholinguistics and Generative Grammar. New York: McGrawHill.
Lana, Robert E. The cognitive approach to language and thought. Journal of Mind
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