Attitudes are formed as a reaction to one’s own personal characteristics and the social environment; they are determined partly by biological inheritance (McConnell 1980), but are predominantly developed by learning in its broadest sense from birth onwards (Crafter 1997b). Children are primarily exposed to the attitudes of their parents, close relatives and friends, and have a fairly consistent environment in terms of attitudes, values and beliefs. This is because, when couples meet, each is
How are attitudes formed? 67
Box 6.1 The personality theories of Freud, Maslow and Rogers
Sigmund Freud
Freud identifies personality as having three distinct structures:
• id (unconscious inherited processes)
• ego (the guard of the id, requiring behaviour acceptable to the outside world)
• superego (from which the conscience develops).
The individual has defence mechanisms that protect the ego and the superego from conflicts that threaten the status quo of existence. Freud identifies denial, repression and sublimation as examples of the defence mechanisms. He believed that these processes generally went on in the subconscious with only occasional forays into the conscious, and influenced all of our day-to-day thoughts and human interactions. His theories are popular partly because his ideas can be explained simply and followed easily when observing the way people react in different situations.
Abraham Maslow
Maslow developed the widely used ‘Hierarchy of needs’, which encapsulates the development of personality from birth to adulthood, based on the philosophy that in normal circumstances people are motivated, or moved to achieve more and more sophisticated needs, in order to find self-fulfilment and ‘self-actualization’ – the feeling of being comfortable with oneself. Maslow’s hierarchy is often used to demonstrate the stepping-stones in life’s developmental processes.
Midwives will recognize many of the stages mirrored in pregnancy, childbirth and early motherhood, e.g. esteem needs can be met when a woman feels that she has achieved her goals of the birth (be it safe delivery, or perhaps birth with optimal drug usage) or self-fulfilment in reaching her potential. For some women, giving birth and becoming a mother will be their ultimate life experience,
described by many as the most important significant event of their life. Maslow’s stepping stones offer midwives a framework of care – offering safe care, accepting women and families for what they are as they present themselves to the maternity services, and enhancing women’s self-esteem by helping them to explore and understand their experiences.
Carl Rogers
Rogers identified the features of self-conceptandpositive regardin his theory of personality. Self-concept depends on how an individual sees him- or herself in the world, how this affects behaviour, and how that individual views the world. Rogers’ ideal self-concept is positive regard. Internal anxiety is evoked, he believes, when the individual does not behave or perform in the way expected, and self-esteem is reduced when the self-concept conflicts with behaviour.
(Adapted from Crafter 1997a)
68 Attitudes, values and health behaviours
attracted to the other because of shared values and similar socioeconomic and educational backgrounds. Therefore their children, whose early environment is closely controlled by their family and immediate friends, are exposed to a biased sample of life experience. The value of such early experience is in security and continuity at a time when the outside world appears to be a place of contradictions and confusion. It is easy to see how an unsettled family life may affect an individual’s early experiences.
Sears (1969) suggested that the critical period for attitude formation, becoming long lasting and harder to alter in a significant or radical way, was between the ages of 12 and 30. The teenage years are a particularly important time for attitude formation, when strong social groups are formed. It is a time of experimentation, excitement and turbulence, and an occasion for shaking off the authority of parents and teachers. It can be divided into two phases: 13–16 years of age when young people push for greater independence from their parents but retain great internal conflicts about dependence and independence, and 16–19 when they wish to forge a separate identity from parents and close family (Chambers et al. 2001). These are key staging points in growing up and entering adulthood. With the move from parental control young people look elsewhere for confirmation of their acceptance within a social group. Usually the one nearest to hand is their own peer group. Normative and behavioural beliefs are aired and re-evaluated; sexuality and the new possibility of reproduction are often areas of great consideration and debate within which attitudes are discussed, shared, formed and changed. Such attitudes and beliefs are not necessarily coherent or constant. It is a time to try out different behaviours, different peer groups and different attitudes. Most will settle, a few years down the line, with attitudes not dissimilar to those of their parents, especially if they had a reasonably happy childhood; however, for those with less happy childhoods the settling phase may take longer or may not occur at all (SEU 1999, Chambers et al. 2001).
Every social group develops norms and expectations to which members are expected to adhere. There is considerable social pressure for individuals to share values, attitudes and behaviours, and to ‘fit’ in. People tend to mix in many social groups during the same period of their lives, e.g. family, neighbours, workmates, friends from school or a previous job – each may require the adoption of different values to ‘fit’ in. In order to accommodate these different values, an individual will live with a small amount of discord or feeling out of place, e.g. a teenager maynormativelyagree with friends that sexual freedom is a good thing, while behaviourallychoosing to remain celibate for the time being without feeling too uncomfortable. However, the need to ‘fit’ in and conform within a group is very strong, and a divergence in beliefs and values among group members may lead to a break-up and a need to form new friendships where values are re-explored and shared. Where a social group share the same values and attitudes, their relationship is likely to be long lasting, and add much to the psychological well-being of each participating member (Crafter 1997a, 1997b).
On becoming pregnant for the first time, a woman will enter a new social group of ‘expectant mothers’. Many women are keen to look for information at this time about their pregnant condition, but along with this information inevitably come other people’s values and attitudes. Although the way women accept the new knowledge may be preset by their personality and social environment, major life events often bring with them the propensity for openness to absorb new information
The relationship between attitudes and health behaviours 69
and new or reconsidered attitudes, in an attempt to ‘fit’ in this new social group of mothers. However, the midwife needs to be aware that, for women who are in socially excluded groups, this entry into a new social group may be prevented and cause problems with attitude formation with regard to childbirth and good parenting (Bartley 2005, Janssen and Pfaff 2005).