The Sierra Leone Ebola Virus Disease (EVD) epidemic not only ravaged the affected community but also changed it on a national, community, family, and personal levels. The Social Cognitive Theory (SCT) can enable an evaluation and appreciation of how EVD changed the families and the people of Sierra Leone on a micro-level. EVD found traditional, closely knit and socially stable extended families that involved tens of people living under the same roof. At its wake, it left a divided, suspicious, and generally broken community which had been ravaged by the diseases itself, the economic impact it visited upon them, and the government efforts to contain the epidemic. SCT seeks to define how people acquire and maintain certain behaviors and mannerisms at a personal and social level. Under SCT, acquiring a trait is only part of the behavioral matrix, since the ability to retain the behavior is also important (Bandura, 2014). The theory thus canvasses how bearing factors based on nature and nurture affect the social constitution of an individual and how changes in the nurture aspects change this social constitution. Applied to the Sierra Leone EVD epidemic, SCT shows how the community changed from what it was at the beginning of the epidemic, the changes that happened due to the effects of the epidemic, and the behavioral and social outcomes in the years following the epidemic.
The social cognitive theory was first developed as the Social Learning Theory by Albert Bandura, about half a century ago. In 1986, it was adjusted, advanced, and renamed to become SCT. The basic concept under SCT is that learning is a continuous process that happens through the interaction of people, their environment, and their behavior (Bandura, 2014). People observe the behavior of a model and its outcomes, which eventually affect the behavior of the observers. For example, a child will observe older children’s behavior and also whether this behavior is being rewarded or punished. The combination of the behavior and the rewards, to some extent determines how the child will behave, or how the child’s current behavior will change. The scope of observation is not limited to direct contact and can include all elements of nurture such as TV, books, the internet, social media, and other mediums of learning. The primary point of descent between SCT and most of the other theories about social behavior is that SCT goes beyond acquiring behavior and into the maintenance of that behavior (Bandura, 2014). The extended nature of SCT into maintaining behavior makes it uniquely qualified for the understanding of human behavior as human behavior is dynamic and malleable. A person acquires a set of social behaviors then it keeps on changing from time to time, based on different bearing factors. Although the behavior keeps on changing, it will still retain some prerequisites of what it was at the beginning. Studying behavior is thus like looking at a collage that has different ingredients, some being more prominent than others, but all contributing to its overall characteristics. SCT provides the ability to study each ingredient of human behavior and what role it plays within the overall character of the individual (Bandura, 2014).
Delegate your assignment to our experts and they will do the rest.
The core concept of SCT is reciprocal determinism, which relates to the tripartite interaction between people, the environment, and their behavior. The name is based on the fact that the tripartite interaction is both dynamic and reciprocal and the three elements of people, the environment, and behavior affect and change one another as they continue to interact (Riley et al., 2015). The Sierra Leone EVD epidemic affected certain people within the country. These people had a definitive set of behaviors in 2013 when the epidemic started, based on the environment they had lived in before then. EVD changed the environment that the people live in, triggering a change in the people and by extension, their behavior. These changes will, by extension affect the environment thus keeping the cycle of change going on. The dynamism means each of the three characteristics will keep on changing while the reciprocity refers to the fact that the change in one leads to a subsequent change in the other two. Under reciprocal determinism, any change to either people, the environment, or behavior leads to a change in the entire system through a continuous loop of ripple effects (Riley et al., 2015).
The loop of ripple effects will, however, not begin unless there is a behavioral capability to learn the behavior that is being observed. Behavioral capability is thus the second critical concepts under SCT (Kelder, Hoelscher, & Perry, 2015 ) . For example, a poor African child who is watching an American movie can copy how the movie star walks and talks, but not how the movie star steers a helicopter or drives a ten-second car. The child has the behavioral capability for some of the behaviors observed but not all of them. It is thus only the behaviors that the child had capability over, that will affect the behavior of the child and not all the behaviors. Nature is one of the critical bearing factors for behavioral capability as some behaviors are associated more to boys than to girls. As with the movie example above, geographical location and social class are also major determinants of behavioral capability. When behavioral capability is missing from a society or an individual, changes in the environment will not affect changes in the people or their behaviors, the ripple effect will not begin thus no actual changes will take place (Kelder, Hoelscher, & Perry, 2015 ) . However, when there is a specific behavioral capability for the changes in the environment, the reciprocal determinism ripple effect begins and all three factors of people, behavior, and environment begin to change.
Among the main drivers of the envisaged change can be better understood through the SCT concept of observational learning that relates to the ability to observe and replicate behavior (Kelder, Hoelscher, & Perry, 2015 ) . The social environment around an individual, family, society or community is extremely complex and complicated with many moving parts that might not be observed by most. The environmental changes that cannot be observed or for some reason are not observed will not result in any changes to the people or the environment. For example, if the environmental change is based on social media, only those with access to social media have the observational abilities for such a change. The ability to learn will then trigger the ability to reciprocate what has been learned. It is due to the concept of observational learning that different bearing factors will change a specific community in different ways (Kelder, Hoelscher, & Perry, 2015 ) . A change in one family member, for example, has a higher chance of changing other family members as close proximity increases the ability to observe and learn from that family member.
The observed change can have a positive or negative effect on the observer based on the SCT concept of reinforcement. In this context, reinforcement refers to whether the observed behavior led to a reward or a punishment in the eyes of the observer (Kelder, Hoelscher, & Perry, 2015 ) . The concept of reinforcement in SCT is subjective as opposed to being objective since it is more about how an event is interpreted, as opposed to how it actually happened. For example, a person may commit a crime and be arrested, convicted, and jailed. Most people will consider that a punishment, and be encouraged to avoid crime. However, a child in a gang that considers being put in jail for crime as becoming a hero may look at the arrest as a reward, as opposed to punishment. The child will be eager to commit crimes and become a hero in the eyes of his peers, instead of avoiding crime to avoid jail. Under the concept of reinforcement, how environmental factors are interpreted is inter alia determined by people and their behavior. The same event might, therefore, create different reactions and behavioral changes to different people (Kelder, Hoelscher, & Perry, 2015 ) .
The SCT concept of expectations also plays an important role in how reinforcements are interpreted and thus how the entire interrelation of the environment, people, and behavior plays out. Expectations can differ at the personal, family, and community levels (Kelder, Hoelscher, & Perry, 2015 ) . The expectations at a personal level mainly relate to how a person views family and community and how those views affect the behavior and behavioral changes of the individual. Family expectations relate to what a family expects from its members and conversely, how the family would want to be viewed by the larger community. Finally, community expectations are mainly based on norms, customs, laws, rules, and regulations within the community. When a change happens in the environment, its impact on the individuals, families and the communities at large will, to some extent be determined by the three levels of expectations. In most cases, the expectations will collide with one another. Some personal expectations may differ from community expectations while some community expectations will differ from family expectations. For example, a Muslim family living in an urban community and may have a son who has become irreligious will have different expectations. For the son, some personal expectations will vary from those of the family and may also vary from those of the community. A change in the social environment in that community will thus affect the son in a peculiar manner (Kelder, Hoelscher, & Perry, 2015 ) .
Key among the peculiarities in SCT is informed by the concept of self-efficacy which relates to the self-assessed ability to adopt and maintain a certain behavior. Self-efficacy combines both the ability to maintain the behavior and the assumed ability to maintain the behavior (Kelder, Hoelscher, & Perry, 2015 ) . The assumed ability to maintain the behavior is key to the ability of the individual to adopt a behavioral change. For example, five boys will watch a movie and three of them will assume that they can adopt and maintain the behavior that they observe in the movie. It is possible that the two boys who do not believe that they can adopt and maintain the behavior could actually have managed to. But because they did not believe they can, their ability becomes inconsequential. However, for the three that got started on the behavioral change journey, their ability becomes pertinent as it will determine whether or not they succeed in adopting and maintaining the behavior. If they can succeed, the change will affect their personal behavior, which in turn will change who they are as people. Their change as people will affect their environment and the cycle will continue (Kelder, Hoelscher, & Perry, 2015 ) .
The application of SCT to Sierra Leone during and after the 2013-2014 EVD epidemic is predicated on the understanding of the trifecta of the environment, people, and behavior, then consider how the environmental change affected the entire matrix. EVD was a completely new factor in Sierra Leone as the country had never experienced it before (Ajeli et al., 2015). Its novelty exponentially affected its impact as a social environment bearing factor. Due to a failure to understand its possible consequences, the people reacted slowly to the change that EVD presented to their environment. Due to the slow reaction, the people’s behaviors did not change, leading to the exacerbation of the epidemic. Eventually, their behavior had to change as the effects of EVD increased and the government moved in to forcefully eliminate behaviors that was making the epidemic worse (Caleo et al., 2018) . The changes in behavior led to changes in the people themselves creating a slippery slope effect that changed the entire community.
The change in environment occurred when Sierra Leoneans attended a funeral in Guinea and brought with them the EVD virus which begun to spread rapidly within the two respective districts that the people came from. The initial effects of EVD were sickness and death of a few members of the community which increasingly got worse (Caleo et al., 2018) . The primary missing SCT component at this initial change was observational learning as the community was unable to understand what changes EVD had brought to their community and how it was going to affect them. For example, people are not new to the flu in the USA and even know when the flu season is about. The people are thus able to effectively adjust their behavior to mitigate the effects of the flu. Similarly, the people of Congo, Uganda, and Sudan have experienced EVD before and know what to do when they see any signs of it. Sierra Leone in 2013 had never experienced EVD and thus did not have observational learning competence (Ajeli et al., 2015). Due to the lack of observational learning competence, the community did not do what was expected of them, nor cease to do what was not expected of them.
The first adverse reaction by the Sierra Leoneans was failing to take all their sick to the hospital immediately, but instead, took good care of them at home, take them to traditional healers, or to churches for prayers (Caleo et al., 2018) . Under the SCT concept of reciprocal determinism, the lack of reaction in itself has an effect in the environment since people and behavior are environmental bearing factors. The nature and nurture of the local communities defined who they were and how they behaved. Having experienced years of civil war, massacres, and violence taught them to trust one another more than they trusted their government and its systems. When EVD struck, the communities did not turn to the government and the health department for help. Instead, they relied on their own systems that had always been known to work before, for other sickness (Caleo et al., 2018) . Since the environment had changed, the reactions that used to help them became their worst enemies. Working together as a family to take care of their sick at their time of need only spread EVD within the family. Going to the local healer or church led to the interfamily and intercommunity spread of EVD. By doing what they thought was right for them, Sierra Leoneans ended up encouraging the spread of EVD.
The poor reaction to the environmental change created by the advent of EVD exacerbated the situation and people started dying from EVD, yet the society had not developed the observational learning competence to deal with the situation. In their deathbeds, the sick were surrounded by their families and loved ones who served and comforted them. Available research about EVD shows that as the disease progresses, the viral load in the blood and body fluids increases thus augmenting propensity for infection (Ajeli et al., 2015). The right reaction by the families of the sick should have been to stay away from their invalid, but instead, they drew closer to them. After they died, elaborate funeral rites would follow, including cleaning the bodies of the dead, oiling them, hugging them and even kissing them. The behavior of the Sierra Leoneans, based on who they were exacerbated the social environment change triggered by EVD within the country. The situation exacerbated gradually and required an aggressive and concerted effort by the government with support from the international community (Fang et al., 2016) .
A crisis ensued in Sierra Leone based on the fact that doing the right thing no longer seemed right from a practical perspective, coupled with the fact that the government was directly advocating against doing what the families considered as the right thing (Fang et al., 2016) . Few theories would be as equipped as SCT to understand the social chaos and pandemonium that must have been going in Sierra Leone at the height of the EVD epidemic. The people knew what was right and wrong yet they were doing the right thing and getting the wrong results. The people knew that the right thing to do was take good care of loved ones when they are sick. The government asked them to take their loved ones to the hospital and abandon them under quarantine (Fang et al., 2016) . Similarly, people knew that when your loved ones die, you take very good care of them, wash them, oil them and give them a decent burial. The government said, when people die, they should be buried safely with zero contact with the dead. The families that did what was right as per the community got more sickness and death while the families that did what was wrong as per the community survived. Sierra Leone was emersed into a social crisis where the cultural identity of the community was in jeopardy.
When the behavioral change finally came, it was definitive and extreme that it was not only the people’s behavior that changed but also the people themselves. The behavior of the people changed first, either out of choice or by being compelled by the government. When people got sick, they were taken to quarantine where over 50% of them would never be seen alive again. Secondly, when people died, they would be given safe burials without any of the traditional burial rites. The people then changed as they begun to adjust to the absence of the ritual bonds and ties that had united the family unit so tightly for so long (Fang et al., 2016) . The oneness and unity in the communities were lost alongside the cultural attributes that came with it.
The environment also changed as the government limited travel to try and stem the spread of EVD. The limitation of movement added to the problem caused by EVD, leading to serious economic problems with families lacking even food (Maconachie & Hilson, 2015) . The families lacking food were also lacking in the strong familial bonds that enabled them to support one another in times of need. Gradually, the social structure in the areas most affected by EVD in Sierra Leone begun to crumble and fall apart. Eventually, the EVD epidemic petered out and those who survived in quarantine were released back to the community, but they never found the community that they had left. Instead of the united and loving community that they had left, the survivors found a divided and devastated community. The survivors were stigmatized and discriminated due to the fear that they might infect their loved ones with EVD and begin the vicious cycle all over again (Scott et al., 2016) .
It is evident that the SCT is the arguably the best theoretical approach for understanding the changes in the Sierra Leonean social fabric as a consequence of the 2013/14 EVD epidemic. SCT enables an understanding of the social factors that led to the exacerbation of the EVD epidemic in the country and also how the epidemic ended up transforming Sierra Leone completely. Based on the concept of reciprocal determinism, three primary factors were involved; the people, their behavior, and their environment. EVD affected their environment but the people lacked the observational learning competence to deal with it. Instead of seeking medical attention and observing preventative public health measures, they continued with their ordinary behavior thus driving the epidemic. The epidemic and measures by the government to control it would lead people to doubt, then shun their normal ways of doing things. Their behavior changed, then they changed as a people. Poverty and other vagaries of EVD worsened the social environment increasing the chaos. By the time the EVD epidemic ended, the Sierra Leonean community had completely changed.
References
Bandura, A. (2014). Social cognitive theory of moral thought and action. In Handbook of moral behavior and development (pp. 69-128). London; Psychology Press
Riley, W. T., Martin, C. A., Rivera, D. E., Hekler, E. B., Adams, M. A., Buman, M. P., ... & King, A. C. (2015). Development of a dynamic computational model of social cognitive theory. Translational Behavioral Medicine , 6 (4), 483-495
Kelder, S. H., Hoelscher, D., & Perry, C. L. (2015). How individuals, environments, and health behaviors interact. Health Behavior: Theory, Research, and Practice , 159-188
Ajelli, M., Parlamento, S., Bome, D., Kebbi, A., Atzori, A., Frasson, C., ... & Merler, S. (2015). The 2014 Ebola virus disease outbreak in Pujehun, Sierra Leone: Epidemiology and impact of interventions. BMC Medicine , 13 (1), 281
Caleo, G., Duncombe, J., Jephcott, F., Lokuge, K., Mills, C., Looijen, E., ... & Lamin, M. (2018). The factors affecting household transmission dynamics and community compliance with Ebola control measures: A mixed-methods study in a rural village in Sierra Leone. BMC Public Health , 18 (1), 248
Fang, L. Q., Yang, Y., Jiang, J. F., Yao, H. W., Kargbo, D., Li, X. L., ... & Liu, K. (2016). Transmission dynamics of Ebola virus disease and intervention effectiveness in Sierra Leone. Proceedings of the National Academy of Sciences , 201518587
Scott, J. T., Sesay, F. R., Massaquoi, T. A., Idriss, B. R., Sahr, F., & Semple, M. G. (2016). Post-Ebola syndrome, Sierra Leone. Emerging Infectious Diseases , 22 (4), 641
Maconachie, R., & Hilson, G. (2015). Ebola and alluvial diamond mining in West Africa: Initial reflections and priority areas for research. The Extractive Industries and Society , 2 (3), 397-400
