Chapter 3:THEORIES BASED ON

ATTITUDES AND BELIEFSActive people have attitude!

Theories of Exercise Behaviour

Belief-AttitudeTheories

Competence-BasedTheories

Control-BasedTheories

Stage-BasedTheories

Example:Theory of

Planned Behaviour

Example:Self-Efficacy

Theory

Example:Self-Determination

Theory

Example:Transtheoretical

Model

HybridModels

Example:HAPA

Chapter 3: AIMS

• define attitudes• summarise the Health Belief Model and

research findings from physical activity • review the Theory of Planned Behaviour• consider the Health Action Process

Approach and Protection Motivation Theory

ATTITUDES

AFFECT COGNITION BEHAVIOUR

FEELINGS ABOUTPHYSICAL ACTIVITY

BELIEFS ABOUTPHYSICAL ACTIVITY

APPROACH ORAVOIDANCE OF

PHYSICAL ACTIVITY

THE HEALTH BELIEF MODEL

PerceivedSusceptibility

PerceivedThreat of Disease

PerceivedBenefitsminus

PerceivedBarriers

Likelihood ofTaking Health

Action

Cues to Action

DemographicVariables

PerceivedSeriousness

HBM: Basic assumptions

• People will not seek health action behaviours unless:

they possess minimal levels of health motivation and knowledge

view themselves as potentially vulnerable view the condition as threatening are convinced of the efficacy of the 'treatment' see few difficulties in undertaking the action.

HBM: Evidence

• Meta-analysis across several health behaviours (Janz & Becker, 1984) concluded that:

there was substantial support for the model across more than 40 studies

the HBM is the most extensively researched model of health-related behaviours

'perceived barriers' was the most consistently powerful predictor beliefs associated with susceptibility appeared to be more

important in preventive health behaviours beliefs in the perceived benefits of action seemed more

important in sick-role and illness behaviours despite the variability of measuring instruments, the HBM has

remained robust across a wide variety of settings and with a wide variety of research techniques.

HBM and physical activity

• Does the HBM work well for predicting physical activity as a health behaviour?

• The illness-avoidance orientation of the model is generally not appropriate for the explanation or prediction of physical activity.

HBM and physical activity

• Conclusion:

• The HBM has intuitive appeal, but its application to physical activity has not been clearly shown

THE THEORIES OF REASONED ACTION & PLANNED

BEHAVIOUR

Attitudetoward

Behaviour

BEHAVIOURSubjective Norm

Intention

BeliefsRegardingBehaviour

Evaluationof outcomes

Beliefs thatImportant

Others have

Motivation toComply with

Important Others

PerceivedBehavioral

Control

ControlVariables

Power overControl Factors

TRA

TPB

TPB: Evidence from exercise

• Associations between:• I: intention• B: behaviour• A: attitude• SN: subjective norm• PBC: perceived

behavioural control0

0.1

0.2

0.3

0.4

0.5

0.6

I-B A-I SN-I PBC-I PBC-B

Hagger et al. (2002)

TPB: critique 1

• the TPB is a unidirectional model • the model relies on cognitions and omits

other potentially important determinants of action, such as environmental influences

• the model predicts behaviour from measures of behavioural intention taken at one point in time

TPB: critique 2

• insufficient attention has been paid to the measurement of behaviour

• the TPB investigates the interrelationships between model constructs and a single behaviour. It does not account for alternative behaviours

• One problem with the TPB is the lack of consistency in defining and assessing perceived behavioural control

Implementation Intentions

• self regulatory strategies, or goals and plans, that involve specifying when, how, and where performance of the behaviour will take place.

• implementation intentions were developed from concerns about the intention-behaviour gap.

• implementation intentions help people move from a motivational phase to a volitional (behavioural) phase

• They assist intentions being converted into action

THE HEALTH ACTION PROCESS APPROACH

(HAPA)

HAPA: Basic assumptions

• a model that integrates continuous and stage assumptions

• is therefore a hybrid model

• integrates motivational (prediction of intention) and behaviour-enabling (implemental) models

Three main phases of HAPA

• non-intentional stage: behavioural intention is being developed

• intentional stage: the person has already formed an intention but still remains inactive while the exercise behaviour is being planned and prepared.

• action stage: are then physically active at the recommended or criterion level.

Cons

Risk

Pros

SE

PlanIntention Behaviour

Non-Intentional Stage

Intentional Stage

ActionStage

PROTECTION MOTIVATION THEORY

PMT: Background

• a cognitive model based on expectancy-value principles

• developed as an explanation for the effects of 'fear appeals' in health behaviour change

• A model of health decision-making• Health behaviour intentions ('protection

motivation') are predicted from the cognitive appraisal mechanisms (severity, probability, efficacy)

PerceivedSeverity

PerceivedProbability

Efficacy ofPreventiveBehaviour

PerceivedSelf-Efficacy

ProtectiveBehaviour

Threatappraisal

Copingappraisal

Intentionto protect

Chapter 3: Conclusions 1

• the early physical activity attitude research was mainly descriptive • This approach has limited utility in predicting participation in physical

activity although it may be of use in eliciting descriptive information in population surveys

• the TRA has consistently predicted exercise intentions and behaviour across diverse settings

• the TPB appears to add to the predictive utility of the TRA in physical activity

• both TRA and TPB models are limited by their focus on conscious decision-making through cognitive processes, they are essentially static and uni-dimensional approaches, and the prediction of physical activity from intentions may depend on the proximity of measurement of these two variables

• the TRA and TPB have, however, been the most successful approaches in exercise psychology linking attitudes and related variables to intentions and participation

Chapter 3: Conclusions 2

• The Health Belief Model has been shown to be a reasonably effective integrating social psychological framework for understanding health decision-making

• But meta-analytic results suggest small amounts of variance in health behaviours are accounted for by the major dimensions of the HBM.

• The utility of the HBM in physical activity settings has not been demonstrated, However, it may be useful for service providers to evaluate why some people do not accept the opportunity to attend a GP-referral appointment for cardiac rehabilitation class.

Chapter 3: Conclusions 3

• The Health Action Process Approach allows for a distinction between a motivation phase and a volition/post-decision phase of health behaviour change and is a ‘hybrid’ model combining aspects of intention-behaviour links (continuous) and stage-based models.

• Protection Motivation Theory may be useful in predicting exercise intentions, but current data are more supportive of the role of efficacy beliefs rather than health threats themselves

• Implementation intentions are self regulatory strategies that involve the formation of specific plans that specify when, how, and where performance of behaviour will take place.

• Attitudes are important determinants of physical activity. • Intentions and behaviour can be predicted from attitudes if

appropriate social psychological theories and procedures are applied.