Chapter 3: THEORIES BASED ON ATTITUDES AND BELIEFS

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Chapter 3THEORIES BASED ON ATTITUDES AND BELIEFS

• Active people have attitude!

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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

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THE HEALTH BELIEF MODEL
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Perceived Benefits minus Perceived Barriers
Demographic Variables
Perceived Susceptibility
Perceived Threat of Disease
Likelihood of Taking Health Action
Perceived Seriousness
Cues to Action
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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.

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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.

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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.

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HBM and physical activity

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

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THE THEORIES OF REASONED ACTION PLANNED
BEHAVIOUR
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Beliefs Regarding Behaviour
Attitude toward Behaviour
Evaluation of outcomes
TRA
Beliefs that Important Others have
Subjective Norm
Intention
BEHAVIOUR
Motivation to Comply with Important Others
Control Variables
Perceived Behavioral Control
TPB
Power over Control Factors
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TPB Evidence from exercise

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

Hagger et al. (2002)
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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

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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

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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

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THE HEALTH ACTION PROCESS APPROACH

• (HAPA)

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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

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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.

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Non-Intentional Stage
Intentional Stage
ActionStage
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PROTECTION MOTIVATION THEORY
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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)

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Perceived Severity
Threat appraisal
Perceived Probability
Intention to protect
Protective Behaviour
Efficacy of Preventive Behaviour
Coping appraisal
Perceived Self-Efficacy
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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

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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.

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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.