Chapter 3: THEORIES BASED ON ATTITUDES AND BELIEFS

1. Chapter 3:THEORIES BASED ON ATTITUDES AND BELIEFS Active people have attitude!

3. 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

5. THE HEALTH BELIEF MODEL

6. Perceived Benefits minus Perceived Barriers Demographic Variables Perceived Susceptibility Perceived Threat of Disease Likelihood of Taking Health Action Perceived Seriousness Cues to Action

7. 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.

8. 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.

9. 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.

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

11. THE THEORIES OF REASONED ACTION & PLANNED BEHAVIOUR

12. 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

13. TPB: Evidence from exercise • Associations between: • I: intention • B: behaviour • A: attitude • SN: subjective norm • PBC: perceived behavioural control Hagger et al. (2002)

14. 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

15. 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

16. 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

17. THE HEALTH ACTION PROCESS APPROACH (HAPA)

18. 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

19. 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.

20. SE Pros Intention Plan Behaviour Cons Risk Non-Intentional Stage Intentional Stage ActionStage

21. PROTECTION MOTIVATION THEORY

22. 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)

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

24. 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

25. 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.

26. 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.