Predicting and understanding safety helmet use among schoolboy cyclists: A comparison of the theory of planned behaviour and the health belief model

Factors affecting the intention to wear helmets for e-bike riders: the case of Chinese college students

As the popularity of electric bicycles (e-bikes) continues to surge, the number of accidents involving them has commensurately increased. A significant factor contributing to the high fatality rate in these accidents is the low usage of helmets among e-bike riders. Helmets have been proven to reduce the severity of injuries, yet their usage remains unexpectedly low. This issue is particularly pronounced among college students, the primary buyer group for e-bikes. Regrettably, there is a lack of research exploring their intentions to wear helmets. Understanding determinants of their intentions to wear helmets is crucial in promoting safe e-bike travel. Therefore, the present study aims to develop an integrated theoretical model that combines the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM) to examine the factors influencing e-bike riders' helmet-wearing intentions among college students. Additionally, two variables-descriptive norms and law enforcement-are incorporated. The results indicate that the integrated model accounts for 76% of the variance in helmet-wearing intention, surpassing single-theory models. Specifically, the TPB accounts for 65%, while the HBM explains 53%. Notably, law enforcement emerges as the most influential factor, highlighting the crucial role of enforcing regulations and promoting awareness. Other significant factors include subjective and descriptive norms, attitudes, perceived benefits, perceived susceptibility, perceived barriers, and perceived severity. These findings provide valuable insights for policy development and targeted interventions aimed at improving helmet wear rates among e-bike riders, especially among the college student population.

Understanding nonuse of mandatory e-scooter helmets

OBJECTIVES

Head injuries resulting from e-scooter use have led to calls for helmet use to be promoted or mandatory. Helmet use is mandatory for e-scooters in Australia but observational studies have reported significant levels of nonuse, particularly by riders of shared e-scooters. The aim of this study is to understand whether nonuse in the mandatory context is a consistent behavior for an individual or is situationally-influenced, and what are the factors associated with nonuse.

METHODS

An online survey was completed between 2022 and 2023 by 360 adult e-scooter riders in Canberra, Australia. Riders were asked whether they had worn a helmet on their last ride and how often they had not worn a helmet when riding in the last 30 days. The survey also asked about rider characteristics (demographics, frequency of e-scooter and bicycle use, perceived risk of e-scooter use, e-scooter ownership, and risky behaviors while riding), trip duration and perceptions of the helmet requirement (knowledge of and support for the law).

RESULTS

Respondents were mostly male, young, highly educated, and full-time workers. Of the 29.1% of riders who reported riding without a helmet in the last 30 days, 24.4% had worn a helmet at least once during that period and 4.8% had consistently not worn a helmet. Younger age, shared e-scooter use and more frequent riding frequency (shared e-scooters only) were associated with helmet nonuse in the bivariate analyses but not in the logistic regression. Logistic regression showed that the independent predictors of helmet nonuse were the number of risky riding behaviors, lack of knowledge, and lack of support for the law.

CONCLUSIONS

Most nonuse of helmets in a mandatory context seems to be situational, rather than consistent. Many of the factors associated with nonuse of helmets for e-scooters are similar to those reported for bicycles. Nonuse of helmets appears to be one of a number of risky behaviors performed by riders, rather than being primarily an outcome that is specific to factors associated with helmets (e.g., concerns about hygiene, discomfort or availability).

As Much As I Can - Utilizing Immersive Theatre to Reduce HIV-Related Stigma and Discrimination Toward Black Sexual Minority Men

BACKGROUND

Despite advances in biomedical HIV prevention modalities such as pre-exposure prophylaxis to prevent the transmission of HIV, racial/ethnic and sexual/gender minority populations are disproportionately impacted by HIV epidemic. Alarming rates of HIV have persisted among Black gay and bisexual men, particularly in Southern states.

METHODS

Utilizing data from the ViiV ACCELERATE! initiative, we explored the impact of As Much As I Can, an immersive theatre production, on HIV-related stigma behaviors. A self-administered post-performance survey was conducted with a cohort (n = 322) of randomly selected audience members.

RESULTS

Overall, the results showed participants had a highly favorable experience, rating the performance with a mean score of 9.77/10. Respondents indicated they intended to change behaviors to promote HIV prevention education and to reduce stigma and discrimination including: (1) Say something if I hear stigmatizing language against people living with HIV (75.4%), (2) Say something if I hear anti-gay language (69.7%) and (3) Tell others about HIV prevention options (e.g., PrEP, PEP, condoms (64.1%). The findings show there is an association between HIV-related behavior intention and linkage to HIV care. Respondents who reported they were more likely to say something about HIV stigma were almost three times (O.R. 2.77; 95% C.I. 0.98-7.8) more likely to indicate they would follow up with a healthcare professional.

CONCLUSIONS

This study suggests that immersive theatre is an effective method for communicating HIV prevention education and reducing HIV-related structural stigma and discrimination that increases HIV vulnerability for Black sexual minority men.

The frequency of bicycle helmet use among college students and health beliefs for bicycle helmet attitude

Objective: The aim of this study is to determine the frequency of bicycle helmet use among college students and health beliefs about bicycle helmet attitude. Participants: Turkish university students (n = 799). Methods: This descriptive and cross-sectional study was conducted over the period 2019. A sociodemographic and cycling related questionnaire form and the Bicycle Helmet Attitudes Scale were used in the data collection. Descriptive statistics, t-test, Anova and Kruskal Wallis tests were used in the statistical analysis. Results: Only 10.4% of students wear a bicycle helmet. Students who using bicycle helmets had higher benefit health belief scores compared to those who didn't, while barrier health belief scores were lower. There is a significant relationship between health belief scores for bicycle helmet attitude and gender, obeying traffic rules, thinking about helmet (unnecessary/disturbing/expensive/ridiculous) and helmet use. Conclusion: In this study, the frequency of using bicycle helmets is very low.

Predictors of older people's intention to engage in cycling violation behaviour with an integrative model

In China, bicycles are a popular mode of transportation for senior citizens. A disproportionate number of traffic-related fatalities and injuries involve cyclists. The violation of cycling laws is a significant cause of cyclist crashes. Few studies have analyzed the cycling violation behaviour of seniors. Therefore, it is essential to examine the factors that influence older individuals' intention to engage in cycling violation behaviours. In this study, the effects of social-demographic characteristics, the exogenous constructs in the health belief model (HBM), and the theory of planned behaviour (TPB) on senior cyclists' violation intention were investigated using hierarchical regression analysis. Interviews were conducted with older cyclists in urban areas of Wuhan City, all above 60 years of age. The results showed that very little variance in behavioural intention could be explained by social-demographic factors. The TPB has a significantly greater capacity than the HBM to explain variance in behavioural intention. Perceived susceptibility, perceived benefit, cues to action, subjective norm and attitude significantly impacted behavioural intention, whereas perceived severity, perceived barrier and self-efficacy did not.

A comparative study of eight COVID-19 protective measures and their impact on Swiss tourists' travel intentions

A comparative vignette-based experimental survey design incorporating various socio-psychological factors, linked to the Theory of Planned Behavior (TPB), the Health Belief Model (HBM) and the Domain-Specific Risk-Taking scale (DOSPERT) was carried out to test variations in eight travel-related COVID-19 protective measures on Swiss tourists' travel intentions. Among the tested measures, vaccination passports, surgical masks and quarantining are those that stand out the most, with surgical masks having the greatest acceptance and willingness to adopt while traveling. Quarantining, on the other hand, appears to have a deterrent influence on travel intentions, and vaccination passports have the lowest perceived barriers during travel, but the highest perceived benefits in mitigating the spread of the infection. The discussion of individual differences has specific implications for tourism management against the background of our empirical findings.

Predicting behavioral intentions for unsafe off-highway vehicle use

INTRODUCTION

Hundreds of adults are killed or injured each year while operating off-highway vehicles. Four common risk-taking behaviors were identified on off-highway vehicles in the literature and examined intention to engage in such behaviors within the context of the Theory of Planned Behavior.

METHOD

One hundred and sixty-one adults completed measures of experience on off-highway vehicles and injury exposure followed by a self-report created according to the predictive structure of the Theory of Planned Behavior. Behavioral intentions to engage in the four common injury risk behaviors on off-highway vehicles were predicted.

RESULTS

Similar to research on other risk behaviors, perceived behavioral control and attitudes emerged as consistently significant predictors. Subjective norms, the number of vehicles operated, and injury exposure showed varying relationships to the four injury risk behaviors. Results are discussed in the context of similar studies, intrapersonal predictors of injury risk behaviors, and with regard to implications for injury prevention efforts.

Community Safety Behavior in Response to Coronavirus Pandemic

The purpose of this study is to explore the behavior and lifestyle of individuals in response to the coronavirus that the safety behavior of people in the coronavirus disease of 2019 pandemic. Hence, the study integrates the theory of planned behavior and the health belief model to understand the behavioral change in response to the coronavirus pandemic. The current study is qualitative therefore, a survey-based online questionnaire was used for data collection from university students and staff (faculty and nonfaculty) residing in top-tier cities of Pakistan, nonprobability convenient sampling was used to approach the audience. A two-stage approach was used to test the model using partial least square (variance-based structural equation modeling). The reliability and validity of the measurement model indicate that the data is reliable and valid. Outcomes prove all the relationships as proposed by the study, except for the impact of perceived barriers on intention and individual safety behavior. Perceived barriers act as obstacles that abstain individuals from following the standard operating procedures. The research agenda provides new insights into the fields of marketing, health care, consumer behavior, and behavioral studies. It contributes to the existing literature in the field of social marketing by studying the behavior and changes in the behavior of people in the global pandemic.

Prediction of Helmet Use Behavior among Motorcyclists Based on the Theory of Planned Behavior

BACKGROUND

Road traffic injuries (RTIs) are one of the most critical factors that endanger human health. More specifically, head and neck injuries are the main causes of deaths and disabilities among motorcyclists. This study aimed to investigate the predictive factors of helmet use behavior among motorcyclists based on the theory of planned behavior (TPB).

STUDY DESIGN

This study followed the cross-sectional design.

METHODS

This study was conducted on randomly selected 730 motorcyclist employees in Qom, Iran, in 2021. The data collection tool was a self-administered researcher-made questionnaire, including items on demographic characteristics, history of RTIs, and constructs of TPB. Data were analyzed using descriptive summary statistics, analysis of variance, independent samples t test, Pearson correlation coefficient, and structural equation modeling (SEM).

RESULTS

In this study, only 9.8% of the participants reported that they always used a helmet while riding a motorcycle. About 60% reported a history of a motorcycle crash, and 11.5% had a history of head injuries. The direct effect of attitude, subjective norms, and perceived behavioral control on the intention to use a helmet were statistically significant, explaining 59% of the variation in behavioral intention (intention to use a helmet) (R2=0.59). Moreover, perceived behavioral control and behavioral intention had significant effects on helmet use behavior (R2=0.26).

CONCLUSION

The prevalence of helmet use among the studied population was very low. Moreover, TPB was useful in identifying the determinants of behavior and especially behavioral intention of helmet use among motorcyclists.

Pointers to Interventions for Promoting COVID-19 Protective Measures in Tourism: A Modelling Approach Using Domain-Specific Risk-Taking Scale, Theory of Planned Behaviour, and Health Belief Model

Based on the factors of the Theory of Planned Behaviour (TPB), the Health Belief Model (HBM), and the DOSPERT scale, used to measure general risk-taking behaviour, a combined model has been developed for investigating tourists’ intentions to implement protective measures against the coronavirus disease 2019 (COVID-19). The purpose of the study is to formulate a model that Swiss tourism practitioners can use to understand tourists’ decision-making regarding the acceptance and proper implementation of non-pharmaceutical interventions (NPIs). A large-scale cross-sectional population study that is representative for the Swiss population has been designed to validate the model (N = 1,683; 39% response rate). In our empirical investigation, a simple regression analysis is used to detect significant factors and their strength. Our empirical findings show that the significant effects can be ordered regarding descending effect size from severity (HBM), attitude (TPB), perceived behavioural control (TPB), subjective norm (TPB), self-efficacy (HBM), and perceived barriers (HBM) to susceptibility (HBM). Based on this information, intervention strategies and corresponding protective measures were linked to the social-psychological factors based on an expert workshop. Low-cost interventions for tourists (less time, less money, and more comfort), such as the free provision of accessories (free mask and sanitizers) or free testing (at cable cars), can increase the perceived behavioural control and lower the perceived barriers and thus increase the acceptance of this protective measure.

Understanding the predictors of hand hygiene using aspects of the theory of planned behaviour and temporal self-regulation theory

OBJECTIVE

Adherence to proper hand hygiene practice is relatively low and is particularly salient in light of the current COVID-19 pandemic. Having a greater understanding of the psychosocial predictors of engaging in proper hand hygiene is warranted. One way to do this is through the application of a combined theory of planned behaviour and temporal self-regulation theory model.

DESIGN

A prospective two-part study was conducted between May - November 2020, with N = 232 Australians. At time one, variables from both the theory of planned behaviour (attitude, subjective norm, perceived behavioural control, and intention) and temporal self-regulation theory (habit, environmental cues, and planning) were completed.

MAIN OUTCOME MEASURES

One week later, engagement in proper hand hygiene behaviour over the previous week was assessed.

RESULTS

Two hierarchical multiple regressions were conducted, with 47% of variance accounted for in intention, with subjective norm being the strongest predictor, and 38% of variance accounted for in hand hygiene behaviour, with intention being the strongest predictor. Environmental cues also moderated the relationship between intention and behaviour.

CONCLUSIONS

To increase intention, incorporating subjective norm messages in advertisements may be helpful. Incorporating environmental cues in places where hand washing is recommended may assist in increasing hand hygiene.

A Comparison of Motorcycle Helmet Wearing Intention and Behavior between Urban and Rural Areas

The motorcycle is one of the important modes of transport for Thai people in all provinces due to its convenience and ability to access all areas and cover short distances, which is especially convenient for rural people. However, according to the accident record, it was found that the motorcycle was the vehicle causing the highest amount of accidents, and helmet wearing could save lives and reduce the level of severe injuries. In this regard, the objective of this study was to study and develop a model of factors that affected helmet use behavior using structural equation modeling (SEM) based on the Health Belief Model (HBM). Further, this study compared urban and rural models, so as to suggest suitable guidelines for the promotion of helmet use in the study areas. The sample comprised 801 motorcycle users divided into 401 urban residents and 400 rural residents. From the parameter invariance testing in the two areas, a chi-square difference test found differences in the factor loading, intercepts, and structural paths between urban and rural societies.

Preventing tobacco in vocational high schools: study protocol for a randomized controlled trial of P2P, a peer to peer and theory planned behavior-based program

BACKGROUND

In France, the issue of youth smoking remains a major challenge for public health. School failure, socio-economic and socio-cultural backgrounds influence the initiation and maintenance of smoking behavior in adolescents. Vocational students are at particularly high risk of using psychoactive substances, including tobacco. One of the most important factors is the environment, whether family, friends or peers. Therefore, peer education has a positive potential to change smoking behavior of adolescents. It has also been demonstrated that the Theory of Planned Behavior (TPB) has yielded the best prediction of intentions and behavior, in several health domains, including on tobacco. However, it is usually confined to the measurement of processes by which interventions change behavior, rather than to the development of these interventions. The objective of this paper is to describe the protocol for a randomized controlled trial of a peer intervention based on the TPB on a highly exposed young population.

METHODS/DESIGNS

This is a cluster randomized controlled trial comparing an intervention group to a control group, randomized into clusters (professional schools and classes) and stratified in three departments (Hérault, Aude and Gard) in the Languedoc-Roussillon region. The primary issue is the prevalence of daily smoking at 24 months, defined by a daily tobacco use of at least 1 cigarette, validated by CO levels in exhaled air. The primary hypothesis is that intervention will lead to decrease the daily smoking prevalence of 10% between the intervention group and the control group during a 2-year follow-up.

DISCUSSION

The results from this trial will provide evidence on the effectiveness of an innovative peer-to-peer intervention based on the TPB.

TRIAL REGISTRATION

ISRCTN: 37336035 , Retrospectively registered 11/12/2015.

Prediction of safe driving Behaviours based on health belief model: the case of taxi drivers in Bandar Abbas, Iran

BACKGROUND

Road accidents are among the main causes of mortality. As safe and secure driving is a key strategy to reduce car injuries and offenses, the present research aimed to explore safe driving behaviours among taxi drivers based on the Health Belief Model (HBM).

METHODS

This study was conducted on 184 taxi drivers in Bandar Abbas who were selected based on a multiple stratified sampling method. Data were collected by a questionnaire comprised of a demographic information section along with the constructs of the HBM. Data were analysed by SPSS ver19 via a Pearson's correlation coefficient and multiple regressions.

RESULTS

The mean age of the participants was 45.1 years (SD = 11.1). They all had, on average, 10.3 (SD = 7/5) years of taxi driving experience. Among the HBM components, cues to action and perceived benefits were shown to be positively correlated with safe driving behaviours, while perceived barriers were negatively correlated. Cues to action, perceived barriers and perceived benefits were shown to be the strongest predictors of a safe drivers' behaviour.

CONCLUSIONS

Based on the results of this study in designing health promotion programmes to improve safe driving behaviours among taxi drivers, cues to action, perceived benefits and perceived barriers are important. Therefore, advertising, the design of information campaigns, emphasis on the benefits of safe driving behaviours and modification barriers are recommended.

Social psychological aspects of ACL injury prevention and rehabilitation: An integrated model for behavioral adherence

Managing rehabilitation for ACL injury is dependent on uptake of, and compliance with, medical and safety recommendations. In this paper, we propose a multi-theory model that integrates self-determination theory and the theory of planned behavior to identify the motivational determinants ACL injury prevention and management behaviors and the processes involved.

Investigation and identification of factors affecting migrating peasant workers' usage of safety footwear in the Chinese construction industry

A sample of 300 migrating peasant workers from 15 Chinese building construction sites completed a demographic questionnaire to investigate the usage of safety footwear. The survey form was constructed based on the theory of planned behaviour, and a total of 12 questions focusing on the workers' past experience, attitudes, subjective norms and perceived behavioural control were included in the survey. It was found that 92% of the participants did not wear safety footwear while working on construction sites, although more than 91% of them believed that safety footwear would protect the foot from injury; none of the participants had been provided free safety footwear by their employer. Regression analysis shows that employers' attitude is the most important factor affecting their usage of safety footwear, 'providing free safety footwear' and 'comfortability of the safety footwear' ranking second and third respectively.

Models of health behaviour predict intention to use long acting reversible contraception use

The aim of this study was to investigate women’s intention to use long-acting reversible contraception using two established models of health behaviour: the theory of planned behaviour and the health belief model. A questionnaire was completed by a convenience sample of 128 women attending a community sexual health clinic. The independent variables were constructs of theory of planned behaviour (attitude, subjective norm and perceived behavioural control) and health belief model (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, health motivation and cues to action). The dependent variable was intention to use long-acting reversible contraception. The theory of planned behaviour and the health belief model accounted for 75% of the variance in intention to use. Perceived behavioural control, perceived barriers and health motivation predict the use of long-acting reversible contraception. Public health information for women considering using long-acting reversible contraception should be based around addressing the perceived barriers and promoting long-acting reversible contraception as a reliable contraceptive method.

An extension of the theory of planned behavior to predict pedestrians' violating crossing behavior using structural equation modeling

This paper aimed to examine pedestrians' self-reported violating crossing behavior intentions by applying the theory of planned behavior (TPB). We studied the behavior intentions regarding instrumental attitude, subjective norm, perceived behavioral control, the three basic components of TPB, and extended the theory by adding new factors including descriptive norm, perceived risk and conformity tendency to evaluate their respective impacts on pedestrians' behavior intentions. A questionnaire presented with a scenario that pedestrians crossed the road violating the pedestrian lights at an intersection was designed, and the survey was conducted in Dalian, China. Based on the 260 complete and valid responses, reliability and validity of the data for each question was evaluated. The data were then analyzed by using the structural equation modeling (SEM). The results showed that people had a negative attitude toward the behavior of violating road-crossing rules; they perceived social influences from their family and friends; and they believed that this kind of risky behavior would potentially harm them in a traffic accident. The results also showed that instrumental attitude and subjective norm were significant in the basic TPB model. After adding descriptive norm, subjective norm was no more significant. Other models showed that conformity tendency was a strong predictor, indicating that the presence of other pedestrians would influence behavioral intention. The findings could help to design more effective interventions and safety campaigns, such as changing people's attitude toward this violation behavior, correcting the social norms, increasing their safety awareness, etc. in order to reduce pedestrians' road crossing violations.

Old Clothes and an Older Look

Social cognition models (SCMs) have been described by Ingham as old clothes fit only for the jumble, yet their use in investigations of health behaviour performance in recent years has proliferated rather than declined. In a critique of the literature, this paper highlights a range of theoretical, methodological and performance-based limitations of the SCM approach and demonstrates that a ceiling has now been reached whereby more than half the variance in health behaviour performance is routinely unexplained, despite all efforts to improve the models. A major conceptual flaw within the SCM approach is identified and it is argued that `health behaviours', as generally defined, do not exist and that health-related activities only acquire meaning and significance on the basis of their relationship to the broader social prac- tices of which they form a part. A `new look' is proposed for research in this field which takes this alternative conceptualization into account.

Parental attitudes and behaviours concerning helmet use in childhood activities: rural focus group interviews

Previous research demonstrates the importance of parents in ensuring that their children practice proper helmet use. Parents encourage helmet use by setting an example when they wear helmets, as well as establishing rules that the children are expected to follow. Research in the area of helmet use predominantly focuses on bicycle helmets, but there are a number of childhood activities for which a helmet is required. The purpose of this research was to examine rural parents' attitudes toward helmet use and investigate when, and for what activities, they require their children to wear helmets. Rural parents were selected as there is evidence that helmet use is less frequent among children in rural settings. Expanding on the literature, an exploratory qualitative methodology was used to gather data. Eight focus groups were held in rural Saskatchewan to explore what influences parents' decisions to wear helmets themselves, and when and why they enforce helmet rules with their children. A thematic analysis was subsequently conducted on the data. The results suggest that parents recognize that their rules and their example influence their children. Participants mentioned being consistent, establishing rules and using positive reinforcement as ways to encourage helmet use among their children. Helmet costs and lack of awareness of helmet necessity in particular activities were barriers to helmet use. Specific barriers to helmet use in rural areas included the difficulty in finding proper helmets, the lack of exposure to helmet promotion initiatives, and the perception that activities in rural areas were safer than in the city. Parents tended to make their own helmet decisions based on personal experience and threat perception of the activity. This reasoning was the basis for when and why they established helmet rules. It is important to raise awareness of the risks of head injury and the benefits of wearing a helmet in other activities besides bicycling. More effort is needed to reach rural populations with information and opportunities to access appropriate and affordable helmets. Legislating mandatory helmet use could be useful in promoting helmet use in adults and children. Alternatively, the use of incentives for children wearing helmets could also serve as a reinforcement mechanism to increase use. A synthesis of the data gathered suggests that a theoretical approach based on increasing predisposing, enabling and reinforcing factors for helmet use may be useful in future interventions.

Health belief model based evaluation of school health education programme for injury prevention among high school students in the community context

Background

Although multifaceted community-based programmes have been widely developed, there remains a paucity of evaluation of the effectiveness of multifaceted injury prevention programmes implemented in different settings in the community context. This study was to provide information for the evaluation of community-based health education programmes of injury prevention among high school students.

Methods

The pre-intervention survey was conducted in November 2009. Health belief model (HBM) based health education for injury prevention started in January 2010 and stopped in the end of 2011 among high school students in the community context in Shanghai, China. A post-intervention survey was conducted six weeks after the completion of intervention. Injury-related health belief indicators were captured by a short questionnaire before and after the intervention. Health belief scores were calculated and compared using the simple sum score (SSS) method and the confirmatory factor analysis weighted score (CFAWS) method, respectively.

Results

The average reliability coefficient for the questionnaire was 0.89. The factor structure of HBM was given and the data fit HBM in the confirmatory factor analysis (CFA) very well. The result of CFA showed that Perceived Benefits of Taking Action (BEN) and Perceived Seriousness (SER) had the greatest impact on the health belief, Perceived Susceptibility (SUS) and Cues to Action (CTA) were the second and third most important components of HBM respectively. Barriers to Taking Action (BAR) had no notable impact on HBM. The standardized path coefficient was only 0.35, with only a small impact on CTA. The health belief score was significantly higher after intervention (p < 0.001), which was similar in the CFAWS method and in the SSS method. However, the 95% confidential interval in the CFAWS method was narrower than that in the SSS method.

Conclusions

The results of CFA provide further empirical support for the HBM in injury intervention. The CFAWS method can be used to calculate the health belief scores and evaluate the injury related intervention. The community-based school health education might improve injury-related health belief among high school students; however, this preliminary observation needs to be confirmed in further research.

Theoretical integration and the psychology of sport injury prevention

Integrating different theories of motivation to facilitate or predict behaviour change has received an increasing amount of attention within the health, sport and exercise science literature. A recent review article in Sports Medicine, by Keats, Emery and Finch presented an integrated model using two prominent theories in social psychology, self-determination theory (SDT) and the theory of planned behaviour (TPB), aimed at explaining and enhancing athletes' adherence to sport injury prevention. While echoing their optimistic views about the utility of these two theories to explain adherence in this area and the virtues of theoretical integration, we would like to seize this opportunity to clarify several conceptual principles arising from the authors' integration of the theories. Clarifying the theoretical assumptions and explaining precisely how theoretical integration works is crucial not only for improving the comprehensiveness of the integrated framework for predicting injury prevention behaviour, but also to aid the design of effective intervention strategies targeting behavioural adherence. In this article, we use the integration of SDT and TPB as an example to demonstrate how theoretical integration can advance the understanding of injury prevention behaviour in sport.

Pedestrians' intention to jaywalk: Automatic or planned? A study based on a dual-process model in China

The present study investigates the determining factors of Chinese pedestrians' intention to violate traffic laws using a dual-process model. This model divides the cognitive processes of intention formation into controlled analytical processes and automatic associative processes. Specifically, the process explained by the augmented theory of planned behavior (TPB) is controlled, whereas the process based on past behavior is automatic. The results of a survey conducted on 323 adult pedestrian respondents showed that the two added TPB variables had different effects on the intention to violate, i.e., personal norms were significantly related to traffic violation intention, whereas descriptive norms were non-significant predictors. Past behavior significantly but uniquely predicted the intention to violate: the results of the relative weight analysis indicated that the largest percentage of variance in pedestrians' intention to violate was explained by past behavior (42%). According to the dual-process model, therefore, pedestrians' intention formation relies more on habit than on cognitive TPB components and social norms. The implications of these findings for the development of intervention programs are discussed.

Effect of social influences on pharmacists' intention to report adverse drug events

OBJECTIVES

To identify the groups or individuals that influence pharmacists' decision making to report adverse drug events (ADEs), determine the differences in social influence or subjective norm between intenders and nonintenders, and determine the relationship between subjective norm toward reporting serious ADEs and practice and demographic characteristics.

DESIGN

Nonexperimental cross-sectional study.

SETTING

Texas during June and July 2009.

PARTICIPANTS

1,500 Texas pharmacists.

INTERVENTION

As part of a larger survey, 3 and 18 items were used to assess pharmacists' intentions and subjective norm, respectively, to report serious ADEs to the Food and Drug Administration (FDA).

MAIN OUTCOME MEASURE

Pharmacists' subjective norm toward reporting serious ADEs.

RESULTS

The survey had a response rate of 26.4% (n = 377). Most pharmacists intended to report serious ADEs that they would encounter (15.87 ± 4.22 [mean ± SD], possible range 3-21, neutral = 12). The mean subjective norm scores were moderately high and positive (28.75 ± 9.38, 1-49, 16), indicating that the referents had a moderate influence on pharmacists regarding reporting serious ADEs to FDA. FDA had the greatest (34.82 ± 12.16) and drug manufacturers the lowest (21.55 ± 13.83) social influence. The most important salient referents (important others) in pharmacists' decisions to report serious ADEs were FDA, patients, pharmacy associations, pharmacy managers/bosses, and hospitals and hospital groups. Gender (female equals higher), pharmacists' years of experience (negative correlation), and knowledge of ADE reporting (positive correlation) were associated with subjective norm.

CONCLUSION

Pharmacists had a moderately high subjective norm, suggesting that ADE reporting intentions is influenced by others and that the opinions of others are of great importance in pharmacists' intentions regarding ADE reporting. The main drivers of subjective norm were FDA, patients, pharmacy associations, and managers/bosses.

Self-determined forms of motivation predict sport injury prevention and rehabilitation intentions

OBJECTIVES

Two studies were conducted to examine how motivational regulations from self-determination theory (SDT) influenced athletes' intentions towards sport-injury rehabilitation (Study 1) and prevention behaviours (Study 2) using the theory of planned behaviour (TPB) as a framework.

DESIGN

A cross-sectional survey was employed.

METHODS

Elite athletes (Study 1: N=214; Study 2: N=533) completed the Treatment Self-Regulation Questionnaire and psychometric measures of constructs from the TPB, with respect to their rehabilitation from sport injury in a hypothetical scenario (Study 1), or their injury prevention experiences (Study 2).

RESULTS

Partial least squares path analytic models indicated acceptable fit of the hypothesised model in all samples, and consistently found in both studies that autonomous motivation from SDT was positively associated with attitudes, subjective norms and perceived behavioural control from the TPB, and these three TPB variables positively predicted intentions of injury rehabilitation and prevention. Controlled motivation from SDT was, unexpectedly, positively linked to intentions, but the effect was smaller than that for autonomous motivation.

CONCLUSIONS

Motivational regulations from SDT might serve as sources of information that influence athletes' intentions through their impact on the attitude, perceived social norm and controllability of injury rehabilitation and prevention.

Using the theory of planned behaviour and prototype willingness model to target binge drinking in female undergraduate university students

The current study investigated whether binge drinking in female undergraduates could be reduced by the mere measurement effect (MME), and by altering binge drinker prototypes from the prototype willingness model (PWM). Whether willingness added to the theory of planned behaviour (TPB) was also explored. Female undergraduates aged 17-25 (N=122) were randomly allocated to a prototype manipulation, mere measurement, or control group, and completed two online questionnaires separated by 14-21 days. Controlling for past behaviour, MME group consumed less alcohol than the control group, and this effect was more extreme for those who previously consumed more alcohol. However, the prototype manipulation had no effect. The TPB variables were predictive of intentions and behaviour, but willingness was not. Despite limitations, the MME could be utilised to reduce binge drinking in female undergraduates. The TPB appears to model binge drinking in female undergraduates better than the PWM, implying that binge drinking can be a reasoned behaviour.

Determinants of helmet use behaviour among employed motorcycle riders in Yazd, Iran based on theory of planned behaviour

This paper reports on predictors of helmet use behaviour, using variables based on the theory of planned behaviour model among the employed motorcycle riders in Yazd-Iran, in an attempt to identify influential factors that may be addressed through intervention efforts. In 2007, a cluster random sample of 130 employed motorcycle riders in the city of Yazd in central Iran, participated in the study. Appropriate instruments were designed to measure the variables of interest (attitude, subjective norms, perceived behaviour control, intention along with helmet use behaviour). Reliability and validity of the instruments were examined and approved. The statistical analysis of the data included descriptive statistics, bivariate correlations, and multiple regression. Based on the results, 56 out of all the respondents (43.1%) had history of accident by motorcycle. Of these motorcycle riders only 10.7% were wearing their helmet at the time of their accident. Intention and perceived behavioural control showed a significant relationship with helmet use behaviour and perceived behaviour control was the strongest predictor of helmet use intention, followed by subjective norms, and attitude. It was found that that helmet use rate among motorcycle riders was very low. The findings of present study provide a preliminary support for the TPB model as an effective framework for examining helmet use in motorcycle riders. Understanding motorcycle rider's thoughts, feelings and beliefs about helmet use behaviour can assist intervention specialists to develop and implement effective programs in order to promote helmet use among motorcycle riders.

Predicting intentions not to "drink and drive" using an extended version of the theory of planned behaviour

The aim of this study was to determine to what extent the theory of planned behaviour (TPB) extended with moral norm and descriptive norm is able to predict intentions not to drink and drive. We also wanted to examine whether different processes guide intentions among young drivers (35 years and below) versus drivers aged above 35 years, and women's versus men's intentions. Questionnaires were sent to a sample of 4000 people in Norway aged between 18 and 70 years, and were completed by 1025 respondents. Analyses were conducted among those who had a driver's licence and who reported drinking at least 1-2 times per year, resulting in a sample of 879 individuals (46.6% were men, 30.3% were 35 years and younger, M=43.9 years). The results showed that the TPB variables explained 10% of the variance in intentions in the sample as a whole, and that the extension variables added 2% to the explained variance after controlling for the impact of the TPB components. Perceived behavioural control was the strongest predictor of intentions (β=0.24, p<0.001), followed by descriptive norm (β=-0.12, p<0.001), attitude (β=0.09, p<0.01) and moral norm (β=0.08, p<0.05). Several group differences were found. The extended TPB model explained 16% and 5% of men's and women's intentions, respectively, and 26% and 9% of the variance in intentions among young and older drivers, respectively. The practical implications of these results for the development of interventions to encourage drivers not to drink and drive will be outlined.

Hygienic food handling behaviors: attempting to bridge the intention-behavior gap using aspects from temporal self-regulation theory

An estimated 25% of the populations of both the United States and Australia suffer from foodborne illness every year, generally as a result of incorrect food handling practices. The aim of the current study was to determine through the application of the theory of planned behavior what motivates these behaviors and to supplement the model with two aspects of temporal self-regulation theory--behavioral prepotency and executive function--in an attempt to bridge the "intention-behavior gap." A prospective 1-week design was utilized to investigate the prediction of food hygiene using the theory of planned behavior with the additional variables of behavioral prepotency and executive function. One hundred forty-nine undergraduate psychology students completed two neurocognitive executive function tasks and a self-report questionnaire assessing theory of planned behavior variables, behavioral prepotency, and intentions to perform hygienic food handling behaviors. A week later, behavior was assessed via a follow-up self-report questionnaire. It was found that subjective norm and perceived behavioral control predicted intentions and intentions predicted behavior. However, behavioral prepotency was found to be the strongest predictor of behavior, over and above intentions, suggesting that food hygiene behavior is habitual. Neither executive function measure of self-regulation predicted any additional variance. These results provide support for the utility of the theory of planned behavior in this health domain, but the augmentation of the theory with two aspects of temporal self-regulation theory was only partially successful.

Determinants of seat belt use among drivers in Sabzevar, Iran: a comparison of theory of planned behavior and health belief model

OBJECTIVE

Although seat belt use can significantly decrease the risk of injury, few car drivers make use of seat belts in Iran. The aim of this study was to test the utility and efficiencyof the theory of planned behavior (TPB) and the health beliefmodel (HBM) in predicting intention to use a seat belt among car drivers in Sabzevar, Iran.

METHODS

A cross-sectional, correlational design was employed. Cluster sampling was used to recruit 340 drivers to participate in the study. A self-administered questionnaire was applied to investigate variables of interest. Reliability and validity of the instruments were examined. The statistical analyses of the data included t test, one-way analysis of variance (ANOVA), bivariate correlation, and stepwise regression.

RESULTS

All TPB and HBM variables were related to intention to use a seat belt in car drivers. All TPB (perceived behavioral control, subjective norms, and attitude) and HBM (perceived susceptibility and severity, benefits and barriers, and cues to action) variables were statistically significant predictors of seat belt use intention and accounted for 37.9 and 15.4 percent of the variation, respectively.

CONCLUSIONS

Our results showed that the rate of seat belt use in Iran as a developing country is very low. Thus, developing and implementing effective interventional programs in order to promote seat belt use among car drivers is recommended. The findings of this study provide preliminary support for the TPB model as a more effective framework than HBM for examining seat belt use in car drivers. Our results demonstrated that TPB has greater predictive utility than HBM in seat belt use intention.

An application of an extended health belief model to the prediction of breast self-examination among women with a family history of breast cancer

OBJECTIVES

This study reports an application of the health belief model (HBM) to the prediction of breast self-examination (BSE) among women with a family history of breast cancer. The study also considered the influence of breast cancer worries and past behaviour.

METHODS

Eight hundred and thirty-three women completed questionnaires, based on the HBM, to assess their beliefs about breast cancer and BSE. Of these women, 567 were followed-up at 9 months when BSE frequency was assessed.

RESULTS

Discriminant function analysis was employed to discriminate among infrequent, appropriate and excessive BSE. Two functions were calculated which were predictive of group membership. The first function maximally discriminated between the infrequent BSE group and the other two groups, with infrequent selfexaminers reporting a greater number of self-efficacy and emotion barriers, fewer benefits and less frequent BSE at Time 1. The second function maximally discriminated between the excessive BSE group and the appropriate BSE group, with excessive selfexaminers reporting higher levels of breast cancer worries and perceived severity and fewer self-efficacy barriers.

CONCLUSIONS

The results highlight the importance of focusing on excessive as well as infrequent BSE. Interventions designed to enhance women's confidence in their ability to perform BSE, coupled with attempts to reduce breast cancer worries, may encourage more appropriate and effective BSE.

Social cognitive determinants of the intention to wear safety gear among adult in-line skaters

INTRODUCTION

In-line skating is increasing in popularity with a concomitant raise in the number of injuries associated with this activity. Studies have emphasized the value of protective gears in reducing the incidence of injuries and the subsequent need to identify the factors and processes involved in decision making about safety gear-wearing. The present study examined the contribution of the theory of planned behaviour (TPB) variables, and perceived susceptibility to and perceived severity of skating injury on the safety gear-wearing intention of adult skaters.

METHODS

Skaters (n=181) completed a questionnaire assessing the constructs of the TPB, perceived susceptibility to and perceived severity of skating injuries, and intention to wear safety gear.

RESULTS

Hierarchical regression analyses revealed significant contributions of instrumental attitude and subjective norm to the prediction of safety gear-wearing intention. In addition, perceived susceptibility to and perceived severity of injuries enhanced the prediction of intentions to wear safety gear over and above the contribution of TPB components.

CONCLUSION

As the TPB focuses only on behavioural evaluation, it seems promising to include threat perceptions in this theory as another aspect of health-related cognitions motivating intention formation about safety gear use. Practical implications for future campaigns and countermeasures are discussed.

Discrepancy in bicycle helmet use among college students between two bicycle use purposes: commuting and recreation

OBJECTIVES

The purpose of the study was to examine associations between bicycle helmet use and attitudes among U.S. college students. Bicycle helmet use was assessed for two different bicycle use purposes: commuting to school and recreation.

MATERIALS AND METHODS

Student bicycle riders were recruited on the campus of a large public university in Colorado. Questionnaire development was guided by the Theory of Reasoned Action and Health Belief Model. Bicycle use and helmet use for the two purposes, attitudes toward helmet use and bicycle helmet regulations on campus, perceived risk of bicycle-related injury, subjective norms were asked. Bicycle helmet use was defined by current behaviors and intentions for the future, based on the Stages of Change model.

RESULTS

A total of 192 questionnaires collected from students who rode bicycles for both commuting and recreation was used for the analysis. Bicycle helmet use differed depending on purposes of bicycle riding: 9.4% of bicycle riders wore bicycle helmets every time for commuting, while 36.5% did so for recreation. Different variables were associated with bicycle helmet use for commuting and recreation in logistic regression models, suggesting that psychosocial structures behind bicycle helmet use behaviors might differ between two bicycle use purposes, commuting and recreation.

Understanding sustained behavior change: the role of life crises and the process of reinvention

Much research has addressed behavior change but has tended to focus on short term changes. This study aimed to explore the mechanisms behind sustained changes in behavior and involved qualitative interviews with 34 ;success stories' who had either lost weight through changes in diet and exercise (n = 24) or stopped smoking (n = 10) and had maintained this change for at least 3 years. The results showed that the majority described how their sustained behavior change had been triggered by a significant life crisis relating to their health, relationships or salient milestones. This initial change was then translated into sustained change if three sustaining conditions were met: the function of the unhealthy behavior was disrupted, the individual perceived that their choice over carrying out the unhealthy behavior had been reduced and they adhered to a behavioral model of their problem. Further, these conditions functioned by enabling a process of reinvention with participants showing a shift in identity toward a new healthier self. The results are discussed in terms of self-regulation and the establishment of a new post-crisis healthier equilibrium.

The role of clinical and social cognitive variables in parasuicide

OBJECTIVES

The central aim of the present study was to investigate the extent to which social cognitive variables could mediate the effects of past self-harm behaviour and clinical variables on intentions to engage in deliberate self-harm (DSH) and suicidality in the next three months. In addition, we aimed to extend the application of the theory of planned behaviour (TPB) beyond distal health outcomes to a behaviour that is proximal and extreme. Design and method. A prospective study design was employed. Ninety parasuicide patients admitted via accident and emergency to a general hospital completed measures of hopelessness, depression, anxiety, past self-harm behaviour, standard TPB and group identity measures within days of an overdose. Three months later, participants were asked to complete a measure of suicidal thinking and behaviour.

RESULTS

There was clear evidence that the social cognitive variables were significant predictors of intention to engage in DSH and suicidality three months later. Depression was the only clinical variable which remained significant when all variables were entered into the final model to predict intentions. Attitudes, self-efficacy and intention mediated the clinical variables-suicidality relationship.

CONCLUSIONS

The TPB is a useful framework for understanding suicidal behaviour. The results extend the application of the TPB beyond distal health outcomes to a behaviour that is both proximal and extreme. Future research should explore the implications for screening assessment and suicide prevention.

The effect of age, gender and driver status on pedestrians' intentions to cross the road in risky situations

The theory of planned behaviour (TPB) has been used successfully in the past to account for pedestrians' intentions to cross the road in risky situations. However, accident statistics show age and gender differences in the likelihood of adult pedestrian accidents. This study extends earlier work by examining the relative importance of the model components as predictors of intention to cross for four different adult age groups, men, women, drivers and nondrivers. The groups did not differ in the extent to which they differentiated between two situations of varying perceived risk. The model fit was good, but accounted for less of the variance in intention for the youngest group (17-24) than for other age groups. Differences between the age groups in intention to cross seemed to be due to differences in perceived value of crossing rather than differences in perceived risk. Women were less likely to intend to cross than men and perceived more risk, and there were important age, gender and driver status differences in the importance of the TPB variables as predictors of intention. A key implication of these findings is that road safety interventions need to be designed differently for different groups.

Predicting bicycle helmet wearing intentions and behavior among adolescents

INTRODUCTION

Cycling accidents in Australia, especially those resulting in head injuries, are a substantive cause of death and disability; but despite legislation and evidence that helmets reduce the risk of head injury, few adolescents wear them.

METHOD

This study employed a revised version of the Theory of Planned Behavior (TPB; [Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211]) to investigate the determinants of helmet use among a sample of adolescents. Participants in the initial data collection were 294 high school students in Year 8 and Year 11, with 266 completing a follow-up questionnaire measuring behavior over the previous two weeks.

RESULTS

Social norms, perceptions of control, and past behavior significantly predicted intentions to use helmets and perceptions of control and past behavior predicted actual helmet use.

CONCLUSIONS

Strengthening the routine of helmet use and building young people's confidence that they can overcome any perceived barriers to helmet use will improve adherence to helmet wearing behavior.

The prediction of safe lifting behavior: an application of the theory of planned behavior

PROBLEM

Injuries resulting from lifting are costly, and create significant pain and discomfort. While engineering controls are the most effective means of reducing risks, most organizations continue to rely on manual lifting techniques. The problem, however, is that the use of safe-lifting techniques is inconsistent and managers have a difficult time motivating use of these techniques. Consequently, it is important to understand the factors driving safe-lifting behaviors.

METHODS

This study used a survey to apply the theory of planned behavior (Ajzen., I., 1991. The theory of planned behavior. Organization Behavior and Human Processes, 50, 179-211) to safe-lifting among 136 materials management employees at a heavy manufacturing organization. Structural equation modeling and factor analysis were employed to analyze relationships among constructs.

RESULTS

Results revealed that perceived behavioral control and intention were the strongest predictors of safe-lifting behavior. Subjective norms, to a lesser degree, were also important influences on intention. Attitudes did not surface as effective direct predictors of safe-lifting behavior, but did affect behavior and intent via mediating factors (subjective norms and perceived behavioral control). Finally, the theory of planned behavior was supported as an effective model explaining safe-lifting behavior, and had potential application for many other safety-related behaviors.

IMPACT ON INDUSTRY

Results from this study emphasize the importance of perceived behavioral control as a factor associated with safety-related behavior.