The Theory of Planned Behavior and Breast Self-Examination: Distinguishing Between Perceived Control and Self-Efficacy

Prospective association of eHealth literacy and health literacy with physical activity among Chinese college students: a multiple mediation analysis

Background

The COVID-19 pandemic has decreased physical activity (PA) while increasing demand for electronic health resources. eHealth literacy (EHL) is expected to aid eHealth use and health promotion. EHL was raised on the grounds of health literacy (HL). This study explored the associations among EHL, HL, and PA in Chinese college students and identified mediating mechanisms in the EHL/HL-PA relationship.

Methods

An integrated social-cognitive model was proposed. A total of 947 Chinese college students (52.8% women, age = 19.87 ± 1.68 years) completed the three-wave data collection. Path analysis was performed.

Results

An adequate good-to-fit model was indicated. Perceived EHL (PEHL) was significantly associated with perceived HL (PHL) and HL performance (HLP); PHL was negatively related to HLP; PEHL was significantly associated with self-efficacy (SE) and social support (SS); PHL had a significant effect on SS but not SE; HLP significantly affected SS but not SE; SS and SE positively predicted intention (INT), which then predicted PA. SS mediated PEHL/PHL-INT links; SE mediated the PEHL-INT link; SS and INT jointly mediated PEHL/PHL/HLP-PA; SE and INT jointly mediated PEHL-PA.

Conclusion

Relationships among EHL, HL, and PA were explored with multiple mediating mechanisms identified. Differential SE and SS roles in EHL/HL-PA links suggest new mechanisms to inform EHL/HL intervention development.

Effects of Information Provided to University Students Through an Educational Brochure on Health Beliefs and Testicular Self-Examination

This study aimed to examine the effect of an educational brochure about testicular cancer and its early diagnosis on the health beliefs and self-examination of participants. The pretests/posttests were conducted in a quasi-experimental design with non-randomized groups and a control group of university students. The study recruited students enrolled in the psychological counseling and guidance department of a Turkish public university. The research sample comprised 92 students, 48 in the experimental and 44 in the control group. An educational brochure about testicular cancer and self-examination was provided to the experimental group. The data includes a personal information form, testicular cancer and health beliefs scale about testicular self-examination, and the form for self-examination. Mann Whitney U, Wilcoxon, and chi-square analyses were performed for data analysis. A significant difference was found between the scores of the experimental and control groups regarding seriousness/caring, benefit and health motivation, obstacles, and self-efficacy (p < 0.05). Moreover, the testicular self-examination ratio was determined as 83.3% in the experimental group and 4.5% in the control group. It can be asserted that the training brochure is effective in promoting the self-examination of testicles. It may be recommended to conduct experimental studies with larger study groups to increase testicular self-examination.

Attitude sustains longer than subjective norm and perceived behavioral control: Results of breast cancer screening educational intervention

Breast malignancy is the most frequent carcinoma among females across the world and third-most in Nepal. Early diagnosis of breast cancer through breast health awareness and self-examination, in addition to mammography screening, is a highly feasible and useful technique in poorly resourced settings. However, their intentions, whether to modify behaviors or actions, remain debatable and less explained in the literature. So, we aimed to assess how long an educational intervention affects women's intention to do a breast self-examination (BSE) and mammography screening. After assessing feasibility, one ward was assigned to the intervention (IG; ward number 30) and control group (CG; ward number 33), and then with inclusion criteria, a total of 360 females (180 each in IG and CG) aged 40-75 years enrolled in the study. After the baseline assessment, participants in the IG were delivered an hour-long breast cancer screening-related lecture-discussion- demonstration session that included BSE and mammography, aided with a silicone dummy. The session was carried out by the female trained nurses. Outcome data were obtained at the baseline, 4, 8, and 12 months following the intervention. Attitudes, perceived behavioral controls (PBCs) and behavioral intents (BIs) of both mammography and BSE at baseline were similar in both IG and CG except in case of subjective norms (SNs). Intents of BSE remained effective for 4 months, whereas for mammography, it was effective only at 4 and 12 months. Moreover, attitudes toward both tests remained intact for 4, 8, and 12 months (p = < .05) consistently. With regards to PBCs, women having good control remained only for 4 months in both screening tests. Further, regarding SN, significant mean changes were observed at 4 and 12 months in BSE, and only at 4 months in mammography screening. The session was effective in sustaining BSE and mammography intentions for at least 4 months. To retain the effects longer (up to 12 months), additional educational strategies focusing on subjective norms and perceived behavioral controls of both tests are highly warranted.

Chinese football violence: An extended theory of planned behavior model to predict fans' violent behavioral intentions

This study introduced deindividuation (DI) variables and constructed a mechanism model of football fans' violent behavioral intentions (FVBI) in China based on theory of planned behavior (TPB). Specifically, taking Chinese football fans as the research subjects, we used a structural equation model (SEM) to explore the specific effects of subjective norms (SNs), perceived behavioral control, DI, and attitude (AT) on violent behavior intentions. Our results showed that SNs (β = -0.132, P < 0.01) had a significant negative predictive effect on FVBI, while perceived behavioral control (β = 0.297, P < 0.01), DI (β = 0.239, P < 0.01), and AT (β = 0.416, P < 0.01) had a significant positive predictive effect. However, we found that AT was the most important factor that predicted the FVBI and played a mediating role between SNs and FVBI, between perceived behavior control (PBC) and FVBI, and between DI and FVBI as well.

The Perception and Attitude of Farmers toward Domestic Waste Classifications: A Case Study on Wusheng County, Sichuan Province, China

The effective treatment of rural domestic waste is the key to solving rural environmental pollution and realizing rural ecological revitalization. Giving full play to the main role of farmers' domestic waste classification can improve the efficiency and effect of domestic waste treatment. To explore the key factors affecting the farmers' perception, attitude, and behavior of domestic waste classification, this study with 318 farmers in Sichuan Province as the research object, the research framework of domestic waste classification behavior was constructed based on the theory of planned behavior, and then, the logistic regression model was used for the empirical test. The results show that the farmers' education levels, subjective norms, relatives' and neighbors' views on waste classification, farmers' awareness regarding the negative environmental impacts caused by waste, farmers' private benefits, and farmers' views on the waste management ability of local governments are significantly positively correlated with the classification behavior of farmers' domestic waste. The distance between farmers' houses and waste collection points is significantly negatively correlated with the classification behavior of farmers' domestic waste. This paper provides a certain theoretical reference for realizing the reduction, resourcization, and positive development of rural domestic waste management in China.

Know Your Safe Drinking Skills: Adaptation Strategies for the College Effect

Objective: The current study investigates the effects of an alcohol-prevention program delivered to college students in a formal classroom setting. Participants: The sample comprised 231 first-year college students who enrolled in a multisection “First Year Experience” course at a large northeastern university in the United States. Method: A naturalistic experiment was conducted, with a baseline evaluation at the beginning of the semester and a post-experiment evaluation near the end of the semester. Results: Social drinking attitudes, proximal drinking norm and the college effect are significant predictors of pre- and post-intervention episodic drinking frequency. The intervention reduced episodic drinking frequency as well as perceived distal and proximal drinking norms. It also increased drinking attitudes and did not change perceived efficacy or drinking-outcome expectancies. Conclusions: Practitioners could consider implementing a similar intervention to allow students to learn and practice safe drinking skills in the first year of their college life.

The Theory of Planned Behavior during the COVID-19 pandemic: A comparison of health behaviors between Belgian and French residents

The COVID-19 pandemic presents a global crisis and authorities have encouraged the population to promote preventive health behaviors to slow the spread of the virus. While the literature on psychological factors influencing health behaviors during the COVID-19 is flourishing, there is a lack of cross-national research focusing on multiple health behaviors. The present study overcomes this limitation and affords a validation of the Theory of Planned Behavior (TPB) as a conceptual framework for explaining the adoption of handwashing and limitation of social contacts, two health behaviors that highly differ in their nature. Specifically, we compare TPB model on these two protective behaviors among people living in Belgium (N = 3744) and France (N = 1060) during the COVID-19 sanitary crisis. Data were collected from March 18 until April 19, 2020, which corresponds to the spring lockdown and the first peak of the pandemic in these countries. Results indicated that more positive attitudes, greater social norms, increased perceived control and higher intentions were related to higher adherence to handwashing and limitation of social contacts, for both Belgian and French residents. Ultimately, we argued that the TPB model tends to manifest similarly across countries in explaining health behaviors, when comparing handwashing and limitation of social contacts among individuals living in different national contexts.

The impact of physician support on skin self-examination among melanoma patients: A serial mediation model with self-efficacy and intentions to perform skin exams

OBJECTIVE

Melanoma is the most lethal of skin cancers; however, survival rates are excellent if the tumor is detected early. Clinical practice guidelines for melanoma follow-up care recommend regular skin self-examination (SSE) for individuals at high risk for melanoma. The current analyses tested whether self-efficacy for SSE and intention to perform SSE mediate the relationship between physician support for SSE and SSE behavior among a sample of melanoma patients.

METHODS

We ran a serial mediation model on a cross-sectional sample of melanoma patients (n = 154) drawn from an observational study with longitudinal follow-up.

RESULTS

Self-efficacy and intention to perform SSE sequentially mediated the relationship between physician support and SSE behaviors (β = .31, t(152) = 3.61, p < .001 without mediators versus β = .11, t(150) = 1.50, p = .14 with mediators), as supported by a significant total indirect effect (β = .21, [95 % CI = .08-.35]).

CONCLUSION

Self-efficacy for SSE and intention to perform SSE together explain the link between perceived physician support for SSE and the practice of SSE.

PRACTICE IMPLICATIONS

Physician communication about the importance of SSE plays an important role in encouraging patient adherence to SSE recommendations and, thus, supporting early detection efforts.

How University Entrepreneurship Support Affects College Students’ Entrepreneurial Intentions: An Empirical Analysis from China

Given the major role of new enterprises founded by university alumni in creating employment and promoting economic development, it is well known that Chinese universities have implemented plenty of impressive initiatives to support students’ entrepreneurship. However, little is yet known about how students evaluate university entrepreneurship support and how it affects students’ entrepreneurial intentions. This study utilizes 13,954 recent college graduates from Chinese higher education institutions as a sample and aims to examine students’ perceptions of the support they received from universities and its influence on students’ entrepreneurial intentions. The results illustrate that students are not very satisfied with various university entrepreneurship supports. Findings also indicate that university entrepreneurship support positively impacts students’ entrepreneurial intentions, although it is not a very strong relationship. Moreover, university entrepreneurship support positively affects entrepreneurial attitude, subjective norms, and entrepreneurial self-efficacy, which in turn determine entrepreneurial intention. Entrepreneurial attitude, subjective norms, and entrepreneurial self-efficacy play a mediating role between university entrepreneurship support and entrepreneurial intention. The study contributes to the entrepreneurial literature theoretically and provides practical recommendations for policymakers and university administrators in China to reconsider and improve their entrepreneurship supports to encourage more students to become entrepreneurs.

Examining the External Antecedents of Innovative Work Behavior: The Role of Government Support for Talent Policy

The innovative work behavior (IWB) or creativity of employees is regarded as the key to the sustainable innovation performance of an organization. In the field of human resource management (HRM), the relationship between an organization's high-performance work system (HPWS) and IWB has been studied extensively. However, the current understanding of organizational external antecedents is limited. Our paper focuses on an extra-organizational government support factor, government support for talent policy (GSTP). Similar to HRM policies within an organization, GSTP also has an ability-motivation-opportunity framework that may influence the IWB of employees. We integrate the resource dependence theory, institutional theory, and theory of planned behavior (TPB) to propose a theoretical model of the mechanism of GSTP influence on IWB. Using a structural equation modeling approach, we empirically verify the hypotheses in a survey dataset of HRM practitioners in 152 technology-based enterprises in China. The results indicate that the external antecedent, GSTP, positively influences the innovative attitude, subjective norm, and perceived behavioral control of HRM practitioners in the organization. Innovative attitude and perceived behavioral control completely mediated the relationship between GSTP and innovative intention. Moreover, there is a distal indirect effect between GSTP and IWB. The paper contributes to filling a gap in the innovation policy literature. In practice, both HPWS and individual employees should be concerned about the possible role of GSTP.

Psychosocial Barriers of Public Transport Use and Social Exclusion among Older Adults: Empirical Evidence from Lahore, Pakistan

Transport planning and public health have been intertwined historically. The health impact of public transport services, such as social exclusion, is a widely discussed research topic. Social exclusion is a paramount concern for older adults' health in the wake of emerging global challenges. However, there remains a significant research gap on how psychosocial barriers faced by older adults in using public transport services influence the social exclusion behavior. The present research provides empirical evidence and shows the impact of certain psychosocial barriers of public transportation on older adults' social exclusion. A total of 243 Pakistani older adults (aged 60-89 years old) voluntarily participated in this cross-sectional study. The participants provided self-reports on their psychosocial barriers (including perceived norms, attitude, personal ability, habits, neighborhood social constraints, and intention) and the corresponding social exclusion. Partial Least Square Structural Equation Modeling (PLS-SEM) was utilized for the data analysis. The structural path model supported the significant associations between psychosocial barriers and social exclusion. Except for perceived descriptive norms, all other psychosocial barriers predicted older adults' social exclusion. The research portrays the significance of the psychosocial factors to examine social exclusion and offers practical implications for urban and transport planners. The concerned policymakers can use the research findings to develop age-sensitive, socially sustainable, and healthy cities.

The Effect of Educational Intervention Based on the Theory of Planned Behavior on Mammography Screening in Iranian Women

Mammography is the most special screening method for early diagnosis of breast cancer. The purpose of present research is investigating the effect of educational intervention based on theory of planned behavior on mammography screening of women in Fasa city, Fars province, Iran. In this quasi-experimental study, 400 subjects (200 subjects for experimental group and 200 subjects for control group) were selected in 2017-2018. Educational intervention for the experimental group included 8 educational sessions. A questionnaire used for evaluating demographic information and constructs of theory of planned behavior (knowledge, perceived behavioral control, subjective norms, and attitude) investigated mammography performance of women before and 6 months after intervention. Data were analyzed by using SPSS 22 through chi-square test, McNemar's test, and Wilcoxon-Mann-Whitney test at significance level of P < 0.05. The average age of subjects was 45.52 ± 6.76 years in the experimental group and 45.12 ± 6.64 years in the control group. Six months after intervention, the experimental group showed significant increase in knowledge, perceived behavioral control, subjective norms, and attitude compared to the control group and 174 people (78%) of the experimental group had intention for doing mammography and 148 people (74%) of the experimental group performed mammography. Also, 6 months after educational intervention, 38 people (19%) of the control group had intention for performing mammography and 14 people (7%) of the control group performed mammography.

Testicular self examination among Bahir Dar University students: application of integrated behavioral model

Background

Though the incidence of Testicular cancer among young is rising, little attention is given to promoting testicular self-examination which is recommended for its early prevention in developing countries. This study aimed to assess testicular self-examination and associated factors among Bahir Dar University students using integrated behavioral model.

Methods

Cross sectional study was conducted among Bahir Dar University students in September, 2016. Systematic sampling technique was used to select 884 participants. Data was collected using self-administer questionnaire, entered into EPI Data 3.1 and exported to SPSS 21 for analysis. Path analysis was done using STATA 14.2 to check causal effect of integrated behavioral model constructs on testicular self-examination. Internal reliability of the items was checked using Cronbach’s alpha. Multivariable linear and Logistic regression were used to predict the role of independent variable on Intention and TSE respectively. Findings with p-value <0.05 at 95% confidence interval were considered as statistically significant in the final model.

Results

Only 11.8% of the students practiced testicular self-examination in the previous year. Experiential and Instrumental attitude, Perceived control and Self-efficacy were significantly predicted behavioral intention with β coefficient 0.33, 0.12, −0.08 and 0.36. Students’ academic unit [OR = 0.31, 95% CI: 0.15–0.63], educational status of student’s father AOR = 2.25; CI: 1.15–4.44] and [AOR = 3.00; CI: 1.36–6.64], Intention [OR = 1.2, 95% CI: 1.1–1.31], Know-how of TSE [OR = 3.35, 95% CI:1.94–5.80] and knowledge [AOR = 3.93; CI: 2.30–6.72] were the significant predictors of testicular self-examination. The finding of path analysis also demonstrated as Experiential and Instrumental attitude, Perceived control and Self-efficacy have significant effect on intention with path coefficient of 0.33, 0.12, −0.07 and 0.36. Intention, Knowledge and Know-how have effect on testicular self-examination with path coefficient of 0.2, 0.36 and 0.22 respectively.

Conclusions

Magnitude of testicular self-examination is low among university students and it is a product of the type of the college, family educational status, intention, Know-how and knowledge. So, behavior change communication strategy that focus on these behavioral factors should be designed and implemented to improve students’ regular practice of testicular self-examination.

Electronic supplementary material

The online version of this article (10.1186/s12885-017-3935-8) contains supplementary material, which is available to authorized users.

Meta-Analysis of the Reasoned Action Approach (RAA) to Understanding Health Behaviors

Background

Reasoned action approach (RAA) includes subcomponents of attitude (experiential/instrumental), perceived norm (injunctive/descriptive), and perceived behavioral control (capacity/autonomy) to predict intention and behavior.

Purpose

To provide a meta-analysis of the RAA for health behaviors focusing on comparing the pairs of RAA subcomponents and differences between health protection and health-risk behaviors.

Methods

The present research reports a meta-analysis of correlational tests of RAA subcomponents, examination of moderators, and combined effects of subcomponents on intention and behavior. Regressions were used to predict intention and behavior based on data from studies measuring all variables.

Results

Capacity and experiential attitude had large, and other constructs had small-medium-sized correlations with intention; all constructs except autonomy were significant independent predictors of intention in regressions. Intention, capacity, and experiential attitude had medium-large, and other constructs had small-medium-sized correlations with behavior; intention, capacity, experiential attitude, and descriptive norm were significant independent predictors of behavior in regressions.

Conclusions

The RAA subcomponents have utility in predicting and understanding health behaviors.

Explaining Continuance Intention of Fruit and Vegetable Consumption among the Rural Elderly: An Application of the Expectancy Confirmation Model

Background and Aim

Healthy aging is the permanent right of all people. Thus, the purpose of this work was to investigate the expectation confirmation model constructs on intention of continuing to consume fruit and vegetables among the rural elderly.

Materials and Methods

This cross-sectional study was conducted on 332 elderly. The expectation confirmation model served as a theoretical framework. A random sampling was recruited. Data were collected through face-to-face visit in the second 6 months of 2016. The data were then analyzed using LISREL 8.5 and SPSS 16 software.

Results

This model could explain 79% of intention to continue fruit and vegetable consumption. The usefulness and satisfaction had the most effect on the intention to continue the consumption of fruit and vegetables.

Conclusion

Expectation confirmation model depicted a proper application in explaining the intention to continue the consumption of fruit and vegetables in the elderly. Since perceived benefits were the most important factor in determining the intention to continue F&V consumption in this study, it is required that policymakers utilize suitable efficient strategies to promote the perception of benefits of F&V consumption in the elderly by means of campaigns in the society, organizations, and families.

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.

Visual Exemplification and Skin Cancer: The Utility of Exemplars in Promoting Skin Self-Exams and Atypical Nevi Identification

The present article reports an experiment investigating untested propositions of exemplification theory in the context of messages promoting early melanoma detection. The study tested visual exemplar presentation types, incorporating visual persuasion principles into the study of exemplification theory and strategic message design. Compared to a control condition, representative visual exemplification was more effective at increasing message effectiveness by eliciting a surprise response, which is consistent with predictions of exemplification theory. Furthermore, participant perception of congruency between the images and text interacted with the type of visual exemplification to explain variation in message effectiveness. Different messaging strategies influenced decision making as well, with the presentation of visual exemplars resulting in people judging the atypicality of moles more conservatively. Overall, results suggest that certain visual messaging strategies may result in unintended effects of presenting people information about skin cancer. Implications for practice are discussed.

Validity and reliability analysis of the planned behavior theory scale related to the testicular self-examination in a Turkish context

OBJECTIVE

This study aimed to determine the validity and reliability levels of the Planned Behavior Theory Scale as related to a testicular self-examination.

METHODS

The study was carried out in a health-profession higher-education school in Ankara, Turkey, from April to June 2012. The study participants comprised 215 male students. Study data were collected by using a questionnaire, a planned behavior theory scale related to testicular self-examination, and Champion's Health Belief Model Scale (CHBMS).

RESULTS

The sub-dimensions of the planned behavior theory scale, namely those of intention, attitude, subjective norms and self-efficacy, were found to have Cronbach's alpha values of between 0.81 and 0.89. Exploratory factor analysis showed that items of the scale had five factors that accounted for 75% of the variance. Of these, the sub-dimension of intention was found to have the highest level of contribution. A significant correlation was found between the sub-dimensions of the testicular self-examination planned behavior theory scale and those of CHBMS (p < 0.05).

CONCLUSION

The findings suggest that the Turkish version of the testicular self-examination Planned Behavior Theory Scale is a valid and reliable measurement for Turkish society.

Expectations are more predictive of behavior than behavioral intentions: evidence from two prospective studies

BACKGROUND

Understanding the gap between people's behavioral intentions and their subsequent behavior is a key problem for behavioral scientists, but little attention has been paid to how behavioral intentions are operationalized.

PURPOSE

Test the distinction between asking people what they intend to do, as opposed to what they expect they will do.

METHODS

Two studies were conducted in the domains of alcohol consumption (N = 152) and weight loss (N = 141). Participants completed questionnaires assessing their behavioral intentions, expectations, and self-efficacy at baseline; alcohol consumption/weight were assessed at both baseline and follow-up.

RESULTS

In study 1, expectations were more predictive of alcohol consumption than behavioral intentions, controlling for baseline alcohol consumption and self-efficacy. In study 2, changes in expectations were more predictive of weight loss than changes in behavioral intentions, controlling for baseline weight and self-efficacy.

CONCLUSION

The findings support a potentially important distinction between behavioral intentions and expectations.

An extended version of the theory of planned behaviour: the role of self-efficacy and past behaviour in predicting the physical activity of Chinese adolescents

This study aimed to use an extended theory of planned behaviour (TPB), which incorporated additional self-efficacy and past behaviour, to predict the intention to engage in moderate-to-vigorous physical activity (MVPA) and the MVPA level of Chinese adolescents. Questionnaires that focused on MVPA, attitude, subjective norm, perceived behavioural control (PBC), self-efficacy and past behaviour related to the MVPA engagement were administered to a sample of 488 young people. Multiple regression analyses provided moderate support for TPB. Three TPB constructs predicted 28.7% of the variance in intentions to engage in MVPA, and that PBC, but not intention, explained 3.4% of the variance in MVPA. Self-efficacy significantly affected intention and behaviour over and above the influence of TPB. Past behaviour had a small but significant improvement in the prediction of intention, but no improvement in the prediction of MVPA. Based on the results, interventions should target adolescent self-efficacy and PBC in physical activity participation.

Understanding the Health Behaviors of Survivors of Childhood and Young-Adult Cancer: Preliminary Analysis and Model Development

The current study presents preliminary correlational data used to develop a model depicting the psychosocial pathways that lead to the health behaviors of survivors of childhood and young-adult cancer. Data collected from a sample of 18- to 30-year-old cancer survivors (n = 125) was used to examine the relations among interpersonal support and nonsupport, personal agency, avoidance, depressive symptoms and self-efficacy as they related to health behaviors. The outcome measures examined included tobacco and alcohol use, diet, exercise, sunscreen use, medication compliance and follow-up/screening practices. Correlational analyses revealed a number of significant associations among variables. Results are used to inform the development of a health behavior model. Implications for health promotion and survivorship programming are discussed, as well as directions for future research.

Predicting actual weight loss: A review of the determinants according to the theory of planned behaviour

Weight reduction that corresponds with lifestyle modification is difficult to foster. The theory of planned behaviour has been actively cited in explaining health-related behaviour. This review evaluated the application of the theory of planned behaviour to weight-loss behaviour. Among the three reviewed papers, cross-sectional survey designs and subjective outcome measurements were commonly applied. All of the studies recruited obese female adults as participants, limiting the generalisability of the studies' findings. The theory of planned behaviour can be effectively applied in weight-reduction programmes targeting female obese patients. This review confirmed critiques citing the limitations of experimental studies, the subjective measurement of behaviour and short follow-up periods.

Health literacy predicts change in physical activity self-efficacy among sedentary Latinas

Health literacy (HL) is associated with preventive health behaviors. Self-efficacy is a predictor of health behavior, including physical activity (PA); however, causal pathways between HL and self-efficacy for PA are unknown, especially among Latinas who are at risk for chronic disease. To explore this potential relationship, secondary analyses were conducted on data [Shortened Test of Functional Health Literacy in Adults (STOFHLA), PA self-efficacy, and socio-demographics] from a 6-month, randomized controlled trial of a print-based PA intervention (n = 89 Spanish-speaking Latinas). Linear regression models revealed associations between HL and baseline self-efficacy in addition to changes in self-efficacy at 6-months. After controlling for significant covariates, higher HL scores were associated with lower baseline PA self-efficacy. Regardless of treatment assignment, higher HL scores at baseline predicted greater changes in PA self-efficacy at 6-months. HL may contribute to Latinas' improved PA self-efficacy, though further research is warranted.

Factors Influencing Physical Activity Behavior among Iranian Women with Type 2 Diabetes Using the Extended Theory of Reasoned Action

BACKGROUND

Findings of most studies indicate that the only way to control diabetes and prevent its debilitating effects is through the continuous performance of self-care behaviors. Physical activity is a non-pharmacological method of diabetes treatment and because of its positive effects on diabetic patients, it is being increasingly considered by researchers and practitioners. This study aimed at determining factors influencing physical activity among diabetic women in Iran, using the extended theory of reasoned action in Iran.

METHODS

A sample of 352 women with type 2 diabetes, referring to a Diabetes Clinic in Khoy, Iran, participated in the study. Appropriate instruments were designed to measure the desired variables (knowledge of diabetes, personal beliefs, subjective norms, perceived self-efficacy, behavioral intention and physical activity behavior). The reliability and validity of the instruments were examined and approved. Statistical analyses of the study were conducted by inferential statistical techniques (independent t-test, correlations and regressions) using the SPSS package.

RESULTS

The findings of this investigation indicated that among the constructs of the model, self efficacy was the strongest predictor of intentions among women with type 2 diabetes and both directly and indirectly affected physical activity. In addition to self efficacy, diabetic patients' physical activity also was influenced by other variables of the model and sociodemographic factors.

CONCLUSION

Our findings suggest that the high ability of the theory of reasoned action extended by self-efficacy in forecasting and explaining physical activity can be a base for educational intervention. Educational interventions based on the proposed model are necessary for improving diabetics' physical activity behavior and controlling disease.

The theory of planned behavior and binge drinking among undergraduate students: assessing the impact of habit strength

The present study sought to apply the theory of planned behavior (TPB) to the prediction of binge drinking intentions and behavior among undergraduate students and to test whether habit strength explains additional variance in binge drinking behavior. Undergraduate students (N=137) completed measures of the TPB (i.e., attitude, subjective norm, self-efficacy, perceived control, and intention) and habit strength (Self-Report Habit Index) in relation to binge drinking. Frequency of binge drinking was assessed one month later (n=109). The TPB explained 75% of the variance in binge drinking intentions, with attitude and self-efficacy making significant contributions, and 35% of the variance in binge drinking behavior at one-month follow-up, with only intention making a significant contribution. Habit strength explained additional variance in binge drinking behavior (∆R(2)=.06), although intention remained as a significant predictor. The results suggest that binge drinking among undergraduate students is under the control of both intentional and habitual processes. Interventions to reduce binge drinking should therefore focus on the motivational determinants (e.g., perceived positive and negative consequences) of binge drinking as well as the environmental factors (i.e., contextual cues) that promote binge drinking.

First- and higher-order models of attitudes, normative influence, and perceived behavioural control in the theory of planned behaviour

The present study examined the validity of an augmented version of Ajzen's (1991) theory of planned behaviour (TPB), adopting second-order latent factors to explain relationships between the differentiated components of the theory constructs. This model was tested on data from two independent samples, for exercise and dieting behaviours, respectively. The affective and instrumental attitude, injunctive and descriptive norms, and perceived controllability and self-efficacy constructs all exhibited discriminant validity in the first instance. First- and second-order confirmatory factor analyses exhibited satisfactory fit with the observed data from both samples. There were no substantial differences in the fit indices across the first- and second-order models, and the second-order models exhibited the most optimal parsimony-corrected fit indices. The higher-order models could therefore not be rejected on the grounds of inferior fit or parsimony. First- and second-order structural equation models accounted for significant variance in intentions and behaviour. These results corroborate Ajzen's (2002a) and Bagozzi, Lee, and van Loo's (2001) premise that recent augmentations of the TPB that differentiate the model components can be subsumed by global, higher-order factors while still making the distinction at the subordinate level.

Undergraduates' intentions to take a second language proficiency test: a comparison of predictions from the theory of planned behavior and social cognitive theory

English competency has become essential for obtaining a better job or succeeding in higher education in Taiwan. Thus, passing the General English Proficiency Test is important for college students in Taiwan. The current study applied Ajzen's theory of planned behavior and the notions of outcome expectancy and self-efficacy from Bandura's social cognitive theory to investigate college students' intentions to take the General English Proficiency Test. The formal sample consisted of 425 undergraduates (217 women, 208 men; M age = 19.5 yr., SD = 1.3). The theory of planned behavior showed greater predictive ability (R2 = 33%) of intention than the social cognitive theory (R2 = 7%) in regression analysis and made a unique contribution to prediction of actual test-taking behavior one year later in logistic regression. Within-model analyses indicated that subjective norm in theory of planned behavior and outcome expectancy in social cognitive theory are crucial factors in predicting intention. Implications for enhancing undergraduates' intentions to take the English proficiency test are discussed.

Understanding adolescent peer sexual harassment and abuse: using the theory of planned behavior

This study examines intentions to take protective action against peer sexual harassment and abuse (PSHA). The theory of planned behavior (TPB) proposes that attitudes about protective action, perceptions of what others would think about doing this (subjective norms), and behavioral control would be important predictors. A total of 1,531 Chinese secondary school students (769 boys and 762 girls) from Hong Kong were surveyed to test this model. Results showed that the TPB model was predictive for girls, but only subjective norms and behavioral control significantly predicted boys' intentions to protect themselves. Results supported the influence of subjective norms and perceived behavioral control on youths' intentions to reject PSHA. These factors may be useful in guiding the development of an educational program for prevention of PSHA.

Effective contraceptive use: an exploration of theory-based influences

The purpose of this study was to explore factors that influence oral contraceptive (OC) use among women in Iran using the Theory of Planned Behavior (TPB) and concept of self-efficacy (SE). The study sample consisted of 360 married OC users, aged 18-49 years recruited at public health centers of Mashhad, 900 km east of Tehran. SE had the strongest association with the intent to use after the clinic visit (r = 0.784) and with actual use (r = 0.452). Family planning self-efficacy combined with TPB variables accounted for 65% of the variance for intent and 27% of the variance in behavior. The results provide support for a theory-based approach to improved family planning care that specifically addresses more effective use. Development and evaluation of culturally appropriate public education and changes in clinical efforts designed to enhance the sense of SE are discussed.

Integrating the theory of planned behavior and attitude functions: implications for health campaign design

This study argues that the integration of the theory of planned behavior and attitude functions can provide a more detailed theoretical explanation and more precise practical guidance regarding behavioral prediction. Relying on a survey of 549 undergraduate students, this research found that individuals' intentions to regularly participate in physical activity were predicted by their utilitarian and self-esteem maintenance attitudes, the effects of which were further moderated by individuals' strength of self-monitoring and self-esteem, respectively. In addition to theoretical implications, this research indicates that campaign planners should consider the use of more-detailed attitude constructs and design functionally matched messages according to the target's personality traits.

Attitudes and intentions to performing testicular self-examination: utilizing an extended theory of planned behavior

This study examined the ability of an extended theory of planned behavior (TPB) to predict 500, 17- to 35-year-old male students' intentions to perform testicular self-examination (TSE). In a hierarchical regression analysis TPB components attitude, subjective norm and self-efficacy and the added constructs, past behavior, and anticipated regret all emerged as significant independent predictors of TSE intention. Overall, 64% of the variance in TSE intention was explained. Although prospective research is needed to confirm these preliminary findings, they suggest that an extended TPB might be a useful framework to guide interventions aimed at promoting TSE.

The effects of subjective norms on behaviour in the theory of planned behaviour: a meta-analysis

A meta-analysis investigated the effects of perceived injunctive (IN) and descriptive (DN) norms on behaviour (BEH) within the theory of planned behaviour (TPB) in a sample of 196 studies. Two related correlation matrices (pairwise and listwise) were synthesized from the data and used to model the TPB relations with path analyses. Convergent evidence indicated that the relation between DN and BEH was stronger than the relation between IN and BEH. Evidence also suggested a significant direct relation between DN and BEH in the context of TPB. A suppressor effect of IN on DN in its relation with BEH was also noted. Moderator analyses indicated that the DN-BEH relation was stronger when there was more time between measures of cognition and behaviour, when behaviours were not socially approved, more socially motive and more pleasant; results were mixed in the case of the IN-BEH relation. Results imply that IN and DN are conceptually different constructs.

Applying an extended model of the theory of planned behaviour to breast self-examination

Few studies have examined the predictors of breast self-examination in younger women, where it is the primary method for the early detection of breast cancer. Female college students (N = 253, aged 17 to 50 years) completed items related to breast self-examination assessing theory of planned behaviour (TPB) constructs (intentions, attitude, subjective norm, perceived behavioural control), social influence variables of self-identity and group norm, and demographic characteristics. One month later, breast self-examination behaviour was assessed. Results supported this application of the TPB model and highlight the importance of group norms for strategies to increase breast self-examination in younger women.

Motives and Determinants of Volunteering in Older Adults: An Integrated Model

The present study focused on changes in volunteering over time among Italian adults and examined a model in which motives from self-determination theory (SDT) were hypothesized to influence a series of social-cognitive processes including self-efficacy judgments and constructs from the theory of planned behavior (TPB). The study was conducted with 312 male (mean age = 66.10; SD = 5.28) and 253 female adults (mean age = 66.67; SD = 5.79) who worked as volunteers in several associations and organizations in Italy. In two occasions over the course of several months, participants respectively completed paper-and-pencil questionnaires and responded to telephone interviews which assessed the study's constructs of interest. Structural equation model analyses provided support for the guiding hypothesis and findings suggested that the more general approach of SDT can be successfully integrated with a social-cognitive framework such as the TPB to provide a better insight onto the origins of the cognitive predictors of intentions in older volunteers.

Predictors of intentions to perform six cancer-related behaviours: roles for injunctive and descriptive norms

This study reports an application of the integrative model to the prediction of intentions to engage in three cancer screening behaviours (mammogram, colonoscopy and PSA test) and three healthy lifestyle behaviours (exercising, eating fruits and vegetables, and controlling ones diet to lose weight). We examined the roles of attitudes, perceived behavioural control, injunctive norms (what important others think one should do), and descriptive norms (perceptions of what others do) as predictors of participant's intentions to engage in each behaviour. Results indicated that injunctive norms were the strongest predictors of prostate and colon cancer screening intentions and contributed significantly to the prediction of intentions to get a mammogram. In contrast, injunctive norms contributed relatively little to the prediction of lifestyle behaviours, but were strongly predictive of intentions to eat fruits and vegetables. Implications for designing behaviour-specific communications and interventions are discussed.

Distinguishing among perceived control, perceived difficulty, and self-efficacy as determinants of intentions and behaviours

Perceptions of control hold a dominant position in social cognitive theories yet there is a lack of conceptual and empirical clarity regarding what kind of control is most associated with particular behaviours. Three prominent types of control are perceived control (PC), perceived difficulty (PD), and perceived confidence or self-efficacy (SE) for performing the desired behaviour. Three studies are presented with a primary goal of distinguishing PC, PD, and SE from each other, and a secondary goal of determining which of the three is the superior predictor of health-related intentions and behaviours. The first study replicates earlier work by Trafimow et al. (2002) distinguishing the three constructs for reading 1, 30, and 100 pages, and extends it to exercising one, two, four, and six times per week and also to predicting intentions to exercise 4 days per week and behaviour 1 week later. The second study examines the predictive capability of the three constructs for intentions to floss one's teeth everyday and to eat 5-10 servings of fruits and vegetables everyday and subsequently on behaviour assessed 7 days later. The third study reports a meta-analysis of the relative influence of PC, PD, and SE on behaviours when defined in conceptually consistent ways. The results of all three studies support the conceptual and empirical distinction of PC, PD, and SE and the superiority of SE as a predictor of health behaviours and intentions.

The theory of planned behavior and binge drinking: assessing the impact of binge drinker prototypes

The present study assessed the value of including prototype perceptions within the theory of planned behavior (TPB) when predicting young people's binge drinking intentions and behavior. Undergraduate students (N=94) completed questionnaires assessing the main constructs of the TPB as well as measures of prototype evaluation and prototype similarity. Binge drinking behavior was assessed at one-week follow-up (N=79). The TPB explained 58% of the variance in binge drinking intentions and 22% of the variance in binge drinking at one-week follow-up. The prototype perception measures explained additional variance in both binge drinking intentions (DeltaR(2)=.04) and behavior (DeltaR(2)=.09), although only prototype similarity emerged as a significant predictor. In addition, a significant interaction was found between prototype similarity and subjective norm in relation to the prediction of binge drinking behavior, suggesting that the perception of supportive norms may enhance the impact of prototype perceptions on health-risk behavior. The implications of the findings for interventions to encourage more appropriate drinking behavior are outlined.

Gender power imbalance and differential psychosocial correlates of intended condom use among male and female adolescents from Venda, South Africa

OBJECTIVES

In South Africa, a gender power imbalance exists which may prevent women from negotiating safe sexual encounters. In this study we tested which constructs from Protection Motivation Theory (PMT) and the Theory of Planned Behavior (TPB) under these circumstances were most related to condom use intention. We hypothesized that in a situation of gender power imbalance self-efficacy would be a more salient correlate of intended condom use for females, while for males attitude to condoms and subjective norm would be more important.

DESIGN

This study employed a cross-sectional questionnaire design.

METHOD

Male participants (N=94) and female participants (N=101) from Venda, South Africa completed standard, multi-item, reliable measures of TPB constructs (condom-related attitude, subjective norm, perceived behavioural control, intention) and PMT constructs (vulnerability, severity, fear, response-efficacy, self-efficacy) and reported their past condom use behaviour.

RESULTS

Regression analysis indicated that among males attitude to condoms and subjective norm were significantly related to intended condom use. Among females attitude and self-efficacy were significantly related to intended condom use.

CONCLUSION

The findings indicate that in a situation of gender power imbalance psychosocial correlates of intended condom use differ for males and females. Gender-specific analysis of determinants of condom use may be more appropriate in a situation of gender power imbalance.