Predicting intention and behaviour following participation in a theory-based intervention to improve gluten free diet adherence in coeliac disease

Objective: To determine whether changes in theory of planned behaviour (TPB) constructs could predict intention and gluten-free diet (GFD) adherence following participation in an online theory-based intervention designed to improve adherence in coeliac disease.

Design: Theory-based process evaluation of the mechanisms of change over the course of a six-week online intervention. Measures of GFD adherence and TPB variables were administered at baseline and follow-up (immediate post-intervention: n = 74; three-month: n = 68; six-month: n = 65). Hierarchical regression analyses using residualised change scores were conducted at each time point (dependent variables: intention and adherence).

Results: Baseline intention and GFD adherence were the strongest predictors of follow-up intention and adherence, respectively. Change in attitude accounted for significant variance in intention. Change in intention accounted for significant variance in GFD adherence immediately post-intervention; by the six-month follow-up change in perceived behavioural control was the stronger predictor.

Conclusions: Partial support for the hypotheses suggests that, for certain behaviours, the TPB may be relevant in explaining the mechanism of action responsible for changes in intention and behaviour following participation in a behaviour change intervention. Additional predictive pathways are also likely to exist and, in the area of GFD adherence, may include habit strength and actual behavioural control.     

Predicting Psychologists' Intentions to Integrate Complementary and Alternative Therapies Into Their Practice

Drawing on an extended Theory of Planned Behaviour (TPB) framework, we employed a cross‐sectional design study to investigate psychologists' intentions to integrate complementary and alternative therapies (CAT) into their practice via recommending CAT to clients or referring clients to CAT practitioners. Participants were registered practicing psychologists from a range of therapeutic orientations (e.g., narrative, cognitive behavioural, psychodynamic). The psychologists were either recruited by phone, following a search of the Internet, or were contacted through their place of employment (hospitals, university counselling service). Those who agreed to participate (N = 122; n = 88 females, n = 34 males) completed a questionnaire that included standard TPB items of attitude, subjective norm, and perceived behavioural control, along with items measuring perceived risk, past behaviour, CAT knowledge, and gender. The outcome variables of interest were (a) intention to recommend CAT to clients and (b) intention to refer clients to CAT practitioners. Structural equation modelling revealed that the extended model was a good fit, explaining 69% (recommending CAT) and 51% (referring to CAT practitioners) of the variance in intentions. For both behaviours, direct paths from attitude and subjective norm to intentions were observed, with perceived risk and past behaviour influencing the TPB predictors of attitudes, subjective norm, and perceived behavioural control. The findings illustrate the role that cognitive and risk factors have on psychologists' decisions to integrate CAT into their practice. Understanding psychologists' cognitions and decisions about CAT integration forms an important basis on which to consider future changes in policy or practice.     

Menopausal stage and age and perceptions of body image

Abstract

The aim of This study was to investigate the association between menopausal stage and age and women's perception of their body image. Females from a community sample (n = 304. age range from 35 to 65 years) volunteered to complete a structured questionnaire which contained the Multidimensional Body Self Relations Questionnaire (MBSRQ) and the Stunkard Body Shape Figure Scale. One hundred and twenty women were premenopausal, 76 women were perimenopausal and 108 were postmenopausal. The effects of age and menopausal stage could not be separated in ratings of appearance evaluation, fitness evaluation, current, ideal and societal ratings of the Stunkard Body Shape Figure Scale. Premenopausal women (who were likely to be younger) had more positive ratings of appearance evaluation and fitness evaluation than menopausal women (who were likely to be older). Women who were premenopausal nominated smaller figures from the Stunkard Body Shape Figure Scale for ratings of the current, ideal and societal body shape than women who were perimenopausal and postmenopausal. The implications of these findings as they relate to women as they progress through the menopausal transition and as they become older is discussed.     

Academic career intention beyond the PhD: can the theory of planned behavior explain gender differences?

Are women less interested in becoming professors than men? We applied the theory of planned behavior (TPB) to investigate the intention to pursue an academic career. Postdocs who recently finished their PhD at a German university participated in an online survey (N = 380, mean age: 33; 45% women). Women reported lower academic career intentions (d = 0.40); TPB variables (attitude, subjective norm, self‐efficacy) explained 87% of this gender difference. At an 8 month follow‐up, we found no gender difference in the intention to continue in an academic career among the postdocs who were still working in academia (n = 129). Addressing TPB constructs early in women's academic careers could encourage them to remain in academia and strive for a professorship.     

Question–behaviour effect: A randomised controlled trial of asking intention in the interrogative or declarative form

Objective: This study investigated the question–behaviour effect of measuring intention in the interrogative or declarative form combined or not with a measure of moral norm.

Design: A sample of 762 participants was randomised according to a 2?×?2 factorial design.

Main outcome measures: Cognitions were assessed at the baseline, and physical activity behaviour was self-reported three weeks later. Results: At baseline, there were no significant differences on the studied variables. An ANOVA showed a significant interaction effect between the two experimental conditions (p?=?0.04). Post-hoc contrast analyses showed that the interrogative intention-only condition significantly differed from the declarative intention-only (d?=?0.21, p?=?0.03) and interrogative intention?+?moral norm (d?=?0.22, p?=?0.03) conditions.

Conclusion: Results suggest that self-posed questions about a future action increases the likelihood of doing it when these questions are not accompanied by measures of moral norm. This provides support for using introspective self-talk to favour the adoption of behaviour.     

Unrealistic optimism and genetic risk

The study examined whether life stress moderated the effects of a physical activity intervention. Women (n = 184) and 154 men (61% non-Hispanic white, average age 24 years) from an urban university participated. Data were analyzed separately for men and women using a 2 × 2 ANCOVA adjusting for baseline physical activity (intervention vs. control × high life stress vs. low stress) with total physical activity at one-year and two-year assessments as dependent variables. No significant main effect for stress or condition was found. The interaction was significant (p = 0.015) for men at one-year, indicating that men in the intervention group with high stress were more active than low stress intervention men. Instruction received in the intervention group on the stress-relieving properties of physical activity may have helped men with high stress to adopt or maintain physical activity.     

Predicting People’s Intention to Donate Their Body to Medical Science and Research

Predictors of people’s intention to register with a body bequest program for donating their deceased body to medical science and research were examined using standard theory of planned behavior (TPB) predictors (attitude, subjective norm, perceived behavioral control) and adding moral norm, altruism, and knowledge. Australian students (N = 221) at a university with a recently established body bequest program completed measures of the TPB’s underlying beliefs (behavioral, normative, and control beliefs) and standard and extended TPB predictors, with a sub-sample reporting their registration-related behavior 2 months later. The standard TPB accounted for 43.6%, and the extended predictors an additional 15.1% of variance in intention. The significant predictors were attitude, subjective norm, and moral norm, partially supporting an extended TPB in understanding people’s body donation intentions. Further, important underlying beliefs can inform strategies to target prospective donors.     

Integration of five health behaviour models: Common strengths and unique contributions to understanding condom use

The purpose of this research was to select from the health belief model (HBM), theories of reasoned action (TRA) and planned behaviour (TPB), information–motivation–behavioural skills model (IMB) and social cognitive theory (SCT) the strongest longitudinal predictors of women's condom use and to combine these constructs into a single integrated model of condom use. The integrated model was evaluated for prediction of condom use among young women who had steady versus casual partners. At Time 1, all constructs of the five models and condom use were assessed in an initial and a replication sample (n?=?193, n?=?161). Condom use reassessed 8 weeks later (Time 2) served as the main outcome. Information from IMB, perceived susceptibility, benefits, and barriers from HBM, self-efficacy and self-evaluative expectancies from SCT, and partner norm and attitudes from TPB served as indirect or direct predictors of condom use. All paths replicated across samples. Direct predictors of behaviour varied with relationship status: self-efficacy significantly predicted condom use for women with casual partners, while attitude and partner norm predicted for those with steady partners. Integrated psychosocial models, rich in constructs and relationships drawn from multiple theories of behaviour, may provide a more complete characterisation of health protective behaviour.     

Predicting students’ intention to smoke by theory of planned behaviour variables and parental influences across school grade levels

Differences were examined in Theory of Planned Behaviour determinants of students’ intention to smoke including parents’ attitudes towards smoking and parents’ current cigarette use among Greek students of different school grade levels. Students (N?=?763) aged 10–18 years reported their attitudes towards smoking, subjective norms, perceived behavioural control, self-identity and intention to smoke while their parents (N?=?525) reported their attitudes towards smoking and their current cigarette use. All the TPB variables increased from lower to higher school grade level. Multi-sample path analyses showed that parent's attitudes towards smoking positively predicted students’ intention to smoke only for elementary school children. Parents’ current cigarette use did not contribute significantly. Students’ attitudes, perceived behavioural control and self-identity predicted systematically intention to smoke in contrast to the subjective norm that did not contribute at all. Perceived behavioural control contributed to a higher degree in intention to smoke for senior high school students compared to the junior high school and elementary students. Self-identity contributed to a higher degree in intention to smoke for elementary compared to the junior high school students. The results of this study suggests that the determinants of smoking vary between early and late adolescence.     

Deepening the measurement of motivation in the physical activity domain: Introducing behavioural resolve

ObjectivesIntention is theorized as the proximal determinant of behaviour in many leading theories and yet tests of its absolute predictive utility show discordance. While one line of research has been investigating constructs that may augment intention, another possibility may be to improve measurement. The purpose of this study was to compare a typical measure of exercise intention with a measure that attempts to deepen the motivational domain via considerations of contextual barriers and other competing goals (named behavioural resolve).DesignTwo-week prospective.MethodParticipants were a random sample of university students who were subsequently randomized to groups who completed either measures of behavioural intention (n = 179) and behavioural resolve (n = 227) in relation to exercise and a 2-week follow-up of exercise behaviour.ResultsComparing the two measures showed that the behavioural resolve construct explained significantly more variance in exercise behaviour than the standard intention construct (q = .35). Further comparison of the two measures showed that absolute discordance with subsequent exercise behaviour was considerably lower with behavioural resolve (mean = ?.09) compared to behavioural intention (mean = ?1.28).ConclusionsThese findings indicate that at least some of the intention–behaviour gap may be from inadequate measurement of the motivational domain, and this can be partially rectified with shifting to a behavioural resolve measure.     

Young adults' intention to eat healthy food: Extending the theory of planned behaviour

Abstract

The present study predicts adults' intention to eat healthily, using the theory of planned behaviour (TPB) and additive and moderating effects of role identity, group norms and group identification, derived from identity theory and self categorisation theory. A total of 735, 25 years old adults participated in a mailed questionnaire survey in 1997. The TPB explained 52% of the variance in young adults' decision to eat healthily, with perceived behavioural control and subjective norms being the strongest (β= .56, p < .001) and weakest (β = .05, p < .005) determinants, respectively. Although, role identity accounted for an additional amount of 4% of the variance in behavioral intention, past behaviour did not moderate the impact of role identity on intention, as hypothesised. Neither perceived group norm nor group identification added to the prediction of intention over and above the TPB. However, group identification was found to act as a moderator on the relation between group norm and behavioural intention in the predicted direction. The wider social context seems to play a stronger role for the formation of adults' healthy eating decisions than indicated by the TPB.     

Noncompliance with Persuasive Appeals for a Prosocial,Altruistic Act: Blood Donating1

Effects of persuasive messages, responsibility denial (RD), and attitude-accessing on blood-giving attitudes, intentions, moral obligations, and behavior were examined. In Study 1, participants (n= 84) who heard a message emphasizing moral reasons for donating indicated a more favorable postmessage attitude and stronger moral obligation to donate than participants exposed to a message aimed at reducing fear, a combined moral and fear- reduction message, or no message. Combined message participants showed greatest intent to donate, yet only 14% of all participants attended a campus drive. In Study 2, low (n= 52) and high (n= 60) RD individuals heard the message arguments and were asked to access their attitudes. Low compared to high RD individuals stated a stronger sense of moral obligation, particularly when they accessed their thoughts relevant to blood donating, and behavioral intention, especially in the combined message condition. Few participants attended a blood drive (12.5%), yet most were low RD individuals from the nonaccessed attitude condition (83%). Results suggest that few individuals will engage in the altruistic act of blood donating, despite the experimental use of persuasive messages and accessing issue-relevant attitudes.     

A randomised controlled trial of the effects of implementation intentions on women's walking behaviour

The combination of low physical activity rates and increased cardiovascular deaths indicate the overwhelming need for behaviour change interventions that can effectively promote physical activity among sedentary women. This 11-week randomised controlled trial examined the effects of an implementation intentions intervention on sedentary women's walking behaviour. Seventy-five women (M age = 48.17) were randomly assigned to either a control group where they were required to self-monitor their daily pedometer-determined step count or to an experimental group where they were asked to form specific walking plans (i.e. implementation intentions) every 6 weeks and to self-monitor their daily pedometer-determined step count. Measures of exercise intentions, perceived behavioural control, scheduling and barrier self-efficacy were administered at baseline, week 6 and week 11. Analyses indicated higher step counts over the first 6 weeks for women in the experimental condition (p < 0.02). Furthermore, higher self-efficacy to schedule (p < 0.01) and overcome walking barriers (p < 0.03), as well as higher perceptions of behavioural control (p < 0.02) were found at week 11 for women in the experimental versus control condition. However, none of the control beliefs were found to mediate the effects of the intervention on the women's walking behaviour. Furthermore, the intervention did not have any effect on the strength of the goal intention–behaviour relationship. The findings suggest implementation intentions are an effective strategy for initiating leisure-time walking within sedentary women.     

A preliminary study of hormone replacement therapy and psychological mood states in perimenopausal women

Hormone replacement therapy (HRT) for perimenopausal women has been suggested to minimize the physical symptoms of menopause and improve mood and psychological functioning; however, the therapy remains controversial. In this study the effects of such therapy (comprising tablets, patches, and implants) on mood states was investigated within a sample of 70 perimenopausal women who were attending a family planning clinic within the Brisbane metropolitan area. On a battery of standardized questionnaires, including the General Health Questionnaire, the Profile of Mood States, the Eysenck Personality Questionnaire, and the Menstrual Distress Questionnaire, those 35 women who were using hormone replacement therapy prescribed by the clinic physician reported significantly lower scores on anxiety, insomnia, and somatic symptoms than did a comparable group of 35 untreated perimenopausal women. These findings provide some tentative support for the beneficial effects of the therapy on physical symptoms and psychological mood states related to the onset of menopause. Given increased life expectancy, there is a growing need for research into issues of aging.     

Private self-consciousness as moderator of the importance of attitude and subjective norm: The prediction of voting

The influence of private self-consciousness on the components of Ajzen and Fishbein's attitude model (attitude and subjective norm) is analysed. The impact of past behaviour on both current behaviour and behavioural intention is also studied. This model was applied to the prediction of voting intention and reported behaviour in the Spanish Parliamentary elections held in 1989, Attitude showed stronger influence than subjective norm on behavioural intention for subjects with a higher private self-consciousness. The opposite was true for subjects having a lower private self-consciousness. Past behaviour had a significant influence on both behavioural intention and behaviour.     

Community-Based Interventions to Reduce Low Income, African American Women's Risk of Sexually Transmitted Diseases: A Randomized Controlled Trial of Three Theoretical Models

A community-based sample of disadvantaged African American women (n = 445) was recruited to participate in 1 of 3 theoretically driven experimental interventions based on either the theory of gender and power, social learning theory, or cognitive behavioral theory. Intervention outcomes were compared with a waiting list control condition. From baseline to postintervention, women in the experimental interventions showed differential change on cognitive indices (knowledge and attitudes) and skill acquisition (partner negotiation skills, correct condom application, lubricant selection, and information-provision to social networks) whereas control participants were unchanged. Women in the 3 experimental interventions also completed follow-up assessments for 1 year following the interventions. In all 3 experimental conditions, condom use increased relative to the control group and there were no differences between the experimental interventions. Women who participated in one of the theoretically grounded interventions continued to increase condom use over the following year. Women entering new relationships reported significantly more condom use than did women who remained in ongoing relationships. The findings suggest that intervention models that have proven effective for women who engage in high-risk behavior may be less effective for women in established relationships for whom risk is primarily derived from the extrarelationship behavior of their partners.     

Social and moral norm differences among Portuguese 1st and 6th year medical students towards their intention to comply with hand hygiene

This study examines social and moral norms towards the intention to comply with hand hygiene among Portuguese medical students from 1st and 6th years (N = 175; 121 from the 1st year, 54 from the 6th year). The study extended the theory of planned behaviour theoretical principles and hypothesised that both subjective and moral norms will be the best predictors of 1st and 6th year medical students' intention to comply with hand hygiene; however, these predictors ability to explain intention variance will change according to medical students' school year. Results indicated that the subjective norm, whose referent focuses on professors, is a relevant predictor of 1st year medical students' intention, while the subjective norm that emphasises the relevance of colleagues predicts the intentions of medical students from the 6th year. In terms of the moral norm, 6th year students' intention is better predicted by a norm that interferes with compliance; whereas intentions from 1st year students are better predicted by a norm that favours compliance. Implications of the findings highlight the importance of role models and mentors as key factors in teaching hand hygiene in medical undergraduate curricula.     

Illness disclosure and mental health among women with HIV/AIDS

The current study examines two contrasting models of the relationship between illness disclosure and mental health among an ethnically‐diverse group of women with HIV/AIDS. In the first, and commonly accepted model, illness disclosure predicts enhanced mental health status. In the second or alternate model, based on the stigmatization that accompanies HIV/AIDS infection, illness disclosure predicts poorer mental health. We also explore an alternate interpretation for this second model, namely that the mental health status of participants is predictive of their levels of disclosure. A total of 176 women from three major ethnic groups were interviewed and assessed during the baseline visit for a comprehensive longitudinal study. Results showed that these women constituted a highly‐disclosed population; over one‐third of them had disclosed their HIV status to their entire social networks. Contrary to expectation, disclosure was unrelated to mental health among the African‐American (n = 72) and European‐American (n = 47) women. Among the Latina women (n = 57), however, greater disclosure was related to higher levels of depression, psychological distress, and reported pain. Regression analyses controlling for age, education, and illness severity showed that disclosure makes a small but independent contribution to the prediction of mental health status. Thus, among the Latinas, the data were consistent with both the stigma model and the hypothesis that greater distress predicts wider disclosure. General patterns of disclosure are described and possible explanations for the inconsistent relationships found between disclosure and mental health among the three ethnic groups are considered. Copyright © 2000 John Wiley & Sons, Ltd.