Application of a modified health belief model to hiv preventive behavioral intentions among gay and bisexual men

Abstract

The utility of a modified health belief model (Janz and Becker, 1984) for predicting the intention to use condoms was tested in a study among gay and bisexual men. The model explained a reasonable amount of variance. It was found that younger men's decision to have safe sex was guided by factors other than those that influenced older men. Among younger men, the intention to use a condom was positively related to the relative number of persons with AIDS in their social environment (cues to action) and to the perceived benefits of HIV preventive behavior. Among older men, this behavioral intention was much more determined by their perception of the prevalence of HIV and by their perception of their vulnerability to HIV infection. These findings are important because they may partly explain the recent increase in AIDS-risk behavior among young gay and bisexual men. The discussion focuses on these findings and on the implications for interventions aimed at promoting safe sex.     

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.     

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.     

The Role of Self‐identity in the Theory of Planned Behavior: A Meta‐Analysis

The present study used meta‐analysis to evaluate the role of self‐identity in the theory of planned behavior (TPB). Altogether, 40 independent tests (N = 11607) could be included in the review. A large, sample‐weighted average correlation between self‐identity and behavioral intention was observed (r₊ = .47). Multiple regression analyses showed that self‐identity explained an increment of 6% of the variance in intention after controlling for the TPB components, and explained an increment of 9% of the variance when past behavior and the TPB components were controlled. The influence of self‐identity on behavior was largely mediated by the strength of behavioral intentions. Theoretical implications of the findings are discussed.     

Posttraumatic Stress Among Women With Breast Cancer and Their Daughters: Relationship With Daughters' Breast Cancer Screening

Cancer-related posttraumatic stress (PTS) in women with breast cancer, perceived risk of cancer in these women's daughters, and daughters' PTS related to their mothers' breast cancer were tested for relationships to daughters' breast self-examination (BSE) and mammography activity. Daughters' mammography frequency was related to her own PTS, but not to her perceived risk or her mothers' PTS. In contrast, daughters who overperformed BSE had mothers reporting significantly greater PTS than those performing BSE at recommended rates or underperforming BSE. Daughters' BSE and mammography frequency were not correlated. Differing demands related to BSE and mammography, and their relationship to different distress variables are discussed.     

Influence of Church Attendance and Spirituality in a Randomized Controlled Trial to Increase Mammography Use Among a Low-Income, Tri-Racial, Rural Community

Background The influence of church attendance and spirituality on mammography use was studied among Native American, White, and African American women living in a rural county. Methods A randomized trial was conducted to increase mammography use. Women (n = 851) were randomly assigned to receive either an educational program delivered by a lay health advisor or a physician letter and brochure about cervical cancer screening (control group). Church attendance and spirituality were measured at baseline and mammography use was evaluated 12 months after enrollment using medical record review. Results Almost two-thirds of the women reported that they attended church at least once a week, and less than 4% were classified as having low spirituality. Church attendance (P = 0.299) or spirituality (P = 0.401) did not have a significant impact on mammography use. Conclusions Church attendance and spirituality did not impact mammography use.     

Health Beliefs and Illness Perceptions as Related to Mammography Uptake in Randomly Selected Women in Greece

Previous research has shown that, although routine mammography screening can reduce mortality from breast cancer, the use of annual mammography screening remains well under 65%. In an effort to determine the factors that are associated with women’s mammography behaviors, this study used the health belief model and the common-sense model of self-regulation as the theoretical frameworks to explore health beliefs, illness representations, and women’s mammography practice. Data were obtained from a nationally representative sample of 408 Greek women, 40 years of age or older, with no personal history of cancer. Three dependent variables were considered: recent mammography, repeat mammography, and no mammogram during lifetime. Predictors included socio-demographic and medical variables, perceived benefits of mammography screening, perceived barriers to mammography screening, self-efficacy, as well as illness perceptions. Multivariate analyzes indicated that never having had a mammogram was more likely for women who perceived fewer benefits and more barriers to mammography screening, had more negative emotional representations of breast cancer, and had no private health insurance coverage. Factors associated with recent mammography were younger age, a good knowledge of the recommended mammography screening interval, a family history of breast cancer, and use of patient reminders for next mammogram. Adequate knowledge about the recommended mammography screening interval and higher values for breast cancer worry were associated with an increased number of repeat lifetime mammograms. Implications of the results and suggestions for future research are outlined.     

The Theory of Planned Behavior as a model for understanding sedentary behavior

ObjectivesSedentary time has emerged as an independent risk factor for numerous adverse health outcomes. However, little is known about the social-cognitive correlates of sedentary behavior. The purpose of this study was to provide preliminary evidence for the factor structure and composition of sedentary derived Theory of Planned Behavior (TPB) constructs and to determine the utility of these constructs in predicting sedentary intention and sedentary time.MethodTwenty-three items were created to assess attitudes, subjective norms (SN), perceived behavioral control (PBC), and intention with respect to time spent being sedentary. Using a web-based survey, 372 adults completed a modified Sedentary Behavior Questionnaire and were then randomised to one of three TPB questionnaire packages: general, weekday, and weekend. Weekday and weekend participants completed items for work/school (less-volitional) and leisure/recreation (volitional) activities separately, resulting in five TPB models being analyzed: general, weekday work/school, weekday leisure/recreation, weekend work/school, and weekend leisure/recreation.ResultsIrrespective of model, items grouped into coherent factors consistent with TPB and explained 9–58% and 8–43% of the variance in intention and behavior, respectively. The strongest and most consistent predictor of intention and behavior were SN and intentions, respectively. Mediation analyses indicated that attitudes consistently affected sedentary time through intention.ConclusionsThere is growing evidence that the TPB is a useful framework for understanding sedentarism.     

Testing an extended theory of planned behavior to predict young people's intentions to join a bone marrow donor registry

An extended theory of planned behavior (TPB) was used to understand the factors, particularly control perceptions and affective reactions, given conflicting findings in previous research, informing younger people's intentions to join a bone marrow registry. Participants (N = 174) completed attitude, subjective norm, perceived behavioral control (PBC), moral norm, anticipated regret, self‐identity, and intention items for registering. The extended TPB (except PBC) explained 67.2% of variance in intention. Further testing is needed as to the volitional nature of registering. Moral norm, anticipated regret, and self‐identity are likely intervention targets for increasing younger people's bone marrow registry participation.     

Predicting Child Restraint Device Use: A Comparison of Two Models1

This study's first objective was to apply Ajzen's theory of planned behavior (TPB) in the context of automobile child restraint device use to identify determinants of that behavior. A second objective was to test two specific hypotheses regarding the predictive role of perceived behavioral control: (a) Its inclusion should increase the proportion of variance already explained in intention by the attitudinal and normative components included in the theory of reasoned action; and (b) given the behavior under study, a model in which perception of behavioral control's influence on behavior is entirely mediated by intention, should fit the data. Subjects (N= 590) were parents driving with their 3- to 5-year-old children intercepted while entering or leaving parking lots of different public settings. The behavior of interest, child restraint device use, was rated by two independent observers. A self-report questionnaire assessing all constructs of Ajzen's model was given to the parent, who was instructed to return it by mail. Data were analyzed using LISREL VII. Results showed that perceived behavioral control and, to a lesser extent, attitude, emerged as the main determinants of behavioral intention which was itself predictive of child restraint device use. In addition, both hypotheses regarding the relation between perceived behavioral control on the one hand and intention and behavior, on the other, were supported. Discussion centered first on the mechanism through which perceived behavioral control exerts its influence, and second on the implications of the present results for the theory of reasoned action as well as for the theory of planned behavior.     

The Impact of Breast Cancer Genetic Risk Assessment on Intentions to Perform Cancer Surveillance Behaviors

One hundred and fifty-four women undergoing breast/ovarian cancer genetic risk assessment completed questionnaires at entry into the Cancer Genetic Service for Wales (CGSW) assessment program and following risk provision, mapping the strength of intentions to engage in a number of preventive/surveillance behaviors, including seeing specialists, breast self-examination, and involvement in screening programs, including mammography. A number of potential predictors of intentions were also assessed, including participants' mood and emotional response to receiving risk information, the perceived benefits (in terms of reassurance and early disease detection) of engaging in each preventive behavior, and the perceived desires of their family and General Practitioner. Intentions to self-examine did not change following risk provision, although strength of intentions to engage in some other preventive behaviors did lessen. Family and General Practitioners appeared to be strong social influences on behavioral intentions, as were the perceived benefits of gaining reassurance and/or early detection of disease.     

The influence of self‐efficacy,subjective norms,and risk perception on behavioral intentions related to the H1N1 flu pandemic: A comparison between Korea and the US

This study examined the extent to which individualism‐collectivism moderates the relative effects of agency control beliefs (i.e., self‐efficacy), social norms (i.e., subjective norms), and risk perception (perceived vulnerability and perceived severity) on behavioral intention to engage in self‐protection behavior in the context of the H1N1 flu pandemic. Using multistage stratified sampling, the present study sampled people from the US (n = 399) and Korea (n = 500), two countries that have been found to be prototypical of individualistic and collectivistic national cultures, respectively. Consistent with the contrast between individualism and collectivism, the results of moderated regression analyses showed that intrapersonal control beliefs (i.e., self‐efficacy) and risk perception (i.e., perceived severity) had stronger effects on behavioral intention in the American sample than in the Korean sample, whereas social norms (i.e., subjective norms) had a stronger predictive power for the Korean sample than for the American sample. Overall, the findings contribute to health and risk studies by specifying which aspects of risk perceptions or beliefs are affected by national culture and how this translates into cross‐national variations in health risk behavioral intention.     

Explaining the effects of a decision intervention on mammography intentions: The roles of worry,fear and perceived susceptibility to breast cancer

Objective: This study examines the effects of a mammography decision intervention on perceived susceptibility to breast cancer (PSBC) and emotion and investigates how these outcomes predict mammography intentions.

Design: Randomised between-subjects online experiment. Participants were stratified into two levels of risk. Within each stratum, conditions included a basic information condition and six decision intervention conditions that included personalised risk estimates and varied according to a 2 (amount of information: brief vs. extended) × 3 (format: expository vs. untailored exemplar vs. tailored exemplar) design. Participants included 2465 US women ages 35–49.

Main Outcome Measures: PSBC as a percentage, PSBC as a frequency, worry, fear and mammography intentions.

Results: The intervention resulted in significant reductions in PSBC as a percentage for women in both strata and significant increases in worry and fear for women in the upper risk stratum. Of the possible mediators examined, only PSBC as a percentage was a consistent mediator of the effect of the intervention on mammography intentions.

Conclusion: The results provide insight into the mechanism of action of the intervention by showing that PSBC mediated the effects of the intervention on mammography intentions.     

The utility of socio-demographics,knowledge and health belief model variables in predicting reattendance for mammography screening: A brief report

Abstract

The aims of the present study were to investigate socio-demographic and knowledge variables as predictors of re attendance for mammography screening and to examine the utility of the Health Belief Model (HBM) in predicting reattendance for mammography screening above and beyond socio-demographic and knowledge variables. A total of 88 reattenders and 44 non-reattenders of an Australian breast screening service completed a questionnaire assessing socio-demographics (age, marital status, education, physician recommendation and family history), knowledge and HBM variables. Results showed that reattenders were more likely to be older, married and report physician involvement than non-reattenders. Family history and knowledge did not significantly predict reattendance. Of the HBM variables, perceived benefits was related to reattendance above and beyond socio-demographics. Results support the utility of the HBM as a focus for improving regular attendance for breast screening. It is concluded that non-reattenders should be investigated as a seperate group to women who have never attended for mammography screening.     

Perceived variety,psychological needs satisfaction and exercise-related well-being

Objective: Perceived variety represents a psychosocial experience that gives rise to, and supports the maintenance of, an individual’s well-being. In this study, we developed an instrument to measure perceived variety in exercise (PVE), and examined whether ratings of PVE predict unique variance in indices of exercise-related well-being in addition to that explained by satisfaction of the three basic psychological needs (for competence, relatedness and autonomy) embedded within self-determination theory (SDT). We also examined the extent to which variance in perceived variety is empirically distinct from (or subsumed by) competence, relatedness and autonomy in the context of exercise.

Methods: A convenience sample of community adults (N?=?507) completed online surveys twice over a six-week period (n?=?367).

Results: PVE was found to prospectively predict unique variance in indices of exercise-related well-being, in addition to that explained by perceived competence, relatedness and autonomy. Using exploratory and confirmatory factor analytic procedures, perceived variety was found to be empirically distinct from perceived competence, relatedness and autonomy.

Conclusion: Results from this work suggest that perceived variety holds potential for theoretical and applied advancements in understanding and predicting well-being in exercise settings.     

Adherence to Hormone Replacement Therapy: A Longitudinal Study Using the Theory of Planned Behaviour

The aim of this longitudinal study was to assess the stability and determinants of the intention to adopt HRT over a one-year period using the Theory of Planned Behaviour. At baseline, a total of 644 middle-aged premenopausal women who had never used HRT, were recruited. At follow-up, 417 women completed an interview to assess any change in their reproductive status and in their behavioural intention. Among women who stayed premenopausal (n = 172) and among those who became perimenopausal (n = 209), the intention to adopt HRT was quite stable over the one-year period. However, being perimenopausal had a significant effect on the intention to adopt HRT at follow-up, as did subjective norm, perceived behavioural control and moral norm measured at baseline. Attitude towards HRT did not have a significant effect on the intention to adopt HRT one year later. Therefore, interventions to support women's decision-making about HRT should be tailored to their menopausal status and take into account their perception of social pressure to perform, control over this behaviour and moral obligation.     

Cancer-Related Channel Selection: A Focus On Women Who Have Had a Mammography1

This study examines the impact of three major classes of factors—triggers, impediments, and demographics—on the selection within and across four different channels: doctors, friends/family, organizations, and media. A sample of women over 40 (n = 209) who had had a mammography were asked which channels they had turned to within the last year for cancer-related information. Discriminant analyses revealed significant functions for the family/friends and media channels. The most important variables in these functions were a woman's age and the number of things she did to minimize her chances of getting breast cancer. These results are discussed in terms of their theoretic and pragmatic implications for future cancer control efforts targeted at women who have had a mammography.     

Predicting intended contraception in a sample of ethiopian female adolescents: The validity of the theory of planned behavior

Abstract

The purposes of the study were threefold. First, to test the validity of Ajzen's (1991) theory of planned behavior (TPB) in predicting intended contraception in the Ethiopian cultural setting. Second, to examine the additional predictive roles of past behavior and perceived pregnancy risk in the TPB model. Third, to identify the salient contraceptive beliefs influencing intended contraception. Data stemmed from a community sample of 354 sexually active female adolescents aged 15 to 19 years. The findings of the study supported TPB as a robust model in Ethiopian cultural setting, with subjective norm being the strongest predictor of intended contraception. In addition, both past contraceptive behavior and perceived pregnancy risk demonstrated to have significant contributions in predicting intention over and above that explained by attitude, subjective norm and perceived behavioral control elements of the TPB. Moreover, the study also identified salient and important contraceptive beliefs that need to be addressed in family life education and counseling programs designed for adolescents and the youth.