Social cognitive models of health and exercise behavior: An introduction and review of conceptual issues

Abstract

This article reviews the major social cognitive models of adherence or compliance in health and exercise behavior and attempts to show that these models are more similar to each other than different from each other. Self-efficacy theory and the theory of reasoned action/planned behavior have guided most of the theory-based research on exercise behavior. Two other models, protection motivation theory and the health belief model, have guided much research on the role of social cognitive factors in other health behaviors. These models are comprised largely of the same basic set of social cognitive variables: self-efficacy expectancy, outcome expectancy, outcome value, and intention. Two other factors, situational cues and habits, although not common to all the models, round out the theoretical picture by explaining how the relationship between the major social cognitive variables and behavior may change with repeated performance of a behavior over time.An integration of these models is offered using the theory of planned behavior as a foundation. It is suggested that research on health and exercise behavior that pits one model against another to determine which one is the better predictor of behavior is likely to be unproductive due to the striking similarities of the models. It is suggested instead that theorists and researchers focus their efforts on integration of the major social cognitive models and on determining the relative predictive utility of the various social cognitive factors with various health behaviors and in various contexts.     

Safer Sex Behavior: The Role of Attitudes, Norms, and Control Factors

A study was undertaken to assess the utility of revisions to the theories of reasoned action/planned behavior in the context of HIV-preventive behaviors. Revisions to the models incorporated the addition of group norm (behavioral norm and group attitude) to the nonnative component of the reasoned action model and the distinction among three aspects (self-efficacy, perceived behavioral control, and planning) of the control component of the theory of planned behavior. Respondents were 211 sexually experienced heterosexual undergraduates. The study employed a longitudinal design, with the proposed predictors of performing the behaviors under consideration (using a condom every time you have sexual intercourse during the next month and discussing whether to use a condom with any new partners during the next month) assessed prior to the measures of reported behavior. Consistent with expectations, group norm emerged as a distinctive predictor (in addition to attitude and subjective norm) of intentions to practice both safer sex behaviors. The data also revealed some support for the distinction among the different measures of control. The results of the study suggest that the normative component of the theories of reasoned action and planned behavior should be revised to incorporate more subtle influences of the referent group and that tests of theory of planned behavior should distinguish among the different aspects of behavioral control.     

The Process by Which Relative Autonomous Motivation Affects Intentional Behavior: Comparing Effects Across Dieting and Exercise Behaviors

A motivational model integrating self-deter-mination theory and the theory of planned behavior was tested in two samples for exercise and dieting behavior respectively. Relative autonomous motivation from self-determination theory was hypothesized to predict intentions to exercise or diet via the mediation of attitudes and perceived behavioral control (PBC) from the theory of planned behavior. It was also expected that attitudes and PBC would predict actual levels of exercise and dieting behavior via the mediation of intentions. Relations in the proposed model were expected to be invariant across the behaviors. Two samples of participants (N = 511) completed measures of the autonomous motives, attitudes, subjective norms, PBC, and intentions with respect to exercise and dieting behavior. Four weeks later, participants self-reported their behavior. Structural equation models supported the replicability of the proposed model in both behaviors. Findings supported the majority of the hypothesized effects in the proposed model across the two health behaviors. However, four effects were significantly different across the two behaviors: the effect of autonomous motives on intentions, subjective norms and PBC on intentions, and intentions on behavior. Findings extend knowledge of the processes by which psychological antecedents from the theories affect health behaviors integral to the maintenance of energy balance.

Social Cognitive Determinants of Blood Donation

This article reports two studies designed to test a theory of planned behavior-based model of blood donation. In Study 1 ( n = 136), self-efficacy and self-identity accounted for unique variance in behavioral intention. Study 2 ( n = 172) extended Study 1: self-efficacy, perceived control over behavior (PCB), self-identity, and moral norm were all independently predictive of intention; behavioral intention predicted a proxy measure of behavioral enaction. Both studies provided evidence to support a distinction between self-efficacy and PCB, and for the inclusion of self-identity and moral norm into the model. Belief-based measures discriminated intenders from nonintenders, and beliefs that accounted for unique variance in self-efficacy and PCB were identified. The findings are discussed in relation to using models such as the theory of planned behavior to intervene in social and health behaviors.     

Studying, Practicing, and Mastering: A Test of the Model of Goal-Directed Behavior (MGB) in the Software Learning Domain

The present study tested the model of goal-directed behavior (MGB). The model proposes that behavioral intentions to perform instrumental behaviors are primarily motivated by desires to perform the acts. In turn, desires mediate the effects of attitudes, subjective norms, perceived control, and anticipated emotions on intentions. Construct validity for MGB variables is assessed, and the predictive utility of the MGB is compared with that of the theory of planned behavior (TPB). College students ( N = 102) provided measures for MGB and TPB variables while participating in a training program to use statistical software. We focused on two goal-related instrumental behaviors: studying handbooks and practicing with the package. The results show that the MGB accounts for a greater proportion of variance in intentions and instrumental behaviors than does TPB. Although desires mediate most of the effects of other predictors on intentions to perform the instrumental behaviors, it is proposed that when the behavior is normatively relevant, or when self-efficacy appraisals play a major role, subjective norms and perceived behavioral control may directly affect intentions.     

Task and Scheduling Self-efficacy as Predictors of Exercise Behavior

Social cognitive theory (Bandura, 1986, 1995, 1997) has figured prominently among social psychological approaches taken to the investigation of exercise behavior. The present study validated two measures of self-efficacy (scheduling and task) through confirmatory factor analytic procedures. In a separate study, the resultant factors were then used as independent variables in the prediction of exercise behavior and behavioral intention in a structural equation model. Task self-efficacy was found to be more related to behavioral intention than scheduling self-efficacy. Scheduling self-efficacy was found to be more related to behavior than task self-efficacy or behavioral intention. Results support different types and motivational functions of self-efficacy for exercise intentions and behavior.     

Motivation is not enough: prediction of risk behavior following diagnosis of coronary heart disease from the theory of planned behavior.

Perceived behavioral control (PBC) and intention, the proximal predictors from the theory of planned behavior (TPB), were used to predict cardiovascular risk behaviors in 597 patients 1 year after diagnosis with coronary heart disease. The outcome measures were self-report measures of exercise plus objective measures of fitness (distance walked in 6 min) and cotinine-confirmed smoking cessation. In multivariate analyses incorporating both PBC and intention, PBC predicted exercise, distance walked, and smoking cessation, but intention was not a reliable independent predictor of any health behavior measured. Thus, the effective theoretical component of the TPB was PBC. Similar predictions could derive from social-cognitive theory. In coronary patients, behavioral change needs to address issues of action implementation rather than motivational factors alone.     

Self-Efficacy as a Mediator of the Relationship Between Causal Attributions and Exercise Behavior

The primary purposes of this study were to examine whether the attribution–intention link was mediated by self-efficacy and whether the attribution–behavior link was mediated by self-efficacy. As a secondary purpose, we examined whether the attribution–behavior link was mediated by exercise intentions. These relationships were tested prospectively at multiple time points. Participants were 260 adult exercisers ( M age=32 years) enrolled in 12 weeks of structured exercise classes. Social cognitive measures were assessed at early and midprogram; attendance was tracked for the first and second half of the program. Hierarchical multiple regression procedures indicated support for self-efficacy as a mediator of the relationship between attributions and behavior. Secondary analyses revealed support for intention as a mediator of the attribution–behavior relationship. Finally, additive relationships in support of social cognitive theory also were detected. The attribution/self-efficacy/behavior link is important for adherence interventions and should be investigated further in both asymptomatic and symptomatic populations.     

A Contextual Model of Control Beliefs,Behavior, and Health: Latino and European Americans with Type 2 Diabetes

Sense of control is frequently found to be related to health. A model of control beliefs, disease-management behaviors, and health indicators was tested in a sample of 74 Latino Americans and 115 European Americans with Type 2 diabetes. Two measures of control beliefs, one diabetes-specific (diabetes self-efficacy) and one global (mastery), were examined for their effects on management behaviors (diet and exercise) and on health (Hb_A1C and general health). Results indicated that the relationship between control and management behaviors varied by measure of control and by group. For Latino participants, global mastery was related to management behaviors; whereas, self-efficacy was related to such behaviors among European Americans. The relationship between control and health did not appear to be mediated by management behaviors. This study provides support for a diversified approach to control, behavior, and health.     

How do I feel about the behavior? The interplay of affective associations with behaviors and cognitive beliefs as influences on physical activity behavior.

Individuals have affective associations with health behaviors. In other domains such associations have been shown to influence behavior, but affective associations with health behaviors are not included in current health decision-making models. The authors examined whether affective associations with exercise predicted individuals' activity behavior and, if so, how they interfaced with other decision-making constructs to influence behavior. Adult participants (N = 433) reported their current physical activity behavior and affective associations with physical activity. Health belief model and theory of planned behavior constructs were also assessed. More positive affective associations with activity significantly predicted greater activity behavior. Moreover, the influence of the health belief model and theory of planned behavior constructs on activity behavior was mediated through affective associations. Affective associations were shown to play a central role in individuals' activity behavior, both as a mediator of the effects of cognitively based decision-making factors and as an independent predictor of activity behavior. The results suggest the need to include affective influences on behavior in formal models of health decision making and, potentially, to explore affectively based intervention routes to change behaviors.     

The role of self-efficacy in predicting rule-following behaviors in shelters for homeless youth: a test of the theory of planned behavior

Through a prospective study of 70 youths staying at homeless-youth shelters, the authors tested the utility of I. Ajzen's (1991) theory of planned behavior (TPB), by comparing the constructs of self-efficacy with perceived behavioral control (PBC), in predicting people's rule-following behavior during shelter stays. They performed the 1st wave of data collection through a questionnaire assessing the standard TPB components of attitudes, subjective norms, PBC, and behavioral intentions in relation to following the set rules at youth shelters. Further, they distinguished between items assessing PBC (or perceived control) and those reflecting self-efficacy (or perceived difficulty). At the completion of each youth's stay at the shelter, shelter staff rated the rule adherence for that participant. Regression analyses revealed some support for the TPB in that subjective norm was a significant predictor of intentions. However, self-efficacy emerged as the strongest predictor of intentions and was the only significant predictor of rule-following behavior. Thus, the results of the present study indicate the possibility that self-efficacy is integral to predicting rule adherence within this context and reaffirm the importance of incorporating notions of people's perceived ease or difficulty in performing actions in models of attitude-behavior prediction.     

Conscientiousness, the transtheoretical model of change, and exercise: a neo-socioanalytic integration of trait and social-cognitive frameworks in the prediction of behavior

ABSTRACT Relationships between conscientiousness-related traits and transtheoretical model (TTM) of change constructs, exercise self-efficacy, and exercise behavior were examined in college and community samples ( N =566). Measures of the conscientiousness-related traits of conventionality and industriousness were expected to show positive relations with measures of exercise behavior stage location, processes of exercise behavior change, endorsing the benefits of exercise behavior (i.e., decisional balance), exercise self-efficacy, and self-reported exercise behavior. In addition, based on Neo-Socioanalytic Theory ( Roberts & Wood, 2006 ) an intervening role was predicted for TTM constructs and exercise self-efficacy in the relationship between conscientiousness-related traits and exercise behavior stage location. The results showed industriousness (being hardworking) to be the most robust conscientiousness-related predictor of stage location, processes of change, endorsing the benefits of exercise behavior, and exercise self-efficacy. Mediation analyses showed the relationship between industriousness and exercise behavior stage location to be fully accounted for by select processes of change and exercise self-efficacy scales. The results are discussed in terms of a useful integration of trait and social-cognitive approaches to exercise behavior, with an emphasis on the role of industriousness as an important individual difference factor therein.     

Comparative Study Between the Theory of Planned Behavior and the Value–Belief–Norm Model Regarding the Environment,on Spanish Housewives' Recycling Behavior

Environmental behaviors have been analyzed from different theoretical models. The theory of planned behavior emphasizes the attitudinal aspects associated with behavior, while the value–belief–norm model regarding the environment focuses on the importance of moral components when setting environmental behaviors in motion. The objective of this study was to analyze both models, comparing both their degree of fit and their predictive power regarding recycling behavior. To do so, we used a sample made up of 154 Spanish housewives. The results indicated that despite the fact that the theory of planned behavior is a general model for predicting and explaining behavior, it has a greater degree of fit and greater capacity to predict recycling behavior than the value–belief–norm model regarding the environment.     

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

This paper reports an application of the theory of planned behavior (TPB) to the prediction of breast self-examination (BSE) intentions and behavior. The study also considered the distinction between perceived control and self-efficacy within the TPB and the additional predictive utility of past behavior. A sample of 95 women completed questionnaires based on the TPB and were followed up at 1 month. Support for the distinction between perceived control and self-efficacy was provided by principal components analysis. The TPB was found to be highly predictive of intention to perform BSE and subsequent BSE behavior. Regression analyses revealed self-efficacy and attitude to be predictive of intention to perform BSE. Intention, in turn, was the sole predictor of BSE at 1-month follow-up. Past behavior was found to explain additional variance in intention, but not BSE behavior at 1-month follow-up. The results are discussed in relation to the conceptual status of the perceived behavioral control construct, and the practical implications of the results are highlighted.     

From psychological need satisfaction to intentional behavior: testing a motivational sequence in two behavioral contexts

The present study tested a motivational sequence in which global-level psychological need satisfaction from self-determination theory influenced intentions and behavior directly and indirectly through contextual-level motivation and situational-level decision-making constructs from the theory of planned behavior. Two samples of university students (N = 511) completed measures of global-level psychological need satisfaction, contextual-level autonomous motivation, and situational-level attitudes, subjective norms, perceived behavioral control, intentions, and behavior in two behavioral contexts: exercise and dieting. A structural equation model supported the proposed sequence in both samples. The indirect effect was present for exercise behavior, whereas both direct and indirect effects were found for dieting behavior. Findings independently supported the component theories and provided a comprehensive integrated explanation of volitional behavior.     

Causal Models of Physical Exercise Participation: Testing the Predictive Power of the Construct "Pressure to Change"

This study examines 2 different causal models to predict physical exercise motivation and behavior under a longitudinal perspective. The first model includes 5 latent variables that were hypothesized to have an impact on exercise intention and behavior: behavior-specific social support, exercise self-efficacy, perceived health benefits, perceived barriers, and subjective vulnerability to cardiovascular disease. The second model was based on all variables of the first model, but additionally included the new variable "pressure to change." Pressure to change was defined as the extent to which a person feels the necessity that specific personal life circumstances (e.g., health status, social relations) may not remain as they are and ought to be changed. It was hypothesized that the inclusion of health-related pressure to change would result in a better prediction of exercise intention. The proposed causal models were tested separately at the stages of exercise adoption and maintenance. Covariance structure analyses (LISREL) confirmed that pressure to change may be an important factor in the motivational process that leads to the adoption of regular physical exercise. Adding this latent variable to the basic model improved the amount of explained variance in exercise intention by 6%. Furthermore, the results did not support the assumption that cognitive control is critical especially during the acquisition of exercise behaviors, but may be less influential once the behavioral routines have been established. Our data rather indicate that regular physical exercise, even if performed on a regular basis for years, always remains a behavior that requires a high level of cognitive guidance.     

Can the theory of planned behavior predict the maintenance of physical activity?

This study tested the ability of the theory of planned behavior to predict actual participation in physical activity and explored the development of activity habits in a 12-week longitudinal study. People enrolling in a gymnasium (N = 94) completed standard theory of planned behavior measures at baseline and follow-up; behavior was monitored objectively in the intervening period. The data were analyzed by using both standard and repeatable events survival analysis. Results showed that (a) perceived behavioral control was significantly predictive of intentions and actual behavior, (b) stable exercise habits developed in the first 5 weeks of the study, and (c) successful prior performance enhanced perceptions of behavioral control. The implications for developing theory-based interventions that promote the maintenance of health behavior are discussed.