Relative contributions of protection motivation theory components in predicting exercise intentions and behavior

A factorial design was employed to test the relative effectiveness of the four cognitive appraisal processes (severity, vulnerability, response efficacy, and self-efficacy) contained in the revised protection motivation theory (PMT). One hundred sixty undergraduate women read persuasive appeals for increasing exercise, which varied on these four dimensions. As predicted, both the vulnerability and self-efficacy variables enhanced intentions to exercise along with similar effects on self-reported exercising. Intentions were predictive of self-reported changes in behavior. The obtained interaction between vulnerability, self-efficacy, and response efficacy suggests that individuals employed a "precaution strategy": They intended to adopt the recommended behavior even though they held weak beliefs about its effectiveness and were not convinced of their at-risk status. These findings are compared to others obtained using the PMT, and the issue of main and interactive effects produced by the model is also addressed.     

Beyond Protection Motivation: An Integrative Theory of Health Appeals

We develop an integrated theory of health communication by combining protection motivation theory (PMT; Rogers, 1983) with the stages of change described in the transtheoretical model (Prochaska & DClemente, 1982). Our study challenges the assumption implicit in PMT that perceptions of vulnerability, severity, response efficacy, and self-efficacy are equally weighted across individuals. Rather, we propose that people at different stages of readiness to change are differentially affected by levels of these predictor variables. Results from our experiment confirm that vulnerability, severity, and efficacy (response and self) are the main motivators to change behavior during the precontemplation, contemplation, and action stages, respectively. Furthermore, we explore how specific categories of beliefs identified by the transtheoretical model are associated with perceptions of vulnerability, severity, response efficacy, and self-efficacy.     

Cognitive organization of favorable and unfavorable beliefs about performing a behavior

Intentions to perform behaviors are influenced by beliefs about their consequences, but researchers have not addressed how such beliefs are cognitively organized. In 3 experiments, the authors tested the hypothesis that beliefs are organized according to whether they are favorable or unfavorable in regard to performing a behavior. In Experiment 1, a group of U.S. students first read a list of beliefs favorable and unfavorable to going to a vacation resort and then listed their beliefs about condom use. In Experiment 2, another group of U.S. students listed their beliefs about condom use. In Experiment 3, a 3rd group of U.S. students listed their beliefs about a novel behavior (asking the experimenter for candy). The results of all 3 experiments were consistent with the hypothesis that people cognitively organize their beliefs according to whether they are favorable or unfavorable to the behavior in question.     

The Relationship of Subordinate Upward-Influencing Behavior,Health Care Manager Interpersonal Stress,and Performance1

This investigation examined the relationship among subordinate upward-influencing behavior, superior interpersonal stress, and superior performance within a health care setting. It was predicted that hard upward-influencing behavior as exerted by subordinates would be (a) inversely related to subordinate ratings of health care manager performance and (b) positively associated with health care manager interpersonal stress. Data were collected from 76 females and 4 males who were subordinates to 10 health care managers. All were employees in a 116-bed not-for-profit acute care community hospital. Subordinates completed the Satisfaction With My Supervisor Scale (Scarpello & Vandenberg, 1987), work unit and health care manager effectiveness scales (Bass, 1985b), and Form M of the Profiles of Organizational Influence Strategies (Kipnis & Schmidt, 1982). Interpersonal stress was assessed by the 10 health care managers' completion of the Responsibility for People subscale of the Stress Diagnostic Survey (Ivancevich & Matteson, 1980). The results generally supported the two hypotheses. The implications of these findings were discussed. It was recommended that organizations should encourage rational subordinate upward-influencing behavior to reduce interpersonal stress and promote performance.     

Vulnerability Beliefs, Symptom Experiences, and the Processing of Health Threat Information: A Self-Regulatory Perspective

This study used a self-regulation model of health behavior to explore the impact of risk perceptions and disease-risk symptoms on responses to health messages. Undergraduates with beliefs of high or low vulnerability to heart disease participated in a task that either did or did not induce disease-risk symptoms. Participants were then given a threatening or reassuring message about heart disease prevention, or no message. Participants with high-vulnerability beliefs reported higher exercise intentions only after the reassuring message, and then only in the absence of risk symptoms. However, their exercise rates were increased by both messages and by the symptoms. Participants with preexisting beliefs of low vulnerability reported higher risk perceptions after experiencing the symptoms; only the threat message enhanced their exercise rates.     

Cognitive Organization of Favorable and Unfavorable Beliefs About Performing a Behavior

Abstract

Intentions to perform behaviors are influenced by beliefs about their consequences, but researchers have not addressed how such beliefs are cognitively organized. In 3 experiments, the authors tested the hypothesis that beliefs are organized according to whether they are favorable or unfavorable in regard to performing a behavior. In Experiment 1, a group of U.S. students first read a list of beliefs favorable and unfavorable to going to a vacation resort and then listed their beliefs about condom use. In Experiment 2, another group of U.S. students listed their beliefs about condom use. In Experiment 3, a 3rd group of U.S. students listed their beliefs about a novel behavior (asking the experimenter for candy). The results of all 3 experiments were consistent with the hypothesis that people cognitively organize their beliefs according to whether they are favorable or unfavorable to the behavior in question.     

Relationships between locus of control,health value,and preventive health behaviors among women

This study examines the relationships between locus of control expectancies, rated health value, and reported participation in preventive health behaviors among a healthy sample of undergraduate women. The prediction that participation in preventive health behaviors would be a joint function of an internal health-related locus of control belief and holding health in high value was not supported. Instead, individuals who valued their health reported participating in a greater number of health-enhancing behaviors compared to those who valued their health less. Respondents' scores on a health value scale in combination with their rated health status proved to be better predictors of health behaviors than their locus of control beliefs. Limitations of locus of control research with young, healthy individuals are discussed and further investigation into the utility and validity of health value scales is recommended.     

The Role of Intentions, Social Norms, and Attitudes in the Performance of Dental Flossing: A Test of the Theory of Reasoned Action

The theory of reasoned action proposed by Fishbein and Ajzen (1975) was tested as an explanatory model for a preventive dental behavior, dental flossing, in a sample of 65 undergraduate students. Intentions and direct attitudes were found to be the strongest predictors of flossing. Social influences exerted their influence by way of direct attitudes. Flossers (>1/week) and non-flossers (<1/week) were observed to agree with belief statements referring to the health value of flossing. However, statements referring to the social and sensory aspects of flossing were found to effectively discriminate the two groups. Implications for health education strategies are discussed in which a greater focus is placed on more immediate social and sensory benefits of flossing rather than on long-term health benefits.     

Health Promotion,Health Locus of Control,and Health Behavior: Two Field Experiments1

In spite of a sizable body of research on the effects of information promotions on health knowledge and health behavior, relatively little is known about how such efforts affect change (or why they do not). This paper addresses that problem by exploring the particular role that health locus of control (HLC) beliefs play in individual responses to health promotion efforts aimed at encouraging preventive health behaviors. Two field experiments are presented. The first experiment examined the extent to which HLC beliefs are related to differences in individual levels of health knowledge following the distribution of an informational booklet on health. Internals high on health value who received the information booklet demonstrated greater health knowledge three months later than did other subjects, although this difference was greater among men than among women. The second experiment explored how HLC beliefs interact with differently framed “control” messages to promote behavior change in breast self-examination (BSE). HLC beliefs interacted with the control language of the BSE promotional message and a neutral reminder to affect subsequent BSE practice. Together, these studies suggest a more influential role for health locus of control beliefs in shaping responses to health messages than has previously been documented in field settings.     

The Effects of Health Threat Seriousness and Personal Efficacy upon Intentions and Behavior1

Eighty dental patients were pretested with a scale measuring health locus of control and then exposed to a persuasive communication designed to manipulate their beliefs about the seriousness of periodontal disease and their susceptibility to it. The high seriousness condition increased feelings of fear, concern, and threat as well as intentions and reported compliance with recommended oral hygiene procedures. However, patient's perceived personal efficacy in performing the recommended behavior was the most important predictor of subsequent behavior. The implications of the results for Roger's protection motivation theory are discussed.     

Environmental attitudes, knowledge, intentions and behaviors among college students

College students (N = 90) reported their pro-environment behaviors as well as their pro-environment intentions, their explicit and implicit attitudes about the environment, and their knowledge about environmental issues. Intentions and knowledge significantly and independently predicted behavior. Environmental knowledge was not significantly related to attitudes. Implicit and explicit attitudes were significantly but only moderately related. Only explicit attitudes, however, were strongly related to intentions, and intentions completely mediated the influence of explicit attitudes on behavior. Men were found to be more knowledgeable than women about environmental issues; older students had more favorable implicit and explicit environmental attitudes. This research suggests that knowledge about the environment and explicit attitudes influence behavior through different pathways, which may have implications for interventions seeking to increase environmentally friendly behavior.     

Protection Motivation Theory and Adolescents' Perceptions of Exercise1

Coping strategies endorsed by adolescents in dealing with a potential threat to their health were assessed in a study which investigated components of protection motivation theory. Year 9 and 10 high school students were presented with information about cardiovascular disease risk and the role of exercise in maintaining cardiorespiratory fitness. Three components specified by the theory were manipulated: response efficacy (effectiveness of exercise in preventing cardiovascular disease), response costs (costs associated with taking up a regular program of exercise) and self-efficacy (belief in ability to carry out a program of exercise) in a 2 × 2 × 2 factorial design with two levels (high vs. low) of each variable. It was hypothesized that such information would affect participants' perceptions of response efficacy, response costs, self-efficacy, and their selection of coping strategies. Six dependent variables were investigated: two adaptive coping strategies (behavioral intention to exercise, rational problem solving) and four maladaptive strategies (avoidance, wishful thinking, hopelessness, arid fatalism). Manipulation checks found significant differences between the high and low conditions of each independent variable. Adaptive strategies were strongly endorsed, whereas endorsement of the maladaptive strategies ranged from minimal to complete disagreement. Participants in the high self-efficacy condition indicated stronger intentions to exercise. Students in the low response efficacy condition demonstrated more endorsement of hopelessness and fatalism than did students in the high response efficacy condition. When exercising status was included as a fourth independent variable, it was found that active adolescents endorsed the adaptive coping strategies more strongly than did inactive adolescents. The cognitive coping strategies adopted by adolescents when dealing with perceived threats to their health may be influenced by information on the efficacy of relevant behavior, by perceptions of their ability to perform such behavior, and by their actual involvement with the behavior of concern.     

The theory of planned behavior and healthy eating.

Application of the theory of planned behavior (TPB) to healthy eating in 144 health promotion clinic attendees is reported. Respondents completed self-report TPB measures after the clinic (Time 1) and 6 months later (Time 2) with a measure of perceived past behavior. Intention stability was assessed on Time 1-2 differences. Six years later (Time 3), respondents completed measures of healthy eating intentions and behavior. Intentions were predicted by attitudes, perceived behavioral control, and perceived past behavior (cross-sectionally). Healthy eating behavior (Time 3) was predicted from intentions (Time 2). As intention stability increased, intentions and perceived past behavior became stronger and weaker predictors of behavior, respectively. Implications for understanding health cognitions in long-term performance of health behavior are discussed.     

Health Locus of Control After Lung Transplantation: Implications for Managing Health

Health locus of control (HLC) beliefs may influence the health behaviors that patients perform on their own behalf. Likewise, the HLC beliefs that clinicians consider desirable may influence how active they encourage patients to be in managing health. It remains unclear how involved lung recipients want to be and how involved transplant clinicians believe they should be. The aims of this study were to describe HLC beliefs and behaviors manifested by recipients and clinicians in the setting of lung transplantation. Mixed-methods were used, including quantitative techniques to measure demographics, clinical characteristics, and HLC using the Multidimensional Health Locus of Control Scale (MHLC), and qualitative techniques to explore how HLC beliefs were manifest in the clinical setting. Nearly all participants manifested behaviors consistent with high internality and externality, highlighting the importance of holding ‘dual health locus of control’ beliefs for optimal health management and lending support for recipients and clinicians to share responsibility for managing post-transplant health.Funded by the Nursing & Social Sciences Council of the International Society of Heart and Lung Transplantation.     

Health protection: attitudes and behaviors of LPNs, teachers, and college students

Three groups of subjects, college students, high school teachers, and licensed practical nurses (LPNs), were asked to rate 30 health-protective activities in terms of (a) importance (attitude) and (b) the frequency with which they performed them (behavior). Correlational analyses revealed reasonably high consistency between attitudes and behaviors in all three groups. Multidimensional scaling procedures identified two basic dimensions of Health-Protective Behaviors (HPBs) accounting for 57% of the variance. The two dimensions were (a) degree of effectiveness and (b) amount of effort. Although students emphasized effectiveness in rating HPBs and teachers used both dimensions equally, the LPNs tended to consider only amount of effort. Additional analyses indicated that group differences were not related to age or gender but rather to health orientation. In sum, individuals' attitudes and behaviors related to health protection are stable, simply organized, and relatively consistent, but samples of health care providers (LPNs) and lay people (students and teachers) differentially weight the importance of effort and effectiveness when considering HPBs. The implications of these results for patient-provider communication, treatment adherence, as well as an understanding of health behavior are discussed.     

Self-esteem, self-serving cognitions, and health risk behavior

The current article reviews prospective and experimental research on the relation between self-esteem and perceptions of vulnerability. These studies demonstrate that individuals with high self-esteem who engage in risk behavior often utilize a variety of self-serving cognitive strategies that protect them from fully acknowledging their vulnerability to the potential negative consequences of their behavior; e.g., they minimize their estimates of personal risk and overestimate the prevalence of the risk behavior among their peers. The article also provides data on an additional self-serving cognitive strategy employed by adolescents with high self-esteem--alteration of perceptions of others' reactions to their own risk behavior. Finally, the article reviews the emerging literature on the relation between these cognitive strategies and maladaptive health behavior, and proposes that whether these strategies are maladaptive depends on the nature of the threat and the availability of opportunities to engage in compensatory self-enhancement.     

Appraisals of marital conflict and children's adjustment, health, and physiological reactivity.

Children's appraisals of marital conflict were examined as moderators and mediators of conflict and children's adjustment, physical health, and physiological reactivity. Mothers completed measures of marital conflict and children's adjustment and physical health, and elementary school children provided information on their parents' marital conflict, appraisals of perceived threat and self-blame in relation to parents' conflicts, and their internalizing symptomatology. Children's heart rate, systolic and diastolic blood pressure, and skin conductance response and level were examined during both a baseline and an interadult argument. Higher levels of both self-blame and perceived threat functioned as robust vulnerability factors for children exposed to higher levels of marital conflict in relation to internalizing behaviors, health problems, and higher levels of cardiovascular reactivity to the argument. Further, a higher level of perceived threat was a vulnerability factor for externalizing problems associated with exposure to marital conflict.     

Effectiveness of the counterconditioning procedure in eliminating avoidance behavior

Data were obtained on the effectiveness of three forms of counterconditioning—each differing in the degree to which competing responses were introduced. Counterconditioning was also compared with an extinction procedure in eliminating an instrumental avoidance response. Only the counterconditioning procedure which evoked and reinforced another conditioned response during extinction of the avoidance response, was significantly more effective than a traditional extinction procedure in achieving a decrement in avoidance responding and this was only on the first session on which such procedures were in effect. When the opportunity to perform the competing response was removed, only Ss in this group evidenced a significant increase in avoidance responding.

All procedures were equally effective over sessions in eliminating avoidance behavior. A delay in effectiveness occurred to the degree to which a procedure introduced a competing response. It was in terms of the immediacy of response reduction and achievement of a very low rate of responding with very few responses being performed, that the counterconditioning procedure was superior to the extinction procedure.

The implication of these results for behavior theory and therapy were elaborated.     

Forming, changing, and acting on attitude toward affirmative action programs in employment: a theory-driven approach

A model of attitude toward affirmative action programs (AAPs) was applied in 4 studies involving 1,622 participants. In Study 1, attributes people tacitly associate with AAPs were identified by open-ended elicitation. Using those attributes, an instrument was developed and administered in Studies 2, 3, and 4. In those studies, a multiplicative composite of beliefs and evaluations about the AAP attributes predicted AAP attitude, consistent with M. Fishbein and I. Ajzen's (1975) theory of reasoned action. Demographic effects on AAP attitude were partially mediated by this composite. In Studies 3 and 4, an experimental manipulation of AAP information was successful in changing AAP attitude, but in a way that polarized existing demographic differences. Study 4 also showed that AAP attitude and subjective norm jointly and uniquely predicted intentions to perform AAP-related behaviors. Intentions predicted the actual behavior of mailing postcards to political representatives reflecting participants' support for AAPs.