Week 2 Theory of Planned Behavior

1. Week 2Theory of Planned Behavior Stephanie sprauer Toby Lewis H571

2. Theory of Reasoned Action • First must understand the Theory of Reasoned Action (TRA) • Beliefs about health behaviors shape behavioral intent • Subjective norms or social influences also shape behavior intent • DiClemente, 67

3. Theory of Planned Behavior • Theory of Reasoned Action plus the added construct of perceived behavioral control • “the extent to which a person or group perceive that they are able to control the outcome, meaning that change is within their control” (DiClemente, 72) • People might try harder to perform a behavior if they feel they have a high degree of control over it. (NCI, 17)

4. Theory of Planned Behavior Cont. • Beliefs about health behaviors shape behavioral intent • Subjective norms or social influences shape behavioral intent • Perceived Control shapes behavior intent

5. Theory of Planned Behavior Model Attitude toward behavior Behavioral Beliefs Subjective Norm Normativebeliefs Intention Behavior Perceived Behavioral Control Control Beliefs DiClemente, Figure 4-4

6. Perceived Behavioral Control • Control is made up of factors external to the person making the decision and their cognitive evaluation of those external factors • These external factors either: • Facilitate • OR • Inhibit • DiClemente, 73

7. Facilitating Factors • Definition - Any actual or perceived external factor that increases likelihood of the occurrence of the behavior. • Seen as positive or motivating and possessing necessary skills to carry out behavior • Example: Routine Pap Testing • Clinic hours accommodating for women who work during the day • Clinic provides child care services • DiClemente, 73

8. Inhibiting Factors • Definition – Any external perception or reality that inhibits a behavior • Negative, prohibitive to goal, lacking necessary skills • Example: Routine Pap Testing • Some women may believe that a positive pap test result indicates “full blown cancer” which is only treated by hysterectomy • The costs of the Pap test may be prohibitively expensive • DiClemente, 73

9. Facilitating/Inhibiting Factors Table 4-2 (DiClemente, 74)

10. Class Example Wearing a seatbelt

11. TPB: Affective Beliefs • In addition to facilitating and inhibiting factors TPB suggests that the perceived power of these factors is considered by people in the process of adopting a health-protective behavior • Perceived power is the strength of the facilitating and inhibiting factor • A single but strong inhibiting factor may negate translation of behavioral intent into behavior • E.g., Cost associated with a Pap test for uninsured • Also includes strength of self-determination or will to do the behavior

12. Theory of Planned Behavior Model Attitude toward behavior Behavioral Beliefs Subjective Norm Normativebeliefs Intention Behavior Perceived Behavioral Control Control Beliefs DiClemente, Figure 4-4

13. TPB: Another Version

14. TPB Model: Dr. Flay Knowledge/Expectancies Values/Evaluations Skill Will, Self-determination , with Flay adaptations

15. THE THEORY OF TRIADIC INFLUENCE GENETICS ENVIRONMENT IntraPersonal Environment Social Situation Attitudes Toward Behavior Self-Efficacy Social Normative Beliefs Intentions/Decision BEHAVIOR 15

16. Trafimow & Causal Pathways Trafimow examined different casual pathways to behaviors for different persons Some are lead to a behavior on the primary basis of attitudinal pathways, others primarily by normative How can we tell which pathway is primary? Consider a large set of behaviors in a domain of interest rather than a single one Example – Cancer Prevention Behaviors, Exercise Behaviors, Healthy Eating Behaviors Trafimow, 5

17. Pathways of Behavior • According to Trafimow • Attitudinal • Personal orientation towards specific behavior • Normative • Should or should not do according to family, friends, etc. • Control • To what extent one has power over outcome

18. Test of the TPB Plotnikoff, et al Examine the TPB to explain physical activity behavior in a large population sample of adolescents, while also testing gender and intention. Study asked questions of participants regarding enjoyment of physical activity as well as importance. Researchers found that perceived behavioral control was the strongest correlate of behavior and attitude was the strongest correlate of intention. (Journal of Adolescent Health 49 (2011) 547-549)

19. Plotnikoff et al’s test of TPB

20. TPB Model Applied Attitude toward behavior Behavioral Beliefs Subjective Norm Normativebeliefs Intention Behavior Perceived Behavioral Control Control Beliefs DiClemente, Figure 4-4

21. Application of TPB • Increasing Adherence to Care Plans, medication, and health promotion habits using TPB to ultimately sustain quality of life specifically in 65+ • Behavioral Beliefs – What does the patient believe about health management or their particular condition in relation to their health (how serious)? • *misconceptions about positive health habits • Normative Beliefs – Who are the patient’s primary influence upon their life/attitude? What are they pressuring, influencing patient towards? • *mistrust of physicians and their guidance based on word of mouth • Control Beliefs – To what degree does the patient believe that their health and quality of living is within their control to affect? • *disengagement, condition has gotten so bad, their desire for control is gone)

22. Questions?