Transcript Models and Theories in Health Promotion

Theory of Reasoned Action/
Planned Behavior and the
Integrated Behavioral Model
Presentation by Irving Rootman
to SFU Class on Principles and
Practices of Health Promotion
September 27, 2010
Development of Theory
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Theory of Reasoned Action (TRA) developed by
Fishbein in mid-1960’s
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Fishbein and Ajzen modified TRA in 1970’s and
called it the Theory of Planned Behavior (TPB)

Kasprzyk and Montano collaborated with Fishbein to
produce further extension of the TRA/TPB called the
Integrated Behavioral Model (IBM) in the 1990’s
Description of TRA/TPB

TRA/TPB concerned with individual motivational
factors as determinants of the likelihood of
performing a specific behaviour

TRA includes measures of attitude and social
normative perceptions that determine behavioural
intention, which in turn affects behavior.

TPB contains an additional construct: perceived
control over performance of the behaviour
Definitions of TRA Constructs

Behavioral intention: “perceived likelihood
of performing the behavior”

Attitude toward behavior: “evaluation of
the behavior”
Subjective norm: “belief about whether
most people approve of disapprove of the
behavior”

Definitions of TRA Constructs
(Cont.)

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Behavioral beliefs: “belief that behavioral
performance is associated with certain attributes or
outcomes”
Evaluation of behavioral outcomes: “value
attached to a behavioral outcome or attribute”
Normative beliefs: “belief about whether most
important people approve or disapprove of
behaviour”
Motivation to comply: “Motivation to do what each
referent thinks”
Definitions of TPB Constructs

Perceived behavioral control: “perceived
control over the behavior”

Control belief: “perceived likelihood of
occurrence of each facilitating or constraining
condition”
Perceived power: “perceived effect of each
condition in making performance difficult or
easy”

Measurement: Example of
Glove Use (Levin, 1999)
Behavioral Intention: How likely is it you will wear gloves each time?
Attitude Toward Behavior: How important do you think wearing gloves is?
- Behavioral Belief: Is wearing gloves when there is contact with blood…
awkward/inconvenient/keep you safe?
- Evaluation of Behavioral Outcome: How likely is it that wearing gloves will be
effective?
Subjective Norm: To what extent do the majority of people think it is a good idea to wear
gloves?
- Normative beliefs – Do most people in healthcare think it is important to wear
gloves?
- Motivation to comply – How much do you want to comply?
Perceived Behavior Control:
- Control beliefs: Is it up to you whether or not you wear gloves?
- Perceived power: Do you have the ability to put on gloves?
Description of IBM (Cont.)

Substitutes “Evaluations of behavioral
outcomes” with “Feelings about behavior”
and “Perceived power” with “Efficacy beliefs”

Divides “Normative beliefs” into “Others’
expectations” and “Others’ behavior”

Drops “Motivation to comply”
Description of Integrated
Behavioral Model (IBM)

Most important determinant of behaviour is
still intention to perform behaviour

Adds 4 other determinants of behaviour:
Knowledge and skills; Salience of behaviour;
Environmental constraints; and Habit

Expands and renames Attitude, Normative
and Control elements
Definitions of new or changed
constructs in IBM


Experiential attitude: “Affective evaluation
of the behaviour”
Instrumental attitude: “Cognitive evaluation
of the behaviour”
Injunctive norm: Called “subjective” norm in
TRA/TPB
 Descriptive norm: “what others in one’s
social networks are doing”
Definitions of new or changed
constructs in IBM (Cont.)

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Personal agency: “bringing one’s influence to bear on one’s
own functioning and environmental events” (Bandura, 2006)
Self-efficacy: “ones degree of confidence in the ability to
perform the behavior in the face of various obstacles or
challenges”
Feelings about behavior: Not defined
Control beliefs: “beliefs about the likelihood of occurrence of
various constraining or facilitating conditions”
Efficacy Beliefs: “perceived effect of these conditions in making
behavior easy or difficult”
Integrated Behavior Model
(IBM)
Steps in Applying IBM
Framework
1.
2.
3.
4.
5.
6.
7.
8.
Clearly specify behavior
Conduct elicitation study
Use findings to design survey
Confirm that measures explain behavioral intention
Use findings to analyze and identify specific beliefs
for intervention
Develop arguments to change beliefs
Select and train channels for communication
Introduce and evaluate intervention
Strengths

Helps organize thought and planning of research, interventions and
analysis

Provides framework to understand cognitive factors and motivation
behind behaviours

Requirement of elicitation studies and precise measures provide
evidence relevant to individuals, groups or populations

Predicts and explains wide range of health behaviours

Has evolved over time based on research and experience

Has been used extensively to develop interventions
Limitations

Uncertainties regarding whether or not intentions will yield behavior change

New alternative ways to conceptualize intentions

Attitudes often affect behavior directly

Intentions can change over time

Some variables not extensively tested

Does not address emotional elements
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Time consuming/expensive to collect data
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Focus related to individual motivation

TRA and TPB predictors based on subjective factors

Doesn’t include interpersonal, group and community factors to any great extent
Implications for Aging

Only one of the references in Chapter 4 of the Glanz
book mentioned seniors (Montano, D. & Kasprzk,
2008)

In a search of published literature from 2005-2010
on TPB several papers involving seniors appeared,
many having to do with predicting physical activity
among seniors

A search over the same time period in relation to the
IBM yielded no papers on aging or seniors.
Example of Project Using TRA in relation to
Aging (Albarracin, et al., 2006)
Purpose: Test utility of structural and volitional factors as
determinants of support-seeking intentions
Sample: 106 middle-aged women in Argentina
Methods: TRA questionnaire on support-seeking behaviors; women
asked about (1) intention to visit doctor one a year after age 55;
(2) intention to visit family member at least once a week after 55
Findings: Intentions could be successfully predicted from attitudes
and norms but not from structural factors
Conclusion: Study provides support for TRA as predictor of
intentions to seek social support in old age
Example of Project Using TPB in
relation to Aging (Dean et al., 2007)
Purpose: Use TPB constructs to understand factors influencing older
adults’ participation in strength training
Sample: 200 men and women aged 55+ purposely sampled from seniors’
centres in Ontario
Methods: TPB questionnaire; Regression analysis
Findings: Subjective norm and perceived behavioral control predicted 42%
of variance; Gender and current strength-training did not moderate
relationship
Conclusion: interventions targeting subjective norm and perceived control
might be helpful in promoting strength-training behavior among older
adults.
References
Albarracin, D., Fishbein, M. & de Muchinik, E. (1997). Seeking social
support in old age as reasoned action. Journal of Applied Social
Psychology, 27 (6), 463-476.
Dean, RN, Farrell, JM, Kelley, ML, Taylor, MJ &Rhodes, RE. (2007).
Testing the efficacy of the theory of planned behavior to explain
strangth training in older adults. Journal of Aging and Physical
Activity, 15 (1), 1-12.
Levin, P. (1999). Test of the Fishbein and Ajzen models as predictors
of health care workers’ glove use. Research in Nursing & Health,
22, 295-307.
Montano, D. & Kasprzk, (2008). The Theory of Reasoned Action,
Theory of Planned Behavior and the Integrated Behavioral Model.
In Glanz, K.M., Rimer, B.K.& Viswanath, K. (Eds.). Health behavior
and health education: Theory, research and practice, pp. 67-96, 4th
Edition, San Francisco, California: Jossey- Bass.