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 Theory of Reasoned Action (TRA) developed by Fishbein in mid-1960’s 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.) 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.) 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 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 Time consuming/expensive to collect data 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 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.