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The highly influential theory of planned behavior suggests that norms and attitudes predict an important antecedent of behavior: intention. Cross-cultural research suggests that culturally influenced self-construals can be primed and differentially affect behaviors that are influenced by norms and attitudes. The purpose of this experiment was twofold: (1) To investigate whether language functions as a prime for culture in Hispanics, and (2) if so, if norms and attitudes differentially predict condom use intention. Fluent English–Spanish bilingual participants (N = 145) of Mexican descent were randomly assigned to answer questionnaires in English and Spanish. Subjective norms and private evaluations towards condom use were assessed and their relative strength in predicting condom use intention was evaluated. Results suggest that language can prime culture and affect the relative accessibility of culture-relevant norms and self-construals in Hispanics. Moreover, consistent with our expectations, norms and attitudes differentially predicted condom use intention.

Background

Over half of kidney cancer survivors (KCS) are completely inactive and only a quarter are meeting physical activity (PA) guidelines. This highlights the need to identify and understand the determinants of PA in this understudied population. The purpose of this study is to determine the social cognitive correlates of PA intention and behavior in KCS using the Theory of Planned Behavior (TPB).

Methods

All 1,985 KCS diagnosed between 1996 and 2010 in Alberta, Canada were mailed a self-report survey that consisted of the Godin Leisure Time Exercise Questionnaire and standard TPB items for intention, planning, perceived behavioral control (PBC), affective and instrumental attitudes, and descriptive and injunctive norms. Standard demographic and medical variables were also collected.

Results

Completed surveys were received from 703 of 1,654 (43%) eligible KCS. The TPB was tested using structural equation modelling and demonstrated an adequate-to-good fit to the data [χ² = 256.88, p < .001; TLI = 0.97; CFI = 0.98; RMSEA = 0.06, 90% CI = 0.05-0.06].

There were significant pathways to PA from PBC (ß = 0.18, p = 0.02), planning (ß = 0.22, p < 0.01), and intention (ß = 0.31, p < 0.01); and to planning from intention (ß = 0.81, p < 0.01). In addition, there were significant model pathways to intention from instrumental attitude (ß = 0.28, p = 0.03), descriptive norm (ß = 0.09, p = 0.01), and PBC (ß = 0.52, p < 0.01). Overall, the TPB accounted for 69%, 63%, and 42% of the variance in intention, planning and PA, respectively.

Conclusion

The TPB appears to be a useful model for explaining PA in KCS. All TPB constructs except injunctive norm and affective attitude were useful for explaining intention with PBC emerging as the largest correlate. Developing PA interventions based on the TPB may be effective in promoting PA in KCS and may lead to important improvements in health.

Attitudes, norms, behavioral control, and chemotherapy patients' intentions to participate in medical error prevention were examined using the theory of planned behavior.

Background.

Patients can make contributions to the safety of chemotherapy administration but little is known about their motivations to participate in safety-enhancing strategies. The theory of planned behavior was applied to analyze attitudes, norms, behavioral control, and chemotherapy patients' intentions to participate in medical error prevention.

Methods.

A quantitative, cross-sectional survey study among chemotherapy patients treated at the oncology/hematology department of a large regional hospital was conducted. Confirmatory factor analysis and structural equation modeling were used to investigate the relationship between patients' responses to measures of attitudes, norms, and behavioral control and their intentions.

Results.

Four hundred seventy-nine patients completed the survey (52% response rate). Attitudes, perceived behavioral control, and subjective norms explained 62% of the variance in intentions to engage in error monitoring and reporting. Perceived behavioral control (β = 0.476), norms relating to patients' relatives (β = 0.343), and instrumental attitudes (β = 0.281) were the strongest (direct) predictors of patients' intentions. Experiential attitudes had the smallest effect on intentions (β = 0.178). Subjective norms relating to expectations attributed to oncology staff had strong direct and indirect effects on patients' intentions (total effect, 0.382).

Conclusions.

Patients acknowledge the benefit of error monitoring and reporting and anticipate positive outcomes of involvement, but their valuations of the process of engaging in error prevention are less positive. Behavioral control and perceptions of staff approval are central for patients. Involvement of cancer patients in safety requires oncologists to address their patients' normative and control beliefs through education and proactive approval of patient engagement.

Purpose:

The theory of reasoned action is a health behavioral theory that has been used to predict personal health behaviors and intentions as well as those of providers delivering health care. The purpose of this study was to determine interns' future practices regarding the use of health promotion using this model to develop survey questions and to determine attitudes and perceived influences on their prospective behaviors in general, toward the use of health promotion once in practice.

Methods:

Across the course of one year, all graduating interns at a chiropractic college were queried with a 20 question survey designed using the theory of reasoned action. Frequencies and inferential statistics were performed including prediction modeling using logistic regression.

Results:

A majority (>85%) of interns indicated they would use health promotion in practice. Differences were noted based on perceived skill levels, perception of educational emphasis, various normative beliefs, and gender.

Conclusion:

Most interns will use some form of health promotion in practice. Normative influences including those seen as key influencers are as powerful a predictor as perceived education or skill levels on future practice of health promotion.

Despite the fact that corporal punishment (CP) is a significant risk factor for increased aggression in children, child physical abuse victimization, and other poor outcomes, approval of CP remains high in the United States. Having a positive attitude toward CP use is a strong and malleable predictor of CP use and, therefore, is an important potential target for reducing use of CP. The Theory of Planned Behavior suggests that parents’ perceived injunctive and descriptive social norms and expectations regarding CP use might be linked with CP attitudes and behavior. A random-digit-dial telephone survey of parents from an urban community sample (n = 500) was conducted. Perceived social norms were the strongest predictors of having positive attitudes toward CP, as follows: (1) perceived approval of CP by professionals (β = 0.30), (2) perceived descriptive norms of CP use (β = 0.22), and (3) perceived approval of CP by family and friends (β = 0.19); also, both positive (β = 0.13) and negative (β = −0.13) expected outcomes for CP use were strong predictors of these attitudes. Targeted efforts are needed to both assess and shift the attitudes and practices of professionals who influence parents regarding CP use; universal efforts, such as public education campaigns, are needed to educate parents and the general public about the high risk/benefit ratio for using CP and the effectiveness of non-physical forms of child discipline.

The present research aimed to (1) determine if students underestimate gender-specific descriptive normative perceptions for protective behavioral strategies; (2) to evaluate the relationships among perceived gender-specific descriptive and injunctive drinking norms and perceived gender-specific descriptive norms for protective behavioral strategies; and (3) to examine whether normative perceptions for protective behavioral strategies relate to use of these strategies when controlling for relevant drinking behavior factors (i.e., alcohol consumption, negative consequences, and attitude toward drinking behavior) and social norms factors (i.e., perceived descriptive and injunctive norms). Students (N = 666; 56.6% male) completed measures assessing drinking behavior and attitudes toward drinking, perceived descriptive and injunctive norms, perceived protective behavioral strategies, and protective behavioral strategies. Findings demonstrated that students consistently underestimated the use of strategies for the typical male student, whereas results were less consistent for the typical female student. In addition, results indicated that same-sex normative perceptions for protective behavioral strategies were associated with personal use of these strategies, even when controlling for relevant drinking behavior and social norms factors. Results stress the importance of evaluating factors that are associated with use of protective behavioral strategies. Implications for social norms preventative interventions are discussed.

The authors investigated whether a causal-indicator model or an effect-indicator model of the theory of planned behavior (TPB) is more suitable for predicting behavioral intention and for which behaviors. No previous studies have evaluated this question using the same sample and same behavior. In this study, African American adolescents ages 12–17 participating in risk reduction classes were assessed on their initial attitudes, norms, perceived control, and intention regarding condom use. Second-order structural equation modeling indicated that the effect-indicator model exhibited superior fit above the causal-indicator model. Furthermore, modeling the behavioral antecedents in a causal way may not be as accurate due to the underlying uni-dimensional nature of attitudes, subjective norms, and control. The TPB was not disconfirmed as a suitable model for African American adolescents’ regarding condom use. Prevention programs may benefit by focusing on adolescent behavior change with regard to the global components in order to influence more specific concepts of these social cognitions. Editors’ Strategic Implications: Despite limitations including correlational data, this study yields implications for prevention programming and, more broadly, an important theoretical elaboration on effect-indicator and causal-indicator models of the TPB.

Background: Regular physical activity is ranked as a leading health indicator. Despite the extensive benefits of physical activity, elder people are much less active than desired. Using Theory of Planned Behavior (TPB) and the self-efficacy construct, this study examined the prediction of physical activity intention and behavior in a sample of elderly male resident of a nursing home.

Methods: In a cross-sectional study of the residents of Kahrizak Nursing Home in Tehran, Iran, elderly men who were 60 years or older, capable of independent living, mobility, and verbal communication were asked to complete measures of the TPB, self-efficacy and physical activity behavior.

Results: A hierarchical step-wise multiple regression analysis indicated that affective/instrumental attitude, subjective norm, and perceived behavioral control (PBC) explained 32.8% of the variance in physical activity intention, and self-efficacy provided an additional 2.7%. In a reverse step regression, the TPB variables explained an additional 12.2% of physical activity intention. In a multiple regression analysis on physical activity behavior, affective/instrumental attitude, subjective norm, perceived behavioral control (PBC) and intention explained 15.7% of the variance in physical activity behavior while self-efficacy contributed an additional 5.6%. In the reverse step regression, TPB predictors contributed an additional 3.0% in explaining the variance in physical activity behavior.

Conclusion: The results indicate that in addition to the TPB, self-efficacy may also play an important role in the prediction of behavior, and should be included in the design of physical activity programs for elderly men of nursing home residents.

Objective

Guided by the Theory of Reasoned Action this study examined the association of behavioral beliefs, attitudes, normative beliefs and subjective norms with waterpipe tobacco smoking intention in college students.

Design and Sample

A cross-sectional design was used. A web-based survey was sent to a random sample of 1,000 undergraduate students from a public institution in the Southeast to recruit participants.

Measures

The Theory of Reasoned Action Waterpipe Questionnaire, a modified version of the Fishbein-Ajzen-Hanson Questionnaire, was used to capture modal constructs of the Theory of Reasoned Action related to waterpipe use. Cronbach’s alpha coefficients for the scales of the Theory of Reasoned Action Waterpipe Questionnaire ranged from .76 to .95.

Results

Of the sample (n=223), 13.5% currently smoked a waterpipe and 61% had ever done so. Using multiple regression, attitudes, behavioral beliefs, and subjective norms were associated with intention to smoke a waterpipe in the next three months and collectively explained 35% of the variance in intention. The full model, which included all the constructs of the Theory of Reasoned Action, demographic variables, and tobacco use variables, explained 83% of the variance in intention to smoke a waterpipe in the next three months.

Conclusions

This study provides valuable information that may be used to target students at risk for waterpipe smoking and serves as a starting point in developing theoretically-driven interventions to prevent waterpipe smoking.

Greek-affiliated college students have been found to drink more heavily and frequently than other students. With female student drinking on the rise over the past decade, sorority women may be at particular risk for heavy consumption patterns. The current study is the first to apply the Theory of Planned Behavior (TPB) to examine drinking patterns among a sorority-only sample. Two-hundred and forty-seven sorority members completed questionnaires measuring TPB variables of attitudes, norms, perceived behavioral control, and intentions, with drinking behaviors measured one month later. Latent structural equation modeling examined the pathways of the TPB model. Intentions to drink mediated the relationship between attitudes and norms on drinking behavior. Subjective norms predicted intentions to drink more than attitudes or perceived behavioral control. Perceived behavioral control did not predict intentions but did predict drinking behaviors. Interpretation and suggestions from these findings are discussed.

Introduction:

Smoking is highly prevalent among lesbian, gay men, bisexual, and transgender (LGBT) persons and contributes to health disparities. Guided by the theory of planned behavior (TPB), we identified beliefs related to attitudes, perceived behavioral control, and subjective norms, as well as LGBT-specific variables, to explain variance in intention to quit smoking in the next 6 months in LGBT smokers.

Methods:

Individual interviews (n = 19) identified beliefs about quitting smoking and LGBT-salient variables and aided in survey development. Surveys were sent to a random sample from an LGBT community center's mailing list and center attendees, with a 25.4% response rate. Bivariate and multivariate analyses were conducted with the final sample of 101 smokers.

Results:

No sociodemographic or LGBT-specific variables beyond the TPB constructs were related to intention to quit smoking. A multivariate TPB model explained 33.9% of the variance in quitting intention. More positive attitudes and specific beliefs that cessation would make smokers feel more like their ideal selves and improve health and longevity were related to greater intention to quit (p values < .05). Subjective norm and perceived behavioral control were marginally significant, with perceived approval of partners and others and beliefs that life goal achievement would make it easier to quit positively related to intention. Depression and stress levels were high.

Discussion:

This is among the first studies to examine theoretically grounded variables related to intention to quit smoking in LGBT smokers. We identified specific behavioral, normative, and control beliefs that can serve as intervention targets to reduce smoking in the LGBT community.

Objective The study examined individual differences between general practitioners (GPs) to determine their impact on variations in intention to refer a hypothetical patient with disordered eating to specialist eating disorder services. The study also examined the impact of patient weight on intention to refer.

Method GPs within three primary care trusts (PCTs) were posted a vignette depicting a patient with disordered eating, described as either normal weight or underweight. A questionnaire was developed from the theory of planned behaviour to assess the GPs' attitudes, perception of subjective norms, perceived behavioural control, and intention to refer the patient. Demographic details were also collected.

Results Responses were received from 88 GPs (33%). Intention to refer the patient was significantly related to subjective norms and cognitive attitudes. Together these predictors explained 86% of the variance in the intention to refer. GP or practice characteristics did not have a significant effect on the GPs' intention to refer, and nor did the patient's weight.

Conclusion Despite National Institute for Health and Clinical Excellence current guidance, patient weight did not influence GPs' decisions to refer. Much of the variance in actual referral behaviour may be explained by cognitive attitudes and subjective norms. Interventions to reduce this variation should be focused on informing GPs about actual norms, and best practice guidelines.

Social norms theories hold that perceptions of the degree of approval for a behavior have a strong influence on one’s private attitudes and public behavior. In particular, being more approving of drinking and perceiving peers as more approving of drinking, are strongly associated with one’s own drinking. However, previous research has not considered that students may vary considerably in the confidence in their estimates of peer approval and in the confidence in their estimates of their own approval of drinking. The present research was designed to evaluate confidence as a moderator of associations among perceived injunctive norms, own attitudes, and drinking. We expected perceived injunctive norms and own attitudes would be more strongly associated with drinking among students who felt more confident in their estimates of peer approval and own attitudes. We were also interested in whether this might differ by gender. Injunctive norms and self-reported alcohol consumption were measured in a sample of 708 college students. Findings from negative binomial regression analyses supported moderation hypotheses for confidence and perceived injunction norms but not for personal attitudes. Thus, perceived injunctive norms were more strongly associated with own drinking among students who felt more confident in their estimates of friends’ approval of drinking. A three-way interaction further revealed that this was primarily true among women. Implications for norms and peer influence theories as well as interventions are discussed.

Despite research indicating that effective parenting plays an important protective role in adolescent risk behaviors, few studies have applied theory to examine this link with marijuana use, especially with national data. In the current study (N=2,141), we hypothesized that parental knowledge (of adolescent activities and whereabouts) and parental warmth are antecedents of adolescents’ marijuana beliefs—attitudes, subjective norms, and perceived behavioral control—as posited by the Theory of Planned Behavior (TPB; Ajzen 1991). These three types of beliefs were hypothesized to predict marijuana intention, which in turn was hypothesized to predict marijuana consumption. Results of confirmatory factor analyses corroborated the psychometric properties of the two-factor parenting structure as well as the five-factor structure of the TPB. Further, the proposed integrative predictive framework, estimated with a latent structural equation model, was largely supported. Parental knowledge inversely predicted pro-marijuana attitudes, subjective norms, and perceived behavioral control; parental warmth inversely predicted pro-marijuana attitudes and subjective norms, ps<.001. Marijuana intention (p<.001), but not perceived behavioral control, predicted marijuana use 1 year later. In households with high parental knowledge, parental warmth also was perceived to be high (r=.54, p<.001). Owing to the analysis of nationally representative data, results are generalizable to the United States population of adolescents 12–18 years of age.

Background

For effective health promotion using health information technology (HIT), it is mandatory that health consumers have the behavioral intention to measure, store, and manage their own health data. Understanding health consumers’ intention and behavior is needed to develop and implement effective and efficient strategies.

Objective

To develop and verify the extended Technology Acceptance Model (TAM) in health care by describing health consumers’ behavioral intention of using HIT.

Methods

This study used a cross-sectional descriptive correlational design. We extended TAM by adding more antecedents and mediating variables to enhance the model’s explanatory power and to make it more applicable to health consumers’ behavioral intention. Additional antecedents and mediating variables were added to the hypothetical model, based on their theoretical relevance, from the Health Belief Model and theory of planned behavior, along with the TAM. We undertook structural equation analysis to examine the specific nature of the relationship involved in understanding consumers’ use of HIT. Study participants were 728 members recruited from three Internet health portals in Korea. Data were collected by a Web-based survey using a structured self-administered questionnaire.

Results

The overall fitness indices for the model developed in this study indicated an acceptable fit of the model. All path coefficients were statistically significant. This study showed that perceived threat, perceived usefulness, and perceived ease of use significantly affected health consumers’ attitude and behavioral intention. Health consumers’ health status, health belief and concerns, subjective norm, HIT characteristics, and HIT self-efficacy had a strong indirect impact on attitude and behavioral intention through the mediators of perceived threat, perceived usefulness, and perceived ease of use.

Conclusions

An extended TAM in the HIT arena was found to be valid to describe health consumers’ behavioral intention. We categorized the concepts in the extended TAM into 3 domains: health zone, information zone, and technology zone.

Purpose: An increasing number of elderly individuals are diagnosed with Alzheimer’s disease and related disorders (ADRD), many of whom receive daily caregiving from spouse or adult child. Caregiving is a “cultural activity,” and as such it is strongly influenced by sociocultural beliefs about caregiving and how it should be enacted. Understanding this thinking–action process has important implications for future research and service. Reasoned action theory provides empirical evidence that attitudes and beliefs, as they are influenced by the social environment, predict intentions to act. In turn, behavioral intentions can reliably predict behaviors. This grounded theory study describes a typology of caregiving styles relevant to family members of an individual with ADRD, where caregiving style is defined as a culturally based pattern in thinking and action. The goal of this study was to characterize the relationship between caregiver intentions and care strategies. Methods: Study participants included 97 individuals residing in the Washington, DC, area, who provide daily care for a family member with ADRD. Narrative data were collected from each caregiver during three 1-hr interview sessions. A subset of 30 caregiver–care recipient (CR) dyads was videotaped during typical interactions. Results: Four caregiving styles were identified (facilitating, balancing, advocating, and directing), which differ primarily in the intended focus of care and preferred interactions with the CR. Implications: The results provide a foundation for future studies of the relationships between sociocultural context, caregiving styles and strategies, and ensuing outcomes for caregiver–CR dyads.

The purpose of this study was to test a version of the Theory of Planned Behavior (TPB) for predicting safe sex behavior in a sample of 228 HIV-negative heterosexual methamphetamine users. We hypothesized that, in addition to TPB constructs, participants’ amount of methamphetamine use and desire to stop unsafe sex behaviors would predict intentions to engage in safer sex behaviors. In turn, we predicted that safer sex intentions would be positively correlated with participants’ percentage of protected sex. Hierarchical linear regression indicated that 48% of the total variance in safer sex intentions was predicted by our model, with less negative attitudes toward safer sex, greater normative beliefs, greater control beliefs, less methamphetamine use, less intent to have sex, and greater desire to stop unsafe sex emerging as significant predictors of greater safer sex intentions. Safer sex intentions were positively associated with future percent protected sex (p<.05). These findings suggest that, among heterosexual methamphetamine users, the TPB is an excellent model for predicting safer sex practices in this population, as are some additional factors (e.g., methamphetamine use). Effective interventions for increasing safer sex practices in methamphetamine user will likely include constructs from this model with augmentations to help reduce methamphetamine use.

Background

Bicycle use entails high safety and health risks especially for adolescents. Most safety education programs aimed at adolescents focus on accident statistics and risk perceptions. This paper proposes the investigation of the social-cognitive correlates of risky cycling behaviors of adolescents prior to developing safety education programs.

Method

Secondary school students aged 13 to 18 years (n = 1446) filled out questionnaires regarding bicycle behavior, risky intentions, accident experience, and social-cognitive determinants as suggested by the theory of planned behavior.

Results

Regression analysis revealed that the proximal variables (i.e., self-efficacy, attitudes towards drunk driving, personal norm regarding safekeeping of self and others, and compared risk) were able to predict 17% of the variance of risky behavior and 23% of the variance of risky intentions. The full model explained respectively 29% and 37% of the variance in risky behavior and risky intentions. Adolescents with positive attitudes towards risky behavior and low sense of responsibility report risky behavior, even when having been (close to) an accident.

Conclusions

Adolescents realize whether they are risk takers or not. This implies that the focus of education programs should not be on risk perceptions, but on decreasing positive attitudes towards alcohol in traffic and increasing sense of responsibility instead. Cognitions regarding near accidents should be studied, the role of safe cycling self-efficacy is unclear.

Objective

To identify factors associated with intention to attend a hypothetical eye health test and provide an evidence base for developing an intervention to maximise attendance, for use in studies evaluating glaucoma screening programmes.

Design

Theory-based cross-sectional survey, based on an extended Theory of Planned Behaviour (TPB) and the Common Sense Self-Regulation Model, conducted in June 2010.

Participants

General population including oversampling from low socioeconomic areas.

Setting

Aberdeenshire and the London Boroughs of Lewisham and Southwark, UK.

Results

From 867 questionnaires posted, 327 completed questionnaires were returned (38%). In hierarchical regression analysis, the three theoretical predictors in the TPB (Attitude, Subjective norm and Perceived Behavioural Control) accounted for two-thirds of the variance in intention scores (adjusted R2=0.65). All three predictors contributed significantly to prediction. Adding ‘Anticipated regret’ as a factor in the TPB model resulted in a significant increase in prediction (adjusted R2=0.74). In the Common Sense Self-Regulation Model, only illness representations about the personal consequences of glaucoma (How much do you think glaucoma would affect your life?) and illness concern (How concerned are you about getting glaucoma?) significantly predicted. The final model explained 75% of the variance in intention scores, with ethnicity significantly contributing to prediction.

Conclusions

In this population-based sample (including over-representation of lower socioeconomic groupings), the main predictors of intention to attend a hypothetical eye health test were Attitude, Perceived control over attendance, Anticipated regret if did not attend and black ethnicity. This evidence informs the design of a behavioural intervention with intervention components targeting low intentions and predicted to influence health-related behaviours.

Article summary

Article focus

The current UK practice of opportunistic case finding during routine sight tests misses a majority of those with glaucoma. Early detection and treatment of glaucoma reduces the risk of blindness.

The feasibility and cost-effectiveness of screening programmes is largely determined by uptake by the target population.

This study identified empirical evidence, based on models of behaviour change, to inform the design of an intervention to maximise uptake.

Key messages

Intention to attend an eye health check to detect glaucoma is associated with positive Attitude, Perceived control over screening attendance, Anticipated regret if test is not attended, perceived consequences of glaucoma and black ethnicity. These factors can be targeted in an intervention to maximise uptake.

Strengths and limitations of this study

This study is the largest of its kind and uses a robust methodology based on plausible models of change to identify potential barriers to attendance for eye care.

The response rate was 38%, which is higher than generally achieved in similar population-based surveys.

There was evidence to suggest that this sample was representative of the target population (general population with over-representation of black ethnicity or of low socioeconomic status).

Objective. To measure the impact of medication therapy management (MTM) learning activities on students’ confidence and intention to provide MTM using the Theory of Planned Behavior.

Design. An MTM curriculum combining lecture instruction and active-learning strategies was incorporated into a required pharmacotherapy laboratory course.

Assessment. A validated survey instrument was developed to evaluate student confidence and intent to engage in MTM services using the domains comprising the Theory of Planned Behavior. Confidence scores improved significantly from baseline for all items (p < 0.00), including identification of billable services, documentation, and electronic billing. Mean scores improved significantly for all Theory of Planned Behavior items within the constructs of perceived behavioral control and subjective norms (p < 0.05). At baseline, 42% of students agreed or strongly agreed that they had knowledge and skills to provide MTM. This percentage increased to 82% following completion of the laboratory activities.

Conclusion. Implementation of simulated MTM activities in a pharmacotherapy laboratory significantly increased knowledge scores, confidence measures, and scores on Theory of Planned Behavior constructs related to perceived behavioral control and subjective norms. Despite these improvements, intention to engage in future MTM services remained unchanged.

Background

To investigate the efficacy of the Theory of Planned Behavior (TPB) to predict healthy eating behavior in a group of urban Native American youth.

Methods

Native American boys and girls (n = 139), ages 9–18 years old, were given a self-administered survey to assess eating behavior using the TBP constructs (intention, attitude, subjective norm, barriers, self-efficacy, and perceived behavioral control). Youth were also measured for height and weight and body mass index (BMI) was calculated. Bivariate correlations and stepwise regression analyses of TBP model were performed with SPSS software.

Results

No association was found between intention and healthy eating behavior. However, independently healthy eating behavior was correlated with barriers (0.46), attitude (0.44), perceived behavioral control (0.35), and subjective norm (0.34). The most predictive barriers to eating healthy included the availability and taste of foods. Boys' eating behavior was most predicted by subjective norm, while girls' eating behavior was most predicted by barriers.

Conclusion

Lack of association between intention and healthy eating behavior suggests that factors other than intentions may drive healthy eating behaviors in urban Native American youth. Results indicate that programs promoting healthy eating to youth might focus on collaborating with families to make healthy foods more appealing to youth.

Background

Although measures of knowledge translation and exchange (KTE) effectiveness based on the theory of planned behavior (TPB) have been used among patients and providers, no measure has been developed for use among health system policymakers and stakeholders. A tool that measures the intention to use research evidence in policymaking could assist researchers in evaluating the effectiveness of KTE strategies that aim to support evidence-informed health system decision-making. Therefore, we developed a 15-item tool to measure four TPB constructs (intention, attitude, subjective norm and perceived control) and assessed its face validity through key informant interviews.

Methods

We carried out a reliability study to assess the tool's internal consistency and test-retest reliability. Our study sample consisted of 62 policymakers and stakeholders that participated in deliberative dialogues. We assessed internal consistency using Cronbach's alpha and generalizability (G) coefficients, and we assessed test-retest reliability by calculating Pearson correlation coefficients (r) and G coefficients for each construct and the tool overall.

Results

The internal consistency of items within each construct was good with alpha ranging from 0.68 to alpha = 0.89. G-coefficients were lower for a single administration (G = 0.34 to G = 0.73) than for the average of two administrations (G = 0.79 to G = 0.89). Test-retest reliability coefficients for the constructs ranged from r = 0.26 to r = 0.77 and from G = 0.31 to G = 0.62 for a single administration, and from G = 0.47 to G = 0.86 for the average of two administrations. Test-retest reliability of the tool using G theory was moderate (G = 0.5) when we generalized across a single observation, but became strong (G = 0.9) when we averaged across both administrations.

Conclusion

This study provides preliminary evidence for the reliability of a tool that can be used to measure TPB constructs in relation to research use in policymaking. Our findings suggest that the tool should be administered on more than one occasion when the intervention promotes an initial 'spike' in enthusiasm for using research evidence (as it seemed to do in this case with deliberative dialogues). The findings from this study will be used to modify the tool and inform further psychometric testing following different KTE interventions.

The HIV/AIDS pandemic continues to challenge the African American community with disproportionate rates of infection, particularly among young women ages 25 to 34 years. Development of a preventive HIV vaccine may bring a substantial turning point in this health crisis. Engagement of the African American community is necessary to improve awareness of the effort and favorably influence attitudes and referent norms. The Theory of Reasoned Action (TRA) may be a useful framework for exploration of community engagement outcomes including future attendance, community mobilization, and study participation. Within the context of HIV vaccine outreach, we conducted a cross-sectional survey in early 2007 with 175 African-American adults (≥ 18 years). Confirmatory factor analysis and structural equation modeling were performed and the findings support the potential of the model in understanding behavioral intentions toward HIV vaccine research.

Whereas substantial research has linked perceived norms and HIV sexual risk behavior, less attention has been given to the relationship between perceived norms and injection drug practices. This study investigated the relationship between needle sharing and perceived norms in a sample of injection drug users. Data were collected through face-to-face interviews with 684 injectors from the STEP Into Action (STEP) project in Baltimore, Maryland. Logistic regression was used to assess the associations between perceived norms (descriptive and injunctive norms) and needle sharing. Results were stratified by gender. Descriptive norms were significantly related to needle sharing among males (AOR = 1.58, 95%CI = 1.20–2.40) and females (AOR = 1.78; 95%CI = 1.24–2.55). Whereas injunctive norms were significantly associated with needle sharing among men (AOR = 1.30 95%CI = 1.05–1.61), this association was not significant among women (AOR = 0.99; 95%CI = 0.74–1.31). These findings suggest the utility of peer education interventions that promote norms regarding risk reduction among injection drug users. The data also provide support for gender-specific HIV prevention interventions.

Harm reduction approaches may benefit from research extending the exploration of predictors of alcohol use per se to those components most directly related to alcohol-related harm. This investigation evaluated the relationship between perceived injunctive norms of alcohol use (level of approval of drinking behaviors in specific situations) and the experience of alcohol-related consequences as a function of typical student reference groups at increasing levels of similarity to the respondent: based on race, gender, Greek status, and combinations of these dimensions, as well as parents, close friends, and the students' own attitudes. Participants were 3753 students (61% female) from two campuses who completed an online survey. Preliminary analyses determined that there were no differences in the relationship between perceived injunctive norms and consequences across the eight student groups of varying specificity, thus all eight levels were combined into one variable of perceived student injunctive norms. However, the relationship between this variable and consequences was weaker than the perceived attitudes of more proximal referents (parents, close friends, as well as their own personal attitudes). Subsequent analyses predicting consequences while controlling for demographic variables and drinking level, revealed that perceived injunctive norms for students, parents, and close friends as well as personal attitudes each significantly predicted consequences. Results suggest an important role for perceived injunctive norms in the experiencing of consequences over and above the amount of consumption and point to types of injunctive norms feedback that might form effective interventions (i.e., incorporating close friend and parent feedback as well as general student feedback).