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1.  Moderators of the intention-behaviour and perceived behavioural control-behaviour relationships for leisure-time physical activity 
Background
Intention is a key determinant of action. However, there is a gap between intention and behavioural performance that remains to be explained. Therefore, the aim of this study was to identify moderators of the intention-behaviour and perceived behavioural control (PBC)- behaviour relationships for leisure-time physical activity.
Method
This was tested in reference to Ajzen's Theory of Planned Behaviour. A sample of 300 volunteers, 192 women and 108 men, aged 18 to 55, participated in the study. At baseline, the participants completed a self-administrated psychosocial questionnaire assessing Ajzen's theory variables (i.e., intention and perceived behavioural control). The behavioural measure was obtained by mail three months later.
Results
Multiple hierarchical regression analyses indicated that age and annual income moderated the intention-behaviour and PBC-behaviour relationships. However, in the final model predicting behaviour (R2 = .46), only the interaction term of PBC by annual income (β = .24, p = 0.0003) significantly contributed to the prediction of behaviour along with intention (β = .49, p = 0.0009) and past behaviour (β = .44, p < 0.0001).
Conclusion
Physical activity promotion programs would benefit not only from focusing on increasing the intention of low intenders, but also from targeting factors that moderate the perceived behavioural control-behaviour relationships.
doi:10.1186/1479-5868-5-7
PMCID: PMC2275296  PMID: 18241339
2.  Factors influencing intentions of pregnant women to exercise after giving birth. 
Public Health Reports  1989;104(2):188-195.
The aim of this study was to identify factors that may influence a pregnant woman's decision to exercise after giving birth. A sample of 98 pregnant women were asked to complete a questionnaire investigation attitudes, social norms, perceived barriers to exercise, and intention regarding exercising after giving birth. Also determined were age, education level, exercise habits, number of months elapsed since onset of present pregnancy, and number of children. The regressions of intentions to exercise on all variables yielded R2 of 0.52 for nulliparous and 0.60 for pluriparous pregnant women. Important differences in variables that explained intentions were found between both groups of women, with perceived barriers to exercise being a key predictor that was, in turn, influenced by previous experience with pregnancy. It is suggested that the experience of the postnatal period modifies the interrelation between the variables explaining intentions regarding exercise after giving birth. Consequently, the programs should take into account the impact that the birth of a first child will have on the perceived barriers to exercise.
PMCID: PMC1580036  PMID: 2495554
3.  The Importance of Autonomous Regulation for Students' Successful Translation of Intentions into Behavior Change via Planning 
Physical activity has a high prevention potential in adolescents. This study investigated the relations between physical activity and intention, autonomous regulation, and planning. We hypothesized that planning mediates the relationship between intention and behavior and that this mediation should depend on the level of autonomous regulation. Stratified randomization sampling method was administered to assemble a sample of N = 534 students among two schools in China. To test the hypothesis, autonomous regulation, intention, and physical activity were assessed at baseline as well as planning and follow-up physical activity four weeks after the pretest. A moderated mediation model confirmed that planning mediated the intention-behavior relation with the effect of planning being moderated by autonomous regulation. Study results demonstrated that autonomous regulation facilitated the translation of intention into behavior change via planning. To promote physical activity among adolescents, interventions targeting planning and autonomous regulation might facilitate successful translation of intentions into behavior change.
doi:10.4061/2011/697856
PMCID: PMC3170742  PMID: 21991441
4.  Psychosocial predictors of eating habits among adults in their mid-30s: The Oslo Youth Study follow-up 1991–1999 
Background
The predictive value of the psychosocial constructs of Theory of Planned Behaviour (TPB) on subsequent dietary habits has not been previously investigated in a multivariate approach that includes demographic factors and past dietary behaviour among adults. The aim of this study was to investigate to what extent TPB constructs, including intention, attitudes, subjective norms, perceived behavioural control, and perceived social norms, measured at age 25 predicted four eating behaviours (intake of fruits and vegetables, whole grains, total fat and added sugar) eight years later.
Methods
Two hundred and forty men and 279 women that participated in the Oslo Youth Study were followed from 1991 to 1999 (mean age 25 and 33 years, respectively). Questionnaires at baseline (1991) included the constructs of the TPB and dietary habits, and at follow-up (1999) questionnaires included demographic factors and diet. For the assessment of diet, a food frequency questionnaire (FFQ) with a few food items was used at baseline while an extensive semi-quantitative FFQ was used at follow-up.
Results
Among men, attitudes, subjective norms and previous eating behaviour were significant predictors of fruit and vegetable intake, while education and past eating behaviour were predictive of whole grain intake in multivariate analyses predicting dietary intake at follow-up. For women, perceived behavioural control, perceived social norms and past behaviour were predictive of fruit and vegetable intake, while subjective norms, education and past eating behaviour were predictive of whole grain intake. For total fat intake, intention was predictive for men and perceived behavioural control for women. Household income and past consumption of sugar-rich foods were significant predictors of added sugar intake among men, while past intake of sugar-rich foods was a significant predictor of added sugar intake among women.
Conclusion
After adjusting for potential confounding factors, all psychosocial factors assessed among young adults appeared predictive of one or more eating behaviours reported eight years later. Results point to the influence of psychosocial factors on future eating behaviours and the potential for interventions targeting such factors.
doi:10.1186/1479-5868-2-9
PMCID: PMC1208934  PMID: 16076386
5.  Affective response to exercise as a component of exercise motivation: Attitudes, norms, self-efficacy, and temporal stability of intentions 
Problem:
A positive affective response is associated with increased participation in voluntary exercise, but the mechanisms by which this occurs are not well known. Consistent with a Theory of Planned Behaviour perspective, we tested whether affective response to exercise leads to greater motivation in terms of attitudes, subjective norms, self-efficacy and intentions to exercise. We were also specifically interested in whether a positive affective response leads to more temporally stable intentions.
Method:
Participants (N = 127) self-reported Theory of Planned Behaviour constructs and exercise behavior at baseline and three months later, and provided reports of exercise-related affect during a 30-minute bout of moderate intensity treadmill exercise at baseline.
Results:
We show that participants who experience greater improvements in positive affect, negative affect and fatigue during exercise tended to report more positive attitudes, exercise self-efficacy and intentions to exercise three months later. Affective response was not predictive of subjective norms. As hypothesized, positive affective response was associated with more stable intentions over time.
Conclusions:
We conclude that a positive affective response to acute bouts of exercise can aid in building and sustaining exercise motivation over time.
doi:10.1016/j.psychsport.2009.05.010
PMCID: PMC2782828  PMID: 20161385
exercise motivation; affective response; exercise mood states; temporal stability of intentions
6.  Attitudes of asthmatic and nonasthmatic children to physical exercise 
Purpose
The aim of this study was to examine the physical activity of children with and without asthma in Greece, the factors affecting their intention to exercise, and the influence of gender.
Method
The study involved 50 children with asthma and 50 children without asthma, aged 9–14-years old. We used the leisure time exercise questionnaire to assess the frequency and intensity of exercise. The planned behavior scale examined seven factors affecting physical activity: attitude, intention, self-identity, attitude strength, social role model, information, and knowledge.
Results
Asthmatic children did not differ significantly in mild, moderate, and overall level of physical activity from children without asthma but they participated less in intense and systematic exercise. The two asthmatic groups did not differ in any of the planned behavior factors. Significant differences between genders occurred with respect to self-identity and social role model. Boys appeared to exercise more regularly and intensely compared to girls.
Conclusion
Asthmatic children did not systematically participate in physical activity, preferring mostly mild and moderate intensity activities. Children with and without asthma had comparable positive attitudes and intentions toward exercise.
doi:10.2147/PPA.S40577
PMCID: PMC3554104  PMID: 23378744
planned behavior theory; asthma; sports; health behavior
7.  A Reasoned Action Approach to Health Promotion 
This article describes the integrative model of behavioral prediction (IM), the latest formulation of a reasoned action approach. The IM attempts to identify a limited set of variables that can account for a considerable proportion of the variance in any given behavior. More specifically, consistent with the original theory of reasoned action, the IM assumes that intentions are the immediate antecedents of behavior, but in addition, the IM recognizes that environmental factors and skills and abilities can moderate the intention-behavior relationship. Similar to the theory of planned behavior, the IM also assumes that intentions are a function of attitudes, perceived normative pressure and self-efficacy, but it views perceived normative pressure as a function of descriptive as well as of injunctive (i.e., subjective) norms. After describing the theory and addressing some of the criticisms directed at a reasoned action approach, the paper illustrates how the theory can be applied to understanding and changing health related behaviors.
doi:10.1177/0272989X08326092
PMCID: PMC2603050  PMID: 19015289
medical decision making; attitude; behavioral prediction; reasoned action; integrative model
8.  Small business owners' health and safety intentions: A cross-sectional survey 
Environmental Health  2005;4:23.
Background
Little is known about the variables underlying small business owners' behavioural intentions toward workplace health and safety. This project explores the relationship between three mediating variables (Attitude Toward Safety, Subjective Norm and Perceived Behavioural Control) and owners' Intentions Toward Safety, following the Theory of Planned Behaviour. We also investigate the role of beliefs underlying each mediating variable.
Methods
Seven hundred businesses (5–50 employees) were randomly selected from 4084 eligible companies in a manufacturing business database (SIC codes 24 to 39). The 348 respondents are on average 51 yrs of age, 86% male, 96% white and have 2 to 4 years of post-secondary school.
Results
All three mediator variables are significantly correlated with Intentions Toward Safety; Attitude Toward Safety shows the strongest correlation, which is confirmed by path analysis. Owners with higher attitudes toward safety have a higher probability of believing that improving workplace health and safety will make employees' healthier and happier, show that they care, increase employee productivity, lower workers' compensation costs, increase product quality and lower costs.
Conclusion
These results suggest that interventions aimed at increasing owners' health and safety intentions (and thus, behaviours) should focus on demonstrating positive employee health and product quality outcomes.
doi:10.1186/1476-069X-4-23
PMCID: PMC1277835  PMID: 16242041
9.  Social-psychological predictors of self-reported actual and intended physical activity in a university workforce sample. 
This study investigated the social-psychological predictors of self-reported actual and intended physical activity in a university workforce sample. Based on the 'Theory of Planned Behaviour', but with additional variables of benefits, barriers and self-efficacy, it was found that both intended and actual activity could be predicted but only when strenuous activity was considered. In addition, the predictors were different for men and women. Specifically, the best predictors of intention to exercise were attitude, perceived control, benefits and self-efficacy for women, but only attitude for men. Predicting self-reported strenuous activity for women were intention and self-efficacy, and for men intention and attitude. Theoretical and practical implications for attitude research and exercise promotion are discussed.
PMCID: PMC1332058  PMID: 8000812
10.  Shared Decision Making Does Not Influence Physicians against Clinical Practice Guidelines 
PLoS ONE  2013;8(4):e62537.
Background
While shared decision making (SDM) and adherence to clinical practice guidelines (CPGs) are important, some believe they are incompatible. This study explored the mutual influence between physicians’ intention to engage in SDM and their intention to follow CPGs.
Methods
Embedded within a clustered randomized trial to assess the impact of training physicians in SDM about using antibiotics to treat acute respiratory tract infections, this study evaluated physicians’ intentions to both engage in SDM and follow CPGs. A self-administered questionnaire based on the theory of planned behavior evaluated both behavioral intentions and their respective determinants (attitude, subjective norm and perceived behavioral control) at study entry and exit. We used path analysis to explore the relationships between the intentions. We conducted statistical analyses using the maximum likelihood method and the variance-covariance matrix. Goodness of fit indices encompassed the chi-square statistic, the comparative fit index and the root mean square error of approximation.
Results
We analyzed 244 responses at entry and 236 at exit. In the control group, at entry we observed that physicians’ intention to engage in SDM (r = 0, t = 0.03) did not affect their intention to follow CPGs; however, their intention to follow CPGs (r = −0.31 t = −2.82) did negatively influence their intention to engage in SDM. At exit, neither behavioral intention influenced the other. In the experimental group, at entry neither behavioral intention influenced the other; at exit, the intention to engage in SDM still did not influence the intention to use CPGs, although the intention to follow CPGs (r = −0.15 t = −2.02) slightly negatively influenced the intention to engage in SDM, but this was not clinically significant.
Conclusion
Physicians’ intention to engage in SDM does not affect their intention to adopt CPGs even after SDM training. Physicians’ intention to adopt CPGs had no clinically significant influence on intention to engage in SDM.
Trial Registration
ClinicalTrials.gov NCT01116076
doi:10.1371/journal.pone.0062537
PMCID: PMC3634782  PMID: 23638111
11.  Evidence base for an intervention to maximise uptake of glaucoma testing: a theory-based cross-sectional survey 
BMJ Open  2012;2(2):e000710.
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).
doi:10.1136/bmjopen-2011-000710
PMCID: PMC3293143  PMID: 22382121
12.  General practitioner attitudes towards referral of eating-disordered patients: a vignette study based on the theory of planned behaviour 
Mental Health in Family Medicine  2008;5(4):213-218.
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.
PMCID: PMC2777584  PMID: 22477872
decision making; eating disorders; referral
13.  Can language prime culture in Hispanics? The differential impact of self-construals in predicting intention to use a condom 
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.
doi:10.1080/00207590902835710
PMCID: PMC3415329  PMID: 22029664
Hispanic; Condom use; Norms; Prime culture
14.  Which outcome expectancies are important in determining young adults’ intentions to use condoms with casual sexual partners?: a cross-sectional study 
BMC Public Health  2013;13:133.
Background
The prevalence of unwanted pregnancy and sexually transmitted infection amongst young adults represents an important public health problem in the UK. Individuals’ attitude towards the use of condoms has been identified as an important determinant of behavioural intentions and action. The Theory of Planned Behaviour has been widely used to explain and predict health behaviour. This posits that the degree to which an individual positively or negatively values a behaviour (termed ‘direct attitude’) is based upon consideration of the likelihood of a number of outcomes occurring (outcome expectancy) weighted by the perceived desirability of those outcomes (outcome evaluation). Outcome expectancy and outcome evaluation when multiplied form ‘indirect attitude’. The study aimed to assess whether positive outcome expectancies of unprotected sex were more important for young adults with lower safe sex intentions, than those with safer sex intentions, and to isolate optimal outcomes for targeting through health promotion campaigns.
Methods
A cross-sectional survey design was used. Data was collected from 1051 school and university students aged 16–24 years. Measures of intention, direct attitude and indirect attitude were taken. Participants were asked to select outcome expectancies which were most important in determining whether they would use condoms with casual sexual partners.
Results
People with lower safe sex intentions were more likely than those with safer sex intentions to select all positive outcome expectancies for unprotected sex as salient, and less likely to select all negative outcome expectancies as salient. Outcome expectancies for which the greatest proportion of participants in the less safe sex group held an unfavourable position were: showing that I am a caring person, making sexual experiences less enjoyable, and protecting against pregnancy.
Conclusions
The findings point to ways in which the attitudes of those with less safe sex intentions could be altered in order to motivate positive behavioural change. They suggest that it would be advantageous to highlight the potential for condom use to demonstrate a caring attitude, to challenge the potential for protected sex to reduce sexual pleasure, and to target young adults’ risk appraisals for pregnancy as a consequence of unprotected sex with casual sexual partners.
doi:10.1186/1471-2458-13-133
PMCID: PMC3599836  PMID: 23406327
Outcome expectancies; Condom use; Theory of planned behaviour; Attitude; Expectancy-value muddle; Dimensional salience
15.  Evaluation of ventilatory threshold and its relation to exercise habits among Japanese 
Objective
The aim of this study was to evaluate aerobic exercise levels, expressed in terms of ventilatory threshold (VT), in a Japanese population and explore the relationship between VT and exercise habits in this population.
Methods
This was a cross-sectional study in which data collected from 547 men and 524 women aged 20–69 years and not on medications, were used to assess exercise habits and parameters at VT, namely, oxygen uptake, work rate, and heart rate.
Results
Age-related changes in parameters at VT were noted. Of the participants, 205 men (37.5%) and 142 women (27.1%) had exercise habits. Oxygen uptake and work rate at VT in subjects with exercise habits were significantly higher than those without exercise habits after age had been adjusted for in both sexes. Anthropometric parameters were significantly correlated with oxygen uptake at VT, and the highest correlation coefficient rate was found between oxygen uptake at VT and body fat percentage (men r = −0.589, women r = −0.631).
Conclusion
The mean values determined here may provide a useful database for evaluating VT in Japanese adult subjects.
doi:10.1007/s12199-010-0147-0
PMCID: PMC2955908  PMID: 21432569
Exercise habits; Heart rate; Oxygen uptake; Ventilatory threshold; Work rate
16.  Predictors of Chemotherapy Patients' Intentions to Engage in Medical Error Prevention 
The Oncologist  2010;15(8):903-912.
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.
doi:10.1634/theoncologist.2010-0117
PMCID: PMC3228023  PMID: 20682607
Chemotherapy; Patient safety; Medication errors; Theory of planned behavior; Patient-centered care
17.  Variation in the psychosocial determinants of the intention to prescribe hormone therapy prior to the release of the Women's Health Initiative trial: a survey of general practitioners and gynaecologists in France and Quebec 
Background
Theory-based approaches are advocated to improve our understanding of prescription behaviour. This study is an application of the theory of planned behaviour (TPB) with additional variables. It was designed to assess which variables were associated with the intention to prescribe hormone therapy (HT). In addition, variations in the measures across medical specialities (GPs and gynaecologists) and across countries (France and Quebec) were investigated.
Methods
A survey among 2,000 doctors from France and 1,044 doctors from Quebec was conducted. Data were collected by means of a self-administered questionnaire. A clinical vignette was used to elicit doctors' opinions. The following TPB variables were assessed: attitude, subjective norm, perceived behavioural control, attitudinal beliefs, normative beliefs and power of control beliefs. Additional variables (role belief, moral norm and practice pattern-related factors) were also assessed. A stepwise logistic regression was used to assess which variables were associated with the intention to prescribe HT. GPs and gynaecologists were compared to each other within countries and the two countries were compared within the specialties.
Results
Overall, 1,085 doctors from France returned their questionnaire and 516 doctors from Quebec (response rate = 54% and 49%, respectively). In the overall regression model, power of control beliefs, moral norm and role belief were significantly associated with intention (all at p < 0.0001). The models by specialty and country were: for GPs in Quebec, power of control beliefs (p < 0.0001), moral norm (p < 0.01) and cytology and hormonal dosage (both at p < 0.05); for GPs in France, power of control beliefs and role belief (both at p < 0.0001) and perception of behavioural control (p < 0.05) and cessation of menses (p < 0.01); for gynaecologists in Quebec, moral norm and power of control beliefs (both at p = 0.01); and for gynaecologists in France, power of control beliefs (p < 0.0001), and moral norm, role belief and lipid profile (all at p < 0.05).
Conclusion
In both countries, compared with GPs, intention to prescribe HT was higher for gynaecologists. Psychosocial determinants of doctors' intention to prescribe HT varied according to the specialty and the country thus, suggesting an influence of contextual factors on these determinants.
doi:10.1186/1472-6947-5-31
PMCID: PMC1250227  PMID: 16150149
18.  The association between farmers’ participation in herd health programmes and their behaviour concerning treatment of mild clinical mastitis 
Background
In Denmark, it has recently become mandatory for all dairy farmers with more than 100 cows to sign up for a herd health programme. Three herd health programmes are available. These differ in a number of aspects, including the frequency of veterinary visits and the farmer’s access to prescription drugs. The objective of this study was to investigate whether dairy farmers’ behavioural intentions, i.e. to call a veterinarian or start medical treatment on the day that they detect a cow with mild clinical mastitis (MCM), are different depending on the type of herd health programme.
Methods
A questionnaire survey based on the Theory of Planned Behaviour (TPB) was conducted. TPB proposes that a person’s behavioural intention is strongly correlated with his or her actual behaviour. Three behavioural factors determine the behavioural intention: attitude, subjective norm and perceived behavioural control. Each of these factors is decided by a set of beliefs, each of which in turn is weighted by an evaluation: 1) the expected outcomes of performing the behaviour, 2) what a person believes that others think of the behaviour, and 3) the person’s perceived power to influence the behaviour.
A set of statements about the treatment of MCM based on interviews with 38 dairy farmers were identified initially. The statements were rephrased as questions and the resulting questionnaire was distributed to 400 randomly selected Danish dairy farmers who use the two most restrictive herd health programmes, either Core or Module1, and to all 669 farmers with the least restrictive herd health programme, Module2. The association between intention and the herd health programme was modelled using logistic regression.
Results
The farmers with the Module2 herd health programme had a significantly higher behavioural intention to perform the behaviour, when compared to farmers with a more restrictive herd health programme (OR = 2.1, p < 0.0001).
Conclusion
Danish dairy farmers who participate in Module2 herd health programme had a higher intention to treat cases of MCM, compared to farmers who participate in a more restrictive herd health programme in which the veterinarian initiates treatments.
doi:10.1186/1751-0147-54-62
PMCID: PMC3537572  PMID: 23122271
Farmer behaviour; Theory of Planned Behaviour; Mild clinical mastitis; Herd health programme
19.  Environmental Management in Small and Medium-Sized Companies: An Analysis from the Perspective of the Theory of Planned Behavior 
PLoS ONE  2014;9(2):e88504.
In the business context, concern for the environment began to develop when pressure from the public administration and environmental awareness groups raised the specific requirements for companies. The Theory of Planned Behavior considers that people's conduct is determined by the intention of carrying out a certain behavior. Thus, the individual's intent is determined by three factors related to the desired outcome of the behavior: the Personal Attitude toward the Results, the Perceived Social Norms, and the Perceived Behavioral Control over the action. Therefore, the objectives of this paper are to clarify the attitudes of the managers of Canarian small and medium-sized companies about taking environmental measures, and try to demonstrate whether there is a relationship between the proposed factors and the intention to take these measures.
doi:10.1371/journal.pone.0088504
PMCID: PMC3922869  PMID: 24533094
20.  Intention to start cigarette smoking among Iranian male adolescents: usefulness of an extended version of the theory of planned behaviour 
Heart Asia  2012;4(1):120-124.
Background
Smoking is one of the risk behaviours that begin in adolescence, and therefore identifying predictors of smoking is necessary for planning prevention programmes.
Objectives
To examine the ability of the extended theory of planned behaviour (TPB) to predict the intention to smoke.
Methods
This was a cross-sectional study carried out in Iran, 2011. The data were collected by a self-administered questionnaire which included items on demographics, smoking behaviour, components of the TPB model (attitude, subjective norms, perceived behaviour control and intention) and an added construct on smoking self-identity. Data were analysed using descriptive, correlation and linear regression statistics.
Results
365 male high school students with a mean age of 16.5 (SD=1.2) years were studied. Fifty-five (15.1%) of the students surveyed were current smokers. All components of the TPB model and smoking self identity were statistically significantly related to intention to smoke (p<0.001). The TPB constructs with and without smoking self-identity accounted for 58.5% (adjusted R2) and 54.8% of the variance observed for intention to smoke, respectively. Result also revealed the highest weights for perceived behaviour control (β=−0.35).
Conclusions
The extended model of the TPB predicted ‘intention to smoke’ better than the original TPB. The findings of this study might be used as a framework in designing heart disease prevention programmes. Thus the findings have implications for both health promotion specialists and cardiologists. They could place an emphasis on perceived behaviour control, specifying that individuals who do not smoke should not start and if they are smokers it is possible to stop smoking.
doi:10.1136/heartasia-2012-010140
PMCID: PMC3622501  PMID: 23585785
21.  An Application of the Theory of Planned Behavior to Sorority Alcohol Consumption 
Addictive behaviors  2007;33(4):538-551.
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.
doi:10.1016/j.addbeh.2007.11.002
PMCID: PMC2387076  PMID: 18055130
Theory of Planned Behavior; sorority members; female students; college drinking; intentions
22.  Aerobic physical activity and resistance training: an application of the theory of planned behavior among adults with type 2 diabetes in a random, national sample of Canadians 
Background
Aerobic physical activity (PA) and resistance training are paramount in the treatment and management of type 2 diabetes (T2D), but few studies have examined the determinants of both types of exercise in the same sample.
Objective
The primary purpose was to investigate the utility of the Theory of Planned Behavior (TPB) in explaining aerobic PA and resistance training in a population sample of T2D adults.
Methods
A total of 244 individuals were recruited through a random national sample which was created by generating a random list of household phone numbers. The list was proportionate to the actual number of household telephone numbers for each Canadian province (with the exception of Quebec). These individuals completed self-report TPB constructs of attitude, subjective norm, perceived behavioral control and intention, and a 3-month follow-up that assessed aerobic PA and resistance training.
Results
TPB explained 10% and 8% of the variance respectively for aerobic PA and resistance training; and accounted for 39% and 45% of the variance respectively for aerobic PA and resistance training intentions.
Conclusion
These results may guide the development of appropriate PA interventions for aerobic PA and resistance training based on the TPB.
doi:10.1186/1479-5868-5-61
PMCID: PMC2633303  PMID: 19055725
23.  Normative influences on intentions to smoke among Greek adolescents: the moderating role of smoking status 
Tobacco Induced Diseases  2014;12(1):5.
Background
Social norms influence adolescent smoking intentions, but this effect may differentiate depending on current smoking experiences. The presented study assessed the moderation effects of smoking status on the relationship between social norms and smoking intentions among Greek adolescents.
Methods
A cross-section survey-based design was used. Overall, 251 Greek secondary school students (M age = 16.1 years, 61.2% females) completed structured and anonymous questionnaires including demographic characteristics (age, gender), subjective and descriptive social norms towards smoking, self-reported tobacco use, and intentions to smoke in the next 12 months.
Results
Linear regression analysis showed that social norms overall predicted 36.4% (Adjusted R2) of the variance in intentions. Perceived prevalence of smoking in same age peers and adults, having more close friends who smoke and perceived social approval of smoking predicted intentions to smoke in one year. Moderated regression analysis showed that the effects of social norms on smoking intentions were significantly moderated by smoking status.
Conclusions
Social norms predict smoking intentions, but this effect is stronger among ever (than never) smoker adolescents. Adolescents with smoking experiences may selectively attend to pro-smoking social cues and this perpetuates into their motivation to keep up the habit. School-based interventions should target normative beliefs and related cognitive processes, especially among adolescents who have already initiated tobacco use.
doi:10.1186/1617-9625-12-5
PMCID: PMC3973024  PMID: 24670201
Adolescents; Social norms; Smoking intentions
24.  Higher Physical Fatigue Predicts Adherence to a 12-Week Exercise Intervention in Women With Elevated Blood Pressure 
Health Psychology  2011;31(2):156-163.
Objective
To investigate predictors of exercise adherence to a 12-week exercise intervention for sedentary women and men with elevated blood pressure (BP).
Methods
Fifty-one otherwise healthy and unmedicated adults (27 women and 24 men) with elevated BP (≥120/80 mmHg but <179/109 mmHg) participated in a 12-week exercise intervention involving cardiovascular and strength training. Participants kept weekly exercise logs detailing minutes spent exercising each week. The following were assessed before and after the intervention: cardiorespiratory fitness (in mL/kg/min), body mass index (BMI), level of habitual physical activity, physical fatigue, self-efficacy for exercise habits, and social support.
Results
Regression analysis revealed that mean exercise minutes/week were predicted by higher age (p < .05), higher cardiorespiratory fitness (p < .05), and a gender by physical fatigue interaction (p < .01; R2 = 0.34, F < 3.248, p < .01). Women who reported higher physical fatigue prior to the intervention spent more time exercising during the 12-week intervention than those with lower levels of physical fatigue. This relationship persisted after controlling for age, BMI, cardiorespiratory fitness, level of habitual physical activity prior to the intervention, self-efficacy for exercise habits, and social support (p < .01). The gender by physical fatigue interaction explained 13.9% of the variance in mean minutes exercised/week above and beyond the effects of covariates.
Conclusion
Both gender and fatigue should be considered when developing exercise interventions, such that more initial physical fatigue in women is associated with a tendency to devote greater amounts of time to exercising.
doi:10.1037/a0025785
PMCID: PMC3295923  PMID: 21988095
exercise; adherence; gender; fatigue
25.  Beliefs and Norms Associated with Smoking Tobacco Using a Waterpipe among College Students 
Journal of Addictions Nursing  2012;23(2):123-128.
This web-based, cross-sectional survey guided by the Theory of Reasoned Action (TRA), examined behavioral beliefs and normative beliefs associated with smoking tobacco using a waterpipe in a sample of 223 undergraduate college students. Beliefs and norms associated with waterpipe smoking intention were captured using the investigator-developed TRA Waterpipe Questionnaire. Significant behavioral beliefs that contributed to the prediction of smoking intentions included smoking tobacco with a waterpipe “will taste pleasant” and “will allow me to have a good time with my friends.” Significant norms that emerged were perceived approval of waterpipe smoking from friends and significant others. Current smoking status, both waterpipe and cigarette, also contributed to the prediction of smoking intention. The variables of the TRA represent prime targets for intervention and provide useful information that can be used to tailor waterpipe prevention messages.
doi:10.3109/10884602.2012.669420
PMCID: PMC3366060  PMID: 22471778
Tobacco; smoking; college students; waterpipe

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