Theory of Planned Behavior

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Applying the biopsychosocial model to

the management of rheumatic disease
Sarah Ryan RGN PhD MSc BSc FRCN, Alison Carr PhD, in Rheumatology, 2010

THEORY OF PLANNED BEHAVIOUR

The Theory of Planned Behaviour (TPB) is an extension of the Theory of Reasoned
Action (TRA) (Fishbein & Ajzen 1975, Ajzen & Fishbein 1980). Both models are based
on the premise that individuals make logical, reasoned decisions to engage in spe-
cific behaviours by evaluating the information available to them. The performance
of a behaviour is determined by the individual’s intention to engage in it (influenced
by the value the individual places on the behaviour, the ease with which it can be
performed and the views of significant others) and the perception that the behaviour
is within his/her control. In RA a TPB model based on attitudes, social support, self
efficacy and intention was moderately successful in predicting and explaining self
management of arthritis (Strating et al 2006). Whilst no validated questionnaires
are available, a comprehensive guide to developing measures of TPB components
is given in Ajzen (1991). A challenge in TPB measurement is the difficulty in
conceptualising and capturing attitudes.

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Individual interventions
Matthew J. Mimiaga, ... Steven A. Safren, in HIV Prevention, 2009
The theory of planned behavior
The theory of planned behavior (TPB; Ajzen, 1985, 1987, 1991) was developed from
the theory of reasoned action, and is more applicable when the probability of success
and actual control over performance of a behavior are suboptimal. In addition to
attitudes and subjective norms which comprise the theory of reasoned action, the
TPB's key contribution is the concept of perceived behavioral control, defined as
an individual's perception of the ease or difficulty of performing the particular
behavior (Ajzen, 1987). How strong an attempt the individual makes to engage in
the behavior and how much control that individual has over the behavior (behavioral
control) are influential in whether he or she engages in the behavior. Behavioral
intention is produced from a combination of attitude toward the behavior, subjective
norm, and perceived behavioral control (Ajzen, 2002). Behavioral control is similar
to self-efficacy, and depends on the individual's perception of how difficult
it is going to be to engage in the behavior. The more favorable a person's attitude
is toward behavior and subjective norms, and the greater the perceived behavioral
control, the stronger that person's intention will be to perform the behavior in
question. Moreover, given a sufficient degree of actual control over the behavior,
people will be expected to carry out their intentions when the opportunity arises
(Ajzen, 2002). Thus, an individual with positive attitudes about always using condoms
during vaginal or anal intercourse, who perceives social support for these behaviors
from key referent others and who has the conviction that he or she can carry out
these behaviors effectively, will likely take consistent HIV preventive actions (Fisher,
1997). The model emphasizes the roles played by knowledge regarding necessary
skills for performing the behavior, environmental factors, and past experience with
the behavior (Ajzen and Madden, 1986). Critics have argued that these models would
benefit from a more clear and explicit definition of behavior control. Others have
suggested adding the role of beliefs and moral and religious norms would help
improve predictive ability of the models (Godkin and Koh, 1996).

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Health Behaviors
M. Conner, in International Encyclopedia of the Social & Behavioral Sciences, 2001

5.2 Theory of Planned Behavior

The Theory of Planned Behavior (TPB) was developed by social psychologists and has
been widely employed as a tool to aid our understanding of a variety of behaviors
including health behaviors (Ajzen 1991, Godin and Kok 1996). The TPB details how
the influences upon an individual determine that individual's decision to follow a
particular behavior. Within the TPB, the determinants of behavior are intentions to
engage in that behavior and perceived behavioral control (PBC) over that behavior.
Intentions represent a person's motivation. The construct is conceptualized as an in-
dividual's conscious plan or decision to exert effort in order to engage in a particular
behavior. Perceived behavioral control is a person's expectancy that performance of
the behavior is within his/her control. Intentions are determined by three variables.
The first is attitudes, which are an individual's overall evaluation of the behavior.
The second is subjective norms, which consist of a person's beliefs about whether
significant others think he/she should engage in the behavior. The third measures
the extent to which the individual perceives that the behavior is under their personal
control and is labeled PBC.

The attitude, subjective norm and PBC components are determined by underlying
beliefs. Attitude is a function of a person's salient behavioral beliefs; which represent
perceived likely consequences of the behavior (e.g., taking exercise will reduce my
risk of heart disease). Subjective norm is a function of normative beliefs, which
represent perceptions of specific salient others' preferences about whether one
should or should not engage in a behavior (e.g., my family think I should take
exercise). PBC is based on beliefs concerning access to the necessary resources and
opportunities to perform the behavior successfully (e.g., I have easy access to a place
where I can exercise).

So, according to the TPB, individuals are likely to engage in a health behavior if they
believe that the behavior will lead to particular outcomes which they value, if they
believe that people whose views they value think they should carry out the behavior,
and if they feel that they have the necessary resources and opportunities to perform
the behavior.

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Health Behavior☆
P. Norman, M. Conner, in Reference Module in Neuroscience and Biobehavioral
Psychology, 2017

Model Description
The Theory of Planned Behavior (TPB) was developed by social psychologists and has
been widely applied to the understanding of a variety of behaviors including health
behaviors (Ajzen, 1988, 1991; Conner and Sparks, 1995, 2005, 2015; McEachan et al.,
2011) (see Fig. 3). The TPB details how the influences on an individual determine that
individual's decision to follow a particular behavior. This theory is an extension of the
widely applied Theory of Reasoned Action (TRA; Ajzen and Fishbein, 1980; Fishbein
and Ajzen, 1975). The TPB suggests that the proximal determinants of behavior are
intentions to engage in that behavior and perceived behavioral control (PBC) over
that behavior. Intentions represent a person's motivation in the sense of her or his
conscious plan or decision to exert effort to perform the behavior. PBC is a person's
expectancy that performance of the behavior is within his/her control. The concept
is similar to Bandura's (1982) concept of self-efficacy (see Conner and Sparks,
2015). Control is seen as a continuum with easily-executed behaviors at one end
and behavioral goals demanding resources, opportunities, and specialized skills at
the other. Fishbein and Ajzen (2010) emphasize the interactive over the direct effect
of PBC on behavior. PBC mainly is seen as moderating the effect on intention on
behavior such that intentions have stronger effects when PBC is strong and reflects
actual control.

Figure 3. Theory of planned behavior.

Intentions are determined by three variables. The first is attitudes, which are the
overall evaluations of the behavior by the individual. The second is subjective norms,
which consist of a person's beliefs about whether significant others think he/she
should engage in the behavior. The third is PBC, which is the individual's perception
of the extent to which performance of the behavior is within his/her control.

Just as intentions are held to have determinants, so the attitude, subjective norm
and perceived behavioral control components are also held to have determinants.
The attitude component is a function of a person's salient behavioral beliefs, which
represent perceived likely consequences of the behavior. Following expectancy-value
conceptualizations (Peak, 1955), the model quantifies consequences as being com-
posed of the multiplicative combination of the judged likelihood that performance
of the behavior will lead to a particular outcome and the evaluation of that outcome.
These expectancy-value products are then summed over the salient consequences.
It is not claimed that an individual performs such calculations each time he or she
is faced with a decision about whether to perform a behavior or not, but rather
the results of such considerations are maintained in memory and retrieved and
used when necessary (Eagly and Chaiken, 1993). However, it is also possible for the
individual to retrieve the relevant beliefs and evaluations when necessary.

Subjective norm is a function of normative beliefs, which represent perceptions of

specific salient others' views about whether one should or should not engage in a
behavior. In the model, this is quantified as the subjective likelihood that specific
salient groups or individuals (referents) think the person should or should not
perform the behavior, multiplied by the person's motivation to comply with that
referent's expectation. Motivation to comply is the extent to which the person wishes
to comply with the specific wishes of the referent on this issue. These products are
then summed across salient referents.

Judgements of PBC are influenced by beliefs concerning access to the necessary

resources and opportunities to perform the behavior successfully, weighted by the
perceived power of each factor (Ajzen, 1988, 1991). The perception of factors likely
to facilitate or inhibit the performance of the behavior are referred to as control
beliefs. These factors include both internal control factors (information, personal
deficiencies, skills, abilities, emotions) and external control factors (opportunities,
dependence on others, barriers). People who perceive they have access to the nec-
essary resources and perceive that there are the opportunities (or lack of obstacles)
to perform the behavior are likely to perceive a high degree of behavioral control
(Ajzen, 1991). Ajzen (1991) has suggested that each control factor is weighted by
its perceived power to facilitate or inhibit performance of the behavior. The model
quantifies these beliefs by multiplying the frequency or likelihood of occurrence of
the factor by the subjective perception of the power of the factor to facilitate or inhibit
the performance of the behavior.

So, according to the TPB, individuals are likely to intend to follow a particular
health action if they believe that the behavior will lead to particular outcomes which
they value, if they believe that people whose views they value think they should
carry out the behavior, and if they feel that they have the necessary resources and
opportunities to perform the behavior.

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Attitudes and Behavior

A.S.R. Manstead, in International Encyclopedia of the Social & Behavioral Sciences,
2001

4 The Theory of Planned Behavior

Ajzen (1985) proposed the theory of planned behavior (TPB) with the explicit goal of
extending the explanatory scope of the TRA. Recognizing that at least some of the
behaviors that social psychologists want to explain and understand are not under
complete volitional control, Ajzen added a new construct, which he called perceived
behavioral control. This construct represents the individual's perception of how easy
or difficult it is to perform the behavior in question. A behavior that is seen as easy
to perform is high in perceived behavioral control; one that is seen as difficult to
perform is low in perceived behavioral control. The TPB argues that an individual
who has high perceived behavioral control with respect to a particular behavior is
more likely to form the intention to perform that behavior, and is more likely to act
on that intention in the face of obstacles and setbacks, than someone who is low in
perceived behavioral control.

Just as attitudes to behavior and subjective norms are seen within the TRA as
being founded on beliefs, so perceived control is regarded within the TPB as being
founded on control beliefs. These are expected to reflect direct, observed, and related
experiences of the behavior and ‘other factors that may increase or reduce the
perceived difficulty of performing the behavior in question’ (Ajzen 1988, p. 135).

The TPB is shown in Fig. 2. It can be seen that perceived behavioral control deter-
mines both intentions (together with attitudes to behavior and subjective norms)
and behavior (together with intentions). The joint determination of intentions is
straightforward: it is assumed that when individuals form intentions they take into
account how much control they have over the behavior. The joint determination of
behavior (together with intention) can be understood in two ways. The first relates
to motivation: an individual who has high perceived behavioral control and who
has formed the intention to do something will simply try harder to carry out that
action than someone with an equally strong intention but who has lower perceived
behavioral control. The second explanation assumes that when someone has the
intention to perform a behavior and fails to act on that intention, this failure is
attributable to his or her lack of control over the behavior. The role of perceived
behavioral control here is ‘nonpsychological’ in the sense that it is not the perception
of control that causes the failure to act in accordance with intentions; rather, it is
a lack of actual control. However, to the extent that perceived control is accurate
thereby reflecting lack of actual control, a measure of perceived behavioral control
should help to predict behavior. This is why the direct link between perceived
behavioral control and behavior is depicted in Fig. 2 as a broken line, rather than a
solid one: perceived behavioral control only helps to predict behavior if the individual
has sufficient experience with the behavior to be able to make a reasonably accurate
estimate of his or her control over the behavior.

Figure 2. Theory of planned behavior (after Ajzen 1991)

Ajzen (1991) reviewed the findings of more than a dozen empirical tests of the TPB. In
most of these studies the addition of perceived behavioral control to the TRA resulted
in a significant improvement in the prediction of intentions and/or behavior. More
recently, Godin and Kok (1996) reviewed the results of 54 empirical tests of the TPB
within the domain of health behavior, and came to broadly similar conclusions. It
is safe to assume that for most behaviors that are likely to be of interest to social
scientists, it is worth using the TPB rather than the TRA.

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Patient education and self management

Alison Hammond PhD MSc BSc(Hons), Karin Niedermann MPH BScPT, in
Rheumatology, 2010

The Theory of Reasoned Action and Theory of Planned Behav-

iour
The Theory of Reasoned Action (Fishbein & Ajzen 1975) and the Theory of Planned
Behaviour (Ajzen 1985) (see Ch. 5) also consider intention and perceived control as
other important determinants for health behaviour. Intention towards a behaviour
is shaped by the person’s attitudes and subjective norm (expectancies of social
environment) which act as pros and cons towards a behaviour. Perceived control
emerged from work on locus of control and perceived self-efficacy and it was
assumed that intention and perceived control interact.

The implications for patient education are:

• Consider attitudes: reinforce the advantages of the target behaviour and ad-
dress barriers.
• Develop strategies for improving control over environmental factors (i.e. prob-
lem solving strategies): e.g. time constraints, weather conditions.
• Take into account social environment and influences.

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Control Beliefs: Health Perspectives

K. Wallston, in International Encyclopedia of the Social & Behavioral Sciences, 2001

3 Perceived Behavioral Control

Ajzen (1988) introduced the construct ‘perceived behavioral control’ into his theory of
planned behavior as a determinant of both behavioral intention and of the behavior
itself. On a conceptual basis, perceived behavioral control is similar to self-efficacy-
—both constructs refer to the person's belief that the behavior in question is under
his or her control—but, operationally, perceived behavioral control is often assessed
by the ease or difficulty of the behavior (e.g., ‘I find it difficult to exercise three
times a week’), while self-efficacy is operationalized by the individual's confidence
in being able to carry out the behavior in the face of extenuating circumstances
(e.g., ‘I am confident that I can exercise three times a week even when I am away on
vacation’).

Like Ajzen's theory of planned behavior, most psychosocial theories of health be-
havior (e.g., the health belief model (Rosenstock 1990), the protection motivation
theory (Prentice-Dunn and Rogers 1986), and the health-action process approach
(Schwarzer 1999) have incorporated perceived behavioral control as a major determi-
nant of intention to engage in a health behavior and/or as a determinant of actually
engaging in the behavior, but these last three theories explicitly label this construct
as ‘self-efficacy.’ Regardless of the label attached to the construct, believing that
one has control over a behavior is highly associated with actually doing that behavior.

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Social Media and Health Behavior

Change
L. Laranjo, in Participatory Health Through Social Media, 2016
6.3.5 I-Change Model (Integrated Change Model)
The I-Change Model integrates several models of behavior change (such as the
Theory of Reasoned Action and the Theory of Planned Behavior) and defends that
the primary determinant of behavior is a person’s intention to carry out that behavior
[14]. In this stage-based model, behavior is defined as having two categories (“trial”
and “maintenance”) and intention as having three different states (“precontempla-
tion,” “contemplation,” and “preparation”). According to this model, intentions may
not always transfer into behavior, depending on ability factors and barriers to action.
The primary determinant of intentions is motivation, which in turn is determined
by three factors: attitudes, social influences, and self-efficacy. Social influences
encompass others’ perceptions of the behavior (social norms), observation of others
carrying out the behavior (social modeling), and the pressures or support from others
to execute the behavior (pressure/support).

As is the case with Social Cognitive Theory, the I-Change Model is particularly well
suited for social media interventions, which may contribute to facilitate the effects
of social influence.

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Action Planning, Psychology of

M. von Cranach, F. Tschan, in International Encyclopedia of the Social & Behavioral
Sciences, 2001

In a broad sense, action planning refers to mental activities that serve action steering,
and thus to the selection of goals. Several concepts contribute to the explanation of
processes underlying action steering: Expectancy theories explain why people choose
a specific action among alternatives. The theory of planned behavior explains under
what conditions attitudes influence the choice of an action. While these approaches
explain what goals and intentions are chosen, action regulation theory concen-
trates on functional cycles that regulate behavior, beginning with orientation and
goal determination, followed by the development plans and monitored execution,
terminated by action-evaluation. In a narrower sense (and embedded in the more
general processes), action planning denotes the anticipatory, cognitive construction
of the action and its steps. Conditions, possible executions, and outcomes of an
action are anticipated, ways of executing and their sequence are decided. Planning
is less required if the task is well known or automated, it is more necessary for
dynamic and complicated tasks. People's abilities to plan differ, and planning often
is inefficient. It may be simply false, but also too detailed or too general, or fails to
include unforeseen or delayed effects. Problem solving and error research show the
difficulties of appropriate planning.

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Health Psychology
Marie Johnston, Derek W. Johnston, in Comprehensive Clinical Psychology, 1998

8.04.2.3 Health Cognitions

A major group of theoretical models have been developed to predict health-related
behaviours from health-relevant social cognitions (see Chapter 8.01, this volume;
Conner & Norman, 1996). Models such as the Health Belief Model, Social Cognitive
Theory, and the Theory of Planned Behavior propose that a range of health and
health-behavior cognitions determine health-relevant behaviors. Health cognitions
include outcome expectancy, perceived severity, perceived vulnerability, health locus
of control, and health value, whereas health-behavior-relevant cognitions include
response efficacy, self-efficacy, behavioral intention, implementation intention,
and action plans.

These models raise some important measurement issues: the individual may not
be aware of the cognitive processes influencing behavior; it may be difficult
to operationalize all of the model's constructs; and the problems with self-report
measures have been noted. Further, the models vary in the precision of specificat-
ion of measurement of core constructs, ranging from the proscriptive Theory of
Planned Behavior to the very poorly defined constructs of the Health Belief Model.
Some constructs have standardised measures that have psychometric validation and
published norms. The best known of these is the Multidimensional Health Locus
of Control (MHLC) scale (Wallston, Wallston, & Devellis, 1978), which assess three
components: internal, powerful others, and chance locus of control.

Although this measure has been criticized for its lack of specific relevance for people
who are ill, it continues to be appropriate for healthy populations. Wallston (1992)
has proposed that locus of control by itself should not be enough to predict health
behavior and proposed that it should be combined with a new construct, perceived
health competence, a construct akin to generalized health self-efficacy (Smith,
Wallston, & Smith 1995). The social learning theory, from which locus of control
derived, would suggest that the MHLC should only predict health behavior in
combination with a measure of health value (Lau, Hartman, & Ware, 1986) and there
has been criticism of investigations in this area for using the model inappropriately.
 This relates to a more general methodological problem in this area of investiga-
tion—the selection of variables from models without addressing complete models.
The investigator needs to have a clear objective. If the intention is simply to explain
as much behavior as possible, then the investigator is justified in choosing the most
likely combination of variables from whichever models seem appropriate. If the
objective is to test a model, then all the constructs of the model, and none from
other models, should be assessed. If the aim is to test the power of the model to
explain behavior, then only the proximal determinants specified by the model need
to be investigated; so, for example, in the Theory of Planned Behavior (see Chapter
8.01, this volume), only behavioral intention and perceived behavioral control would
need to be assessed as all other variables act through these two.

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