BASIC AND APPLIED SOCIAL PSYCHOLOGY, 1986, 7(4), 259-276

Copyright © 1986, Lawrence Erlbaum Associates, Inc.

Correspondence Between Health

Attitudes and Behavior
Icek Ajzen and Christine Timko
University of Massachusetts

College students completed a questionnaire that assessed general beliefs and at-
titudes with respect to matters of health and illness, as well as specific beliefs
and attitudes concerning each of 24 health-related behaviors selected in a pilot
study. In addition, the frequencies with which each of the 24 behaviors were
reportedly performed were used as single-act criteria and to construct an aggre-
gate measure of health behavior (multiple-act criterion). Consistent with previ-
ous work on the attitude-behavior relation, predictability of health behavior
was contingent on measurement correspondence. Specific health behaviors
were largely unrelated to general attitudes toward medical services, concern
about illness, evaluations of health practices, or health locus of control; but
they did correlate quite well with equally specific attitudes toward, and per-
ceived control over, each behavior. Also consistent with the principle of corre-
spondence, attitudes toward performing recommended health practices in gen-
eral were found to correlate with the aggregate, multiple-act measure of health
behavior. Interestingly, this was true of an affective judgment concerning en-
joyment or displeasure associated with performance of health practices but not
of a more cognitive evaluation of the desirability of engaging in health-related
activities.

Much empirical research on health-related behavior has tended to emphasize

attitudinal and other motivational determinants. Guided in part by the health
belief model (Maiman& Becker, 1974; Rosenstock, 1966), investigators typi-
cally assume that readiness to perform health-related behavior is a function
of such general orientations as health concerns, willingness to seek medical
help, perceived vulnerability to illness, faith in doctors and medicine, and
feelings of control over disease. In addition, the research has also assessed

Requests for reprints should be sent to Icek Ajzen, Department of Psychology, University of
Massachusetts, Amherst, MA 01003-0034.
260 AJZEN AND TIMKO

factors more specifically related to the particular behavior and medical con-
dition under consideration, such as perceived severity of the present problem
and perceived effectiveness of the behavior as a means of dealing with the
threat of the disease (Becker & Maiman, 1975; Becker, Maiman, Kirscht,
Haefner, & Drachman, 1977; Janz & Becker, 1984).
This approach can be found in research on a broad range of activities re-
lated to issues of health, illness, and the role of the patient (for reviews, see
Haynes, Taylor, & Sackett, 1979; Kirscht & Rosenstock, 1979; Masur, 1981;
Sackett & Haynes, 1976; Wallston & Wallston, 1981). Overall, these efforts
have produced rather unsatisfactory results. The proposed determinants of
health-related behavior are often found to be relatively poor predictors (e.g.,
Kirscht & Rosenstock, 1977; Taylor, 1979) and to have inconsistent effects
across different investigations (e.g., Becker, Kaback, Rosenstock, & Ruth,
1975; Kirscht & Rosenstock, 1979; Langlie, 1977). Partly in response to these
disappointing findings, investigators have tended to expand the number of
predictor variables to the point at which the model has become so general as
to be virtually untestable (cf. Wallston & Wallston, 1981). Moreover, the se-
lection of attitudinal and other measures to be included in the prediction
equation is often accomplished ad hoc by means of multiple regression analy-
ses without clear guiding principles. The particular combination of variables
found to correlate significantly with behavior thus varies from one study to
another, with few, if any, generalizable conclusions.
The present article takes a close look at the relation between health atti-
tudes and behavior. In our opinion, the failure of much past research in the
health domain can be traced in part to the tendency of investigators to rely on
very global measures of attitude (e.g., concerns about health, belief in mod-
ern medicine, health locus of control) to predict such specific behaviors as
smoking, drinking, taking prescribed medication, or keeping medical ap-
pointments (cf. Hecker & Ajzen, 1983). The various global attitudes em-
ployed tend to correlate with specific behaviors only poorly, if at all, and
even in combination, they account for only a limited proportion of behav-
ioral variance.
Low correlations between global attitudes and specific health behaviors
are, however, not unexpected in light of recent theory and research concern-
ing the attitude-behavior relation (Ajzen, 1982; Ajzen & Fishbein, 1977;
Schuman & Johnson, 1976; Sherman & Fazio, 1983). It is now widely recog-
nized that correspondence in the measures of attitude and behavior is an im-
portant precondition for strong correlations. Ajzen and Fishbein (1977) and
Fishbein and Ajzen (1974) showed that attitudes can be expected to exhibit
strong associations with behavior only if the measure of attitude corresponds
to the measure of behavior at least in terms of the action involved and in
terms of the target at which the action is directed. Global measures of health
 HEALTH ATTITUDES AND BEHAVIOR 261

attitudes tend to reflect a multitude of specific behavioral dispositions with

respect to such factors as taking care of one's own health or the health of
one's children. They can therefore not be expected to correlate with specific
health-related actions. This is not to say, however, that global attitudes have
no predictive validity; only that they are expected to correlate with equally
global behavioral criteria. Broad indices of health behavior can be obtained
by aggregating across a variety of specific health-related activities. Like glo-
bal attitudes, such multiple-act criteria reflect general behavioral disposi-
tions, rather than tendencies to engage in specific behaviors.
A global measure of attitude is thus expected to have predictive validity to
the extent that it corresponds in scope and content to the behavioral domain
represented by the multiple-act criterion (Ajzen, 1982). For example, to pre-
dict a measure of behavior that deals with various ways in which patients do
or do not follow doctors' instructions, a measure of attitude toward follow-
ing doctors' orders would have to be employed. However, if the multiple-act
criterion generalized across virtually any type of health-related behavior,
then it becomes necessary to assess attitude toward performing health behav-
iors in general.
In a parallel fashion, the principle of correspondence also implies that spe-
cific health behaviors are likely to correlate only with equally specific atti-
tudes toward those behaviors. Thus, to predict the behavior of avoiding high
cholesterol foods, we would have to assess attitudes toward avoiding high
cholesterol foods (rather than attitudes toward performing health-related be-
haviors in general). Some evidence in support of the idea that specific health
behaviors can be predicted from corresponding attitudes toward those be-
haviors was recently reported by Turk, Rudy, and Salovey (1984). These in-
vestigators assessed the perceived importance and self-reported performance
frequency for each of 30 health-protective behaviors identified by Harris and
Guten (1979). Attitude-behavior correlations ranged from .51 to .68 for
three different samples of respondents. These correlations, however, were
based on group averages (i.e., the mean responses to the 30 attitude items
were correlated with the mean responses to the 30 behavioral items). Such
group-level analyses tend to produce much higher correlations than do analy-
ses based on individual data (e.g., Wyer, 1970). More important, the Turk et
al. study was not designed to test the principle of correspondence. It did not
assess general health-related attitudes and thus does not permit us to com-
pare the predictive validity of general as opposed to specific attitude
measures.
The principle of correspondence can also be applied to the health locus of
control construct, which has played a major role in research on preventive
health behavior (Lefcourt, 1982; Strickland, 1978). It is usually assumed that
individuals who believe they have a high degree of control over their health
262 A.I/EN AND TIMKO

(internal locus of control) are more likely to engage in preventive practices

than are individuals who score low on this dimension (external locus of con-
trol). However, consistent with the principle of correspondence, measures of
this generalized belief regarding locus of control over health and sickness are
often found to correlate very poorly with specific health-related actions (e.g.,
Seeman & Seeman, 1983; Tobias & MacDonald, 1977). According to the cor-
respondence principle, a general health locus of control measure can only be
expected to correlate with an equally general measure of preventive health be-
havior, not necessarily with any specific action. Moreover, available health
locus of control scales (e.g., Wallston, Wallston, & DeVellis, 1978) deal not
with control over preventive practices but more generally with control over
health and disease. They can thus be expected to exhibit only a modest rela-
tion even with an aggregate measure of health behavior.
By way of contrast, it would be possible to assess beliefs regarding degree
of control over specific health-related activities (i.e., how easy or difficult
performance of a given behavior is considered to be). This concept of per-
ceived behavioral control over specific behaviors is similar to Bandura's
(1977, 1982) "self-efficacy" construct. Bandura and his associates (e.g.,
Bandura, Adams, & Beyer, 1977; Bandura, Adams, Hardy, & Howells,
1980) have shown that people's ability to overcome phobic reactions is
strongly influenced by their confidence in their ability to perform the re-
quired behaviors (i.e., by perceived control). In the same way, measures of
perceived control over specific preventive health behaviors may be expected
to permit relatively accurate prediction of corresponding actions. The major
difference between the two concepts is that self-efficacy focuses on factors
internal to the individual, whereas perceived behavioral control is assumed to
reflect external factors (e.g., availability of time or money, cooperation of
other people, etc.) as well as internal factors (ability, skill, information, etc.).
For a discussion of factors related to behavioral control, see Ajzen (1985).
Finally, the present study considered several additional factors that have
often been assessed in research related to matters of health: perceived vulner-
ability to illness, perceived harmfulness of illness, concern about illness, and
perceived effectiveness of recommended health practices. The first three fac-
tors correspond neither to any particular health-related activity nor to an ag-
gregate measure of health behavior. We would thus expect them to be largely
unrelated to either type of behavioral criterion. In contrast, perceived effec-
tiveness of health practices does deal with health behavior, but it involves
only one of many potentially relevant beliefs. (Other beliefs may have to do
with expenses, inconvenience, interference with other activities, setting an
example for one's children, etc.) Consequently, a measure of perceived effec-
tiveness can be expected to exhibit only a modest relation with an aggregate
index of health behavior.
 HEALTH ATTITUDES AND BEHAVIOR 263

METHOD

Pilot study

A brief questionnaire was constructed containing 53 common behaviors re-

lated to matters of health. The questionnaire was administered to 40 male
and female undergraduate students in a classroom setting. Respondents were
asked to report how frequently they were performing each of the health be-
haviors, using a 6-point scale that ranged from never to always. These re-
sponses were submitted to an item analysis; the 24 behaviors listed below had
the highest correlations with the total score (all exceeding .40) and were se-
lected for further study.

1. I make sure I have plenty of light when I'm reading.

2. I comb or brush my hair vigorously every day.
3. I dress for cold weather (warm coat, hat, etc.).
4. I take time to relax.
5. I take vitamin supplements.
6. I watch my caloric intake.
7. I eat three meals a day.
8. I avoid sharing a drinking cup, hairbrush, or towel.
9. I drink fruit juice.
10. I avoid drinking sodas (Coke, Pepsi, 7-Up, etc.).
11. I avoid drinking beverages that contain caffeine.
12. I avoid picking at pimples.
13. I stay out of smoke-filled rooms.
14. I reheve my bowels on a regular schedule (e.g., every morning).
15. I read books or articles about health and disease.
16. I get periodic antitetanus boosters.
17. I have regular dental checkups.
18. I perform self-examinations to discover possible cancer tumors.
19. I avoid eating high cholesterol foods (e.g., butter, eggs).
20. I eat fresh fruit and vegetables.
21. I brush my teeth at least twice a day.
22. I avoid eating salty foods, or adding salt to my food.
23. I get periodic TB tests.
24. I get a yearly physical checkup.

It can be seen that the behaviors thus selected represent for the most part
common, socially approved actions related to the protection of one's health.
There is considerable commonality between this list and the list of health-
protective behaviors identified by Harris and Guten (1979). Our list includes
264 AJZEN AND TIMKO

many important health-related activities (e.g., regular dental checkups, peri-

odic antitetanus boosters, self-examinations to discover cancer), but it is not-
ably lacking in references to drinking, smoking, and self-medication. Al-
though behaviors of this kind were included in the initial list of 53 activities,
they failed to correlate highly with the total score and were thus not retained
for further study. This finding is consistent with past research which has also
reported only modest relations between different kinds of health-protective
behaviors (e.g., Steele & McBroom, 1972; for a review, see Kirscht, 1983).
Our selection procedure resulted in a relatively homogeneous set of behav-
iors, with an internal consistency coefficient of .73, as assessed by
Cronbach's alpha.

Main Study

Respondents and procedures. One hundred thirteen undergraduate

college students took part in the main study (42 males, 71 females); they
ranged in age from 18 to 44 with a mean of 20.23, and the overwhelming ma-
jority rated themselves as middle class. Participants completed a self-
contained questionnaire that was described as dealing with attitudes and be-
liefs about health-related behaviors. The questionnaire was administered to
the students in groups of 10 to 15, and it took between 30 and 45 min to com-
plete. At the end of the session, each participant received a written explana-
tion of the study and all questions were fully answered.

Questionnaire. Most items in the questionnaire employed a format of

the semantic differential type. Instructions for use of the 7-place scales were
followed by a series of questions deahng with the 24 health-related behaviors.
Several questions were asked with respect to each behavior, but only three are
of interest for present purposes; they can be exemplified with reference to
"eating three meals a day."

1. Attitude toward the behavior

For me to eat three meals a day is
good : : : : : : : : bad
2. Perceived behavior control
For me to eat three meals a day is
easy : : : : : : : : difficult
3. Behavior
I eat three meals a day
always : : : : : : : '• never

The remainder of the questionnaire assessed a variety of relatively broad

attitudinal dispositions. To obtain a measure of attitude toward performance
 HEALTH ATTITUDES AND BEHAVIOR 265

of health-related behavior in general, the concept of "performing generally

recommended health practices" was rated on a 20-item semantic different-
ial scale. The bipolar adjectives were taken from Osgood, Suci, and
Tannenbaum (1957); 12 adjectives that usually load on the evaluative factor
and 4 each from the potency and activity factors were chosen. Responses to
the 20 adjective scales were submitted to a principal axis factor analysis which
resulted in the extraction of three factors with eigenvalues in excess of 1.0.
They accounted, respectively, for 34^o, 22^o, and 13% of the variance.
The factor analysis was followed by orthogonal rotation. Inspection of the
scales with high factor loadings revealed that, as is typically the case, the first
factor was clearly evaluative. However, the second factor to emerge from the
analysis was also evaluative in nature, and there was some overlap in the ad-
jective scales that loaded highly on the two factors. Therefore, an oblique ro-
tation was applied to the factor structure. The first two factors could again be
characterized as evaluative, but this time they were clearly differentiated
from each other. Scales with high loadings (at least .50) on the first factor
were useful-useless, good-bad, harmful-beneficial, and wise-foolish. The
scales that had loadings of .50 or more on the second factor were
interesting-boring, hard-soft, pleasant-unpleasant, and hot-cold.
The first factor appears to represent an assessment of the benefits that can
be derived from performing generally recommended health practices and
may therefore be termed the "desirability" factor. By way of contrast, the sec-
ond factor is more emotional in tone. It may be labeled the "enjoyment" fac-
tor because it reflects largely the pleasures or displeasures associated with
performing generally recommended health practices. Two scores were com-
puted, one for desirability and one for enjoyment, by averaging across the
scales with high loadings on the appropriate factor. The internal consistency
of each set of scales, as measured by Cronbach's alpha, was quite high (.79
for desirability and .65 for enjoyment). The correlation between the two
scores was .06 (not significant).
Toward the end of the questionnaire, the 20-item semantic differential
scale appeared again, but this time it was used to assess attitudes toward med-
ical services. Specifically, respondents were asked to rate the concept "the
medical care provided by U.S. health professionals and institutions (e.g.,
doctors, nurses, hospitals)." A factor analysis revealed only one evaluative
factor which, in terms of the adjective scales with high loadings (> .50), was
very similar to the desirability factor in the previous analysis. Scores repre-
senting attitudes toward medical services were obtained by averaging across
the five scales with the highest factor loadings (i.e., useful-useless,
good-bad, harmful-beneficial, wise-foolish, and important-unimportant).
In addition to the two semantic differential scales, the questionnaire con-
tained a series of items that were designed to assess perceived vulnerability to
illness, perceived harmfulness of, and concern about, illness, and perceived
266 AJZEN AND TIMKO

effectiveness of generally recommended health practices. Twelve medical

conditions of varying severity were selected: lung cancer, tooth decay, strep
throat, heart disease, hypertension, insomnia, kidney disease, ulcers, mono-
nucleosis, muscular dystrophy, pneumonia, and overweight. With respect to
each of these conditions, respondents answered a series of four questions:
how likely they thought it was that they would develop the condition in the
foreseeable future (in percentage), how harmful it would be if they developed
it (on a 7-point scale ranging from extremely harmful to not very harmful),
how concerned they were about the possibility of developing the condition
(on a 7-point scale ranging from very much concerned to not at all con-
cerned), and how likely they thought it was that by performing generally rec-
ommended health practices they could reduce their chances of developing the
condition (on a 7-point scale ranging from likely to unlikely). A measure of
perceived vulnerability was obtained by averaging across the 12 judgments
concerning the likelihood of developing each of the conditions. In a similar
fashion, scores representing perceived harm, concern, and perceived effec-
tiveness of health behavior were derived by averaging across the 12 judg-
ments corresponding to each of these variables.
Perceived vulnerability to, and harmfulness of, illness, concern about dis-
ease, and perceived effectiveness of health behavior are variables associated
with the health-belief model. As noted in the introduction, these variables are
usually assessed at a very general level without reference to any particular
protective health behavior (see, e.g., Harris & Guten, 1979). Our measures
are consistent with this approach.
Finally, the questionnaire contained the 18-item "health locus of control
scale" developed by Wallston et al. (1978). Scores for each of the three
subscales (internal health locus of control, powerful others health locus of
control, and chance health locus of control) were obtained by averaging
across the appropriate items.

RESULTS AND DISCUSSION^

Generally speaking, female respondents tended to be more favorably in-

clined toward performing health-related practices than were male respond-
ents. This trend can be discerned most clearly in the behavioral self-reports.
Averaging over the 24 behaviors used in this study, the mean reported fre-
quency for females was 4.66 (on a 7-point scale) as compared to a mean fre-
quency of 4.37 for males (/ = 2.21, p < .05). Of course, with a different se-

'The study reported in this article is part of a larger investigation dealing with health-related
attitudes and behavior. Results concerning other, more theoretically oriented, aspects of the in-
vestigation can be found in Ajzen and Timko (1984).
 HEALTH ATTITUDES AND BEHAVIOR 267

lection of behaviors this sex difference might well disappear or even be

reversed. The focus of the present study, however, was not on descriptive
data of this kind but on the relations among such constructs as attitude, per-
ceived control, intention, and behavior. In terms of these relations, no sys-
tematic sex differences were discovered. The data for the two sexes were
therefore pooled in the remaining analyses.

Global Attitudes and Health Behavior

Single-act criteria. The various global beliefs and attitudes assessed in

this study were correlated with each of the 24 specific health behaviors
(single-act criteria). The results of these analyses once again confirm the im-
portance of maintaining correspondence between measures of attitude and
behavior. None of the global beliefs and attitudes that were assessed was
found to predict specific health behaviors with any degree of accuracy. The
first two columns in Table 1 show the range of correlations obtained across
the 24 behaviors and the average correlation for each independent variable.
Consistent with previous research, the correlations were quite low and, for
the most part, not significant. Considering the range of correlations obtained
(from a low of - .27 to a high of .37), it is hardly surprising that studies which
have attempted to predict different specific behaviors from general attitude
measures have reported conflicting results. On the basis of our findings, we
would in fact expect only few studies of this kind to obtain significant
attitude-behavior relations, and even those to be usually of very low magni-
tude. Most studies using global beliefs and attitudes to predict specific health
behaviors would be expected to produce nonsignificant results, and a few
might even discover negative relations.

TABLE 1
Correlations of Global Attitudes and Beliefs With Single-Act Criteria and Multiple-Act
Criterion

Single-Act Criteria
Independent Variable Range M Multiple-Act (

Attitude toward medical services - .23 to .23 -.03 -.10

Perceived vulnerability to illness -.27 to.16 -.01 -.02
Perceived harmfulness of illness -.12 to .20 .03 .08
Concern about illness -.18 to .25 .07 .17
Perceived effectiveness of health practices -.13 to .32 .11 .30
Internal health locus of control - . 1 4 t o .18 .10 .26
Desirability of health practices -.16 to .22 .03 .07
Enjoyment of health practices - .07 to .36 .16 .43

Note. A correlation of .19 is significant atp < .05, and a correlation of .24 is significant at/? <
.01.
268 AJZEN AND TIMKO

Multipie-act criterion. The importance of correspondence is also evi-

denced by the relations of general attitudes with an aggregate index of health
behavior obtained by averaging the individual behavioral scores (multiple-
act criterion).^ Although this criterion is much broader in scope than any
single action, it corresponds only to those attitudes that address the same
content domain (i.e., attitudes that deal in a general way with promoting
one's health). The correlations presented in the last column of Table 1 tend to
support this argument. Thus the attitude toward medical services (hospitals,
doctors, etc.) is much broader in scope than the multiple-act criterion. The
correlation between these two measures was actually negative (r = - . 10), al-
though not significant. Similar arguments apply to the next three predictors
in Table 1. Perceived vulnerability to, harmfulness of, and concern about ill-
ness correspond neither in content nor in scope to the multiple-act criterion.
In fact, only concern about illness had a marginally significant, albeit low
correlation with the aggregate measure of health behavior (r = .11, p <
.07).3
As expected, perceived effectiveness of performing generally recom-
mended health practices and internal health locus of control had significant
but relatively low relations with the multiple-act criterion (rs = .30 and .26,
respectively; p < .01 in each case). The other two subscales of the health lo-
cus of control inventory did not correlate significantly with the aggregate
measure of health behavior.
The most interesting results, however, emerged with respect to attitude to-
ward performing generally recommended health practices, assessed by
means of the semantic differential scale. This measure was designed to corre-
spond closely to the multiple-act criterion. It can be seen in Table 1 that desir-
ability of engaging in health practices failed to correlate significantly with the
aggregate measure of health behavior. By way of contrast, the correlation be-
tween the enjoyment factor and the multiple-act criterion was of considera-
ble magnitude (r - .43) and highly significant (p < .01). Examination
of the data revealed that scores on the desirability factor tended to be quite
positive. In fact, the scores of all respondents fell above the scale's midpoint
(4.00), with a low of 4.(X), a high of 7.00, and a mean of 6.64. In other words,
all respondents agreed that it was desirable to perform generally recom-
mended health practices, although there was some variability in the judged
degree of its desirability. By comparison, the range of scores on the enjoy-

^Responses to the 24 measures of behavior were factor analyzed. As might be expected, given
that the behaviors were selected for their consistency with each other, no clearly interpretable
factor pattern emerged. All responses were therefore combined into a single aggregate measure
of behavior. The internal consistency of the aggregate behavior index, as assessed by Cronbach's
alpha, was .71.
significance tests for correlations reported in this article are two-tailed.
 HEALTH ATTITUDES AND BEHAVIOR 269

ment factor was much greater than the range of scores on the desirability fac-
tor, and it included the negative end of the scale. Respondents' enjoyment
scores had a mean of 4.01, and they ranged from 1.75 to 7.00. The standard
deviation of the enjoyment scores (.94) was significantly greater, F(\12, 112)
= 3.18,/7 < .01, than the standard deviation of the desirability scores (.53).
These findings suggest that, at least in the health domain, we must distin-
guish between two types of evaluative judgment. One is a relatively sober as-
sessment of a given behavior's usefulness (whether it is "good for your
health"). The second is more emotional in tone, reflecting how pleasant or
unpleasant performance of the behavior is perceived to be. It stands to reason
that considerable displeasure or inconvenience may be associated with cer-
tain health behaviors whose desirability is otherwise rarely questioned. The
results of the present study suggest that, in cases of this kind, a measure of
perceived enjoyment or pleasure associated with the behavior is a better pre-
dictor than is a measure of its desirability or utility.

Specific Health Attitudes and Behavior

Singie-ievel analysis. Each of the 24 individual health behaviors was

correlated with the corresponding attitude and perceived behavioral control.
In contrast to the results obtained for the prediction of specific behaviors
from global attitudes, the correlations between specific attitudes and corre-
sponding behaviors were generally quite high and, in all but two instances,
statistically significant (see Table 2). The average attitude-behavior correla-
tion was computed to be .42. Table 2 also reveals similar results with respect
to perceived control over specific behaviors. The correlations of these mea-
sures with the corresponding behaviors were all significant, and the average
correlation was .77. These results make it quite clear that specific behaviors
could be predicted with a high degree of accuracy. Each behavior was related
to the corresponding attitude as well as to the degree of perceived control
over that behavior. The results of multiple regression analyses showed that,
together, these two factors accounted for an average of 56% of the variance
in reported health behavior, and across the 24 behaviors, the range of ex-
plained variance was 28% to 76% (see Table 2).

Aggregate-levei analysis. At the aggregate level, correlations among

attitude, perceived control, and behavior were computed in two ways. First,
the 24 scores available for each variable (one for each health behavior) were
averaged, and these indices were used to compute correlations across re-
spondents (between-subjects correlations).^ Second, by treating the 24 scores

^Coefficient alpha was .79 for attitude toward the behavior and .70 for intention. As in the
case of the 24 behaviors, factor analyses of the individual attitude and intention scores again re-
vealed no clearly interpretable factor patterns (see Footnote 2).
270 AJZEN AND TIMKO

TABLE 2
Correlations of Specific Behaviors With Attitudes
and Perceived Controi

Perceived
Attitude Control

Behavior r b r b R

Light for reading .47 .43 .32 .25 .53

Comb or brush hair .74 .46 .74 .45 .82
Dress for cold .64 .43 .62 .39 .72
Take time to relax .47 .21 .82 .75 .84
Vitamin supplements .51 .40 .62 .54 .73
Watch calories .49 .43 .47 .40 .63
Eat three meals a day .38 .26 .83 .79 .86
Avoid sharing .47 .28 .69 .60 .74
Drink fruit juices .35 .09* .72 .69 .73
Avoid drinking sodas .56 .28 .75 .62 .79
Avoid caffeine .34 .30 .70 .69 .77
Avoid picking pimples .41 .20 .77 .71 .80
Stay out of smoke .31 .14 .83 .80 .84
Regular bowels .55 .14 .87 .79 .87
Read about health .34 .09* .60 .56 .61
Antitetanus boosters .52 .25 .72 .62 .76
Dental checkups .46 .25 .63 .54 .67
Self-examinations .17 * .02* .62 .61 .62
Avoid cholesterol .19 .04* .64 .63 .64
Eat fresh fruit .06 * -.03* .78 .78 .78
Brush teeth .55 .23 .84 .73 .86
Avoid salt .23 .13 .80 .79 .82
Periodic TB tests .33 .19 .61 .56 .64
Yearly physical .30 .07* .70 .67 .70

Note. Detailed descriptions of the behaviors can be found in the

method section; r = correlation coefficient, b = regression coeffi-
cient, R = multiple correlation.
*Not significant; all other coefficients significant at/? < .05.

for each variable as separate data points, correlations for individual respond-
ents could be obtained; these within-subjects correlations were averaged,
using Fisher's r io z transformation.* The between-subjects and within-
subjects correlations complement one another in that the former rely on dif-
ferences across respondents, whereas the latter take advantage of variability

'Large differences among the average scores of the 24 behaviors can exaggerate within-
subjecis correlations of this kind because some behaviors will receive uniformly higher ratings
than others (Epstein, 1983). To avoid spuriously high correlations, the data for each vziriable
were first converted to standard scores around the sample mean.
 HEALTH ATTITUDES AND BEHAVIOR 271

TABLE 3
Correlations Among Specific Attitudes, Perceived Control,
and Single-Act Criteria

A ttitude Perceived Control Behavior

Attitude - .21* .28

Perceived control .28 — .78
Behavior .39 .67

Note. Correlations above the diagonal are between subjects; correla-

tions below the diagonal are within subjects.
*p < .05; all other correlations significant at/? < .01.

across behaviors within each respondent. For comparisons of between-

subjects and within-subjects correlations, see Epstein (1983) and Davidson
and Morrison (1983).
The results of these analyses are displayed in Table 3. Above the main diag-
onal are the between-subjects correlations, and in the lower half of the table
are the within-subjects correlations. It can be seen that the two analyses
yielded very similar results: Attitudes toward performing health-related be-
haviors had significant correlations of low to moderate magnitude with self-
reports of actual performance, and perceived behavioral control was found
to predict behaviors with considerable accuracy.^ The fact that the between-
subjects and within-subjects analyses produced closely comparable results
suggests that intraindividual processes underlying health behavior are not id-
iosyncratic but, rather, are of sufficient generality to hold across different in-
dividuals (Epstein, 1983). The effects of attitudes and perceived control on
health-related behavior thus seem to reflect general psychological processes
common to all or most respondents.

CONCLUSIONS

The present study explored the correlates of specific as well as aggregate

measures of health behavior. The results demonstrate the importance of
maintaining strict correspondence between measures of independent and de-
pendent variables. Attitudes and perceived control with respect to specific
health-related actions correlated highly with corresponding behaviors, but
global attitudes toward generally recommended health practices and general

'The correlations between specific attitudes and corresponding behaviors are considerably
lower than those reported by Turk et al. (1984). Recall, however, that Turk et al. computed cor-
relations on the basis of group average data. When this is done in the present study, the
attitude-behavior correlation is found to be .75.
272 AJZEN AND TIMKO

beliefs regarding health locus of control were found to account for little vari-
ance in specific health behaviors. These global variables became useful only
in relation to an aggregate, multiple-act, measure of health behavior.
It was argued in the introduction that such variables as concern about
health or perceived vulnerability to illness, often studied in the health do-
main, tend to lack correspondence with any specific health behavior. They
also fail to correspond in any direct way to a multiple-act measure of behav-
ior. As might therefore be expected, these variables were found to be very
poor predictors of either kind of behavioral criterion. This is not to say that
factors of this kind are of no explanatory value. Some factors, such as per-
ceived vulnerability to illness, attitudes toward doctors, or sex, may have in-
direct effects on health-protective behavior. They may thus provide useful
background information and may explain some of the variance in variables
that have a more direct impact. However, variables of this kind are probably
too remote from concrete actions to permit consistently strong predictions.
Other factors that have been studied are more directly relevant to health be-
havior, but we would argue that these factors have often been assessed at in-
appropriate levels of generality or specificity. For example, perceived control
over one's health in general has often been used to predict performance of
specific health-protective actions. According to the principle of correspond-
ence, and consistent with the findings of the present study, it would be more
appropriate to assess beliefs regarding control over the specific health-related
behavior or behaviors of interest in a given investigation.
Consistent with this argument, the present study examined the role of per-
ceived behavioral control in the context of the attitude-behavior relation.
Perceived control is assumed to reflect the presence (imagined or real) of
partly nonmotivational factors (i.e., beliefs concerning resources and op-
portunities that may be required for performance of a given behavior). By
contrast, attitude is a motivational concept; it is assumed to reflect beliefs
about the advantages or disadvantages, the positive or negative properties,
of the behavior in question (cf. Feather, 1959; Fishbein & Ajzen, 1975;
Rosenberg, 1956). The results of the present study suggest that exclusive reli-
ance on factors of this kind tends to overlook a second important source of
influence, namely, perceived behavioral control. At least with respect to the
sample of behaviors selected, and for the student population investigated,
perceived control over specific health-related actions turned out to have very
strong relations to self-reports of corresponding behaviors.
A third conclusion to be reached is that at least in the health domain, we
may have to distinguish between evaluations related to the advantages (or
disadvantages) of certain behaviors, and positive or negative affect associa-
ted with these behaviors. This proposition is similar to Abelson's (1963) dis-
tinction between "hot cognitions" and perceptual responses of a less emo-
tional kind. It appears that the desirability of performing health-related
 HEALTH ATTITUDES AND BEHAVIOR 273

behaviors is generally noncontroversial, but that the extent to which they are
perceived to give us pleasure or displeasure is another matter altogether. For
example, most smokers agree that quitting would be desirable for improved
health, but they differ in their perception of how much discomfort would be
associated with an attempt to stop smoking. Consistent with this line of rea-
soning, the present study found that health behavior was predicted with
greater accuracy from an affective than from an evaluative measure of atti-
tude. A similar finding in the political domain was reported by Abelson,
Kinder, Peters, and Fiske (1982).
It should be recalled at this point that the present study assessed behavior
by means of self-reports, and that these reports referred to present behavior,
not behavior performed some time after completion of the questionnaire. It
is, of course, common practice to use self-report measures in the health do-
main because the behaviors in question are often performed in the privacy of
one's home and are not open to observation by an investigator. There is some
recent evidence for the validity of self-reports with respect to smoking behav-
ior (Dwyer, Lippert, Wuenschman, & Hertzog, 1984). More important, the
pattern of results obtained in the present study offers no grounds for sus-
pecting that the behavioral self-reports were biased to be consistent with
other responses. For example, attitudes toward performing a given behavior
were assessed prior to inquiring into actual behavior. To appear consistent,
respondents who expressed positive attitudes toward performing the behav-
ior would have had to state that they in fact performed it, and respondents
who evaluated the behavior negatively would have had to indicate that they
rarely or never engaged in it. The fact that attitude-behavior correlations
were, in a few cases, quite low suggests that more than mere pressure toward
consistency was at work. Thus, although the pattern of results obtained in the
present study is generally consistent with the principle of correspondence, it
is very difficult to see how the obtained relations could be explained by refer-
ence to a bias toward consistency or any similar impression management
strategy.
More problematic, perhaps, is the use of reports concerning past rather
than later behavior. It is true, of course, that for ongoing activities of the
kind examined in this study, past behavior tends to be a highly accurate pre-
dictor of future behavior. Nevertheless, the strong relation between per-
ceived control and self-reports of previous behavior may simply reflect an in-
ference, based on past experience, about one's ability to engage in a given
action. That is, people who regularly perform certain health behaviors are
more likely to come to believe that they can easily do so than are people who
rarely or never engage in these behaviors. This is not to say, of course, that
there is no reverse causal effect of perceived behavioral control on behavior;
only that the present study does not permit us to determine the direction of
influence.
274 AJZEN AND TIMKO

Although emphasizing the conclusions that can be derived from the pres-
ent study, our discussion also makes clear the need for replicating the results
with better measures, other sets of behaviors, and different populations. Our
measure of "perceived behavioral control" might perhaps better be labeled
perceived difficulty ofperforming a given behavior, although recent research
(e.g., Ajzen & Madden, in press) has shown that the easy-difficult scale tends
to correlate highly with other measures of perceived behavioral control or
self-efficacy beliefs. Nevertheless, a replication using alternative measures
would clearly be desirable. Similarly, problems created by the retrospective
nature of our behavioral self-reports could be avoided by means of a pro-
spective investigation. Finally, it would be desirable to use alternative sets of
health-related behaviors with different kinds of respondents to increase the
generalizability of our findings.

ACKNOWLEDGMENTS

We are grateful to Paul Cleary and Sy Epstein for their comments on an

earlier draft of this article.

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