Most prominent health behavior theories include self-efficacy (or
similar constructs). Self-efficacy is a proximal and direct
predictor of intention and of behavior. According to Social
Cognitive Theory (SCT; Bandura,
1997
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Bandura, A. (1997). Self-efficacy: The exercise of control.
New York: Freeman. ), a personal sense of control facilitates
a change of health behavior. Self-efficacy pertains to a sense
of control over one's environment and behavior.
Self-efficacy beliefs are cognitions that determine whether
health behavior change will be initiated, how much effort
will be expended, and how long it will be sustained in the
face of obstacles and failures. Self-efficacy influences the
effort one puts forth to change risk behavior and the persistence
to continue striving despite barriers and setbacks that may
undermine motivation. Self-efficacy is directly related to
health behavior, but it also affects health behaviors indirectly
through its impact on goals. Self-efficacy influences the
challenges that people take on as well as how high they set
their goals (e.g., "I intend to reduce my smoking," or "I
intend to quit smoking altogether"). Individuals with strong
self-efficacy select more challenging goals (DeVellis
& DeVellis, 2000
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DeVellis, B. M., & DeVellis, R. F. (2000). Self-efficacy
and health. In: A. Baum, T. A. Revenson, & J. E. Singer
(Eds.), Handbook of Health Psychology (pp. 235-247). Mahwah,
NJ: Erlbaum. ). They focus on opportunities, not on
obstacles (e.g., "At my university there is a smoking ban,
anyway," instead of "There are still a lot of ashtrays at
my university.").
According to the Theory of Planned Behavior
(TPB; Ajzen,
1991
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Ajzen, I. (1991). The theory of planned behavior. Organizational
Behavior and Human Decision Processes, 50, 179-211. ),
intention is the most proximal predictor of behavior. Cognitions
that affect a specific intention are attitudes, subjective
norms, and perceived behavioral control (perception about
being able to perform a specific behavior). A typical item
to assess perceived behavioral control is, "It is easy for
me to do xy." Self-efficacy and behavioral control are seen
as almost synonymous constructs. However, self-efficacy is
more precisely related to one's competence and to future behavior.
According to the Transtheoretical Model
(TTM; Prochaska,
Norcross, Fowler, Follick, & Abrams, 1992
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Prochaska, J. O., Norcross, J. C., Fowler, J., Follick, M.
J., & Abrams, D. B. (1992). Attendance and outcome in
a worksite weight control program: Processes and stages of
change as process and predictor variables. Addictive Behaviors,
17, 35-45. ), self-efficacy and perceived positive
("pros") and negative ("cons") outcomes are seen as the main
social-cognitive variables that change across the stages.
Self-efficacy is typically low in early stages and increases
when individuals move on to the later stages. For a critical
discussion of this model, see Sutton
(2005)
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Sutton, S. (2005). Stage theories of health behavior. In M.
Conner & P. Norman (Eds.), Predicting health behaviors.
(2nd ed., pp. 223-275). Maidenhead, England: Open University
Press. and West
(2005)
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West, R. (2005). What does it take for a theory to be abandoned?
The transtheoretical model of behaviour change as a test case.
Addiction, 100, 1048-1050. .
The Health Action Process Approach (Schwarzer,
1992
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Schwarzer, R. (1992). Self-efficacy in the adoption and maintenance
of health behaviors: Theoretical approaches and a new model.
In R. Schwarzer (Ed.), Self-efficacy: Thought control
of action (pp. 217-243). Washington, DC: Hemisphere.
, 2001
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Schwarzer, R. (2001). Social-cognitive factors in changing
health-related behavior. Current Directions in Psychological
Science, 10, 47-51. ) argues for a distinction
between (a) preintentional motivation processes
that lead to a behavioral intention and (b) post-intentional
volition processes that lead to actual health behavior.
In the motivation phase, one needs to believe in one's capability
to perform a desired action ("I am capable of initiating a
healthier diet in spite of temptations"), otherwise one will
fail to initiate that action. In the subsequent volition phase,
after a person has developed an inclination toward adopting
a particular health behavior, the "good intention" has to
be transformed into detailed instructions on how to perform
the desired action. Self-efficacy influences the processes
of planning, taking initiative, maintaining behavior change,
and managing relapses (see Luszczynska
& Schwarzer, 2003
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Luszczynska, A., & Schwarzer, R. (2005). Multidimensional
health locus of control: Comments on the construct and its
measurement. Journal of Health Psychology, 10, 633-642.
; Marlatt,
Baer, & Quigley, 1995
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Marlatt, G. A., Baer, J. S., & Quigley, L. A. (1995).
Self-efficacy and addictive behavior. In A. Bandura (Ed),
Self-efficacy in changing societies (pp. 289-315).
New York: Cambridge University Press. ). For a critical
discussion, see Sutton
(2005)
xClose
Sutton, S. (2005). Stage theories of health behavior. In M.
Conner & P. Norman (Eds.), Predicting health behaviors.
(2nd ed., pp. 223-275). Maidenhead, England: Open University
Press. .
There are a few studies that have compared the predictive
power of constructs derived from different theories. Dzewaltowski
(1989)
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Dzewaltowski, D. A. (1989). Toward a model of exercise motivation.
Journal of Sport and Exercise Psychology, 11, 251-269.
compared the predictive utility of the Theory
of Reasoned Action (TRA) and SCT in the field of
exercise motivation. The exercise behavior of students was
recorded and then related to prior measures of different cognitive
factors. The variables from TRA predicted exercise behavior.
In addition, strength of self-efficacy, expected outcomes
and satisfaction with level of activities were assessed. Individuals
who were confident that they could adhere to the strenuous
exercise program, who were dissatisfied with their present
level of physical activity, and who expected positive outcomes
also exercised more. TRA variables did not account for any
unique variance in exercise behavior after controlling for
the social cognitive factors. These findings indicate that
SCT provides powerful explanatory constructs. Other studies
using constructs from different theories also show that the
effects of self-efficacy on physical activity are stronger
than those of other psychosocial determinants (see Rovniak,
Anderson, Winett, & Stephens, 2002
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Rovniak, L. S., Anderson, E. S., Winett, R. A., & Stephens,
R. S. (2002). Social cognitive determinants of physical activity
in young adults: A prospective structural equation analysis.
Annals of Behavioral Medicine, 24, 149-156. ).
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