A problem for health education practice is how to interest people in making a health behavior change and maintain that interest throughout the behavior change process. Beliefs can provide motivational force for people to perform health behaviors. Five theories: 1) Diffusion of Innovations (DIT); 2) Health Belief Model (HBM); 3) Reasoned Action (TRA); 4) Locus of Control (LOC); and 5) Social Learning (SLT), are reviewed for motivational factors in promoting health behavior changes at each of six stages in the behavior change process: precontemplation, decision, training, initiation, and maintenance. A degree of overlap and complementariness are identified among the theories resulting in a syntheoretical model of beliefs as motivators in the behavior change process. The common emphasis among the theories on expectancies or cost-benefit calculations is highlighted, suggesting several strategies for employing these considerations in health education campaigns. The paucity of motivational ideas for promoting change among the externally controlled—late majority is noted. Further research must be conducted before these ideas should be generally implemented in practice.
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References
1.
EpsteinL. H.WingR. R.KoeskeR.ValoskiA., Effects of Diet Plus Exercise on Weight Change in Parents and Children, Journal of Consulting and Clinical Psychology, 52, pp. 429–439, 1984.
2.
WeinerB., Theories of Motivation, From Mechanism to Cognition, Markham, Chicago, 1972.
3.
GreenL. W., Modifying and Developing Health Behavior, Annual Review of Public Health, 5, pp. 215–235, 1984.
4.
WallstonB. S.WallstonK. A., Social Psychological Models of Health Behavior: An Examination and Integration, in Handbook of Psychology and Health, Vol. 4: Social Aspects of Health, BaumA.TaylorS.SingerJ. E. (eds.), Erlbaum, Hillsdale, New Jersey, pp. 23–53, 1984.
5.
FeldmanR. H. L.MayhewP. C., Predicting Nutrition Behavior: The Utilization of a Social Psychological Model of Health Behavior, Basic and Applied Social Psychology, 5, pp. 183–195, 1984.
6.
BaranowskiT., Interpersonal Models for Health Behavior Intervention with Minority Populations: Theoretical, Methodologic and Pragmatic Issues, in Health Behavior Research in Minority Populations, WeissS.BeckerD. (eds.), in press.
7.
BaranowskiT., Reciprocal Determinism at the Stages of Behavior Change; An Integration of Community, Personal and Behavioral Perspectives, International Quarterly of Community Health Education, 10: 4, pp. 297–327, 1990.
8.
HornD., A Model for the Study of Personal Choice Health Behavior, International Journal of Health Education, 19, pp. 88–97, 1976.
9.
ProchaskaJ. O.DiClementeC. C., Toward a Comprehensive Model of Change, in Treating Addictive Behaviors, MillerW. R.HeatherN. (eds.), Plenum, New York, pp. 3–27, 1986.
10.
ParcelG.BaranowskiT., Social Learning Theory and Health Education, Health Education, 12: 3, pp. 14–18, 1981.
11.
BeckmanJ.GollwitzerP. M., Deliberative Versus Implemental States of Mind: The Issue of Impartiality in Predecisional and Postdecisional Information Processing, Social Cognition, 5, Dpp. 259–279, 1987.
12.
MarcusB. H.OwenN., Motivational Readiness, Self Efficacy and Decision-Making for Exercise, Journal of Applied Social Psychology, 22, pp. 3–16, 1992.
13.
RogersE.KincaidD., Communication Networks: Toward a New Paradigm for Research, Free Press, New York, 1981.
14.
BaschC. E.EvelandJ. D.PortnoyB., Diffusion Systems for Education and Learning About Health, Family and Community Health, 9, pp. 1–26, 1986.
15.
GreenL. W.McAlisterA. L., Macro-Intervention to Support Health Behavior: Some Theoretical Perspectives and Practice Reflections, Health Education Quarterly, 11, pp. 322–339, 1984.
16.
RogersE.StoreyJ., Communication Campaigns, in Handbook of Communication Science, ChaffeeS.BergerC. (eds.), Sage, Beverly Hills, California, 1987.
17.
BagozziR. P., Expectancy-Value Attitude Models: An Analysis of Critical Theoretical Issues, International Journal of Research in Marketing, 2, pp. 43–60, 1985.
18.
NickersonC. A.McClellandG. H., Across-Person Versus Within-Person Tests of Expectancy-Value Models: A Methodological Note, Journal of Behavioral Decision Making, 2, pp. 261–270, 1989.
19.
SporneyL.ContentoI. R., Stages of Dietary Change with Respect to Fat Intake: Psychosocial and Behavioral Correlates, Proceedings of the Society of Behavioral Medicine, 1992.
20.
RogersE., Diffusion of Innovations, Free Press, New York, 1962.
21.
PrestonM.BaranowskiT.HigginbothamJ. C., Orchestrating the Points of Community Intervention: A Diffusion Strategy, International Quarterly of Community Health Education, 9: 1, pp. 11–34, 1988–1989.
22.
RosenstockI. M., The Health Belief Model and Preventive Health Behavior, Health Education Monographs, 2, pp. 354–386, 1974.
23.
LewinK., Field Theory in Social Science, Harper and Row, New York, 1951.
24.
LeventhalH., Findings and Theory in the Study of Fear Communications, in Advances in Experimental Social Psychology, Vol. 5, BerkowitzL. (ed.), Academic Press, New York, 1970.
25.
RogersR., Protection Motivation and Self-Efficacy: A Revised Theory of Fear Appeals and Attitude Change, Journal of Experimental Social Psychology, 19, pp. 469–479, 1983.
26.
SelfC. A.RogersR. W., Coping with Threats to Health: Effects of Persuasive Appeals on Depressed, Normal, and Antisocial Personalities, Journal of Behavioral Medicine, 13, pp. 343–357, 1990.
27.
KlohnL. S.RogersR. W., Dimensions of Severity of a Health Threat: The Persuasive Effects of Visibility, Time of Onset, and Rate of Onset on Young Women's Intentions to Prevent Osteoporosis, Health Psychology, 10: 5, pp. 323–329, 1991.
28.
WeinsteinN. D., The Precaution Adoption Process, Health Psychology, 7, pp. 355–386, 1988.
29.
AjzenI.FishbeinM., Attitude-Behavior Relations: A Theoretical Analysis and Review of Empirical Research, Psychological Bulletin, 84, pp. 888–919, 1977.
30.
AjzenI., From Intentions to Actions: A Theory of Planned Behavior, in Action-Control: From Cognition to Behavior, KuhlJ.BeckmannJ. (eds.), Springer, Heidelberg, pp. 11–39, 1985.
31.
AjzenI., Attitudes, Personality and Behavior, Dorsey, Chicago, Illinois, 1988.
32.
BrownellK.MarlattG. A.LichtensteinE.WilsonC. T., Understanding and Preventing Relapse, American Psychologist, 41, pp. 765–782, 1986.
33.
AjzenI.FishbeinM., Understanding Attitudes and Predicting Social Behavior, Prentice-Hall, Inc., Englewood Cliffs, New Jersey, 1980.
34.
ReynoldsK. D.KillenJ. D.BrysonS. W.JasonD. J.TaylorC. B.MacCobyN.FarquharJ. W., Psychosocial Predictors of Physical Activity in Adolescents, Preventive Medicine, 19, pp. 541–551, 1990.
35.
GodinG.ValoisP.LepageL., The Pattern of Influence of Perceived Behavioral Control Upon Exercising Behavior: An Application of Ajzen's Theory of Planned Behavior, Journal of Behavioral Medicine, in press.
36.
JaccardJ., A Theoretical Analysis of Selected Factors Important to Health Education Strategies, Health Education Monographs, 3, pp. 152–167, 1975.
37.
RotterJ. B., The Role of the Psychological Situation in Determining the Direction of Human Behavior, in Nebraska Symposium on Motivation, JonesM. R. (ed.), University of Nebraska Press, Lincoln, Nebraska, 1955.
38.
RotterJ. B., Generalized Expectations for Internal Versus External Control of Reinforcement, Psychological Monographs, 80, pp. 1–28, 1966.
39.
HartkeR. J.KunceJ. T., Multidimensionality of Health-Related Locus-of-Control-Scale Items, Journal of Consulting and Clinical Psychology, 50, pp. 594–595, 1982.
40.
WinefieldH. R., Reliability and Validity of the Health Locus of Control Scale, Journal of Personality Assessment, 46, pp. 614–619, 1982.
41.
CousinsJ. H.PowerT. G.Olvera-EzzellN., Health Locus of Control in Mexican-American Women, Proceedings of the Society of Behavioral Medicine, pp. 43, 1992.
42.
WilsonD. K.BryantE. S.AlpertB. S., Racial Differences in Health Locus of Control Beliefs, Proceedings of the Society of Behavioral Medicine, pp. 42, 1992.
43.
KristiansenC. M.ElserJ. R., Predicting Health-Related Intentions from Attitudes and Normative Beliefs: The Role of Health Locus of Control, British Journal of Social Psychology, 25, pp. 67–70, 1986.
44.
PerryC.BaranowskiT.ParcelG., How Individuals, Environments, and Health Behavior Interact: Social Learning Theory, in Health Behavior and Health Education, Theory, Research and Practice, GlanzK.LewisF. M.RimerB. K. (eds.), Jossey-Bass, San Francisco, pp. 161–186, 1990.
45.
BanduraA., Social Foundations of Thought and Action, A Social Cognitive Model, Prentice-Hall, Inc., Englewood Cliffs, New Jersey, 1981.
46.
CooperM. L.RussellM.GeorgeW. H., Coping, Expectancies, and Alcohol Abuse: A Test of Social Learning Formulations, Journal of Abnormal Psychology, 97, pp. 218–23, 1988.
47.
BanduraA., Self-Efficacy: Toward a Unifying Theory of Behavioral Change, Psychological Review, 84, pp. 191–204, 1977.
48.
ArmstrongC. A.SallisJ. F.HovellM. F.HofstetterC. R., Predicting Exercise Adoption: A Stages of Change Analysis, Proceedings of the Society for Behavioral Medicine, pp. 127, 1992.
49.
MarcusB. H.SelbyV. C.NiauraR. S.RossiJ. S., Self-Efficacy and the Stages of Exercise Behavior Change, Research Quarterly for Exercise and Sport, 63, pp. 60–66, 1992.
50.
SallisJ. F.HovellM. F.HofstetterC. R., Predictors of Adoption and Maintenance of Vigorous Physical Activity in Men and Women, Preventive Medicine, 21, pp. 237–251, 1992.
51.
OliverR. L.BergerP. K., A Path Analysis of Preventive Health Care Decision Models, Journal of Consumer Research, 6, pp. 113–122, 1979.
52.
LeventhalH.NerenzD. R.SteeleD. J., Illness Representation and Coping in Health Threats, in Handbook of Psychology and Health, Vol. 4, BaumA.TaylorS. E.SingerJ. E. (eds.), Lawrence Erlbaum Associates, Hillsdale, New Jersey, pp. 219–252, 1984.
53.
BaranowskiT.Simons-MortonB.HooksP.HenskeJ.TiernanK.DunnJ. K.BurkhalterH.HarperJ.PalmerJ., A Center-Based Program for Exercise Change Among Black-American Families, Health Education Quarterly, 17: 2, pp. 179–196, 1990.
54.
BaranowskiT.HenskeJ.Simons-MortonB.PalmerJ.HooksP.TiernanK.DunnJ., Dietary Change for CVD Prevention Among Black-American Families, Health Education Research, 5: 4, pp. 433–443, 1990.
55.
HarrisonJ. A.MullenP. D.GreenL. W., A Meta-Analysis of Studies of the Health Belief Model with Adults, Health Education Research, 7, pp. 107–116, 1992.
56.
MitchellT. R., Expectancy Models of Job Satisfaction, Occupational Preference and Effort: A Theoretical, Methodological, and Empirical Appraisal, Psychological Bulletin, 81, pp. 1053–1077, 1974.
57.
SchoemakerP. J. H., The Expected Utility Model: Its Variants, Purposes, Evidence and Limitations, Journal of Economic Literature, 20, pp. 529–563, 1982.
58.
SimonH. A., A Behavioral Model of Rational Choice, Quarterly Journal of Economics, 69, pp. 174–183, 1955.
59.
TverskyA.KahnemanD., Causal Schema in Judgments Under Uncertainty, in Progress in Social Psychology, FishbeinM. (ed.), L. Erlbaum, Hillsdale, New Jersey, pp. 40–72, 1980.
60.
EvansR. I., Deterring Smoking in Adolescents: Evaluation of a Research Program in Applied Social Psychology, International Review of Applied Psychology, 32, pp. 71–83, 1983.
61.
DanishS. J.KleiberD. A.HallH. R., Developmental Intervention and Motivation Enhancement in the Context of Sport, Advances in Motivation and Achievement: Enhancing Motivation, 5, pp. 211–238, 1987.
62.
TaylorW.BaranowskiT.SallisJ., Family Determinants of Childhood Physical Activity: A Social Cognitive Model, in Exercise Adherence: Its Impact on Public Health, DishmanR. K. (ed.), Human Kinetics Publishers, Champaign, Illinois, 1992.
