1/30/2018 1 THEORY OF REASONED ACTION AND THEORY OF PLANNED BEHAVIOR FISHBEIN AND AJZEN’S THEORY OF REASONED ACTION  Originally developed in 1967; further developed during the 1970’s. By the 1980’s, very commonly used to study human behavior History:  Originated in the field of social psychology.  The concept of “attitude” as a trigger and predictor of human behavior.  Value‐Expectancy theory ASSUMPTIONS OF THE MODEL  Human behavior is under the voluntary control of the individual  Man is “basically a rational information processor”  “Beliefs, attitudes, intentions, and behaviors are influenced by the information available...”  People think about the consequences and implications of their actions behavior the decide whether or not to do something.  A model that assumes the people are “rational actors”; NOT a model of “rational behaviors”  Therefore, intention must be highly correlated with behavior.  Whether or not a person intends to perform a health behavior should correlate with whether or not they actually DO the behavior  Distinguishes between attitude toward an object and attitude toward a behavior (e.g., Attitude toward breast cancer vs. Attitude toward mammography) BEHAVIORAL INTENTION  Perceived likelihood of performing the behavior  Must be a “firm” indication of intent  Affecting “intent” is the goal of a TRA based intervention THEORY OF PLANNED BEHAVIOR  http://www.people.umass.edu/aizen/tpb.diag.html Behavior Behavioral  Intention Subjective  Norm Attitude Toward Behavior Motivation to  comply Normative Beliefs Evaluations of  Behavioral Outcomes Behavioral Beliefs Theory of Reasoned Action ATTITUDE TOWARDS BEHAVIOR  Behavioral Belief  Belief that behavioral performance is associated with certain attributes or outcomes (i.e., What will happen if I engage in this behavior?)  Influential factors?  Past experience  Information received or not received  Social influences (family, peers, etc.)  Evaluation  Value attached to a behavioral outcome or attribute (i.e., Is this outcome desirable or undesirable) 1/30/2018 2 SUBJECTIVE NORM  Normative Belief  Belief about whether each referent approves or disapproves of the behavior (i.e., others’ expectations)  Most influential referents? (Media, teachers, peers, parents, spouses, etc.)  Motivation to Comply  Motivation to do what each referent thinks (e.g., do I want to do what they tell me? How much? Why?)  Parents vs. Peers? EXAMPLES  Bob often engages in DUI behaviors.  Why?  Why would you do to change the behavior?  Peter exercises does not exercise at all.  Why?  Why would you do to change the behavior?  Emma does not take her diabetes medicine regularly.  Why?  Why would you do to change the behavior? LIMITATIONS OF TRA  Are there situations where one may want to do certain behavior (i.e., high intention) but does not perform the behavior?  People who have little power o.

1. 1/30/2018
1
THEORY OF REASONED ACTION AND
THEORY OF PLANNED BEHAVIOR
FISHBEIN AND AJZEN’S
THEORY OF REASONED ACTION
developed in 1967; further developed
during the
1970’s. By the 1980’s, very commonly used to
study human
behavior
in the field of social psychology.
concept of “attitude” as a trigger and
predictor of
human behavior.
theory
ASSUMPTIONS OF THE MODEL
behavior is under the voluntary control of
the
individual
Man is “basically a rational information
processor”

2. attitudes, intentions, and behaviors are
influenced by the
information available...”
thinkabout the consequences and implications
of their actions
behavior the decide whether or not to do
something.
model that assumes the people are “rational
actors”; NOT a model of
“rational behaviors”
intention must be highly correlated with
behavior.
or not a person intends to
perform a health behavior should
correlate with whether or not they actually DO the
behavior
between attitude toward an object
and attitude toward a
behavior (e.g., Attitude toward breast cancer
vs. Attitude toward
mammography)
BEHAVIORAL INTENTION
likelihoodof performing the behavior
be a “firm” indication of intent
“intent” is the goal of a TRA based
intervention

3. THEORY OF PLANNED BEHAVIOR
Behavior
Behavioral
Intention
Subjective
Norm
Attitude
Toward Behavior
Motivation to
comply
Normative Beliefs
Evaluations of
Behavioral Outcomes
Behavioral Beliefs
Theory of Reasoned Action
ATTITUDE TOWARDS BEHAVIOR
Belief
that behavioral performance is associated
with certain
attributes or outcomes (i.e., What will happen if I
engage in
this behavior?)
factors?

4. experience
received or not received
influences(family, peers, etc.)
attached to a behavioral outcome or
attribute (i.e., Is
this outcome desirable or undesirable)
1/30/2018
2
SUBJECTIVE NORM
Belief
about whether each referent approves or
disapproves of the behavior (i.e., others’
expectations)
influential referents? (Media, teachers, peers,
parents, spouses, etc.)
to Comply
to do what each referent thinks (e.g.,
do I want
to do what they tell me? How much? Why?)
vs. Peers?
EXAMPLES
oftenengages in DUI behaviors.

5. would you do to change the behavior?
exercises does not exercise at all.
would you do to change the behavior?
does not take her diabetes medicine regularly.
would you do to change the behavior?
LIMITATIONS OF TRA
theresituations where one may want to do
certain behavior (i.e., high intention) but does not
perform the behavior?
who have little power over their behaviors (or
believe they have little power).
a result, Ajzen added a third element to
the
original theory:
Behavioral Control
THEORY OF PLANNED BEHAVIOR
is problematic when behavior is not
fully under the
individual’s control.
one component to the TRA
Perceived Behavioral Control
account for factors outside the individual’s

6. control that
may affect intention and behavior
on the idea that behavioral performance is
determined
jointly by motivation (intention) and ability
(behavioral
control) (skills and resources)
predictor of future behavior is past
behavior
THEORY OF PLANNED BEHAVIOR
Behavioral Control
person’s perception of the ease or difficulty of
behavioral performance
to self efficacy (Inc. w/ repeated successes)
characteristics is the person with a high
perceived
behavioral control likely to have?
Behavior
Behavioral
IntentionSubjective
Norm
Attitude
Toward Behavior
Motivation to
comply

7. Normative Beliefs
Evaluations of
Behavioral Outcomes
Behavioral Beliefs
Theory of Planned Action
Control Beliefs
Perceived Power
Perceived
Behavioral Control
Behavior
Behavioral
IntentionSubjective
Norm
Attitude
Toward Behavior
Motivation to
comply
Normative Beliefs
Evaluations of
Behavioral Outcomes
Behavioral Beliefs

8. Theory of Planned Behavior
Control Beliefs
Perceived Power
Perceived
Behavioral Control
1/30/2018
3
USES FOR TRA/TPB
control: situations in which individuals
can
exercise a control over the behavior
works best with high volitional control
applied to behaviors that are under the
person’s
control (or they thinkthey are)
works best with low volitional control:
the behavior is NOT perceived to be under
the
person’s control
LIMITATIONS
such as demographics and personality still
not in model

9. clear definition of perceived behavioral control
(hard to measure)
that perceived behavioral control
predicts actual behavioral control.
more time between behavioral intent and
actually doing the behavior, the less likely the
behavior will happen.
assumes people are rational and make
systematic decisions based on available information.
Ignores unconscious motives
1
THE HEALTH BELIEF MODEL
QUESTION
do people behave in health‐
compromising ways?
“Theory needs questioners more than loyal
followers” (Rimer, 2002, p. 156).
WHY DO PEOPLE ...
things that are bad for their
health
cigarettes
too much alcohol

10. things that are health‐
enhancing
low fat foods
things that maximize the
likelihood of better outcomes
seat belts
prescription medicine as doctor
recommended
CHALLENGED FACED BY CAMPAIGNERS
What is the most effective way to change a person’s behaviors?
people about health is not
sufficient to promote behavioral
change
the audience:
specific group who are alike in important ways
Design the campaign in such a way that these groups are targete
d
This is a process that need to be consider before, during, and aft
er the
campaign efforts
is important for health promoters to:
1. Know the audience

11. 2. Why audience members need to act in the recommended way
3. Why the audience may find it difficult to do so
HISTORICAL ORIGINS OF THE MODEL
Theory (1935)
the concept of barriers to and facilitators of
behavior change
Public Health Service (1950’s)
of social psychologists trying to explain why people
did not participate in prevention and screening programs.
major influences from learning theory:
Response Theory
Theory
STIMULUS RESPONSE THEORY
cy of a behavior is determined by its
consequences (i.e., reinforcement)
results from events which reduce the
psychological drives that cause behavior (reinforcers)
other words, we learn to enact new behaviors, change
existing behaviors, and reduce or eliminate behaviors
because of the consequences of our actions.
punishments, rewards

12. 2
COGNITIVE THEORY
the role of subjective hypotheses and
expectations held by the individual.
attitudes, desires, expectations, etc.
theorists argue:
beliefs and expectations about the situation can
drive behavior change, rather than trying to influence the
behavior directly.
VALUE‐EXPECTANCY THEORY
To change an individual’s behavior, one can influence the
individual by influencing their assessments about beliefs
(or expectations) of that behavior and its corresponding
values.
believes that increased effort leads
to improved performance
: person believes that improved
performance leads to a certain outcome or reward
values that reward or outcome
HEALTH BELIEF MODEL
is a value‐expectancy theory
on these assumptions:
1. People desire to avoid illness or get well (value)

13. 2. People believe that a specific health action that is available
to him or her will prevent illness (expectation)
development based on probability‐based studies
of 1200 adults
of the people who believed they were susceptible AND
believed in the benefits of early detection were much more
likely to be screened for TB through a voluntary X‐ray exam
of the people who do not have neither beliefs had a
voluntary X‐ray exam
COMPONENTS OF HBM
Susceptibility:
likely do you think you are to have this health issue?
Severity:
serious a problem do you believe this health issue is?
Benefits:
well does the recommended behavior reduce the risk(s)
associated with this health issue?
Barriers:
are the potential negative aspects of doing this
recommended behavior?
EXAMPLE
What are the….

14. Susceptibility
Severity
Benefits
Barriers
ADDITIONAL COMPONENTS OF HBM
to Action:
which cause you to
change, or want to change.
(not systematically studied)
3
ADDITIONAL COMPONENTS OF HBM
one’s
“conviction that one can
successfully execute the
behavior required to
produce the outcomes”
(Bandura, 1977).
the health concerns of the
nation have shifted to
lifestyle‐related conditions,
self‐efficacy has taken on
greater importance, both as
an independent construct,
and as a component of HBM

15. Individual Perceptions Modifying Factors Likelihood of Action
•Demographics
•Personality
•SES
•Knowledge
Perceived threat
Cues to Action
•Education
•Symptoms
•Media
•Perceived Susceptibility
•Perceived Severity
Perceived Benefits
minus
Perceived Barriers
Likelihood of
Behavior change
FINDINGS FOR HBM
barriers was the most powerful single
predictor of all HBM dimensions
susceptibility is a stronger predictor of
preventive health behavior (than sick‐role behavior)
eived benefit is a stronger predictor of sick role

16. behavior (rather than preventive health behavior)
severity is the least powerful predictor, but
still strongly related to sick‐role behavior
HBM CONCLUSIONS
of the first models that adapted theories from
behavioral science to health behaviors
widely recognized conceptual framework for health
behaviors
model is most effective when used to predict
preventive health behaviors such as obtaining vaccinations
to avoid specific illnesses.
It is less effective when the preventive action is not associated
with a specific
threat (e.g., Annual physical exams)
model is effective when the preventive behavior is a
short term or “one shot” action
change vs. health maintenance
2/6/2018
1
THE TRANSTHEORETICAL MODEL &
STAGES OF CHANGE

17. THE CHALLENGE:
health promotionprograms have been
producing minor impacts on major health issues
is “Justsay NO” a failed campaign
is a need to design cost effective,
successful
interventions that impact entire populations at
risk
THE TRANSTHEORETICAL MODEL
CORE CONSTRUCTS: STAGES OF CHANGE
change takestime
constructs represents a temporal dimension
ange is incremental
not a issueof either you do it or
you don’t
of interventions
Stages of TTM
1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Termination
Precontemplation:
Not Ready To Act

18. ave no intention to start
taking action in next 6
months
Characteristics of a Precontemplator:
reading, talking, and thinking about the
risk or the
behavior.
pressured by others to take action, but
have developed
defenses to cope with such pressures.
or under‐aware of their problems despite
others’
awareness of problems with addictions.
or minimization of problem.
resistant to public policy changes.
CHARACTERISTICS OF A PRECONTEMPLATOR:
nfident about ability to take action.
traditional programs.

19. 2/6/2018
2
Contemplation
Thinking About Taking Action
to start in next 6 months
CHARACTERISTICS OF CONTEMPLATORS:
thinking for acting
awareness of benefits of staying drug
free
and the risks of using
of quitting are very clear
about changing
waiting for the magic moment
Characteristics of Contemplators:
in doubt, don’t act
confident enough about their abilities to
quit, feel unprepared
less than 1% of those at risk
participate in traditional programs
40% of people at risk are Contemplators
Preparation

20. Getting Ready to Take Action
the behavior
to start in next 30 days
Characteristics of Preparation:
confident & less tempted than those in
earlier stages
the Benefits (Pros) as higher than the
Costs (Cons)
likely to participate in programs and
most
likely to benefit from those programs
that health promotionprograms love
than 20% of people at risk are in
Preparation
begin taking small stepstowards action
(24
hour quit attempt)
leap into action prematurely
Characteristics of Preparation:
2/6/2018
3

21. Action
Recently Started to Change Behavior
for less than 6
months
CHARACTERISTICS OF ACTION
change is recent
and recycling a concern
to use specific processes to deal with
temptations
Maintenance
Has Changed Behavior
for 6
months or more
CHARACTERISTICS OF MAINTENANCE
oblems with atypical temptations that have not
occurred before
be overconfident and courtrelapse
static stage‐ Still using processes
TERMINATION
temptation to relapse and 100% self
efficacy
only certain types of behavior
fact, not a realistic goal for most health
behaviors

22. less attention in TTM research
Decisional Balance
of Change
positive consequences
benefits of changing
of Change
negative consequences
ts of changing
2/6/2018
4
PROS AND CONS OF SMOKING
40
45
50
55
60
PC C A M
Pros of Smoking
Cons of Smoking

23. T
S
co
re
s
Stage
Processes of Change
change
affective, evaluative,
interpersonal, and behavioral strategies and
techniques used to change behavior
transitions between stages
of intervention design
Processes of Change
Consciousness Raising
Dramatic Relief
Self Reevaluation
Environmental Reevaluation
Social Liberation
Helping Relationships
Reinforcement Management
Counterconditioning
Self Liberation
Stimulus Control

24. Experiential
Processes
Doing
Behavioral
Processes
Thinking, Feeling or
Experiencing
PROCESSES OF CHANGE (10)
1. Consciousness Raising
2. Dramatic Relief
(or simulate) emotions connected with
unhealthy behavioral risks
3. Self Reevaluation
and affective assessments of self image
with and
without the unhealthy habit
4. Environmental Reevaluation
and affective assessments of the
relationship of the
habitto one’s social environment
5. Self Liberation
that one can change and commitment to
act on that
belief (Self efficacy & Behavioral intent)
PROCESSES OF CHANGE (10)

25. 6. Helping Relationships
support (building psychosocial assets)
7. Counterconditioning
healthier alternatives to unhealthy habits
8. Contingency Management
conditioning (Punishment or incentives)
for taking stepsin a particular
disease
9. Stimulus Control
cues for unhealthy habits
10. Social Liberation
social norms are changing in a
direction that supports
healthy behavior change
STAGES BY PROCESSES
Precontemplation
Contemplation Preparation Action Maintenance
Consciousness Raising
Dramatic Relief
Environmental Reevaluation
Social Liberation
Self‐reevaluation
Self Liberation

26. Helping Relationships
Stimulus Control
Reinforcement Management
Counterconditioning
2/6/2018
5
STAGE BASED INTERVENTIONS
from Pre‐Contemplative to Contemplative
Raising (observations, confrontations,
interpretations, bibliotherapy)
Relief (psychodrama, grieving losses,
role playing)
Reevaluation (empathy training,
documentaries)
from Contemplative to Preparation
Reevaluation (value clarification, imagery,
corrective emotional experience)
from Preparation to Action
(decision‐making therapy, New Year’s
resolutions, Logotherapy
techniques, Commitment enhancing techniques)
from Action to Maintenance

27. Relationships (therapeutic alliances, social
support, self‐help groups)
Management (Contingency contracts,
overtand covert reinforcement,
self‐reward)
Conditioning (relaxation, desensitization,
assertion, positive self‐statements)
Control (restructuring one’s
environment, avoiding high risk cues,fading
techniques)
CRITICAL ASSUMPTIONS OF THE TTM
1. No single theory can account for all the
complexities of behavior change
more comprehensive model will most likely to
emerge from integration across major theories
2. Behavior change is an ongoing process that
unfolds over time and through a sequence of
stages.
3. Stages of change may be stable or open to
change.
chronic behavioral risk factors are both
stable
and open to change
BASIC ASSUMPTIONS OF THE TTM
4. Most at risk populations are not prepared for
action.
They must be prepared by stages. (Education &

28. Income)
5. Specific processes and principles of change should
be
applied at specific changes if progress through
the
stages is to occur(Stage Matching)
planned interventions, populations remain
stuck
in the earlystages.
Assignment 4 Discussion: Design a Health Intervention
Overview
You will participate in a discussion activity to design a health
campaign based on the topics and issues covered this semester.
All topics and
theoretical concepts are fair game. You are free to combine
different theories and justify your reasoning. However, it is
important that you
base your arguments on readings and lectures. NO copy-paste or
any other forms of plagiarism of online or off-line materials.
You have all
worked hard throughout the semester, it’d be stupid to get an F
because of plagiarism. This is a fun exercise, have fun!!
You may want to write your answers on a word processor before
posting the answers on the forum. Let’s get started.
Assignment Description
To design a health intervention, please address the following
topics:

29. 1. Background on the public health problem
2. Objectives of the program (project)
3. Description of the intervention intended to achieve the
objectives.
4. Design of a conceptual framework that shows how the
intervention is expected to achieve the objectives. *This must
be framed in
terms of the theoretical concepts we have explored in class.
5. Word limits: 800-1000 words + a flowchart (can be
scanned/hand drawn/picture)
Instructions and Tips
Background on the public health problem: (100-150 words)
Ordinarily, this section would require an in-depth analysis of
the problem. For purposes of this assignment, we will assume
others have
completed this in-depth analysis. Your job is to provide a brief
summary describing the public health problem that the
intervention is
designed to address. Suggested topics to cover include:
1. Brief description of the problem in epidemiological terms
2. Subgroups within the population most affected
3. Experience to date in addressing the problem (previous or
existing programs/interventions, results from quantitative or
qualitative research studies, program reports, other) 4. Barriers

30. to behavior change
Objectives: (100 words)
The task is to learn from the speakers the stated objectives of
the program and to include them in your plan. If the speakers
do not
present the objectives in SMART terms, reword them to
conform to SMART objectives (even if this means
“embellishing” what is given in
class).
Description of the intervention: (300 words)
This section explains to the reader the different activities that
will be carried out with the aim of achieving the program
objectives. This
information is important for understanding the program and
(later) designing the process evaluation. For the purposes of this
assignment, limit the description to a summary overview.
Conceptual framework: (300-500 words)
The conceptual framework is the most challenging aspect to this
assignment. Allocate the greatest portion of time on this
assignment to
getting it right. You may want to look up the textbook to see
some theoretical framework for inspiration. Here are some tips:
1. On a single page, draw a conceptual framework that

31. illustrates how the program is expected to achieve its long-term
objective (e.g.,
reducing the prevalence of TB or HIV). Use a system of
boxes/circles and arrows to identify the pathways by which the
intervention is
expected to have an impact.
2. Use the boxes to show general concepts (e.g., knowledge).
(In the next exercise [#2], you will convert these concepts into
measurable
indicators).
3. Use the conceptual framework to reflect the main objectives
of the program (expected results).
4. Incorporate the concept of initial, intermediate, and long-
term outcomes in your conceptual framework (you can do so by
using
column headings or labels at the bottom of the page).
5. Focus on results in this exercise; do not worry about the
details of outputs that will get you there (e.g., number of
workshops,
number of people trained, number of spots broadcast)
6. Incorporate the idea of “context” into your framework.

32. 7. Illustrate where the intervention fits within the conceptual
framework.
8. Use the arrows in a causal sense; that is, use arrows to show
that “Box A” influences “Box B.” Do not use arrows between
boxes if
there is not a plausible causal relationship (for example,
exposure to a radio program does not determine or influence the
age of the
listener!).
9. Make the figure flow from left to right. (Note: this is
arbitrary; some graphs flow vertically). Factors on the left
influence those
further to the right.
10. Focus on the most important concepts. For simplicity, limit
the number of concepts mentioned to 15 or less (recommended
range:
10-15 concepts). Note:
11. you may want to further explain a general concept (e.g.,
knowledge) with additional details (e.g., the types of
knowledge), but you
don’t need to be exhaustive. The purpose is to demonstrate
your understanding of how to “illustrate” how a program is
expected to
work in visual/graphic form.

33. 12. Don’t include any narrative with the conceptual framework
(i.e., paragraphs that explain the framework). The figure should
be self-
explanatory.
13. Give a title that explains what the conceptual framework is
supposed to show.
14. You may discuss this exercise with others in the class;
however, the final product must be your own work. (Two
identical frameworks
would be suspect.)
15. You may submit a hand-drawn figure, but the wording must
be legible. (If you choose this option, plan to pass in your
assignment at
the beginning of the class on the due date.)
16. Be as clear and concise as possible. (Test your diagram: is
it easy to understand the main ideas at a glance?)
Submit posts by clicking the Add new discussion topic button
below.
Grading
This assignment is worth 15 points.

34. Discussion Board Rubric
Criteria Excellent Good Average Fair Poor
Content (10 points)
• Shares thoughts,
ideas, or opinions.
• Specific details are
offered to support
the views expressed
in the post (there is
evidence to show
this isn't just "off the
top of your head").
• Has a "So What?"
theme, lesson, or
specific point that
attracts the readers'
attention; it also
addresses all the
questions posed in
the exercise, but
goes beyond just
(8 points)
• Shares thoughts,
ideas, or opinions.
• Details are offered to

35. support the views
expressed in the post
(there is evidence to
show this isn't just
"off the top of your
head").
• Has a "So What?"
theme, or lesson;
addresses all
questions posed in
the exercise.
• Demonstrates
understanding of the
topic.
(6 points)
• Shares thoughts,
ideas, or opinions.
• The opening part of
the post introduces
the main point.
• Details are offered to
support views
expressed in the
post, but they may
be vague or the
connections are not
completely clear.
• Has a point; has

36. something to do with
questions posed.
(4 points)
• Shares a thought,
idea, or opinion.
• The opening part of
the post introduces
the main point.
• Limited details are
offered to support
the views expressed
in the comment.
• Point of post is
unclear; does not
relate to questions.
• Shows some
understanding of the
topic.
(0 points)
• Main point is not
clearly introduced.
• Lacks supporting
details.
• Point of post is

37. unclear; does not
relate to questions.
• Post does not reveal
an understanding of
the topic.
answering them to
reflect on larger
themes.
• Demonstrates
understanding of the
topic.
• Shows some
understanding of the
topic.
Style (5 points)
• Concise (4-5
paragraphs; each
paragraph 200
words) with a
specific focus.
• Opening grabs the
reader's attention
while introducing

38. the point of the post.
• Positive tone
engages the reader.
• Spelling,
punctuation, and
capitalization are
correct.
(4 points)
• Concise (2- 3
paragraphs; each
paragraph 250
words) with a
focus.
• Opening grabs the
reader's attention
while introducing
the point of the post,
but perhaps not as
strongly as the style
in an "A" posting.
• Positive tone
engages the reader.
• Spelling,
punctuation, and
capitalization are
largely correct.
(3 points)

39. • Entries are short (1-
2 paragraphs) with a
focus.
• Positive tone.
• Spelling,
punctuation, and
capitalization are
largely correct.
(2 points)
• Entries are short (1
paragraph) and may
or may not have a
focus.
• Positive tone.
• Spelling,
punctuation, and
capitalization have
mistakes.
(0 points)
• Entries are short (1
paragraph) and lack
focus.
• Tone may not be

40. appropriate.
• Spelling,
punctuation, and
capitalization
contain numerous
mistakes.
OverviewAssignment DescriptionInstructions and TipsGrading