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Motivation Theory: Is This a Worthwhile
Theory for Physical Activity Promotion?
Ronald C. Plotnikoff 1,2,3 and Linda
Trinh 3 1 School of Education,
University of Newcastle, Callaghan,
New South Wales, Australia 2 School of
Public Health, and 3 Faculty of Physical
Education and Recreation, University of
Alberta, Edmonton, Alberta, Canada
PLOTNIKOFF, R.C. and L. TRINH.
Protection motivation theory: is this a
worthwhile theory for physical activity
promotion? Exerc. Sport Sci. Rev., Vol.
38, No. 2, pp. 91Y98, 2010. This article
reviews the published studies in the
physical activity domain, which include
novel hypothesis from our laboratory,
that have tested Rogers’ Protection
Motivation Theory. Across the various
population groups, the theory’s coping
appraisal is generally supported;
however, there is limited support for the
theory’s threat components.
Implications of these findings are
discussed from both theoretical and
practical perspectives. Key Words:
social-cognitive models, exercise,
self-efficacy, threat, heart disease,
cancer INTRODUCTION Rogers’
revised Protection Motivation Theory
(PMT) (21) is a major health psychology
theory aimed at explaining the cognitive
mediation process of behavioral change
in terms of threat and coping appraisal.
The PMT’s threat appraisal component
is composed of the following: the
person’s estimate of the severity of the
disease (perceived severity) and his or
her estimate of the chance of
contracting the disease (perceived
vulnerability). The PMT further
stipulates that the emotional state of
fear arousal influences attitudes and
behavior change indirectly through the
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PROMOTE
3. appraisal of the severity of the danger.
The model’s coping appraisal consists
of the individual’s expectancy that
carrying out recommendations can
remove the threat (response efficacy)
and belief in one’s capability to execute
the recommended course of action
successfully (self-efficacy). The PMT
hypothesizes that the motivation to
protect oneself from danger is a
function of four cognitive beliefs. These
are as follows: (i) the threat is severe;
(ii) one is personally vulnerable to the
threat; (iii) the coping response is
effective in averting the threat; and (iv)
one has the ability to perform the
coping response. Protection motivation
is the proximal determinant of protective
behavior and often measured by or
similar to intention (12,13). Thus, the
cognitive predictors (severity,
vulnerability, response efficacy, and
self-efficacy) should have significant
associations with intentions, which
mediate their influence on behavior
performance. Many studies have
measured self-reported and/or
observed behavior as the outcome
variable of protection motivation (6,11).
Rogers’ proposed full model (i.e.,
subtracting threat from extrinsic and
intrinsic rewards and subtracting
response costs from the coping
appraisal) (21), however, is considered
untestable (23). Indeed, no PMT study
has attempted to test the full model in
this way. Other aspects of the theory
such as (i) the nature of the
relationships between the cognitive
mediators and (ii) the proposed additive
principle (i.e., when combining
components between the two appraisal
processes, a second-order interaction
effect should occur) have been
considered by a number of writers to be
unclear and internally inconsistent,
respectively (7,13). Hence, most
applications of the PMT consider only
the main effects of perceptions of
severity, vulnerability, response
efficacy, and self-efficacy (12,13) (Fig.
1). The PMT has been moderately
successful in predicting health- and
safety-related intentions and behaviors
in a variety of contexts (6,11) such as
smoking, alcohol consumption, and
nutrition. In the two PMT
meta-analyses, Floyd and colleagues
(6) examined 65 studies representing
4. more than 20 health issues (e.g.,
cancer prevention, AIDS prevention,
adherence to medical-treatment
regimes), whereas Milne and
associates (11) used stricter inclusion
criteria in which only empirical
applications of the PMT to
health-related intentions, concurrent
behavior, or subsequent behavior were
included. Across these studies,
self-efficacy was found to be the
strongest predictor of intention and
behavior (6,11), and 91 ARTICLE
Address for correspondence: Ronald C.
Plotnikoff, Ph.D., School of Education,
University of Newcastle, Callaghan,
NSW, 2308 Australia (E-mail:
ron.plotnikoff@newcastle.edu.au).
Accepted for publication: November 10,
2009. Associate Editors: Ryan E.
Rhodes, Ph.D. 0091-6331/3802/91Y98
Exercise and Sport Sciences Reviews
Copyright * 2010 by the American
College of Sports Medicine Copyright
@ 2010 by the American College of
Sports Medicine. Unauthorized
reproduction of this article is prohibited.
intention has been shown to be more
highly correlated with behavior than any
other variable from the PMT (11,12).
The prediction of intention is reported to
be better than behavior for current and
subsequent behavior, and more
variance could be explained
cross-sectionally rather than
longitudinally (11). Overall, the results
of these studies show modest support
for the threat- and coping-appraisal
constructs of the model in predicting
health-related intentions and behavior,
with coping-appraisal components
emerging as the strongest predictors
(6,11,12). The purpose of this article is
to present some of our laboratory’s
novel hypotheses in the physical activity
(PA)YPMT domain, which empirically
test the following: (i) the moderating
effects of age and sex and the coping
appraisal constructs on the PMT’s
threat components; (ii) the integration of
the PMT’s cognitive components within
a stage of change model; and (iii) an
ordered, temporally sequenced model
of the PMT’s threat, fear, and coping
components. This article also
summarizes the published research in
the PA domain, which has tested the
PMT, which includes recent PA studies
published in the past decade not
5. included in past metaanalyses of the
theory. Specifically, we briefly review
the 14 published PA studies (seven of
which are from our laboratory/primary
author) and include samples across the
general adult population, school-aged
youth, cardiac patients, and adults with
diabetes. Furthermore, directions for
future research and a commentary on
the current use of the PMT are
presented. Protection Motivation Theory
Tests in the Physical Activity Domain
Nonintervention, cross-sectional tests In
a cross-sectional test, one of this
article’s authors, Plotnikoff, and
Higginbotham (14) examined the use of
the PMT with a randomly selected
community sample of 800 Australian
adults and found the coping appraisal
constructs to have strong and
significant associations with exercise
intention and behavior. The threat
appraisal (for heart disease)
components had limited association
with the exercise outcomes; fear was
weakly associated with intention,
whereas vulnerability was negatively
associated with intentions and behavior.
Vulnerability’s negative association may
be explained by Rogers’ ‘‘boomerang
effect’’ (21) where people who feel
themselves vulnerable to a disease are
more anxious about that illness and so
adopt a more ‘‘defensive avoidance’’
style of coping, or it could be that those
who are already taking precautions
(e.g., exercising) are feeling less at risk
from having a myocardial infarction.
One of this article’s authors, Plotnikoff,
and Higginbotham (15) also tested the
cross-sectional associations of the
coping and threat (i.e., heart disease
complications) appraisal constructs with
PA intentions and behavior among 147
cardiac patients and found that
self-efficacy and fear were the only the
PMT variables to emerge as significant
correlates of exercise intentions. This
study also examined the PMT’s threat
measures immediately after their
myocardial infarction event and found
no association with fear, vulnerability,
and severity with PA intention or
behavior 6-months later.
Nonintervention, longitudinal tests The
PMT in the PA domain also has been
examined in seven nonintervention,
prospective studies. We (18) examined
the PMT’s predictive ability for PA
6. behavior related to heart disease, in a
large randomly selected population
sample of 1602 adults over two
consecutive 6-month periods (i.e.,
period 1 (time 1 cognitions predicting
time 2 behavior), period 2 (time 2
cognitions predicting time 3 behavior)).
Self-efficacy and intentions significantly
predicted subsequent PA behavior. The
PMT variables and intentions explained
4% and 16% of the variance,
respectively, in period 1 and 3% and
22% of the variance in PA at period 2.
With PA intention, significant
relationships with response efficacy,
self-efficacy, and severity were
observed, explaining 35% and 36% of
the variance for intention at periods 1
and 2, respectively. Lippke and one of
this article’s authors, Plotnikoff, (9)
tested and integrated the PMT and
Stage Model with the above sample of
1602 adults over a 6-month period. The
researchers tested whether the stages
of the Transtheoretical Model (TTM)
moderate the interrelation in predicting
stage motivation, as well as the PMT
variables’ interactions in predicting
stage transitions. The details of this
study will be further outlined in the
theory integration section of the article.
Figure 1. Protection motivation theory
(PMT) V conceptual model. 92 Exercise
and Sport Sciences Reviews
www.acsm-essr.org Copyright @ 2010
by the American College of Sports
Medicine. Unauthorized reproduction of
this article is prohibited. Tulloch and
colleagues (26) tested the PMT in the
prediction of PA intentions and behavior
among 787 cardiac patients in context
of secondary prevention of heart
disease and found that perceived
severity, response efficacy, and
selfefficacy (the strongest construct)
were predictors of exercise intentions
and behavior explaining 23% and 20%
of the variance in intention and
behavior, respectively. In contrast, the
PMT model was not reliable for
predicting exercise behaviors at 12
months after hospitalization. Similarly,
Blanchard and associates (3) examined
the PMT in explaining any significant
variation in exercise intentions and
behavior in 76 cardiac patients
receiving a home-based cardiac
rehabilitation program. Path analyses
revealed that response efficacy was the
7. main predictor of 3- and 6-month PA
intentions. Self-efficacy significantly
predicted 3- and 6-month exercise
behavior. This study concluded that
threat appraisal variables had limited
motivational influence on exercise
levels in home-based cardiac
rehabilitation patients, whereas coping
appraisal variables were useful in
explaining exercise behavior in this
population. A cross-sectional and
6-month longitudinal analysis of 697
adults with type 1 diabetes and 1614
adults with type 2 diabetes was
conducted by Plotnikoff et al. (17) to
examine PMT in the context of diabetes
management. The study revealed that
self-efficacy was a stronger predictor of
intention (Q = 0.64Y0.68) than
response efficacy (Q = 0.14Y0.16) in
individuals with type 1 or type 2
diabetes. Severity was significantly
related to intention (Q = 0.06) in type 2
diabetes individuals only, whereas
vulnerability was not significantly
related to intention or PA behavior.
Self-efficacy (Q = 0.20Y0.28) and
intention (Q = 0.12Y0.30) were
significantly associated with PA
behavior. In another study, we (19)
separately examined the PMT
constructs in predicting aerobic PA and
resistance training behavior over a
3-month period in a national Canadian
sample of 244 adults with type 2
diabetes. Self-efficacy and response
efficacy were both significantly
associated with intention (R2 = 0.43)
and behavior (R2 = 0.19). In terms of
resistance training, the PMT explained
56% and 20% of the variance in
intention and behavior, respectively.
Self-efficacy and response efficacy
were both significantly associated with
resistance training intention, whereas
self-efficacy predicted resistance
training behavior. This study was novel
because research on the psychosocial
predictors of this resistance training has
been very limited, with no apparent
published studies among adults with
diabetes. It is important to note that
none of the nonintervention studies
generated an R2 greater than 0.30 for
explaining PA behavior, which is
considered a minimum acceptable level
for theory testing (2). Therefore, the
integration of constructs from other
theoretical models and the inclusion of
8. moderating variables may need to be
considered to facilitate the PMT in
predicting a greater amount of variance
for PA. Intervention tests Five studies
have conducted experimental
manipulations on the specific PMT
variables, all by providing motivational
essays. These studies related to the
primary prevention of health-related
issues through exercise. Courneya and
Hellsten (4), Stanley and Maddux (24),
and Wurtele and Maddux (30) reported
the application of the PMT for PA
prediction among 427, 195, and 160
university students, respectively. Fruin
and colleagues (7) conducted a study
with 615 adolescents, whereas Graham
and colleagues (8) conducted a study
with 173 teaching and school staff.
Courneya and Hellsten (4) reported that
perceived severity was the only variable
found to have a significant effect on
exercise intentions for cancer
prevention. Stanley and Maddux (24)
found that both self-efficacy and
response efficacy were associated with
subjects’ PA intention, with response
efficacy being the strongest construct.
On the other hand, Wurtele and
Maddux (30) revealed that both
vulnerability and self-efficacy were
associated with exercise intention and
behavior. Fruin and colleagues (7)
found that participants in the high
self-efficacy condition presented
stronger intentions to exercise, whereas
those in the low response efficacy
condition demonstrated more
endorsement of hopelessness and
fatalism than did students in the high
response condition. Graham and
colleagues (8) found that persuasive
message framing (presented in DVDs)
was effective in manipulating
participants’ coping appraisal (response
efficacy), which influenced their
intentions to perform more exercise for
colon cancer prevention, which, in turn,
influenced their behavior to engage in
initial exercise. Milne et al. (11)
conducted the only health education
intervention based on the theory. The
PMT-based health education
intervention had a significant impact on
intentions in a study of 248
undergraduate students but not on
behavior in a 1-wk follow-up (35% vs
38% for the control group). In sum, the
findings from these 14 studies show
9. some support for the use of the PMT’s
application to PA promotion (Table 1).
The coping appraisal variables in
predicting PA behavior is generally
supported, with limited support for the
theory’s threat components that seem
to be mainly salient for only the clinical
populations with chronic diseases. This
suggests threat appeals should be used
judiciously (i.e., in certain clinical
populations), and the promotion of the
benefits and enhancing confidence of
the behavior should be widely and
strongly encouraged. Moderating
effects on PMT The PMT proposes that
becoming aware of the severity of a
threat that one is susceptible to will
initiate protection motivation; however,
the nature of the motivation will be
based on coping appraisal (21).
Although threat perception may
contribute to precautionary motivation
by provoking the consideration of
outcome expectancies, perceptions of
response efficacy and self-efficacy may
predict intention formation and
subsequent behavior change (22).
However, the potentiality of the
moderating effects of the PMT’s coping
cognitions on threat appraisal has been
silent. Additional moderators to threat
cognitions also may include age and
sex. However, literature on potential
demographic moderators of the PMT’s
threat cognitions also has remained
limited. Our longitudinal study of a
randomly selected population sample
(N = 1602 adults) was designed to
determine if the PMT’s coping
cognitions moderate threat cognitions
for predicting PA intention and
behavior, as well as to test if age and
sex are moderators of threat cognitions
for predicting PA intentions and
behavior (18). Volume 38 c Number 2 c
April 2010 PMT and Physical Activity 93
Copyright @ 2010 by the American
College of Sports Medicine.
Unauthorized reproduction of this article
is prohibited. (continued on next page)
TABLE. Authors Sample Design
Results Nonintervention,
cross-sectional tests Plotnikoff and
Higginbotham (14) 800 Australian
adults Cross-sectional Self-efficacy (A =
0.23), intentions (A = 0.42) and
vulnerability (A = j0.12) explained 46%
of the variance in exercise behavior.
Self-efficacy (A = 0.70) and vulnerability
10. (A = j0.12) explained 53% of the
variance with intentions as the
outcome. Plotnikoff and Higginbotham
(15) 147 Australian cardiac patients
Cross-sectional Intentions (A = 0.50),
age (A = 0.17) and sex (A = j0.16)
explained 32% of the variance with
exercise as the dependent variable.
Treatment group (A = j0.14), fear at
time 2 (A = 0.12), and self-efficacy (A =
0.70) contributed to 53% of the variance
in exercise intention. Nonintervention,
longitudinal tests Blanchard et al. (3) 76
cardiac patients Longitudinal Response
efficacy was the main predictor of
3-month (A = 0.53) and 6-month (A =
0.32) intentions. The indirect effect of
3-month response efficacy on 6-month
exercise behavior through intention was
significant (A = 0.11). Self-efficacy
significantly predicted 3-month (A =
0.36) and 6-month (A = 0.32) exercise
behaviors, whereas 3-month intention
significantly predicted 6-month exercise
behavior (A = 0.23). Lippke and
Plotnikoff (9) 1602 Canadian adults
Longitudinal The multi-group structural
equation modeling revealed that
covariances within threat appraisal and
coping appraisal were invariant, and all
other constraints were stage specific
(i.e., stage was a moderator). Only
when threat appraisal and coping
appraisal were high, stage movement
was more apparent in the preparation
stage. Plotnikoff et al. (17) 2311 adults
with type 1 (n = 697) and type 2 (n =
1614) diabetes Longitudinal
Self-efficacy was a stronger predictor of
intention (A = 0.64Y0.68) than response
efficacy (A = 0.14Y0.16) in individuals
with type 1 or type 2 diabetes. Severity
was significantly related to intention (A
= 0.06) in type 2 individuals only,
whereas vulnerability was not
significantly related to intention or PA
behavior. Self-efficacy (A = 0.20Y0.28)
and intention (A = 0.12Y0.30) were
significantly associated with PA
behavior. Plotnikoff et al. (18) 1602
Canadian adults Longitudinal The PMT
explained 35% and 20% of the variance
in intention and behavior, respectively.
Coping cognitions as moderators of
threat explained 1% of the variance in
intention and behavior. Age and sex as
moderators of threat did not contribute
to additional variance in the models.
Plotnikoff et al. (19) 244 adults with type
11. 2 diabetes Longitudinal The PMT
explained 19% and 20% of the variance
respectively for aerobic PA and
resistance training. Significant
associations were found between
self-efficacy (A = 0.45, P G 0.001) and
gender (A = 0.15, P G 0.05) for aerobic
PA, and self-efficacy (A = 0.48, P G
0.001) and age (A = 0.17, P G 0.05) for
resistance training. The PMT accounted
for 43% (P G 0.001) and 56% (P G
0.001) of the variance, respectively, for
aerobic PA and resistance training
intentions. For aerobic PA, response
efficacy (A = 0.14, P G 0.05) and
self-efficacy (A = 0.59, P G 0.001) were
significantly associated with intention,
whereas response efficacy (A = 0.23, P
G 0.001), self-efficacy (A = 0.64, P G
0.001), and age (A = 0.10, P G 0.05)
were significantly associated with
resistance training intention. Tulloch et
al. (26) 787 cardiac patients
Longitudinal Self-efficacy (A = 0.33),
response efficacy (A = 0.32), and
perceived severity (A = 0.10) predicted
exercise intentions (A = 0.24), which
also predicted exercise behavior.
Overall, the PMT variables accounted
for 23% and 20% of the variance in
exercise intentions and behavior,
respectively. The PMT model was not
reliable for predicting exercise behavior
at 12 months after hospitalization.
Intervention tests Courneya and
Hellsten (4) 427 undergraduate
students Intervention A significant main
effect for perceived severity (F1411 =
4.02, P G 0.046) and a significant
interaction between perceived severity
and response efficacy (F1411 = 4.12, P
G 0.043) were noted. Individuals who
believed that colon cancer was a
severe disease (high perceived
severity) were more motivated to
exercise if they also believed that
exercise was effective (high response
efficacy) in reducing their risk of colon
cancer. 94 Exercise and Sport Sciences
Reviews www.acsm-essr.org Summary
of research examining protection
motivation theory and physical activity.
Copyright @ 2010 by the American
College of Sports Medicine.
Unauthorized reproduction of this article
is prohibited. The study reported that
the two coping cognitions did not
emerge as significant moderators of
threat cognitions in the prediction of PA
12. intention and behavior across the
study’s two consecutive 6-month
periods. The coping cognitions as
moderators of threat explained only 1%
of the variance in intention and
behavior. However, it may be that threat
is a precursor in formulating a high
coping appraisal toward the
recommended behavior, suggesting a
possibility for an ‘‘ordered’’ PMT model
(13,25) as described later. Age and sex
as moderators of threat did not provide
additional variance in the models and
thus were not significant moderators of
threat cognitions in the prediction PA
intention and behavior across the two
consecutive periods. Although age and
sex have been shown to significantly
moderate PA in tests of other
social-cognitive models, our study
findings suggest that considering these
two demographic factors in PMT-PA
interventions may not produce
favorable changes in PA behavior
change. In addition to confirming the
null effects of age and sex from this one
study, other potential moderators (e.g.,
social-economic status, personality)
could
bhttps://882fcflo685sndqchg329zczfd.h
op.clickbank.net/e examined in future
research. Theory integration Combining
and testing theoretical models may
complement the explanatory ability of
health behavior and guide interventions.
For instance, the PMT has a clear
model structure (Fig. 1), which TTM
lacks; on the other hand, the TTM
proposes discrete, measurable stages
of behavior change, which are not
included in the PMT. With the stages,
there are various psychologically
relevant outcomes, that is, not only
behavior and motivation (as in the PMT)
but more specific and qualitatively
different mindsets through which
individuals undergo in the process of
actual behavior change. If the PMT
predictions are found to be different
across the TTM stages, the salient
processes across the specific stages of
behavior change may be identified.
Weinstein et al. (28) argue that different
constructs (such as the ones theorized
by the PMT) could be important at
different psychological stages, and
therefore, stage-specific predictions
exist as reported by others (16) As a
13. er successful marketers are notoriously tight-lipped
result, a combination of a continuous
theory and a stage model coulani.com
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