Living a healthy life ain’t always easy. We live busy lives with countless demands on our time and attention. Sometimes eating right, exercising, or even something as simple as taking care of one’s teeth, doesn’t feel all that important. Or, maybe it’s too hard to pull yourself away from that Preachers of Atlanta marathon (not that I know anyone with that issue…). Other health issues, like quitting smoking, can be even trickier to control.
Scientists at the intersection of health issues and social psychology have spent a lot of energy trying to determine the most effective ways to help people improve their health behaviors. It’s a growing area of research, and a wide range of experimental studies have tested such questions as whether teaching self-management skills to home-bound adults can lead to increases in their exercise behavior, or whether college students can be motivated to engage in less binge drinking.
Researchers in this area also consider the types of beliefs most closely linked to engaging in health behaviors. For example, does helping women appreciate the personal costs of not performing breast self-examination make it more likely that they will perform self-examination in the future? Does making adolescent women feel more efficacious make it more likely that they will exercise in the future? The logic is that helping people form particular types of thoughts relevant to a health behavior may make it more likely that they will subsequently engage in that behavior.
There are many theories in social psychology that offer an account of which types of beliefs are most strongly linked to behavior. One of the most commonly used theories is the Theory of Planned Behavior (TPB). This theory, proposed by Icek Ajzen, suggests that four specific types of beliefs are important when trying to understand someone’s behavior. First, the strongest and most direct predictor of behavior should be people’s intentions to engage in the behavior. Makes sense, right? I’m not going to floss during my evening Preachers of Atlanta marathon unless I intend to floss during it. Furthermore, if you want to influence people’s intentions, you must change their attitudes (“flossing during Preachers of Atlanta is a good thing to do”), their sense of what other people think is best (“subjective norms”; “my friends would want me to floss during Preachers of Atlanta”), and their belief that they can engage in the behavior (“perceived behavioral control” or “self-efficacy”; the two terms are largely interchangeable for the present purposes; “I am capable of flossing during Preachers of Atlanta”…a dubious proposition given how riveting the show is).
These are tricky, but potentially important distinctions. True, if I’m a personal trainer I could try do both. But, if you only have one chance to try to help someone quit smoking, for example during a check-up with their doctor, is it best to just remind the smoker of all of their friends and family members who don’t smoke (“subjective norms”)? Well, fortunately there is an approach to answering these types of questions in the research literature. A meta-analysis takes all of the evidence on a given research question (e.g., which types of personal beliefs are most closely linked to healthy behaviors?), and summarizes the findings across all of the studies on the topic. This provides a clearer picture of what we collectively know on the topic (for a brief discussion of meta-analysis, see my previous blog post on interventions targeting eating and exercise behavior).
In our meta-analysis, we included 129 separate findings from experimental research on over 35,000 participants. We found that if you want to help people change their intentions to engage in healthy behaviors, changing their attitudes, their perceived social norms, or their self-efficacy were essentially all equally effective routes to changing theot health intentions. However, if you want to change health behaviors, changing people’s sense of efficacy was more effective than changing people attitudes toward the health behavior or their sense of social norms surrounding the behavior. Changing people’s attitudes or perceived norms were also effective, and equally effective in relation to one another, but less effective than changing people’s efficacy beliefs. So, across a ton of studies the evidence suggests that making people feel more capable of living a healthy life may be the most effective way to help people adopt new health behaviors.
However, like all social science research, our work suggests additional unanswered questions (some of which we do explore in the paper, but I don’t have time to discuss in this post). How does changing more than one type of health belief influence changes in health intentions and behavior (e.g., changing both people’s attitudes and self-efficacy at the same time)? Is increasing a person’s self-efficacy the most effective path to behavior change for all types of health behaviors? Finally, are there more or less effective ways to go about influencing people’s attitudes, subjective norms, or self-efficacy? These questions, and others, are questions worthy of future exploration.
What do you think?