Attitudes, subjective norms and perceived behavioural control factors influencing Canadian secondary school students' milk and milk alternatives consumption

OBJECTIVE

The research objectives were to evaluate factors that influence Canadian secondary school students' milk and milk alternatives (MMA) consumption and to explore associations through age and gender lenses.

DESIGN

A qualitative design was used, consisting of semi-structured interviews and photo-elicitation methods. Analysis was guided by the Theory of Planned Behaviour (TPB). Deductive and inductive thematic analyses were used to generate themes, charting data based on attributes such as gender and age.

SETTING

Interviews were held virtually or via telephone.

PARTICIPANTS

Participants were twenty-eight high school students from Ontario, Canada, diverse in terms of gender and age.

RESULTS

Both desirable and undesirable beliefs about the health outcomes of consuming MMA were commonly discussed. These included health benefits such as strong bones, muscular strength, and growth, and health consequences like unwanted skin conditions, weight gain, and diseases. While boys and girls associated MMA consumption with muscular strength, boys predominantly considered this favourable, while girls discussed outcomes like unwanted skin conditions and weight gain more often. Adolescents' perspectives on taste/perceived enjoyment, environmentally friendly choices and animal welfare also influenced their MMA preferences. Parental influences were most cited among social factors, which appeared to be stronger during early adolescence. Factors involving cost, time and accessibility affected adolescents' beliefs about how difficult it was to consume MMA.

CONCLUSIONS

Recommendations for shifting attitudes towards MMA are provided to address unfavourable beliefs towards these products. Interventions to increase MMA consumption among adolescents should include parents and address cost barriers.

Autonomy and factors affecting dental health care seeking behaviour in women: An application of theory of planned behaviour

Background

Understanding oral health care seeking behaviour and it's determinants is essential in improving oral health. The health care utilization in women was found to be influenced by their autonomy. A socio-cognitive model that can explain variance in dental attendance behaviour in women including autonomy has yet to be validated. The Theory of Planned Behaviour (TPB), which takes into account women's autonomy, attitude, subjective norms, and perceived behavioural control, is empirically tested in this study with regard to self-reported dental visiting intentions and dental health seeking behaviour.

Method

Cross sectional study using self-administered questionnaires was conducted to assess socio-demographic factors, autonomy, dental visiting behaviors as well as constructs of TPB model in 400 women aged 18 years or older in Bangalore city selected via stratified cluster sampling method. Two-stage structural equation modelling (SEM) was used to test the hypothesized TPB model.

Results

The proposed correlated 5-factor measurement model was confirmed through confirmatory factor analysis (CFA). In SEM subjective norm (β = 0.17), perceived behavioural control (β = -0.27) and autonomy (β = 0.49) significantly predicted dental visiting intentions in women. Intention (β = 0.56) and autonomy (β = 0.25) explained dental visiting behaviour. It also revealed indirect effect of autonomy and perceived behaviour control on dental visiting behaviour through intentions. The hypothesized model predicted 27.6 % and 23.8% of the variance in intention and dental visiting behaviour respectively.

Conclusion

The hypothesized model was successful in predicting intention and dental visiting behaviour in women. This could explain the multidimensional nature of dental care utilization in women which in turn might be helpful in improving access to dental care among them in future.

Does the purchase intention of green consumers align with their zero-waste buying behaviour? An empirical study on a proactive approach towards embracing waste-free consumption

In recent years, emerging retail markets in cosmetics have transformed into green markets, as consumers demand more eco-friendly products. However, in scholarly literature, limited studies are available where researchers discuss green consumers' purchase intentions towards eco-friendly products and their relationship with zero-waste buying behaviour. This study is conducted to address the existing gap in current literature. An empirical investigation is carried out, focusing on individuals who use cosmetic products and are active followers of zero-waste beauty influencers on social media. Responses are gathered for data analysis with the help of partial least squares structural equation modelling (PLS-SEM). The results indicate that eco-friendly packaging, pro-environmental belief, and para-social interaction positively impact the altruistic motivation and purchase intention of consumers. Ultimately, these factors collectively contribute to the purchase of zero-waste cosmetic products. The findings of this study can provide valuable insights for policymakers and brand managers in the field of herbal cosmetic formulations. These insights can help in understanding the fundamental reasons that drive consumers to buy zero-waste cosmetic items, potentially leading to a decrease in ecological impact. Additionally, the study contributes to the theory of planned behaviour (TPB) by investigating consumers' purchase intention towards eco-friendly products and their zero-waste buying behaviour.

Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study

Background

Mass vaccination against Covid-19 has been recognised as the most effective strategy for overcoming the pandemic emergency and remains crucial in the ongoing efforts to mitigate the impact of the virus. The present study aimed to test the efficacy of an extended Theory of Planned Behaviour (TPB) model in predicting vaccination intention in three different phases of the pandemic. Understanding how psychological drivers of vaccine acceptance may have changed throughout the pandemic is essential for informing public health strategies and addressing vaccine hesitancy, even in the current post-pandemic context.

Methods

Using a repeated cross-sectional survey, we tested the hypothesised extended TPB model (intention, attitude, subjective norms, perceived behavioural control, anticipated affective reactions, risk perception, trust in science, trust in institutions and religiosity) across three independent samples: before (T1: November-December 2020; N = 657), during (T2: March-May 2021; N = 818), and after (T3: February-March 2022; N = 605) the start of the vaccination campaign in Italy.

Results

Results indicated significant differences between the time points in all investigated variables, pointing to a general trend of improvement in vaccine acceptability levels at T2 compared to T1, and a worsening at T3 compared to the other two time points. Interestingly, net of these differences, a multi-group Structural Equation Modeling analysis supported the invariance, across time, of the structural relationships examined within the extended TPB.

Conclusion

Findings demonstrated the efficacy of the TPB in predicting Covid-19 vaccination intention at different stages of the pandemic, suggesting that the model, in its extended version, represents a valuable framework for designing interventions aimed at promoting vaccine acceptance.

The effects of attitudes, norms, and perceived control on the adaptation of elderly individuals and individuals with chronic health conditions to heatwaves

BACKGROUND

In this study, the theory of planned behaviour (TPB) was used to examine the determinants of the heat protection intentions and actions of elderly individuals and individuals with chronic health conditions. This is an important topic as understanding the motivations for adapting behaviours to heatwaves can inform the design of warning systems and awareness campaigns by public health authorities to mitigate the adverse effects of weather hazards on health.

METHODS

Three phone surveys were conducted in 2015 and 2016 to collect data on a large sample of individuals with increased vulnerability to heatwaves in the city of Longueuil, Canada. Prospective and panel fixed effects logit models for ordinal variables were used to analyse the factors that influenced heat protection intentions and actions.

RESULTS

Attitudes, norms, and perceived control have positive effects on intentions to adopt heatwave protection actions and intentions on the effective adoption of these preventive measures. The hypothesis according to which perceived control moderates the effect of attitudes and norms on intentions is rejected. In addition, the results suggest that elderly individuals are less likely than individuals in other age groups to adopt heat protection actions. Health conditions related to vulnerability to hot weather do not seem to significantly improve the adoption of heat protection behaviours.

CONCLUSIONS

The adoption of heatwave protection actions can be improved by public health interventions that influence attitudes and social norms related to heat protection behaviours and facilitate their adoption.

Household waste management behaviour amongst residents in an informal settlement in Durban, South Africa

In South Africa, household waste management is a significant challenge in informal settlements, as most of these lack basic waste management infrastructure, and the government's waste management services are limited. This contextual setting brings unique challenges that have not been extensively explored in existing research. Understanding waste management behaviour is therefore critical in addressing underlying challenges and improving waste management practices in such settlements. The purpose of this study was to assess the waste management behaviour among residents of the Shannon Drive informal settlement, in Durban, South Africa. Using the Theory of Planned Behaviour, this study conducted a cross-sectional survey amongst 226 residents at the Shannon Drive informal settlement in Durban, South Africa. The findings suggest that whilst individuals have a positive attitude towards managing their household waste, they believe that it is solely the responsibility of the municipality to manage this in their area, which could have implications for waste management policies and programs. The findings suggest that there is a need for continued education and outreach efforts to promote positive behaviour towards household waste management.

Psychosocial Predictors of Colorectal Cancer Screening Intention: An Experiment on the Invitation Letter

BACKGROUND

In Italy, attendance rates for colorectal cancer (CRC) screening are suboptimal. The present work analysed cognitive and emotional predictors of CRC screening intention and tested an intervention on a real invitation letter to improve CRC screening intention, both directly and in interaction with the predictors of our model.

METHODS

Our model included variables from the theory of planned behaviour and the emotional barriers to bowel screening scale. We applied six changes to an invitation letter used in Italy to avoid the repetition of words like 'faeces', 'blood', or 'occult' and reduce the prompting of disgust. The 228 participants were randomly assigned to a between-participants design (original letter vs. manipulated letter).

RESULTS

Disgust hindered CRC screening intention, while embarrassment, fear, and subjective norms (i.e., perception of the social pressures to attend CRC screening) were not associated with intention to screen. More positive attitudes towards CRC screening were associated with a higher intention to screen. The positive association between perceived behavioural control and CRC screening intention was stronger for participants who read the letter with fewer (vs. more) references to bodily waste. Letter manipulation did not affect intention to screen.

CONCLUSIONS

The disgust associated with faecal matter is a critical factor in determining CRC screening attendance, and it should be acknowledged as such in public policies. Until new screening tests avoiding the activation of this emotional reaction are concretely available, public campaigns should improve CRC screening participation by boosting both positive attitudes towards screening and patients' perceived behavioural control.

Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women

OBJECTIVES

Breastfeeding up to 2-years has been associated with short and long-term health benefits for both newborns and mothers. However, few women breastfeed up to 2-years after birth. This study extends previous research on the theory of planned behaviour (TPB) examining the predictors of intention and maintenance of breastfeeding up to 2-years in both primiparous and multiparous women.

DESIGN

155 pregnant women participated in this longitudinal study.

METHODS

Expectant mothers completed a questionnaire and then 2-years after the child's birth were asked to report breastfeeding behaviour. Interactions among parity and TPB constructs were examined.

RESULTS

Attitudes, descriptive and injunctive norms, and perceived behavioural control (PBC) explained 58% of the variance in mothers' intention to breastfeed. Attitudes were the strongest predictor, followed by PBC, descriptive norms and parity. A significant interaction was found between parity and PBC, showing that PBC was only a significant predictor of intention to breastfeed at 2-years in multiparous women. Intentions predicted breastfeeding behaviour at 2-years.

CONCLUSION

Promoting intentions may be a useful way to increase breastfeeding duration to 2-years and targeting attitudes and norms may be one way to increase intentions. Further, targeting PBC may also be useful to increase intentions, but only in multiparous women.

Intention patterns predicting college students' volunteer service participation

Volunteer service activities of college students are crucial for universities to educate students on civic engagement. Education laws and scientific methods must be employed to enhance college students' willingness to volunteer and actively participate in volunteer service activities. Based on literature collection and collation, this study takes the theory of planned behaviour as the basic framework, includes the dimension of "cognition," designs the questionnaire, and discusses the relationship among the relevant factors that affect the volunteer service behaviour of college students. Cognition, defined as understanding volunteerism's personal and social benefits, positively predicted attitudes, norms, and control, but not directly behaviour. A sample survey of Chinese college students and a correlation analysis of effective questionnaires demonstrate that college students' volunteer service attitudes, subjective norms, and perceived behaviour control positively impact volunteer service behaviour intention, which can predict volunteer service behaviour. College students' cognition of volunteer service significantly and positively impacts their attitude toward it, subjective norms, and perceived behavioural control but does not directly impact their volunteer service behaviour. Thus, the following aspects must be improved: guiding attitude, creating atmosphere, improving mechanisms, innovating projects, strengthening cognition, and implementing practical education. The findings of this study can help colleges and universities to clarify the impact mechanism of college students' volunteer service cognition on their volunteer service behaviour. It contributes new evidence on optimising the student environment to engage youth in building community well.

Modelling the mass adoption potentials of eBikes among Malaysian youth

This study examined (1) the effect of environmental concern, environmental knowledge, and health consciousness on attitude towards eBikes; (2) the effect of eBikes attributes of interest and infrastructure on perceived behavioural control; and finally, (3) the effect of attitude towards eBikes, subjective norms, and perceived behavioural control on eBikes commuting intention and its usage among Malaysian youth. This study adopted a cross-sectional design and convenience sampling, and collected quantitative data from 699 Malaysian youth through an online survey. Findings revealed that (1) environmental concern, environmental knowledge, and health consciousness had a positive and significant impact on attitude towards eBikes; (2) eBikes attributes of interest and infrastructure were positively and significantly related to perceived behavioural control; (3) attitude towards eBikes, subjective norms, and perceived behavioural control had a positive and significant effect on eBikes commuting intention; (4) eBikes commuting intention was positively and significantly related to the usage of eBikes; (5) eBikes commuting intention significantly mediated the relationship between attitude towards eBikes and perceived behavioural control on the usage of eBikes among Malaysian youth; and (6) eBikes commuting intention did not mediate the relationship between social norm and usage of eBikes. Although environmental knowledge and social norm are proven to have a positive and significant relationship, this analysis demonstrated a relatively low effect size. To promote environmental and sustainable development in cities through the mass adoption of eBikes among Malaysian youth, policymakers should highlight the benefits of using eBikes, introduce proper policies, and involve the development of improved and connected cycling paths in the city sustainable infrastructure plans.

Web-based need-supportive parenting program to promote physical activity in secondary school students: a randomized controlled pilot trial

BACKGROUND

Current global trend of insufficient physical activity (PA) among children and adolescents highlights the necessity of finding effective ways to promote PA in childhood. Self-determination theory (SDT) has demonstrated efficacy as a conceptual framework for developing interventions aimed at promoting diverse health behaviours. Parents have potential to influence children's health behaviours to a great extent, which could be enhanced from an online, self-paced training to gain knowledge on how to support children's intrinsic motivation towards particular health behaviour. In this pilot study, we developed and tested an online SDT-informed need-supportive training for parents, enabling them to interact with their children in a way to support their intrinsic motivation towards leisure-time physical activity.

METHODS

Sixty eight students (Mage = 12.5 ± 0.72) and one parent for each child were randomly assigned to the 6-week intervention condition or control condition. Students completed psychological measures (i.e., perceptions of parents' need-supportive behaviours, basic psychological need satisfaction and frustration, autonomous and controlled forms of motivation, as well as social cognition beliefs towards leisure-time PA) and self-reported PA pre-intervention, post-intervention, and one-month after the intervention. Repeated measures ANOVAs were conducted to test the effects of the intervention condition and time.

RESULTS

While a statistically significant intervention effect on children's leisure-time PA was not found, students in the intervention group reported higher, albeit marginal, perceptions of intrinsic motivation (F(2, 84) = 3.095, p = 0.050) and lower perceptions of introjected regulation (F(2, 88) = 3.107, p = 0.050) and autonomy frustration (F(2, 84) = 2.987, p = 0.056) at follow-up. Contrary to expectations, children in the control group demonstrated higher perceptions of intention (F(2, 84) = 4.838, p = 0.010) and effort (F(2, 80) = 3.473, p = 0.036) towards leisure-time physical activity at follow-up. No significant changes were found in perceptions of need-supportive behaviour from parents, attitude, and perceived behavioural control.

CONCLUSIONS

Our pilot study highlights the importance of parental training and the potential for SDT-informed interventions to support children's intrinsic motivation towards physical activity. Further research is needed to test the intervention in other domains and combine interventions in several domains to have the highest impact.

TRIAL REGISTRATION

This pilot study is part of preparation for the main study, prospectively registered in ISRCTN registry as ISRCTN78373974 (15.12.2022). The current stage of the main study is 'recruiting'.

Determinants for COVID-19 vaccination intention in Mexico

This investigation aims to determine the predictors that have the most significant influence over COVID-19 vaccination intention for the population of 18 years or above in Mexico. This will be done through a comprehensive theoretical model comprising: the theory of planned behaviour, the health belief model, and the model of goal-directed behaviour. An exploratory, cross-sectional study with a quantitative approach was carried out. The structured questionnaire was applied to 1085 adults in the first trimester of 2021 through Google Forms in social media groups. The data analysis was carried out through partial least square structural equation modelling. Positive anticipated emotions, desire, subjective norms, attitude, and perceived behavioural control were the most significant predictors of intention. The model that combines the theoretical perspectives explains mostly the vaccination intention. The study can be a valuable theoretical perspective for understanding similar behavioural intentions related to health risks. The results are also valuable for public health decision-makers to design strategies that promote vaccination.

Understanding residents' behaviour intention of recycling plastic waste in a densely populated megacity of emerging economy

Plastic waste is choking our planet, but the recycling rate is still universally low. Understanding factors affecting recycling behaviours can help address this pressing issue. Taking Dhaka as an example, this study explores the determinants of the intentions to recycle plastic waste. We employed the Theory of Planned Behaviour (TPB) and extended it with two additional variables: Moral Norms, and Perceived sufficiency of knowledge and policy support. Survey data of 577 were collected and analysed using PLS-SEM. The findings suggest attitude, perceived behavioural control, moral norms and subjective norms significantly impact recycling intention, among which moral norms (β = 0.148, p < 0.05) acts even more strongly than subjective norms (β = 0.12, p < 0.05). Moreover, low level perception of knowledge and policy support makes people perceive less control over recycling behaviour (β = 0.188, p < 0.05), but actually reinforce their recycling intention (β = -0.091, p < 0.1). This study enriches the theoretical discussion of TPB, and contributes to the efforts of encouraging plastic recycling in populated megacity of emerging economy.

E-learning adoption for sustainable higher education

Electronic learning (E-L) is a profound transition that is occurring in education as a new learning platform in countries across the globe. COVID-19 pandemic has forced all higher education institutions in Sri Lanka to adopt e-learning to maintain sustainable teaching. This study identified the relationships between the main influencing factors of e-learning usage behaviour and, in turn, sustainability in teaching. Theory of Planned Behaviour (TPB) was used to formulate the research framework and hypotheses. The population of the study was comprised of permanent academics attached to Sri Lankan public universities under the patronage of UGC. The sample size was 357 for the given population size of 5399, and a stratified sampling technique was used to select the sample. The study used a quantitative method under the philosophical assumption of positivism. The researchers have applied Structural Equation Modelling (SEM) to test the path association among factors. The result explores the path relationship between exogenous and mediating variables, mediating to an endogenous variable. The research outcome shows that attitude and perceived behavioural control influence e-learning usage but not the subjective norm. While behavioural intention mediates the relationship between attitude and perceived behavioural control and e-learning usage, the latter mediates the association between behavioural intention and sustainability in teaching. Gender, academic position and computer literacy level moderate the causal relationships of the factors influencing sustainability in teaching. Finally, this study concludes that Attitude, Perceived Behavioural Control, Behavioural Intention and E-learning Usage Behaviour are the factors influencing sustainability in teaching. This study recommends universities develop infrastructures, train staff members and establish an office for sustainability development. Furthermore, it recommends that future researchers do longitudinal studies and adopt decomposed TPB.

Facilitators of tertiary students' entrepreneurial intentions: Insights for Lesotho's national entrepreneurship policy

This study provides insightful information to guide the Lesotho government's drive to address rising youth unemployment. Through quota sampling technique, this study selected 930 students from 31 departments at National University of Lesotho. Grounded in the theory of planned behaviour (TPB), the study examined the facilitators of students' entrepreneurial intentions using mean, standard deviation, mean rank, correlation, and Mann-Whitney U test. Structural equation modelling was used to determine the relationship between the three components of TPB (attitudes, perceived behavioural control, and subjective norm), and students' entrepreneurial intention. The findings show that attitudes and perceived behavioural control were positive predictors of entrepreneurial intention while subjective norm was a negative predictor. The major findings indicate that students from Business and Management Development, Business Administration, Economics, Nutrition, and Pharmacy departments had higher entrepreneurial intentions, with postgraduate students (at master level) having higher entrepreneurial decisions than undergraduate students. Policy, practice, and research implications are teased out from the findings to improve entrepreneurial education.

Explaining the intention and behaviours of interinstitutional collaboration in chronic disease management among health care personnel: a cross-sectional study from Fujian Province, China

BACKGROUND

The increasing number of chronic diseases consumes a large amount of health resources and puts a huge burden on health service system. The integrated management of chronic diseases in Sanming City aims to improve the efficiency and quality of chronic disease management through the collaboration between different levels of medical institutions.

AIM

The aim of the present study was to use the theory of planned behaviour (TPB) to examine the intention and behaviours of interinstitutional collaboration in chronic disease management (ICCDM) among healthcare personnel.

METHODS

A cross-sectional study of 274 health care personnel was conducted in medical institutions in Fujian Province, China, from March 2022 to April 2022. A self-administered questionnaire based on TPB theory was applied to measure the participants' ICCDM behaviours.

RESULTS

The proposed TPB model revealed that attitude was significantly and positively associated with behaviour intention, and behaviour intention and perceived behavioural control were significant predictors of ICCDM behaviour.

CONCLUSION

TPB provides insights into ICCDM behaviour. Due to the fact that attitude, perceived behavioural control, and behavioural intention towards ICCDM behaviour were demonstrated to be significant predictors of ICCDM behaviour, these factors may be a promising focus of ICCDM interventions in the integrated management of chronic diseases in China.

Exploring preference and willingness for rural water pollution control: A choice experiment approach incorporating extended theory of planned behaviour

Rural water pollution control (RWPC) is a crucial issue for developing countries, particularly because of its importance for improving ecosystems, promoting sustainable development, and ultimately contributing to the health and well-being of individuals. This study adopted a choice experiment (CE) to explore farmers' preference and willingness for RWPC and to investigate whether socioeconomic and psychosocial factors can explain differences in farmers' preferences and values governing RWPC. The theory of planned behaviour (TPB) and some additional constructs (risk perception, knowledge, moral norms, and subjective norms) were included in an empirical test that predicts stated choices. The Wei River basin, one of the most water-polluted areas in China, was used as the location for our study. From June to July 2022, we collected the questionnaire responses of 427 farmers who live and work in this area. The results suggested that farmers have significant heterogeneity in their preference for RWPC attributes, but the majority highly value improving water quality through water pollution treatment. The inclusion of TPB and additional constructs in our test explained the behaviour of farmers. Those with high scores tended to already perform RWPC and have a willingness to continue to do so. According to the results of a latent class (LC) model, the average willingness to pay (WTP) per farmer for rural water pollution treatment was 254.69 Chinese yuan (CNY) per year. Excluding biodiversity, the average WTP was 241.55 CNY per year. This study provides a new path for developing countries to promote RWPC and improve local rural environments and the well-being of rural residents.

Exploring the influence of behavioural, normative and control beliefs on intentions to adhere to public health guidelines during the COVID-19 pandemic: a qualitative interview based study

BACKGROUND

Perceived severity and susceptibility of disease are predictors of individual behaviour during health crises. Little is known about how individual beliefs influence intentions to adhere to public health guidelines during periods of health crises, and how access to and consumption of information influence these intentions. This study investigated behavioural beliefs, normative beliefs, and control beliefs, and their influence on behavioural intentions to adhere to public health guidelines during the COVID-19 pandemic.

METHODS

Participants were recruited from a related COVID-19 study conducted by our team, and through snowball sampling in subsequent. Using a maximum variation sampling technique, we recruited a diverse group of participants representing six major regions in Canada. Participants took part in one-on-one semi-structured interviews from February 2021 to May 2021. Data were analyzed independently in duplicate by thematic analysis. The Theory of Planned Behaviour (TPB) was the conceptual framework used to organize dominant themes.

RESULTS

We conducted a total of 60 individual interviews (137 eligible individuals contacted, 43.8% response rate) and identified six themes organized according to the three constructs of behavioural, normative and control beliefs as described in the TPB: (1) Behavioural: My "New Normal," Individual Rights and Perceived Pandemic Severity, Fatigue with COVID-19, (2) Normative: COVID-19 Collective, (3) Control: Practicality of Public Health Guidelines, and (6) Conflicting Public Health Messages. Most (n = 43, 71.7%) participants perceived individuals in their geographic community to be following public health guidelines adequately. Several participants (n = 15, 25.0%) commented on the unequal impact of restrictions based on socioeconomic factors (i.e., class, race, age).

CONCLUSION

Individual perceptions of risk, loss of control, access to resources (i.e., childcare), and societal expectations, shaped intentions to engage in disease preventative behaviours (i.e., social distancing) during the COVID-19 pandemic.

Predicting the intention and adoption of hydroponic farming among Chinese urbanites

Urban agriculture has become increasingly popular as a viable solution to the global food insecurity, but the uncontrollable expansion of cities and populations has led to the significant decrease in cultivable space for conventional soil-based farming. Unlike conventional agriculture, soil-less hydroponic farming allows sustainable food production in urban areas without compromising the environment and public health. Using both theory of planned behaviour and knowledge-attitude-behaviour theory with four additional factors, the current study examined the intention and adoption of hydroponic farming among Chinese urbanites. An online survey, which involved 661 respondents from different cities in China, was conducted. The results of partial least squares structural equation modeling revealed the significant influence of tolerance of diversity, innovativeness, and knowledge about hydroponic system on attitude towards hydroponic system. Additionally, knowledge and attitude towards hydroponic system, perceived need for hydroponic farming, and hydroponic farming compatibility were found to significantly influence the intention of adopting hydroponic farming, which was also found to exhibit significant influence on its actual adoption. This study presented valuable insights that contribute to the development of a framework that promotes effective farming practices and strategies. The obtained findings can benefit marketers, practitioners, and policymakers in the agricultural and environmental fields, particularly in their efforts of planning, designing, marketing, and strategizing to promote modern agricultural practices and create a favourable environment for urban hydroponic farming in developing countries.

Using the precaution adoption process model to understand decision-making about the COVID-19 booster vaccine in England

BACKGROUND

COVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to maintain population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19.

PURPOSE

To use the Precaution Adoption Process Model (PAPM) to understand decision-making about the COVID-19 booster vaccine (CBV) in England.

METHODS

An online, cross-sectional survey informed by the PAPM, the extended Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making.

RESULTS

Of the total 2,004 participants: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against COVID-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive COVID-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive COVID-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs London).

CONCLUSIONS

Public health interventions promoting CBV may improve uptake through tailored messaging directed towards the specific decision stage relating to having a COVID-19 booster.

Socio-cognitive determinants of sugar-sweetened beverage consumption among young people: A systematic review and meta-analysis

The overconsumption of sugar sweetened beverages is an increasing public health concern. Understanding the socio-cognitive determinants that drive such consumption could inform the development of interventions to reduce sugar sweetened beverage consumption. The aim of the present review and meta-analysis was to determine the strength of associations between socio-cognitive determinants and the amount and frequency of sugar sweetened beverage consumption among young people. A systematic review was conducted in accordance with PRISMA guidelines. A search was performed using the following databases: PsycINFO, MEDLINE, Scopus, ProQuest, and PubMed. The key search terms were: (1) children, adolescents, young adults; (2) sugar sweetened beverage consumption, choice or purchasing behaviour; and (3) socio-cognitive determinants related to sugar sweetened beverage consumption. The search identified 4325 papers, with 22 papers remaining after screening. Two separate meta-analyses were performed, one for amount (n = 14) and one for frequency (n = 8) of consumption. The most strongly associated determinants with amount of sugar sweetened beverage consumed were habit, intention to consume, and attitudes, whereas the most strongly associated determinants with frequency of consumption were intentions, injunctive norms, and descriptive norms. Comparisons between the meta-analyses revealed two distinct differences: injunctive norms were more strongly correlated with frequency of consumption, and self-efficacy with amount consumed. It was suggested that interventions that focus on multiple determinants, including components of the Theory of Planned Behaviour may result in the largest reductions in consumption. Specifically, focussing on changing attitudes, norms and habits, and increasing perceived behavioural control related to sugar sweetened beverages may be maximally effective in reducing consumption behaviour.

The influence of social norms in the context of reducing sugar-sweetened beverages consumption

OBJECTIVES

This study aimed to examine the factors associated with low sugar-sweetened beverage (SSB) consumption and intention to avoid these products as well as investigate the role of different types of social norms in the adoption of this behaviour.

STUDY DESIGN

This study reports the results of a secondary data analysis from a cross-sectional telephone survey.

METHODS

A total of 1000 adults were randomly recruited in the province of Québec, Canada, using a random-digit dialling procedure. Eligibility criteria were to be aged between 18 and 64 years; able to answer a questionnaire in French or English; and to reside in the province of Québec. SSB consumption, social norms and variables from the theory of planned behaviour were assessed by means of a questionnaire. Logistic regression analyses were conducted to examine factors associated with behaviour and intention.

RESULTS

Consuming <1 SSB per day was significantly associated with intention, perceived behavioural control, and risk perception about tooth decay. Descriptive (perceived prevalence in the close surroundings of one person) and perceived societal norms (perceived broad societal approval/disapproval of the behaviour) were associated with behaviour. All theory of planned behaviour variables (including injunctive norm) and risk perception pertaining to chronic diseases predicted intention to avoid the consumption of ≥1 SSB per day. Sex, age, income, and risk perception pertaining to chronic diseases were associated with perceived societal disapproval of SSB consumption.

CONCLUSIONS

This study confirms the importance of social norms in the prediction of SSB consumption but also highlights the need to address motivation and capacities in public health interventions to reduce SSB consumption.

Microplastics in personal care products: Exploring public intention of usage by extending the theory of planned behaviour

Microplastics, artificial plastic particles with a particle size of <5 mm, have attracted considerable attention due to their potential negative impacts on the social economy, ecological environment, and human health. An important direct source of microplastics (i.e., microbeads in cosmetics) is scrub particles from personal care products, such as cosmetics and toothpaste. Therefore, it is necessary to understand consumers' perceptions and behaviours regarding these products, which can help reduce the emission of microplastics at the source. The purpose of this study is to quantitatively analyse the impact factors and interaction mechanisms of the public behavioural intention of reducing the use of personal care and cosmetic products containing microplastics through the expanded theory of planned behaviour (TPB) model. We conducted random face-to-face interviews with 496 respondents in Shanghai, China. The results show that (1) attitude has the most powerful positive influence on behavioural intention, followed by perceived behavioural control and environmental concern, whereas there is no significant direct influence of subjective norms, environmental education, and behavioural experience; (2) subjective norms have an indirect influence on behavioural intention through attitude and perceived behavioural control; and (3) environmental education and behavioural experience both have an indirect impact on behavioural intention through attitude. Practical and effective policy implications are proposed for the government to reduce microplastic pollution based on the results of this article.

State versus action orientation and compliance during the COVID-19 pandemic in Indonesia

This study explored the roles of activity versus state direction in how Indonesians adhered to COVID-19 preventive behaviour using the theory of planned behaviour (TPB). A total of 615 participants were gathered through a web questionnaire containing 68 questions. Structural equation modelling (SEM) was used to determine the causal relationships of the latent variable construct. The results revealed that information sources positively influence both attitudes and subjective norms toward preventive behaviour. The results also support self-regulation as a moderator of the main intent-behaviour relationship. Moreover, state-oriented people cannot self-regulate their behaviour to comply with COVID-19 protocols. This investigation provides productive experiences for strategists and managers to improve COVID-19 compliance. This paper's analysis also contributes to literature by revealing the intention to comply with COVID-19 protocols by emphasizing the role of self-regulation. The findings are relevant to practitioners and policymakers in the field of public health and managing of human behavior, particularly to improve of compliance with COVID-19 prevention. Therefore, governments or public health organizations can be utilized to improve the number of individuals who practice COVID-19 preventative behaviours now and in the future, but various factors must be addressed. Future directions and recommendations for improving TPB are suggested.

Segmentation of intentions towards COVID-19 vaccine acceptance through political and health behaviour explanatory models

BACKGROUND

Management of the COVID-19 pandemic has been plagued by an online 'infodemic', not least on the topic of vaccine safety. Failure to vaccinate is often addressed with corrective, factually based information. However, this may be overly simplistic. European vaccine hesitancy levels correlate closely with popularity of populist parties while scientific populism refers specifically to populist distrust in scientific expertise.

AIMS AND METHOD

Combining an evaluation of risk through the health belief model and the cognitive constructs from the theory of planned behaviour, with the influence of populist statements, anticipated regret, trust, and past healthcare behaviour, an online survey explored the components of vaccine decisions amongst a demographically representative Irish adult sample (N = 1995).

RESULTS

The regression model accounted for a large proportion of variance amongst the total sample. A primary set of influences suggests a considered risk evaluative decision-making approach while a second tier of weaker influences incorporates a broader set of values beyond cost-benefit analysis. Six ideological subsets were identified through K-means analysis. Segments were differentiated by subjective norms attitudes (particularly around social media), populist political attitudes, self-efficacy, perceptions of COVID-19 severity, and susceptibility to the condition.

CONCLUSIONS

While the 'right thing to do' is clear when viewed through a lens of scientific expert advice, this is precisely the paradigm which populist movement rejects. Segmentations, such as the outputs from this study, validate the importance of proactively engaging with diverse communities both on and offline and afford a framework for developing and evaluating more refined, targeted, policies and interventions.

Gastroenterologist and Patient Attitudes Toward Yoga as a Therapy for Irritable Bowel Syndrome: An Application of the Theory of Planned Behaviour

Objectives

To identify irritable bowel syndrome (IBS) patients' attitudes, subjective norms, perceived control and intention to practice yoga and gastroenterologists' attitudes and current yoga recommendations for their patients with IBS.

Methods

Gastroenterologists and IBS patients completed online surveys including Theory of Planned Behaviour (TPB) constructs. Among IBS patients, multiple linear regression determined the multivariate associations between TPB variables and intention to practice yoga while controlling for significant socio-demographic variables. Gastroenterologists were asked about their attitudes and current yoga recommendations for patients with IBS. Chi-square analyses examined associations between gastroenterologists' demographics and recommending yoga. Binomial logistic regression described associations between attitude variables and current yoga recommendations.

Results

For patients (n = 109), controllability (β = 0.5, P < 0.001), affective attitude (β = 0.4, P < 0.05) and self-efficacy (β = 0.3, P < 0.05) were significantly associated with intention to do yoga in the regression model. TPB variables explained 34% of the variance in patients' intentions to practice yoga. The binomial regression analysis revealed that gastroenterologists (n = 79) who have confidence in recommending yoga (39%) were seven times more likely to recommend it (odds ratio = 7.3, P = 0.002) and those who agreed yoga improves IBS symptom severity (54%) were 10 times more likely to recommend yoga (odds ratio = 10.1, P < 0.001). Most (86%) wanted more evidence to support efficacy of yoga for IBS and 44% asked for more knowledge on how to refer a patient.

Conclusion

Controllability, affective attitude and self-efficacy predicted IBS patients' intentions to practice yoga. Although gastroenterologists believed yoga is safe and beneficial for IBS patients, most do not recommend yoga due to lack of confidence and scientific evidence.

The Influence of Environmental Values on Consumer Intentions to Participate in Agritourism-A Model to Extend TPB

This study examines the influence of environmental values on consumer intentions to participate in agritourism through the theory of planned behaviour (TPB) and value-belief-norm (VBN) theory. It proposes an integrative model by adding two variables, i.e., environmental benefits and the human-nature coordination concept, to the TPB. The study employs a questionnaire survey method and a sample of 640, which was statistically analysed through structural equation modeling (SEM). The results reveal that the "environmental values-attitudes-behavioural intentions" framework has scientific applicability in agritourism. Environmental values, measured through the variables environmental benefits and the human-nature coordination concept, are positively correlated directly or indirectly with agritourism consumption intentions, while attitudes and subjective norms serve as mediators. However, the mediating effect of perceived behavioural control is not statistically significant, indicating making efforts to influence attitudes and subjective norms is more useful for and effective in stimulating the public's intentions towards agritourism. As this study tests the hypotheses with empirical data, it provides practical implications for policy-makers and programme managers.

Remote work as a new normal? The technology-organization-environment (TOE) context

The COVID-19 pandemic has established remote work as the new normal. However, the factors that influence the effectiveness of remote work are unexplored. Moreover, the relationships between remote work and job performance and emotional exhaustion are under-investigated. This study addresses these gaps by investigating the factors that influence the effectiveness and outcomes of remote work. The technology-organisation-environment (TOE) framework and the theory of planned behaviour (TPB) are used as a theoretical lens to examine the internal and external factors that affect remote work and work-life balance. An online cross-sectional survey of knowledge workers engaged in remote work in Hong Kong indicates that both external (technological competence, government support) and internal (work flexibility, attitude, perceived behavioural control) factors are significant predictors of successful remote work. Furthermore, remote work is positively associated with job performance but has no association with emotional exhaustion. These findings suggest that to ensure a successful transition to the new normal, governments and organisations should provide technical support to employees engaged in remote work. The theoretical and practical implications of the findings are discussed.

From value perception to behavioural intention: Study of Chinese smallholders' pro-environmental agricultural practices

Internal motivation is a crucial factor determining an individual's behaviour, particularly relevant to smallholders' adoption of pro-environmental agricultural practices. However, there has been limited evidence about smallholders' behavioural intention formation, specifically focusing on pro-environmental agricultural practices. Using large-scale, in-depth interview data from a sample of 549 rural farmers in Shandong province in China, we developed an integrated socio-psychological model, which integrated the value-belief-norm (VBN) theory and the theory of planned behaviour (TPB) into a coherent framework and further tested by using the structural equation modelling (SEM) approach. The results show that the TPB and the VBN models can be well-integrated to examine smallholder's pro-environmental behaviours. The integrated model indicates that smallholders' value perception of environment plays a fundamental role in forming their behavioural intention. Smallholders' subjective norms, and perceived behavioural control (as the core elements in the TPB theory), and their ascribed responsibility (as a core element in the VBN theory) play a significant mediation role in shaping their behavioural intention. This result indicates that to foster smallholders' internal motivation in adopting pro-environmental practices, it is crucial to understand the value perception among farmers, and policymakers should particularly take measures to foster farmers' egoistic values, altruistic values and their biospheric values towards the environment. Only if these proper values are formed, a strong behavioural intention can be formed.

The intention to get COVID-19 vaccine and vaccine uptake among cancer patients: An extension of the theory of planned behaviour (TPB)

The psychosocial impact of coronavirus disease 2019 (COVID-19) on human life is well-known. Although vaccine protection represents an effective way to control the spread of the virus, vaccination hesitancy may decrease individuals’ willingness to get vaccinated, including among cancer patients. Therefore, the objective of the current study was to examine the predictors of cancer patients’ intentions to receive COVID-19 vaccinations and vaccine uptake, using and integrating the theory of planned behaviour (TPB) and the health belief model (HBM). A sample of 276 Italian cancer patients (54% female and 46% male) ranging from 19 to 85 years (M = 49.64, SD = 11.53) was recruited by administering an online questionnaire. The current study results showed that cancer patients with higher trust in health authorities tended to have vaccine-positive subjective norms, perceived that vaccination was under their control, and viewed COVID-19 vaccines positively. On the other hand, the perceived risk of COVID-19 was related to subjective norms but not to perceived behavioural control or attitudes towards COVID-19 vaccination. The current study reveals that TPB variables can function effectively as mediators between perceived risk, trust, and intention to vaccinate but at different levels. Together, these findings suggest that effective interventions (both public health messaging and personal medical communications) should focus on enhancing trust in health authorities, while at the same time endeavouring to highlight subjective norms that are vaccine-positive.

Extending the theory of planned behaviour to investigate the issue of microplastics in the marine environment

The attention to microplastics and the consequences of its presence in the marine environment is increasing in scientific fields as well as on common media channels. In the absence of regulation in many countries, manufacturers are not required to exclude microplastic from their products, however consumers could force the production in a more sustainable direction with their choices. This study demonstrates the utility of the Theory of Planned Behaviour (TPB) in understanding the publics' intention to avoid buying products which contain microplastics. All three TPB antecedents of intentions are important. The study, based on a sample of respondents in NSW (Australia), also reveals respondents' habitual behaviour of avoiding buying products containing microplastics strongly predicts their intended future behaviour. Last, modelling reveals direct and indirect means through which intentions to avoid buying microplastics can be increased, via increased environmental concerns and public knowledge and health concerns about microplastics.

The survey dataset of The Influence of theory of planned behaviour on purchase behaviour on social media

The research aims to study the correlations between attitudes of users, social norms, perceived behavioural control, and purchase behaviours. The research population consists of social media users in Malaysia. The data was collected from 205 respondents via a self-administered online survey. The theory of planned behaviour acts as the underlying theory in the research. Next, descriptive and hypothesis-testing quantitative analysis were adopted to probe the relationships between the variables. Moreover, G*Power was used to identify the minimum sample size, and SPSS v.22 was employed to examine the datasets.

Validation and psychometric properties of the Italian Vaccination Attitudes Examination (VAX-I) scale

Despite the massive volume of scientific evidence on the benefits of immunisation, vaccine hesitancy is still a global health threat and represents an obstacle to controlling the spread of viruses such as SARS-CoV-2 and its associated COVID-19. Thus, the present study aimed to adapt and validate an Italian version of the Vaccination Attitudes Examination (VAX) scale. The Italian version of the scale (VAX-I), along with validation measures (general health perceptions, perceived sensitivity to medicines, intention to get the flu vaccine, and trust in health authorities) were administered to a sample of 534 Italian participants aged 18 to 87 (M = 32.41, SD = 15.35). The original version of the VAX scale was translated into Italian using a back-translation method. The parallel and confirmatory factor analyses showed that the scale's four-factor structure fits the data well, as in the original version. Reliability coefficients indicated that the VAX-I scale showed good internal consistency and measurement invariance results demonstrated that the VAX-I scale is stable across gender. Construct validity was supported by the significant negative correlation with general health perceptions, intentions to get the flu vaccine, and trust in health authorities, and the weak but significant and positive correlation with perceived sensitivity to medicines. Overall, the VAX-I scale appears to be a valid instrument to assess vaccine hesitancy in the Italian context.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03209-5.

Disappointing evaluation of a shared decision-making intervention for residents and orthopaedic surgeons

OBJECTIVE

To evaluate a shared decision-making (SDM) intervention in orthopaedic hip and knee osteoarthritis care.

METHODS

Using a pre- post intervention design study, we tested an intervention, that included a decision aid for patients (ptDA) and a SDM training course for residents in training and orthopaedic surgeons. The theory of planned behaviour was used for intervention development. Primary outcomes included patient reported decisional conflict, SDM, and satisfaction. Secondary outcomes were physicians' attitude and knowledge, and uptake of the ptDA.

RESULTS

317 patients were included. The intervention improved physicians' knowledge about SDM but had no effect on the primary outcomes. 19 eligible patients used the ptDA (17%). SDM was higher for middle educated patients compared to lower educated (mean difference 9.91, p=0.004), patients who saw surgeons instead of residents (mean difference 5.46, p=0.044) and when surgery was chosen and desired by patients compared to situations where surgery was desired but not chosen (mean difference 15.39, p=0.036).

CONCLUSION

Our multifaceted intervention did not improve SDM and ptDA uptake was low.

PRACTICE IMPLICATIONS

In orthopaedic hip and knee osteoarthritic care other ways should be explored to successful implement SDM. Since residents received lower SDM scores, special focus should go to this group.

Assessing predictors of self-management intentions in people with type 2 diabetes

Background

Type 2 diabetes mellitus (T2D) is slowly turning into an international health emergency, evidenced by accelerated growth in prevalence rates worldwide. Experts have now called for greater integration of self-management interventions in clinical practice in light of these worrisome trends, supplanting the prevailing notion of a “glucocentric” approach. In this pilot study designed to complement a novel assessment program currently in development, we describe a concise screening tool designed to stratify the intention to follow through on self-management practices in people with T2D.

Methods

A cross-sectional survey was conducted at 3 regional primary care clinics. Individuals with T2D having the following characteristics were recruited into the study: (i) individuals with T2D between 18 and 65 years, (ii) fluent in English and, and iii) having been diagnosed with T2D for at least 2 years. We assessed the relevance of components in the Theory of Planned Behaviour (TPB) within the context of self-management behaviour in T2D. Participants were requested to complete a questionnaire containing questions related to intention, attitudes subjective norm and perceived behavioural control. Based on their responses, the psychometric properties of the scale were then evaluated using both reliability and validity analysis.

Results

The Cronbach α value for all direct measures of TPB was excellent: intention to adhere to self-management practices (0.98), attitude towards self-management behaviour (0.87), subjective norm (0.83), and perceived behaviour control (0.66). The correlation between intentions and all 3 constructs of TPB was excellent (p < 0.01). Structural equation modeling helped determine attitudes and subjective norms as important predictors of intentions to follow through self-management practices.

Conclusions

By first understanding the dimensions that influence intentions associated with self-management behaviour, clinicians have the opportunity to “triage” individuals with T2D who require greater involvement to bring about better self-care practices. Thus, our research attempts to bridge this gap by devising a psychometric tool suited to a regional setting which allows for an improved person-centered communication between clinicians and patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07731-x.

The influences of emotional factors on householders' decarbonizing cooling behaviour in a subtropical Metropolitan City: An application of the extended theory of planned behaviour

Air-conditioning accounts for a vast amount of electricity consumption in Hong Kong, and household decarbonization of cooling is considered a vital means of reducing electricity use. However, little information is available on the determinants of household decarbonizing cooling behaviour, and emotional factors are often ignored in the pro-environmental behaviour literature. Thus, this study attempts to address this gap by applying an emotional extension of the theory of planned behaviour (TPB). A total of 295 valid responses were obtained using a questionnaire survey and tested via structural equation modeling (SEM). The incorporation of additional variables improves the explanatory power of the household decarbonizing cooling behaviour model, and the results reveal that subjective norms is the most influential factor, followed by affective connection to nature and negative anticipated emotions. Meanwhile, attitude towards the behaviour and perceived behavioural control are found to have a nonsignificant effect on behavioural intention. These findings not only highlight the importance of emotions in predicting electricity-saving behaviour, but also provide useful insights to formulate effective approaches for motivating citizens to engage in decarbonizing cooling behaviour at home.

The effect of perceived risks and perceived cost on using online learning by high school students

As Covid19 Pandemic hit all over the world, Indonesian high schools are struggled to cope with the sudden and forced switch to fully online learning. This study employed an online survey of Indonesian high school students to understand their behaviour in using online learning. The survey gathers data from 462 respondents who resided in 24 provinces. Theory of Planned Behaviour extended with Perceived Risks and Perceived Costs is used as the theoretical framework. Perceived Risks are used to accommodate concerning security-related news that might affect online activities. Perceived Costs is used to address complaints regarding additional financial burden due to fully online learning, namely cost to access and cost to acquire equipment. SmartPLS version3 is used as the main data analysis tools. The result showed that the Theory of Planned Behaviour is indeed able to explain the use of online learning by Indonesian high school students. Perceived Risks are considered as an influence but only have minimal impact. Perceived Costs does not have any influence on online learning. This might be because Indonesian is quick to act and counter the negative impact of the Covid19 Pandemic. One of the Indonesian Government’s efforts is to subsidise Internet costs for students and teachers.

Perceptions of primary health care physicians about the prescription of antibiotics in Saudi Arabia: Based on the model of Theory of planned behaviour

Introduction

Knowledge of different factors that influence physician decision-making in general practice for prescribing antibiotics is vital for successfully implementing antimicrobial stewardship interventions. The Theory of planned behaviour (TPB) is an established model that describes how cognitions drive human behaviour.

Objectives

The present study was performed to identify the socio-cultural and behavioural determinants that affect antibiotics prescription behaviour among primary care physicians and estimate the awareness about antibiotic resistance of public health importance.

Methodology

The questionnaire was divided into three sections: Section-I, which contained demographic content. Section-II contained 21 question items measuring attitudes, subjective norms, perceived behavioural control, and behavioural intentions of the prescribers. Section III had 12 questions related to knowledge about antibiotic resistance. As determined by Cronbach's α for each set of measured constructs of questionnaire scale, the internal consistency was good (α ≥ 0.7). The participants' socio-cultural and behavioural determinants were graded in 3 categories depending upon the mean score, while frequencies were used to estimate antibiotic resistance awareness. The data was analyzed by calculating the one-way ANOVA and by post-hoc Tukey-Kramer HSD multiple comparison test.

Results

Four hundred thirty-four primary health care physicians responded to the questionnaire, and data was statistically investigated. Participants' knowledge of antibiotic-resistant bacteria was poor with greater behavioural intentions to prescribe antibiotics, but a positive attitude and acceptable perceived social pressure towards antibiotics.

Conclusion

Our study showed that awareness towards antibiotic-resistant bacteria among primary care physicians of Saudi Arabia stands insufficient but favourable attitude and satisfactory social pressure towards antibiotics with greater behavioural intentions to prescribe antibiotics. The continued medical education (CME) and frequent training interventions can increase these parameters of rational prescribing practice for antibiotics.

An integrated dual process simulation model of alcohol use behaviours in individuals, with application to US population-level consumption, 1984-2012

INTRODUCTION

The Theory of Planned Behaviour (TPB) describes how attitudes, norms and perceived behavioural control guide health behaviour, including alcohol consumption. Dual Process Theories (DPT) suggest that alongside these reasoned pathways, behaviour is influenced by automatic processes that are determined by the frequency of engagement in the health behaviour in the past. We present a computational model integrating TPB and DPT to determine drinking decisions for simulated individuals. We explore whether this model can reproduce historical patterns in US population alcohol use and simulate a hypothetical scenario, "Dry January", to demonstrate the utility of the model for appraising the impact of policy interventions on population alcohol use.

METHOD

Constructs from the TPB pathway were computed using equations from an existing individual-level dynamic simulation model of alcohol use. The DPT pathway was initialised by simulating individuals' past drinking using data from a large US survey. Individuals in the model were from a US population microsimulation that accounts for births, deaths and migration (1984-2015). On each modelled day, for each individual, we calculated standard drinks consumed using the TPB or DPT pathway. In each year we computed total population alcohol use prevalence, frequency and quantity. The model was calibrated to alcohol use data from the Behavioral Risk Factor Surveillance System (1984-2004).

RESULTS

The model was a good fit to prevalence and frequency but a poorer fit to quantity of alcohol consumption, particularly in males. Simulating Dry January in each year led to a small to moderate reduction in annual population drinking.

CONCLUSION

This study provides further evidence, at the whole population level, that a combination of reasoned and implicit processes are important for alcohol use. Alcohol misuse interventions should target both processes. The integrated TPB-DPT simulation model is a useful tool for estimating changes in alcohol consumption following hypothetical population interventions.

Explicating factors that explain condom use intention among in-school adolescents in Botswana: a structural equation modelling approach

Knowledge with respect to adolescents' intentions to engage in protective sexual behaviours is still deficient in numerous countries around the world, particularly in Sub-Saharan Africa (SSA) where HIV prevalence is the highest. Increasing cross-sectional research suggests that the theory of planned behaviour (TPB) is robust in predicting condom use intentions. This study used secondary, baseline data from a study involving 794 in-school adolescents. A structural equation model was applied to the data. Latent variables were used to validate the applicability of the TPB in HIV/AIDS prevention among adolescents in the Botswana context. The predictors of interest were all derived from the TPB. The results revealed that the TPB predictors, apart from affective and instrumental attitude, were predictive of condom use intention among Batswana adolescents. The independent variables explained 57% of the variance in the model. These results suggest that the TPB is recommended as a framework to establish the predictors of condom use intention among Batswana in-school adolescents. Policy makers working on developing HIV education programmes or interventions targeted at adolescents should improve the intention to use condoms via promotion of positive instrumental attitudes, subjective norms and perceived behavioural control beliefs of condom use.

Patients' attitudes and intentions towards taking medical advice for type 2 diabetes mellitus: a theory of planned behaviour analysis

PURPOSE

A key component of effective diabetes care is understanding patients' perceptions about diabetes management. Patients' attitudes and intentions towards taking medical advice may predict the outcomes for effective diabetes care. This study aims to measure participants' attitudes, beliefs and intentions towards following medical advice to manage their diabetes using the Theory of Planned Behaviour (TPB). The domains of the TPB are correlated with clinical measures of diabetes to determine if these attitudes and intentions are predictive of better diabetes control.

METHODS

A pilot study was conducted. A 34-item survey was designed using the Theory of Planned Behaviour (TPB) framework and administered via mail by four general practice clinics. Included participants (N = 104; response rate 29.5%) had a diagnosis of type 2 diabetes and were taking medication for glycaemic control. Scores for each domain of the TPB survey were correlated with participants' clinical indicators for diabetes: HbA1c, blood pressure, lipid profile, cholesterol, and kidney health (eGFR and albumin: creatinine ratio) and BMI.

RESULTS

Participants surveyed generally reported positive attitudes and intention to follow medical advice. Medical advice was perceived to be beneficial and useful by the majority. However, in general, there was no correlation between positive intentions and improved clinical indicators of disease. Clinical indicators did not improve with duration of illness. The burden of illness is likely a mitigating factor for positive intention as participants perceive medical advice as difficult and inconvenient to follow.

CONCLUSIONS

Patients' individual capacity to implement medical advice should be addressed in shared-decision making models to potentially improve patient outcomes towards therapeutic targets.

Decision-making about corticosteroids in relapses of multiple sclerosis - development of a questionnaire based on the theory of planned behaviour

BACKGROUND

Relapses of multiple sclerosis are burdensome events and entail potentially lasting loss of function. People with multiple sclerosis have to consider corticosteroids, providing limited benefits and the risk of adverse effects.

OBJECTIVE

To develop and validate a questionnaire investigating the internal process of people with multiple sclerosis making decisions about corticosteroids.

METHODS

The questionnaire is structured by three domains, attitude, subjective social norm, and perceived behavioural control, which according to the theory of planned behaviour determine action planning. The development is inspired by a previous questionnaire studying decisions on immunotherapy. The questionnaire was tested in qualitative think-aloud interviews (n=10) for feasibility and comprehensibility and in an online survey (n=203) to assess construct and criterion validity.

RESULTS

The 18-item questionnaire was considered feasible and comprehensible. It predicted the intention to receive corticosteroids in up to 82.3% of cases. "Subjective social norm" impacted most on intention. The questionnaire also proved sensitive for autonomy preferences of people with multiple sclerosis.

CONCLUSION

This study shows that the questionnaire appropriately explains the internal process people with multiple sclerosis run through when considering corticosteroids. It can be used to inform developments of tailored support for people with multiple sclerosis in making informed decisions about relapse management.

Factors related to recycling plastic packaging in Finland's new waste management scheme

Plastic packaging exemplifies recycling's potential; 95 percent of plastic's material use vanishes after a short first-use cycle. Yet over half of plastic packaging could be recycled effectively, economically, and in an environmentally sound manner, with individuals and households playing a focal role in raising recycling rates. This paper draws on the theory of planned behaviour (TPB) to identify and examine household plastic sorting and recycling factors in Finland's new recycling scheme. The results of a regression analysis generally support existing research, except paradoxically, the easier it was to obtain recycling information the less people recycled. TPB's attitude (environmental concerns) and perceived behavioural control factors (low behavioural costs, and dealing with waste) showed significant positive relationships with Finnish recycling behaviour; the subjective norm (social norms) had an insignificant relationship. Age, living quarters, the time spent recycling, the distance to collection points, and the willingness to improve also related significantly to diligent plastic waste sorting. In addition to re-examining the information type and delivery, the significant role of costs and facilitating conditions offer intervention possibilities to support households to recycle more plastic packaging.

State and local pressures drive plastic pollution compliance strategies

Environmental harm from plastic pollution partly results from compliance failure at the individual level. Three prevalent non-compliant motivations for polluting plastics include economic gains, ignorance of the rules and unlikely penalization from inadequately enforced rules. Given compliance is primarily the responsibility of local waste management, we conducted interviews to gain insights to the factors driving changes in the crucial on-ground controls of plastic pollution. We expand on non-compliant motivations and provide a theoretical framework to test the aforementioned. We show that compliance strategies are strongly driven by state judicial and economic controls, specifically new plastic legislation and levies. Furthermore, the priorities of waste managers and the socio-economics and population density of their constituents drove changes in local management efforts. Our findings support the view that the growing global attention on plastic pollution shapes not only what happens at a state level, but also importantly on-ground at the local level.

Willingness among food consumers to recycle human urine as crop fertiliser: Evidence from a multinational survey

Source-separating sanitation systems offer the possibility of recycling nutrients present in wastewater as crop fertilisers. Thereby, they can reduce agriculture's impacts on global sources, sinks, and cycles for nitrogen and phosphorous, as well as their associated environmental costs. However, it has been broadly assumed that people would be reluctant to perform the new sanitation behaviours that are necessary for implementing such systems in practice. Yet, few studies have tried to systematically gather evidence in support of this assumption. To address this gap, we surveyed 3763 people at 20 universities in 16 countries using a standardised questionnaire. We identified and systematically assessed cross-cultural and country-level explanatory factors that were strongly associated with people's willingness to consume food grown using human urine as fertiliser. Overall, 68% of the respondents favoured recycling human urine, 59% stated a willingness to eat urine-fertilised food, and only 11% believed that urine posed health risks that could not be mitigated by treatment. Most people did not expect to pay less for urine-fertilised food, but only 15% were willing to pay a price premium. Consumer perceptions were found to differ greatly by country and the strongest predictive factors for acceptance overall were cognitive factors (perceptions of risks and benefits) and social norms. Increasing awareness and building trust among consumers about the effectiveness of new sanitation systems via cognitive and normative messaging can help increase acceptance. Based on our findings, we believe that in many countries, acceptance by food consumers will not be the major social barrier to closing the loop on human urine. That a potential market exists for urine-fertilised food, however, needs to be communicated to other stakeholders in the sanitation service chain.

Early detection of cervical cancer in western Kenya: determinants of healthcare providers performing a gynaecological examination for abnormal vaginal discharge or bleeding

Background

In western Kenya, women often present with late-stage cervical cancer despite prior contact with the health care system. The aim of this study was to predict primary health care providers’ behaviour in examining women who present with abnormal discharge or bleeding.

Methods

This was a cross-sectional survey using the theory of planned behaviour (TPB). A sample of primary health care practitioners in western Kenya completed a 59-item questionnaire. Structural equation modelling was used to identify the determinants of providers’ intention to perform a gynaecological examination. Bivariate analysis was conducted to investigate the relationship between the external variables and intention.

Results

Direct measures of subjective norms (DMSN), direct measures of perceived behavioural control (DMPBC), and indirect measures of attitude predicted the intention to examine patients. Negative attitudes toward examining women had a suppressor effect on the prediction of health workers’ intentions. However, the predictors of intention with the highest coefficients were the external variables being a nurse (β = 0.32) as opposed to a clinical officer and workload of attending less than 50 patients per day (β = 0.56).

In bivariate analysis with intention to perform a gynaecological examination, there was no evidence that working experience, being female, having a lower workload, or being a private practitioner were associated with a higher intention to conduct vaginal examinations. Clinical officers and nurses were equally likely to examine women.

Conclusions

The TPB is a suitable theoretical basis to predict the intention to perform a gynaecological examination. Overall, the model predicted 47% of the variation in health care providers’ intention to examine women who present with recurrent vaginal bleeding or discharge. Direct subjective norms (health provider’s conformity with what their colleagues do or expect them to do), PBC (providers need to feel competent and confident in performing examinations in women), and negative attitudes toward conducting vaginal examination accounted for the most variance. External variables in this study also contributed to the overall variance. As the model in this study could not explain 53% of the variance, investigating other external variables that influence the intention to examine women should be undertaken.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01395-y.

Understanding intentions to override intelligent speed assistance prior to widespread availability: An application of the theory of planned behaviour

Intelligent Speed Assistance (ISA) offers a technological solution to reduce speeding that will become more common in vehicles in the short to medium term. Many implementations allow drivers to override the system's speed control and minimising such interventions can optimise safety benefits. This paper aims to inform behaviour change interventions to reduce ISA overriding targeted to drivers as they obtain vehicles fitted with ISA. We explore the beliefs underlying intentions to override ISA to exceed the speed limit in drivers with limited ISA experience using the Theory of Planned Behaviour. In a sample of 121 drivers (mean age 36 years), regression modelling showed that attitudes strongly predicted intentions with an additional contribution from subjective norms but not perceived behavioural control. Behavioural beliefs underlying attitudes addressed overriding ISA for (1) responsibly controlling the car to minimise crash risk and (2) reducing journey times and enjoying fast driving. Salient normative beliefs focussed on groups that would disapprove of overriding ISA including emergency services and parents. We discuss how these beliefs might be addressed in interventions to maximise the safe adoption of ISA.

Promoting the propensity for blood donation through the understanding of its determinants

BACKGROUND

The paper aims to understand the main antecedents related to the blood donation propensity related to both donors and non-donors. With our research, we will analyse the two perspectives to identify similarities and differences concentrating on the Italian context. Blood is a vital resource that strongly affects every national healthcare system's efficacy and sustainability and the system's ability to achieve the goal of universal coverage.

METHODS

The purpose of this paper is to understand the main antecedents of citizens' blood donation intention and the propensity to encourage communication about blood donation among both donors and non-donors. The Theory of Planned Behaviour is adopted as a theoretical lens. An empirical investigation was performed in Italy, adopting a mixed methods research design. First, a qualitative analysis was carried out through 30 in-depth interviews. Then, a survey was used to quantitatively investigate the intention to donate among both donors (N = 173) and non-donors (N = 87). A conceptual model was developed and tested through Structural Equation Modelling, developing a multi-group approach.

RESULTS

The present study confirms the relations proposed by the Theory of Planned Behaviour, even though some differences between the two groups are shown. The construct Information and Communication is crucial for donors, non-donors, whereas for non-donor inhibitors is vital. Service quality has an impact on the propensity to recommend and communicate the value of blood donation.

CONCLUSION

This paper reveals the main differences between donor and non-donor perspectives. Fruitful insights for enhancing blood donation awareness are provided.

Changing professional behaviours: mixed methods study utilising psychological theories to evaluate an educational programme for UK medical doctors

BACKGROUND

The Theory of Planned Behaviour (TPB) has been proposed as a useful framework to investigate professional behaviour, however, was not yet applied to the evaluation of an educational intervention. This study will address this gap by utilising the TPB to evaluate the effectiveness of an education programme delivered by the professional regulator for UK doctors in enhancing three professional behaviours: raising concerns, engaging in reflective practice, and use of regulator confidentiality guidance.

METHODS

This is a comprehensive mixed methods study combining qualitative (interviews) and quantitative (quasi-experiment) data. Intervention participants were asked to complete a survey measuring the variables in the TPB (attitudes, subjective norms, perceived behavioural control, and intention) for the three professional behaviours before, immediately post, and 3-months later following the education programme. Ninety-four doctors completed the survey pre/post intervention and 38 at all three times. One hundred and eleven doctors from the same hospital trust who did not take part in the intervention completed the survey at two time points and formed the control group. Forty-two interviews were conducted with intervention participants.

RESULTS

The quantitative study revealed that the educational intervention significantly improved attitudes (raising concerns, using confidentiality guidance), subjective norms (raising concerns, reflective practice, using confidentiality guidance), perceived control (raising concerns, using confidentiality guidance), and intentions (using confidentiality guidance) (Group and Time interaction; Fs ≥ 3.996, ps ≤ .047, ηp² ≥ .020). Non-UK graduate doctors' subjective norms towards raising concerns and confidentiality guidance increased significantly after the intervention (Fs ≤ 6.602, ps ≥ .011, ηp² = .032 F = 6.602, p = .011, ηp² = .032), but not UK graduates (p > .05). Interviews revealed that doctors had positive views about professional behaviours but also mentioned numerous barriers to actually engage in more complex, context dependent behaviours.

CONCLUSIONS

This study demonstrates that an educational intervention was successful in improving the TPB variables of three professional behaviours. It also revealed that teaching professionalism does not happen in isolation and, therefore, personal and contextual factors are crucial to consider. To change complex professional behaviours, barriers at all levels i.e., personal, organisational and system, should be addressed.

Unravelling Belgian Blue cattle farmers' adoption intention towards diagnostic tools: Integrating insights from behavioural economics and socio-cognitive theories

Macrocyclic lactone resistance in Psoroptes ovis mites, causing psoroptic mange, is emerging in beef cattle. Therefore, diagnostic tools that can indicate macrocyclic lactone resistance should be implemented at farms in order to control these parasitic infections and slow down emerging resistance. Unfortunately, the adoption of such tools remains relatively poor. This study explores which beliefs, and behavioural biases that misconstrue these beliefs, underlie farmers' adoption intention. Five semi-structured focus groups were conducted with Belgian Blue cattle farmers (n = 38). Inductive analysis revealed that farmers' positive attitudes towards acaricides use and risk perception towards acaricide resistance made them rather reluctant to implement diagnostic tools. In addition, farmers' susceptibility to acaricide resistance occurring on their farm was weakened by the optimism and availability bias. Deductive analysis revealed that economic reasons, usefulness of the diagnostic tool and contribution to animal wellbeing motivated farmers to adopt such tools (i.e., behavioural beliefs). However, the loss aversion and time discounting bias weakened farmers' beliefs related to economic reasons. The veterinarian was seen as the responsible actor for implementing diagnostic tools, while colleague-farmers' opinion related to the diagnostic tool was also valued (i.e., normative beliefs). The latter belief was strengthened by the bandwagon-effect bias. Farmers' beliefs about economic costs related to the diagnostic tool tended to hinder adoption intention, while the veterinarian's assistance motivated farmers to implement such tools (i.e., control beliefs). The loss aversion bias also strengthened farmers' control beliefs related to the diagnostic tools' perceived costs. As such, this article provides more insights into the (ir)rational factors shaping farmers' intention to adopt diagnostic tools. These insights might help animal health organisations to design communication strategies to stimulate the adoption of diagnostic tools on beef cattle farms.