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Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence
Caitlin C Murphy1, Sally W Vernon, Pamela M Diamond
1Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX, USA.
Background:
Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories.
Purpose:
We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior.
Methods:
We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n = 704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ (2) difference testing.
Results:
Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers.
Conclusions:
Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography.
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