Totato, totahto, and health behavior theories

It's the end of September, and we've just finished a lecture on the Theory of Reasoned Action and the Theory of Planned Behavior. It's time to pause and reflect on what we've covered to date.

Unless you're coming in with some training in psychology, you're probably thinking what I thought when I took this class long ago: are we just giving different names to the same things? What is the difference between perceived behavioral control and self-efficacy? Is an attitude really different from a belief? It's something I still struggle with from time to time.

Let's start with perceived behavioral control and self-efficacy. For the purposes of developing an intervention, assume they're the same (in fact, Fishbein or Azjen or maybe both asserted at a conference at some point that they were the same). From my perspective, though, self-efficacy is a part of perceived behavioral control. Self-efficacy is one's confidence in his/her ability to perform a specific behavior in a specific situation. Perceived behavioral control includes that in its definition, but also includes aspects like access and confidentiality (think enabling factors). Consider an outcome like intention to get the flu vaccine. You might have all the confidence in the world about your ability to handle the pain and ague associated with the shot. If you work and the shot’s only available during working hours, though, you might not have any intention to get it because you perceive that getting the vaccine is not under your control.

The differences between attitudes and perceived benefits/barriers is a little (but not much) cleaner. Attitudes are generally object-evaluation associations (or more relevantly, behavior-evaluation associations) that boil down to "good" or "bad." You say "swimming" and I think "yuck." You say "eating french fries" and I think "yum!" Perceived beliefs and barriers, on the other hand, have more of a this-is-what-the-behavior-achieves feel. Swimming makes me feel nauseous (perceived barrier), or eating french fries improves my mood (perceived benefit). What's the difference? An evaluation of the outcome. If I was bizarre, I might like to feel nauseous or might not want my mood improved.

An explanation that probably works better for class is to think of these theories as languages. When you're talking Health Belief Model, you say "perceived threat, perceived benefits, perceived barriers, and self-efficacy." When you're talking Theory of Planned Behavior, you say "attitudes about behavior, subjective norms, perceived behavioral control, and behavioral intention." You also operationalize your variables differently (extremely important nuances from an evaluation perspective), but I'll let y'all internalize those differences from your notes.

Hope that helps!