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A/H1N1 Vaccine Intentions in College Students: An Application of the Theory of Planned Behavior


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Objective: To test the applicability of the Theory of Planned Behavior (TPB) in college students who have not previously received the A/H1N1 vaccine. Participants: Undergraduate communication students at a metropolitan southern university. Methods: In January-March 2010, students from voluntarily participating communication classes completed a hardcopy survey assessing TPB and clinically significant constructs. Hierarchical regression equations predicted variance in vaccine intentions of students who had not received a flu shot (N=198; 70% Caucasian). Results: The TPB model explained 51.7% (p<.001) of variance in vaccine intentions. Controlling for side effects, self-efficacy and perceived comparative susceptibility predicted intentions when entered in the first block, whereas attitudes, subjective norms, and perceived behavioral control significantly contribute when entered in the second block. Conclusions: For students who have not previously received a flu vaccine, vaccine communication should utilize self-efficacy and perceived comparative susceptibility to employ the TPB to promote vaccine intentions.
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Journal of American College Health
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A/H1N1 Vaccine Intentions in College Students: An
Application of the Theory of Planned Behavior
Vinita Agarwal PhDa
a Department of Communication Arts, Salisbury University, Salisbury, Maryland
Accepted author version posted online: 29 Apr 2014.Published online: 15 Aug 2014.
To cite this article: Vinita Agarwal PhD (2014) A/H1N1 Vaccine Intentions in College Students: An Application of the Theory of
Planned Behavior, Journal of American College Health, 62:6, 416-424, DOI: 10.1080/07448481.2014.917650
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Major Article
A/H1N1 Vaccine Intentions in College Students:
An Application of the Theory of Planned Behavior
Vinita Agarwal, PhD
Abstract. Objective: To test the applicability of the Theory of
Planned Behavior (TPB) in college students who have not previ-
ously received the A/H1N1 vaccine. Participants: Undergraduate
communication students at a metropolitan southern university.
Methods: In January–March 2010, students from voluntarily par-
ticipating communication classes completed a hardcopy survey
assessing TPB and clinically significant constructs. Hierarchical
regression equations predicted variance in vaccine intentions of
students who had not received a flu shot (ND198; 70%
Caucasian). Results: The TPB model explained 51.7% (p<.001)
of variance in vaccine intentions. Controlling for side effects, self-
efficacy and perceived comparative susceptibility predicted inten-
tions when entered in the first block, whereas attitudes, subjective
norms, and perceived behavioral control significantly contribute
when entered in the second block. Conclusions: For students who
have not previously received a flu vaccine, vaccine communica-
tion should utilize self-efficacy and perceived comparative suscep-
tibility to employ the TPB to promote vaccine intentions.
Keywords: A/H1N1 vaccine intentions, college students,
pandemic influenza A (H1N1) 2009 virus, perceived comparative
susceptibility, Theory of Planned Behavior
Although the novel pandemic influenza A (H1N1)
2009 virus disproportionately impacted college
students in the 2009–2010 flu season, surveillance
data suggest that only 8% of college students accepted the
A/H1N1 vaccine.
Epidemiological studies indicate that
young adults up to 24 years of age in college settings are at
a higher risk of contracting influenza.
It is one of the objec-
tives of the Healthy Campus 2020 initiative of the Ameri-
can College Health Association to reduce the proportion of
college students who report adverse performance from
cold/flu/sore throat (from 18% in 2010 to 16.2% in 2020;
AI-1.4, Question 45A7) and increase the proportion of
college students who receive the influenza vaccine each
year (from 39.9% in 2010 to 43.9% in 2020; Question 40C,
Item IID-12).
The pandemic influenza A (H1N1) 2009 virus, also
known as the A(H1N1)pdm09 virus (A/H1N1), was identi-
fied in April 2009 as a genetically and antigenically distinct
form of the influenza A virus subtype previously found in
The A/H1N1 virus was declared a global pandemic
in June 2009. In the United States, the Centers for Disease
Control and Prevention’s (CDC’s) 2009 H1N1 influenza
vaccination campaign (A/H1N1 vaccine) was the primary
public health initiative to address the health threat, with a
goal to increase vaccination uptake among those identified
by epidemiological and virologic data to be at higher risk
of contracting infection.
The US Public Health Emergency
for 2009 H1N1 Influenza expired on June 23, 2010, when
the A/H1N1 influenza virus was classified as postpandemic.
However, the virus is expected to continue to behave as a
seasonal influenza A virus in the postpandemic stage, thus
underscoring the need to continue to update pandemic
surveillance and preparedness.
Young adults are susceptible to health-compromising
behaviors, in part due to a heightened sense of invulnerabil-
ity that leads them to ignore risks.
Evidence of the opti-
mistic bias in college students has been well documented.
For example, recent findings examining the A/H1N1 out-
break in Fall 2009 demonstrate that a sense of self-efficacy
contributes to vaccine intentions in students, and the rela-
tionship was moderated by comparative optimism after con-
trolling for perceived risk.
Further, studies from different
national contexts suggest that although young adults may
make changes in hygienic behavior in response to flu preven-
tion messages,
barriers to vaccine acceptance in this popu-
lation persist. These include factors such as a lack of
perception of vaccination as an efficacious antiepidemic
or a lack of perception of the A/H1N1 virus as a
credible threat.
In the United States, despite the
Dr Agarwal is with the Department of Communication Arts at
Salisbury University in Salisbury, Maryland.
Copyright Ó2014 Taylor & Francis Group, LLC
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institutional availability of preventive vaccines such as the
trivalent inactivated influenza vaccine (TIV), often free of
charge for the seasonal flu, low levels of vaccine accep-
tance have been noted among students.
faced by CDC’s vaccination programs include effective
promotion of vaccination services to target audiences and
getting providers and immunization programs to work
The 2009–2010 flu season A/H1N1 monovalent inacti-
vated vaccine and the live attenuated vaccine for the
A/H1N1 influenza virus were distinct from the seasonal tri-
valent inactivated (TIV) and live attenuated (LAIV) influ-
enza vaccines.
The 2013–2014 seasonal TIV includes the
H1N1 strain and is made to protect against 3 flu viruses—
the influenza A(H1N1) virus, an influenza A (H3N2) virus,
and an influenza B virus, alongside an additional quadriva-
lent vaccine that protects against 2 influenza A viruses and
2 influenza B viruses.
However, in order to be effective,
vaccine communication needs to be tailored to audiences’
immunization knowledge and beliefs. In addition to weigh-
ing vaccine characteristics, individuals also consider vac-
cine perceptions and their likelihood of infection when
weighing the acceptability of voluntary preventive vac-
For example, A/H1N1 vaccine–specific miscon-
ceptions such as fear of the live virus in the LAIV was
confused with the A/H1N1 vaccine, which has the inacti-
vated (killed) virus, which had a negative influence on vac-
cination acceptance.
Other factors such as the influence
of social networks supportive of vaccination
and past
influenza vaccine behaviors (eg, having had a flu shot in the
past 5 years) have also been found to influence vaccine
and intentions.
As a value-expectancy model incorporating attitudes,
subjective norms, and perceived behavioral control to
understand intentions and behavior, the Theory of Planned
Behavior (TPB) can provide a useful framework to examine
vaccination intentions.
The TPB has been used as a the-
oretical framework to examine A/H1N1 vaccination among
different populations and contexts in a few studies glob-
For example, support was found for the TPB
model in predicting vaccination intentions among priority
group adults in the United Kingdom, highlighting the need
to target interventions to well-defined groups.
recently, support has also been found for augmented TPB
models incorporating perceived susceptibility,
and self-efficacy
in a range of contexts and
populations, thus highlighting the need to further examine
these variables in the TPB.
As the TPB has found support in a range of content
domains and populations,
by extending it to the
domain of student voluntary vaccination acceptance,
research can provide public health professionals with useful
insights for reaching specific audiences. This study extends
the applicability of the TPB to understand A/H1N1 vacci-
nation intentions in college students who have not accepted
the vaccine along with the contribution of self-efficacy and
perceived comparative susceptibility.
Theory of Planned Behavior
The TPB builds on the assumption that individuals can
rationally evaluate their options and beliefs associated with
a behavior before formulating their intention to perform the
Further, the TPB posits that behavioral inten-
tion, or the assessment of whether or not a person plans to
perform a particular behavior, is the most important and
immediate antecedent of the actual performance of that
behavior (ie, stronger intentions predict a greater likelihood
of performing the behavior). According to the TPB, an indi-
vidual’s attitude toward the behavior, subjective norms of
behaviors, and perceived behavioral control toward the
behavior are the 3 determinants predicting behavioral
Attitude toward the behavior is an individual’s positive
or negative belief about performing a specific behavior and
is determined by the individual’s beliefs about the conse-
quences of performing the behavior (behavioral beliefs)
alongside an evaluation of those consequences (outcome
In general, an individual is more likely to
perform a behavior if he or she has a positive attitude
toward the behavior (eg, student nurses’ intention to get the
influenza vaccine is predicted by their attitude toward the
Subjective norms are a function of beliefs that significant
others (eg, close friends or family) approve or disapprove
of the behavior and are determined by one’s normative
beliefs (ie, the beliefs that underlie subjective norms) and
motivation to comply with those beliefs. According to the
TPB, an individual is more likely to perform a specific
behavior, such as obtain a vaccine, when the individual per-
ceives that important others hold positive beliefs about the
vaccine, recommend getting vaccinated, or receive the
Perceived behavioral control comprises an individual’s
beliefs about the presence of factors that may impede or
facilitate their ability to perform the behavior.
The con-
ceptual domain of perceived behavioral control includes
the components of self-efficacy (ease or difficulty of per-
forming a behavior) and controllability (the extent to which
the performance of the behavior is within the individual’s
volitional control).
In order to understand the distinct con-
tributions of self-efficacy and controllability, these can be
considered independently in the TPB model.
As self-effi-
cacy has been noted as a salient factor in college students,
the present research seeks to determine its specific contribu-
tion as well as the specific contribution of controllability
(perceived behavioral control) in the TPB model.
The goal of the present study is to examine the applica-
bility of the TPB, taking into account the contribution of
perceived comparative susceptibility in the A/H1N1 vac-
cine intentions of college students who have not received
the vaccine. The following hypotheses are tested:
H1a: Self-efficacy will negatively predict vaccination inten-
tions, controlling for perception of vaccine side effects
and perceived comparative susceptibility such that
A/H1N1 Vaccine Intentions in College Students
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greater self-efficacy will predict lower vaccination
H1b: Perceived comparative susceptibility will positively
predict vaccination intentions, controlling for perception
of vaccine side effects and self-efficacy such that greater
perceived comparative susceptibility will predict higher
vaccination intentions.
H2a: Controlling for subjective norms and perceived behav-
ioral control, attitudes will positively predict vaccination
intentions after accounting for vaccine side effects, self-
efficacy, and perceived comparative susceptibility.
H2b: Controlling for attitudes and perceived behavioral
control, subjective norms will positively predict vaccina-
tion intentions after accounting for vaccine side effects,
self-efficacy, and perceived comparative susceptibility.
H2c: Controlling for attitudes and subjective norms, per-
ceived behavioral control will negatively predict vaccina-
tion intentions after accounting for vaccine side effects,
self-efficacy, and perceived comparative susceptibility.
Setting, Population, and Recruitment
The student sample was derived from self-selected
undergraduate communication classes of a midsize south-
ern, metropolitan research university. The total university
undergraduate student body in Fall 2009–2010 academic
year (AY) was 22,031.
Undergraduate student enrollment
demographics in 2009–2010 AY reflect a predominantly
Caucasian student population with a roughly equal distribu-
tion of males and females (males: ND10,608; females:
ND11,423; 76.1% Caucasian, 11.1% African American;
total undergraduate enrollment: ND15,619), with under-
graduate class ranking reflecting a slightly lower enrollment
in the sophomore and junior years (freshman: nD4,026;
sophomore: nD2,972; junior: nD3,075; and senior: nD
4,130). A majority of the first-time freshmen (59.2%)
reported living on campus and the university reported an
overall 95% student housing occupancy rate. The university
comprises 12 schools conferring degrees in law, business,
arts and sciences, dentistry, social work, medicine, music,
engineering, and public health, among others.
Hardcopy survey administration was completed among
participating undergraduate communication classes in the
communication department between January 2010 and
March 2010. An e-mail was sent to faculty members of the
communication department soliciting study participation of
students in return for extra credit in class. As communication
students study media messages and effects, the study partici-
pants can be considered to be more aware of media messages
and goals than other majors. Participating classes ranged
from senior-level public relations (advanced public relations)
to introductory (introduction to mass communication) clas-
ses, and research methods and special topics (health commu-
nication) courses. Thus, participants ranged from freshmen,
sophomores, juniors, and seniors (Table 1). Students who
were not interested in participating in the survey were pro-
vided an alternative extra credit opportunity. The university
Institutional Review Board approved the study.
Participant recruitment was conducted by the researcher
providing an in-person introduction to the study in the par-
ticipating classes before hardcopy survey administration.
Because of the high media coverage and awareness of the
A/H1N1 virus during the data-gathering period, the intro-
duction explained that communication students were partic-
ipating in the study to understand the role of individual
factors in student intention to obtain the A/H1N1 vaccine.
Additional surveys were also given to instructors to hand
out to students who were absent or otherwise unable to
obtain the survey. Students who were interested in partici-
pating in the study were given the option to return the com-
pleted surveys at the end of 2 weeks during a class
announcement and sign their name on a sign-up sheet in
return for extra credit in the class. Participants could also
drop the survey in a box outside the researcher’s office with
a sign-up sheet for receiving class credit. In that case, the
researcher e-mailed the completed list to the class instruc-
tor. Because a mass e-mail for participant recruitment was
not sent out to the entire student population, a response rate
cannot be determined. However, the sample participant
demographics show these are reflective of the undergradu-
ate population at the university.
The TPB constructs of attitudes, subjective norms, per-
ceived behavioral control, and behavioral intention toward
the A/H1N1 vaccine were adapted from Ajzen’s TPB ques-
The construct of perceived comparative suscep-
tibility was adapted from McQueen et al,
and vaccine
side effects and self-efficacy were adapted from Chapman
and Coups.
Unless otherwise mentioned, all variables
were averaged on a 1–5 Likert scale (1 Dthe lowest value
of the construct and 5 Dthe highest). Items that were
phrased in the semantically opposite direction (ie, 5 Dlow-
est value of construct and 1 Dhighest value of construct)
were reverse-coded such that the higher value of the con-
struct measured the higher numerical choice on the item
response set. Once all items for a scale were in the same
direction, the items were averaged to create the scale.
Demographic Characteristics
Participants were asked to report their age, sex, ethnicity,
class ranking, and whether they knew the university was
offering a free A/H1N1 vaccine (Table 1).
Psychological Measures
Participants reported their attitudes, subjective norms,
perceived behavioral control, perceived comparative sus-
ceptibility, self-efficacy, and behavioral intention on 5-point
interval-level Likert scales.
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TABLE 1. Selected Characteristics of Study Participants
Total sample Have never received flu shot Have received flu shot
Characteristic N%n%n%
Age (years) ND489 nD196 nD291
18–25 460 92.0 186 93.9 272 93.2
26–30 17 3.4 6 3.0 11 3.8
31–40 7 1.4 2 1.0 5 1.7
41–60 4 0.8 1 0.5 3 1.0
61 and older 1 0.2 1 0.5 0 0.0
Ethnicity ND476 nD192 nD282
Caucasian 376 75.2 138 69.7 237 81.2
African American 71 14.2 41 20.7 29 9.9
Asian 19 3.8 10 5.1 9 3.1
Pacific Asian 2 0.4 0 0.0 2 0.7
Other 8 1.6 3 1.5 5 1.7
Sex ND489 nD196 nD291
Male 206 41.2 80 40.4 125 42.8
Female 281 56.2 115 58.1 165 56.5
Other 2 0.4 1 0.5 1 0.3
Year in school ND486 nD196 nD288
Freshman 106 21.2 38 19.2 68 23.3
Sophomore 124 24.8 59 29.8 65 22.3
Junior 148 29.6 64 32.3 83 28.8
Senior 106 21.2 34 17.2 71 24.3
Other 2 0.4 1 0.5 1 0.3
Know university was offering free flu shot this spring ND486 nD195 nD290
Yes 352 70.4 128 64.6 223 76.4
No 133 26.6 66 33.3 67 22.9
Other 1 0.2 1 0.5 0 0.0
A/H1N1 Vaccine Intentions in College Students
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Frequencies and other descriptive statistics were used to
describe the sample. Factor analysis utilizing principal
components analysis (PCA) framework with Varimax rota-
tion was employed to assess the proportion of variance
explained by the factor in the data. Cronbach’s alpha coeffi-
cient was examined to assess internal consistency of items
toward measuring the construct. Participants who marked
“No” to the binary question: “Have you ever received a flu
shot” (Yes D1; No D2) were selected into the data file
used for the present study. Hierarchical multiple regression
equations were set up to test the TPB model. The statistical
software IBM SPSS Statistics 21 (IBM, Armonk, New
York) was used for data analysis.
Sample Description
Table 1 reports the study participant characteristics of all
participants and the study sample of students who did not
receive a flu shot. From the parent data file, those who
marked “No” to the condition “Have you ever received a
flu shot?” (nD198; 39.6%) were selected to a new data set
that was employed for the present analyses (94% between
18 and 25 years old; 70% Caucasian, 21% African Ameri-
can; 58% female). The study sample characteristics are
reflective of the population of undergraduate enrollment at
the university.
Univariate Analyses
Attitude was defined as “a person’s overall evaluation of
performing the behavior in question,”
and included the
items “Getting the H1N1 vaccine from my university will
be beneficial for me” (λD.93), “Getting the H1N1 vaccine
from my university will be painful” (reverse coded),
“Getting the H1N1 vaccine from my university will be
good for me” (λD.92), “Getting the H1N1 vaccine from
my university is not important for me” (λD.64) (reverse
coded), and “Getting the H1N1 vaccine from my university
will be useful for me” (λD.89). All items loaded satisfacto-
rily, with the factor loading of 1 item being acceptable
(“H1N1 vaccine is important to me” [λD.64]). One item
(“Getting H1N1 vaccine from my university will be
painful” (λ.025) did not load satisfactorily and was
dropped from the analysis. Factor analysis (PCA with Vari-
max rotation) obtained a single factor solution (eigenvalue
D2.902, 72.5% variance; 4 items, MD2.61, SD D.90, N
D198). Reliability was good (aD.87).
Subjective Norms
Subjective norms was defined as a measure of family and
friends approval of the behavior
and comprised the
average of items including “My immediate family members
think I should get the H1N1 flu vaccine at my university
this spring (2010)” (λD.69), “I want to do what my imme-
diate family members think I should do about getting the
H1N1 flu vaccine this spring (2010)” (λD.30), “My imme-
diate family members would approve of me getting the
H1N1 flu vaccine at my university this spring (2010)” (λD
.67), and “Most of my family members received an H1N1
vaccine last fall (Fall 2009)” (λD.60), and similarly for
friends (“Friends think I should” [λD.67]; “Friends
approve of me getting a vaccine” [λD.58]; and “Friends
received a vaccine” [λD.67]). Factor analysis (PCA with
varimax rotation) indicated that most items loaded accept-
ably on factor 1 (λ>.55). Two items (“I want to do what
my immediate family members think...”[λD.30]; and “I
want to do what my friends think...”[λD.46]) did not
load satisfactorily and were dropped from the study. Factor
analysis (PCA with varimax rotation) obtained a 2-factor
solution (eigenvalue of first factor D2.514, 41.9% vari-
ance; 6 items, MD2.73, SD D.63, ND198). Reliability
was acceptable (aD.72).
Perceived Behavioral Control
Perceived behavioral control was defined as an individu-
al’s perception of their ability to perform a specific behav-
The scale was assessed as an average of 2 items
including “It is totally up to me whether I would like to
obtain an H1N1 flu vaccine at my university” and “It is
mostly up to me to decide whether or not I get an H1N1 flu
vaccine at my university” (rD.28, p<.001; 2 items, MD
4.08, SD D.61, nD198).
Perceived Comparative Susceptibility
Defined as “the likelihood of experiencing personal harm
if no action is taken,”
the 3 items assessing susceptibil-
ity loaded excellently and included “Compared to the aver-
age man/woman your age, how likely are you to get the
H1N1 flu?” (λD.86), “Compared to all students similar to
you who did get a flu shot, how likely do you think you are
to get the H1N1 flu?” (λD.88), and “Compared to all stu-
dents similar to you who did not get a flu shot, how likely
do you think you are to get the H1N1 flu?” (λD.86). Factor
analysis (PCA with Varimax rotation) obtained a 1-factor
solution (eigenvalue of first factor D2.241, 74.7% vari-
ance; 3 items, MD2.44, SD D.84, ND198). Reliability
was acceptable (aD.83).
Side Effects
Side effects were measured as “How likely do you think
it is that the flu vaccine would cause a person to have a
severe reaction?” (1 item, MD1.83, SD D.38, ND198).
Understood as the ease or difficulty in performing a
behavior in a specific domain,
self-efficacy was measured
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as the average of 2 items: “If I take precautions, I will lower
my risk of contracting the H1N1 infection enough that I
probably don’t need to get the H1N1 vaccine anyway,” and
“If I take all the necessary precautions, I don’t need to get
the H1N1 vaccine”; rD.57, p<.001; MD3.49, SD D.90,
Behavioral Intention
Defined as whether or not a person plans to perform a
particular behavior,
items assessing this measure included
the average of “I intend to get an H1N1 vaccine at my uni-
versity this season” (λD.94), “I will try to get an H1N1
vaccine at my university this season” (λD.86), and “I plan
to get an H1N1 vaccine at my university this season” (λD
.95; 3 items, MD1.89, SD D.88, ND198). Factor analysis
(PCA with Varimax rotation) obtained a single-factor solu-
tion (eigenvalue D2.506, 83.5% variance; 3 items, MD
1.89, SD D.88, ND198). Reliability was good (aD.90).
Multivariate Analysis
To test the hypotheses, a hierarchical regression model
was constructed. Vaccine side effects, self-efficacy, and
perceived comparative susceptibility were entered as inde-
pendent variables in the first block. Attitude, subjective
norms, and perceived behavioral control were entered
together as independent variables in the second block.
Behavioral intention was entered as the dependent variable
(Table 2).
The overall model explained a substantial and significant
51.7% (p<.001) amount of variance in intentions
(Table 2). The first model with side effects, self-efficacy,
and perceived comparative susceptibility explained 13.8%
(p<.001) of variance in vaccine intentions. After account-
ing for side effects, self-efficacy, and perceived compara-
tive susceptibility, the TPB model comprising attitudes,
subjective norms, and perceived behavioral control
explained an additional 37.9% (p<.001) of variance in
vaccine intentions.
In the first block, self-efficacy made a significant contri-
bution (b.255, p<.001) (Table 2) to intentions after
controlling for vaccine side effects and perceived compara-
tive susceptibility. Thus, higher self-efficacy predicted
lower vaccination intentions and H1a was supported. Per-
ceived comparative susceptibility made a significant contri-
bution to intentions after controlling for vaccine side
effects and self-efficacy (bD.238, pD.001) (Table 2).
Thus, H1b was supported.
In the second block, the regression coefficients demon-
strate that all TPB predictors, attitudes (bD.476, p<
.001), subjective norms (bD.335, p<.001), and perceived
behavior control (b.306, p<.001), were significant
contributors to behavioral intention. Attitudes and per-
ceived behavioral control (in the negative direction) are
fairly close in strength, whereas subjective norms are close
in its contribution to A/H1N1 vaccination intentions. Thus,
H2a, H2b, and H2c are supported (Table 2).
The study is the first to demonstrate the substantial con-
tribution of the TPB constructs in vaccine intentions for
college students who have not previously received a flu
vaccine after accounting for the contribution of self-effi-
cacy and perceived comparative susceptibility. Further-
more, the findings demonstrate that controlling for vaccine
side effects, self-efficacy and perceived comparative sus-
ceptibility are important factors influencing student vacci-
nation decisions for this segment of students. Because prior
behaviors are a significant predictor of future intentions and
behaviors, the study makes a unique contribution by identi-
fying salient factors contributing to vaccination intentions
for this specific segment of students.
The support for the overall TPB model after accounting for
the contribution of self-efficacy and perceived comparative
susceptibility suggests important insights for vaccine com-
munication. Because preventive health behaviors for emer-
gent risks are often received with doubts such as those
regarding adequate vaccine testing and safety, highlighting
positive beliefs of the A/H1N1 vaccine as beneficial, useful,
helpful, and good can promote vaccination intentions. Sec-
ond, the study extends prior research finding positive influ-
ence of social networks on health behaviors by demonstrating
the contribution of subjective norms of friends and family (ie,
TABLE 2. Hierarchical Regression Model Testing the TPB in A/H1N1 Vaccine Intentions
Independent variable b(SE)SE btp DR
,F(x, y), p
Block 1
a. Side effects ¡.204 .165 ¡.086 ¡1.236 .218 DR
b. Self-efficacy ¡.255 .068 ¡.260 ¡3.742 <.001 F(x, y)D9.805 (3, 184), p<.001
c. Perceived comparative susceptibility .238 .074 .223 3.229 .001
Block 2
a. Attitude .476 .062 .487 7.725 <.001 DR
b. Subjective norms .335 .085 .237 3.938 <.001 F(x,y)D47.392 (3, 181), p<.001
c. Perceived behavioral control ¡.306 .077 ¡.211 ¡3.959 <.001
Note. DR
D.517, p<.001. Dependent variable = Behavioral intention.
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whether family and friends think it is good, or have received
the vaccine) in this audience segment. Third, independent of
the contribution of self-efficacy, vaccine intentions in this
group of college students is also significantly influenced by
perceived behavioral control—the perception that the vacci-
nation acceptance decision is completely in the hands of the
individual. Although this is in line with existing findings of
resistance to authority in college students in general, it also
suggests that this audience segment (ie, those who have not
previously accepted a flu vaccine) is significantly influenced
by a sense of individual control over decisions.
Furthermore, the study demonstrates support for 2 clini-
cally significant variables of self-efficacy and perceived
comparative susceptibility as important factors to take into
consideration. First, self-efficacy is an important contribu-
tor in vaccination intentions for students who have not pre-
viously obtained a flu vaccine such that students with
higher self-efficacy are less likely to plan to obtain the vac-
cine. Because of challenges inherent in increasing accep-
tance of voluntary, preventive vaccines in young adults (eg,
a disregard for authoritative recommendations
), vac-
cine communication among students who have not accepted
the flu vaccine can highlight how self-efficacy is demon-
strated through portraying vaccine acceptance. Second, per-
ceived comparative susceptibility has found support in
several risk preventive behaviors, and the study findings
extend its applicability in vaccination intentions of college
students. For this segment of students, the study finds that,
controlling for self-efficacy and perception of vaccine side
effects, increasing susceptibility compared with other stu-
dents like them promotes vaccination intentions.
Although the study makes an important contribution to
the applicability of the TPB to the domain of student flu
vaccine intentions, several limitations should be noted.
First, because the study design was cross-sectional, the find-
ings are primarily correlational. Second, although the con-
venience in-class recruitment strategy compromised the
ecological validity of the study, the study sample is reflec-
tive of the overall undergraduate student population of the
university. Third, as participants were self-selected into the
study, the findings may be biased toward those students
who were more (or less) concerned about vaccination due
to preexisting beliefs about vaccination, and nonresponse
bias cannot be assessed. Fourth, since the survey was
administered to undergraduate students from classes in the
communications department, which generally have a
greater focus on media effects and health campaigns, care
should be taken to not overgeneralize its representative-
ness to a larger student population. Because studies on
college students in general reflect important similarities in
beliefs among college students (eg, in the existence of
optimistic bias), future studies can extend the findings
among a range of college student demographics. Fifth,
although the measures used in the study are from
validated scales, these rely on participant self-reports and
are susceptible to a recall bias.
The study demonstrates support for the TPB model in
college student vaccination decisions for the specific seg-
ment of students who have not received a flu vaccine. Fur-
thermore, for this specific segment of college students,
this study is the first to provide insight into the contribu-
tion of self-efficacy and perceived comparative suscepti-
bility. This is a particularly challenging group for public
health professionals to reach, partly because of the signifi-
cant influence of past behaviors on future intentions and
behaviors. Segmenting audiences helps understand the
beliefs and motivations of specific target audiences and is
key to the success of health communication efforts seeking
to reach population segments that can benefit from a spe-
cific health behavior with prevention messages and behav-
ior recommendations.
Implications for Student Health Centers
To reach college students who have not previously
received a flu shot, vaccine communication messages
should underscore individual choice and ability to obtain
the vaccine as an act of responsibility, as well as highlight
positive beliefs (eg, usefulness and benefits), susceptibility
compared with other college students, testimony of family
and friends, and control factors.
The author is grateful to the executive editor and 2 anon-
ymous reviewers for their insightful comments and feed-
back that guided the development of the manuscript. The
author thanks the Department of Communication, Univer-
sity of Louisville, Louisville, Kentucky, for the support pro-
vided the study. Earlier versions of this paper were
presented at the Kentucky Conference in Health Communi-
cation, 2010, the National Communication Association,
2011, and the Eastern Communication Association, 2012.
No funding was used to support this research and/or the
preparation of the manuscript.
The author has no conflicts of interest to report. The
author confirms that the research presented in this article
met the ethical guidelines, including adherence to the legal
requirements, of the United States and received approval
from the Institutional Review Board of the University of
Downloaded by [] at 01:14 25 August 2014
For comments and further information, address corre-
spondence to Vinita Agarwal, Department of Communica-
tion Arts, Salisbury University, FH 272, 1101 Camden
Avenue, Salisbury, MD 21801, USA (e-mail: vxagar-
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Received: 23 August 2013
Revised: 31 March 2014
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... Past research has also found that an individual's perceived efficacy of their behaviour in keeping them safe is linked to compliance with public health guidelines [6][7][8]. The Theory of Planned Behaviour (TPB) is a behavioural psychology model that connects beliefs to behaviour, including the factors that shape individual intentions to engage in certain behaviour [9][10][11][12][13]. In previous pandemics (SARS, H1N1), researchers reported a relationship between health behaviours in response to infectious disease outbreaks, and constructs of the TPB that included behavioural beliefs (personal attitudes toward behaviour), normative beliefs (subjective expectations of others), and control beliefs (beliefs that depend on external barriers) [9-11, 14, 15]. ...
... In previous pandemics (SARS, H1N1), researchers reported a relationship between health behaviours in response to infectious disease outbreaks, and constructs of the TPB that included behavioural beliefs (personal attitudes toward behaviour), normative beliefs (subjective expectations of others), and control beliefs (beliefs that depend on external barriers) [9-11, 14, 15]. These results have been replicated within the context of the COVID-19 pandemic regarding intentions to receive vaccination [9,11,15]; however, little is known about beliefs that are associated with individual intentions to comply with the broader scope of public, non-pharmaceutical health guidelines (e.g., restrictions, masking, hand-washing) [6,8,10] and particularly, the role that access to and consumption of COVID-19 related information plays in shaping these intentions. Widespread adherence to public health guidelines is fundamental to preventing negative health and economic impacts as a result of the COVID-19 pandemic [16]. ...
Full-text available
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.
... Over the past decades, numerous studies, including meta-analyses, addressed and confirmed the explanatory power of TPB ( [11,16,17]; for recent meta-analyses in various health contexts, see [18][19][20][21][22]). Also, scholars have already successfully investigated preventive health behaviors through the lens of TPB in response to previous pandemics [23][24][25] and the coronavirus pandemic [13,[26][27][28][29][30][31][32][33]. It has been shown that compliance with social distancing was positively influenced by positive attitudes toward the behavior, a strong perceived behavioral control, and positive subjective norms [27,33]. ...
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Background With the easing of governmental COVID-19 restrictions, promoting voluntary public compliance with protective measures becomes essential for the pandemic evolution. A highly relevant target group for such health promotion are adolescents and young adults since they showed a strong decline in compliance throughout the pandemic. Building on an extended version of the Theory of Planned Behavior, this article investigates drivers of young people’s intentions to engage in voluntary COVID-19 measures in phases of re-opening. Methods We conducted a sequential multi-method study among 14- to 29-year-olds in Germany: (1) a semi-standardized online survey ( N = 88) to examine underlying beliefs and (2) a standardized online survey ( N = 979) to identify influencing factors of compliance. The pre-study addressed the respondents’ perceptions about wearing a mask, social distancing, and avoiding crowded locations (open-ended questions). Responses for all protective measures were aggregated to identify general behavioral, normative, and control beliefs about COVID-19 protective measures. In order to gain generalizable insights into the factors determining voluntary compliance intentions in younger adults, we conceptualized the model constructs in the subsequent standardized online survey as formative measures based on their underlying beliefs. PLS-SEM was used to examine the effects of attitudes, subjective norms, perceived behavioral control, risk perceptions, and knowledge on young people’s intentions to comply (main study). Furthermore, a multi-group analysis was conducted to investigate differences between compliers and non-compliers. Results The pre-study revealed that young people’s instrumental attitudes not only cover reasons of protection but also aspects of self-presentation (e.g., being a role model). The main study showed that besides knowledge and perceived severity of illness, instrumental attitude is the strongest predictor of intention to comply. The influence is even stronger in the group of non-compliers. Conclusion This article highlights the importance of theory-based campaign planning and provides practical guidance to health communicators on how to increase voluntary compliance with COVID-19 protective measures in adolescents and young adults. The findings demonstrate the great potential of combining the Theory of Planned Behavior with risk perception and knowledge to gain deeper insights into the feelings and thoughts of younger target groups during a health crisis.
... However, self-uniqueness beliefs may be differently associated with health behavior other than the type that we studied. Earlier studies that showed negative associations between comparative optimism and health behavior often focused on information seeking, processing, and application (e.g., Cho et al., 2013;Park et al., 2017) or participation in vaccination programs (e.g., Agarwal, 2014;Delporte et al., 2022 under review). It is possible, therefore, that some behaviors (e.g., behaviors that require discrete decisions at given points in time) are negatively associated with self-uniqueness whereas behaviors that require a sustained effort over a longer period are positively related to them. ...
Rationale Research on health-related self-uniqueness beliefs suggested that these beliefs might predict adherence to precautions against COVID-19. Objective We examined if comparative optimism (believing that one is less at less than others), self-superiority (believing that one already adheres better to precautions than others), and egocentric impact perception (believing that adverse events affect oneself more than others) predicted intended adherence to precautions. Method We measured self-reported intentions, optimism for self and others, perceived past adherence by self and others, and perceived impact of the measures and the disease on self and others in a 5-wave longitudinal study in December 2020–May 2021 (N ≈ 5000/wave). The sample was in key respects representative for the Belgian population. We used joint models to examine the relationship between self-uniqueness beliefs and intended adherence to the precautions. Results Believing that COVID-19 would affect one's own life more than average (egocentric impact perception) was associated with higher intentions to adhere to precautions, as was believing that the precautions affected one's life less than average (allocentric impact perception). Self-superiority concerning past adherence to precautions and comparative optimism concerning infection with COVID-19 were associated with higher intended adherence, regardless of whether their non-comparative counterparts (descriptive norm, i.e., perceived adherence to precautions by others, and personal optimism, respectively) were controlled for. Comparative optimism for severe disease and for good outcome were associated with lower intended adherence if personal optimism was not controlled for, but with higher intended adherence if it was controlled for. Conclusion Self-uniqueness beliefs predict intended adherence to precautions against COVID-19, but do so in different directions.
... It is part of the theory of planned behavior (TPB) which postulates that attitudes, subjective norms, and perceived behavioral control determine behavioral intention, which in turn determines health behavior [45]. Subjective norms were significantly associated with COVID-19 vaccination [28,46], influenza vaccination [47], and COVID-19 preventive behaviors [48,49]. Again, such potential factors have not been studied among MSM. ...
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This study investigated an under-researched topic regarding the prevalence of COVID-19 vaccination behavior among Chinese men who have sex with men (MSM) and the associations of this with general and MSM-specific perceptions grounded in the health belief model (HBM) and the theory of planned behaviors (TPB). A total of 400 Chinese MSM were recruited from multiple sources (site recruitment, online recruitment, and peer referral) in Hong Kong from July to October 2021, who then participated in a structured telephone interview. Of all the participants, the prevalence of COVID-19 vaccination (i.e., taking at least one dose of COVID-19 vaccination) was 78.3%. Multivariable logistic regression analyses showed that, after adjusting for background factors, (1) the general and MSM-specific HBM variables of perceived benefits and self-efficacy were positively associated with COVID-19 vaccination behavior; (2) the items or scale of general/MSM-specific perceived barriers and social norms were negatively associated with COVID-19 vaccination behavior; (3) the general perceived severity and MSM-specific perceived susceptibility, perceived severity, and cue to action were not significantly associated with COVID-19 vaccination behavior. The findings suggest that the HBM and social norm construct of the TPB only partially explained the participant’s COVID-19 vaccination behavior. Health promotion may need to focus more on modifying perceptions related to COVID-19 vaccination rather than COVID-19.
... In TCP there are three factors that determine behavioral intention, which are attitude, subjective norm and perceived behavioral control. TCP assumes that each individual can rationally evaluate their choices, before formulating an intention to perform certain behaviors (Agarwal, 2014). In the case of the first factor, the attitude can be negative or positive, that is, if it is negative, it means that there is no perception of threat in the face of possible contagion by COVID 19 and if it is positive, it means that, if there is this perception of threat about this. ...
This study analyzes the economic impact caused by the COVID-19 pandemic on leisure tourism in Peru, in terms of tourist services such as means of transportation, accommodation, city tours and restaurants. The analysis is based on the application of a survey. The cross-sectional analytical study evaluated 2,443 potential tourists of legal age from the 25 regions of Peru who intended to engage in leisure tourism during the quarantine period. Likewise, potential tourists who intended to make a trip culminating the quarantine (in the remaining time of the year 2020) were evaluated. Based on the study of people who were going to carry out local leisure tourism until the end of 2020, the estimated losses in tourist services amounted to approximately $203 dollars millions (based on a budget less than or equal to $83.00, the amount that most respondents were willing to pay for tourist services). An increase in the demand for domestic leisure tourism is expected associated with the reduction in prices of each tourist service in order to reactivate this sector economically.
To identify factors that predict COVID-19 vaccination refusal and show how expectancies affect vaccination acceptance for non-vaccinated adults, we used a monthly repeated cross-sectional sample from June/2021 to October/2021 to collect data on vaccination behaviors and predictor variables for 2,116 US adults over 50 years of age. Selection bias modeling – which is required when data availability is a result of behavioral choice – predicts two outcomes: (1) no vaccination vs. vaccination for the entire sample and (2) the effects of expectancy indices predicting vaccination Refuser vs. vaccination Accepters for the unvaccinated group. Vaccine refusers were younger and less educated, endorsed common misconceptions about the COVID-19 epidemic, and were Black. Vaccination expectancies were related to vaccination refusal in the unvaccinated eligible group: negative expectancies increased vaccine refusal, while positive expectancies decreased it. We conclude that behavior-related expectancies (as opposed to more stable psychological traits) are important to identify because they are often modifiable and provide a point of intervention, not just for COVID-19 vaccination acceptance but also for other positive health behaviors.
Full-text available
Objectives The COVID-19 pandemic continues to increase around the world and businesses and markets across the world significantly decreased. The purpose of this study was to determine the factors that affect the intention to be vaccinated for the COVID-19 vaccine among young Filipino adults by integrating the Health Belief Model and Extended Theory of Planned Behavior. Study design A cross-sectional study design was utilized. Methods Factors such as understanding of the COVID-19 vaccine, self-efficacy, cues to action, perceived barriers, perceived benefits, perceived side effects, perceived behavioral control, attitude, subjective norm, and intention to be vaccinated were analyzed by utilizing Structural Equation Modeling (SEM). Results With 865 young Filipino adults who answered a self-administered survey, it was seen that Understanding of the COVID-19 vaccine has the highest direct significant effect on cues to action, followed by perceived barriers, and perceived benefits. Interestingly, the primary factor was Understanding COVID-19 vaccines which had an indirect significant effect on the intention to get vaccinated. This is because knowing what the vaccine is for, its effects, and the application would lead to the acceptance of the COVID-19 vaccine. Moreover, the impact of being known to have the COVID-19 vaccine would lead to the intention to get vaccinated. Conclusions The findings of this study can be utilized especially by the government in developing strategies for encouraging people to take the COVID-19 vaccine. Finally, the model construct of the study can be applied to explore more factors that can affect the intention to be vaccinated with the COVID-19 vaccine and other vaccines people worldwide.
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Introduction Enhancing human papillomavirus (HPV) vaccine uptake rates to protect women's health is an important public health issue worldwide. China has taken a series of measures in recent years to promote HPV vaccination among school-aged girls, but the vaccine uptake rate remains low. Investigating the factors influencing vaccination-related decision-making of adolescent girls' parents is key to solving the problem. This study aimed to examine the influence of sociocultural-psychological predictors, including exposure to HPV-related stories (positive/negative), affective reactions (pride/regret), injunctive norms on the Internet and perceived moral obligation, on parents' HPV vaccination-related decision-making for girls aged 13–15 years in mainland China. Methods A cross-sectional online survey using quota sampling was conducted in February 2022. Four hundred and five valid and qualified questionnaires were obtained. Partial least squares structural equation modeling was performed by SmartPLS 3 (i) to evaluate the reliability and validity of the measurement models of 11 constructs, and (ii) to test the effect relationships of the sociocultural–psychological predictors on parents' intention to vaccinate their daughters. Results The study findings showed that parental decision-making regarding HPV vaccination was influenced by sociocultural and psychological factors. At the level of individual psychological factors, exposure to positive stories was significantly associated with perceived vaccine effectiveness (β = 0.331, t = 8.448, p < 0.001), which strongly predicted the attitude toward vaccination (β = 0.521, t = 8.133, p < 0.001); anticipated pride had more positive influence on vaccination-related decision-making (β = 0.156, t = 2.176, p < 0.05) than anticipated regret. In terms of social influence, injunctive norms on the Internet had a significantly positive influence on vaccination intention (β = 0.127, t = 2.382, p < 0.05), similar to descriptive norms (β = 0.135, t = 3.358, p < 0.01). Perceived moral obligation at the cultural level was the strongest predictor of parental decision-making regarding HPV vaccination (β = 0.193, t = 2.139, p < 0.05). Discussion This study is the first in mainland China to systematically examine the sociocultural-psychological predictors of parents' decision-making to vaccinate their 13–15-year-old daughters against HPV. A new extended TPB model with a sociocultural-psychological approach was developed. This model can support the investigation of factors affecting HPV vaccine uptake rates in the mainland Chinese population and similar populations and help to understand the differences in vaccination-related decision-making between Eastern and Western cultures. Furthermore, the study provided some suggestions for HPV vaccination communication campaigns targeting adolescent girls' parents.
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Object During the later period of the COVID-19 pandemic, the public has been at risk of the evolving COVID-19 variants and hesitated to be vaccinated against COVID-19 to a certain extent. In this context, the health belief model (HBM) and the theory of planned behavior model (TPB) were used to compare and summarize the relationship between vaccine hesitation/non-hesitation and the intentions to get COVID-19 vaccines and its influencing factors. Methods The cross-sectional, population-based online survey was conducted from 14 April to 30 April 2021, and 1757 respondents were recruited to participate in the survey through the Wenjuanxing online survey platform. The HBM and TPB covariate scores were expressed using means and standard deviations and compared between groups using t-tests. Backward multiple linear regression models were used to explore the factors influencing the public's intentions to receive the COVID-19 vaccines. Results This study found that educational background is one of the factors influencing vaccine hesitation. Most people with high education do not hesitate (65.24%), while a more significant proportion of people with low education have vaccine hesitation (66.00%). According to HBM, for the vaccine hesitation group, self-efficacy, family advice, and doctor's advice were the most critical factors affecting the public's future vaccination intentions; for the vaccine non-hesitation group, self-efficacy, doctor's advice, and perceived benefits are the most important influencing factors. According to the TPB, the subjective norm is the most critical factor affecting the future vaccination intention of the vaccine hesitation group, and the attitude toward behavior is the most critical factor affecting the future vaccination intention of the vaccine non-hesitation group. Conclusions In the context of COVID-19, the public's hesitation on the “current” vaccines will still affect future vaccination intentions. Using HBM and TPB would help health policymakers and healthcare providers formulate intervention plans.
Objectives: This mixed-methods study compared perspectives of those 'very likely' versus 'very unlikely' to receive a hypothetical COVID-19 vaccine. Methods: We used an explanatory, sequential, mixed- methods design to analyze quantitative data from a rural Pennsylvania sample. Of the 976 participants, 67 selected 'very unlikely' to get the COVID-19 vaccine. Responses to open-ended questions: "What worries you the most about the COVID 19 pandemic?" and "What are your thoughts about a potential COVID 19 vaccine?" were qualitatively compared to answers from the 67 participants who selected 'very likely' to get the COVID-19 vaccine. We used descriptive content analysis to compare themes across the 2 groups. Results: Both groups had thematic commonalities related to their concerns. Themes that were more common among those 'very unlikely' to get vaccinated included concern for politics overriding vaccine safety and rushed vaccine development timeline, whereas themes related to hope and optimism about vaccination were exclusive to the 'very likely' group. Conclusions: Shared beliefs existed across groups with different intents to vaccinate; yet, identification with vaccine spokespersons differed. Messaging campaigns can use these commonalities to address vaccine hesitancy.
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Purpose Athlete's report of concussion symptoms to coaching or medical personnel is an important component of concussion risk reduction. This study applies a model based on the Theory of Planned Behavior (TPB) to the prediction of concussive symptom underreporting among late adolescent and young adult male ice hockey players. Methods Participants were members of an American Tier III Junior A ice hockey league (ages 18–21 years; male; n = 256). Twelve of 14 league teams and 97% of players within these teams agreed to participate. Written survey items assessed symptom reporting behavior, intention, perceived norms, self-efficacy, perceived outcomes of reporting, and concussion knowledge. Structural equation modeling was used to assess the significance of relationships hypothesized by the TPB-based model and the overall model fit. Data were collected in January 2013. Results Results supported the fit of the TPB-based model in explaining reporting behavior; all model pathways were significant in the hypothesized direction. Of the perceived reporting outcomes assessed, those related to athletic performance were identified as most strongly associated with reporting intention. Conclusions Results of this study suggest the importance of considering factors such as perceived outcomes of reporting, perceived norms, and self-efficacy, in addition to knowledge, when analyzing concussion underreporting among adolescent athletes. As concussion education for athletes becomes increasingly mandated, testing and applying psychosocial theories such as TPB may help increase program efficacy.
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Nurse practitioners' (NPs) knowledge, experience, and intention to use health literacy strategies in practice were investigated using the Theory of Planned Behavior as the theoretical framework. NPs who work in outpatient settings were recruited at a national NP conference. Participants were administered 3 self-report instruments: Health Literacy Knowledge and Experience Survey, Parts I and II; and the Health Literacy Strategies Behavioral Intention Questionnaire. Overall knowledge of health literacy and health literacy strategies was found to be low. Screening patients for low health literacy and evaluating patient education materials were found to be areas of knowledge deficit. Most NP participants used written patient education materials with alternate formats for patient education, such as audiotapes, videotapes, or computer software rarely used. Statistically significant differences were found in mean experience scores between NP level of educational preparation and NP practice settings. The intention to use health literacy strategies in practice was found to be strong. The findings of this investigation offer implications for enhancing NP curriculum and for continuing education opportunities. Increasing NPs' knowledge of health literacy and facilitating the use of health literacy strategies has the potential to change clinical practice and support improved patient outcomes.
Interpersonal trust is an aspect of close relationships which has been virtually ignored in social scientific research despite its importance as perceived by intimate partners and several family theorists. This article describes the development, validation, and correlates of the Dyadic Trust Scale, a tool designed for such research. It is unidimensional, reliable, relatively free from response biases, and purposely designed to be consistent with conceptualizations of trust from various perspectives. Dyadic trust proved to be associated with love and with intimacy of self-disclosure, especially for longer married partners. It varied by level of commitment, being lowest for ex-partners and highest for those engaged and living together, for newlyweds, and for those married over 20 years. Partners reciprocated trust more than either love or depth of self-disclosure. Future research could fruitfully relate dyadic trust to such issues as personal growth in relationships, resolving interpersonal conflict, and developing close relationships subsequent to separation or divorce.
"Construct validation was introduced in order to specify types of research required in developing tests for which the conventional views on validation are inappropriate. Personality tests, and some tests of ability, are interpreted in terms of attributes for which there is no adequate criterion. This paper indicates what sorts of evidence can substantiate such an interpretation, and how such evidence is to be interpreted." 60 references. (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Conceptual and methodological ambiguities surrounding the concept of perceived behavioral control are clarified. It is shown that perceived control over performance of a behavior, though comprised of separable components that reflect beliefs about self-efficacy and about controllability, can nevertheless be considered a unitary latent variable in a hierarchical factor model. It is further argued that there is no necessary correspondence between self-efficacy and internal control factors, or between controllability and external control factors. Self-efficacy and controllability can reflect internal as well as external factors and the extent to which they reflect one or the other is an empirical question. Finally, a case is made that measures of perceived behavioral control need to incorporate self-efficacy as well as controllability items that are carefully selected to ensure high internal consistency.
Introduction: There is no national or international recommendation for nursing students to receive the influenza vaccine. Nurses are among the group of health professionals who traditionally have a low uptake of the vaccine and who arguably have the closest contact with patients. Aim: To investigate the uptake of influenza vaccination among student nurses, explore reasons for either declining or receiving it in the past, and establish if and to what extent the theory of planned behaviour (TPB) can explain vaccination behaviour. Methods: A quantitative, descriptive, correlational design was used. Data were collected with a researcher-developed questionnaire; 131 student nurses participated. Ethical approval was gained. Results: 79% (n=104) had never received the vaccine. The most common reason was 'I don't need it as I rarely get ill'. Low mean 'intention' scores indicated that students were unlikely to get the vaccine once qualified. Past behaviour was significantly associated with future intentions. The TPB explained 41.9% of the variance in intention. Attitude emerged as the greatest predictor. Conclusion: Student nurses do not have strong intentions to get the vaccine. Results serve to guide future educational and occupational health initiatives, which would benefit from a framework based on TPB.