Health Behavioral Theory

The Theory of Reasoned Action (T.O.R.A.) (1967, 1975) created by Martin Fishbein and Icek Ajzen suggests that people consider consequences of their behaviors before they act on these behaviors. (Raingruber, 2017) They believed that there is a correlation between attitude and behaviors (the A-B relationship). This theory is based on the individual’s voluntary behaviors and the actions they perform. It consists of three parts: behavioral intention, attitude and subjective norms.

Behavioral intention is the person’s attitude about the behavior coupled with the subjective norm. The subjective norms are their beliefs regarding the approval or disapproval of others that they think are important to them such as family members, co-workers, etc., weighted by their motivation to comply with the wishes of these important people. Essentially, the more positive the attitude and the subjective norms are, and the greater the control is, the stronger the individual’s intentions will be. The theory can be summarized by the following equation:

• Behavioral Intention=Attitude + Subjective Norms. (“Theory of Reasoned Action,” n.d.)

The attitude of a person towards a behavior is determined by beliefs on the consequences of the behavior and what others may think if this behavior was not performed. Self-efficacy is an important part of this theory as well. Does this individual believe he/she could change the behavior in spite of any barriers?

There are some critiques regarding this theory. Such as not all behaviors being under the individual’s control–spontaneous actions, habitual behaviors, and cravings. (Raingruber 2017, p. 53) Such behaviors are excluded because they may not be voluntary or because they may not involve a conscious decision on the individual’s part. Another critique is that environmental, economic, and political factors are not part of the theory. (Raingruber 2017, p.53) Behaviors that are prevented by lack of skill, opportunity, or cooperation of others, could inhibit their ability to engage in the behavior.

Childhood obesity is reaching epic proportions in many nations including the United States. Obesity is a major public health concern. The theory of reasoned action as well as a counterpart theory called the theory of planned behavior is being used to successfully plan and evaluate numerous interventions for many different behaviors when it comes to eating habits, exercise, etc. of young children and adolescents. Research has shown that interventions that are being directed toward changing dietary behaviors in adolescents should include multi-faceted, theory-based approaches. (“Theory of reasoned action and theory of planned behavior”, n.d.)

At least one-third of children and adolescents are overweight or obese in the U.S. alone. (“Theory of reasoned action and theory of planned behavior”, n.d.) Often health behavior theories have shown to have a positive effect in providing guidance in designing, implementing and evaluating interventions to prevent childhood obesity. However, the theory of planned behavior added that not all behaviors will be completely voluntary and so it added perceived behavioral control. If an individual has a favorable attitude towards consuming fruits and veggies, perceives the consumption to be positively viewed by significant others, and feels they have the control to eat it, they will likely intend to consume fruits and vegetables. However, if they don’t have access to the fruits and vegetables due to a food deficit or lack of ability to get these, he or she are said not to have actual behavioral control over the fruits/vegetables consumption.

Dietary behaviors of adolescents and young children are of great concern and most don’t have a healthy diet consistent with food intake recommendations. Exercise is also within the young child and adolescents control, however more and more often for many different reasons they are choosing more sedentary activities resulting in their increasing obesity issues.

Many different interventions have been experimented with to help children choose more wisely for food intakes, as well as increasing their daily exercise. A school-wide approach study was done where they increased the accessibility of fruits/vegetables, promoted marketing materials for the benefits, sent home newsletters for children and parents and had the curriculum include materials regarding the benefits of healthy eating. Increases in knowledge paired with the positive subjective norms led to an increase in fruit and vegetable eating in this particular group of children in the research study. Another similar study was done that included access to fields and playgrounds as well as access to fruits/vegetables, materials sent home, school marketing and bazaars which gave the children opportunities to try various fruits and vegetables. Parents were also involved to plan various intervention activities at the schools. This study also showed an increase in fruits/vegetables as well as physical activity and BP/BMI decreases that were measured.

Many other schools and communities have been trying to come up with ideas to increase healthy eating and physical activities. There seems to be a clear need to help with childhood and adolescent dietary behavior improvements, but no one specific way to help. Both theories seem to lean toward the need for a multi-component intervention.

In a number of school districts they serve breakfast to those in need, most lunches in schools have tried to involve becoming more healthy and offering more wholesome foods than hotdogs and macaroni and cheese. Schools however also have financial restrictions and can at some times be at the mercy of those restrictions in offering a menu that students will feel is more healthy. Culturally there are also drawbacks. Some cultures naturally include less healthy food and food choices which can be hard when trying to get children to eat healthier, but then go home and don’t have the same healthy choices. Finances of the families is also an issue. Cheaper food that tends to be less healthy but tends to feed more people is an issue. If you mother needs to feed a family of 5 and can choose boxes of macaroni and cheese and beans as opposed to fruits and vegetables, sometimes these are the choices that the family has to deal with.

Accessibility to more recreational centers available to children with programs that are free or low cost could also help with activity increases. Basketball courts, wall ball, pools for the summer, volleyball or other areas for children to have safe access to. More skate parks or bike tracks that are safe as well. Many parents need to be able to send their children outside or to a place where they feel they will be safe and can also be low cost. Letting more children who can walk to school or bike to school, the ability to do so. Working out or dancing with your children, using stairs in public places instead of escalators or elevators shows your children that you choose healthier habits as well. Lower-SES communities often must deal with the negative aspects of the environment, such as busy through streets, poor-quality bicycle and pedestrian infrastructure, dilapidated parks and playgrounds, and crime, that deter physical activity (Black and Macinko, 2008; Booth et al., 2005).

The answer has so many steps, as communities, governments, health care workers, schools, and individuals we will have to come together to put all the pieces together for more successful, healthier, more active future generations.