Human beings have struggled with the question of what determines our behavior for millennia. For those of us who believe in free will, the answer is usually that we act out of intention. But this response provokes an inevitable follow-up question: where does intention come from? What determines what we intend to do? These concerns may appear abstractly philosophical, but they are at the heart of health communication scholarship in its efforts to increase participation in health-related behaviors.
The Theory of Planned Behavior (TPB) is a social psychological model that holds how a person behaves is dictated by their intention. Intentions are complex. They are made up of a person’s attitude toward a behavior, their perception of social norms related to that behavior, and their perceived control or agency regarding enacting the behavior. This model has been extremely influential in health communication scholarship and health campaigns, where it guides the design of communicative interventions to promote public health.
This guide provides an introduction to the Theory of Planned Behavior meant to be useful to prospective graduate students interested in health communication. After providing a brief history of the TPB, the sections that follow discuss key constructs of the theory, explore its application in health communication research, and discuss the state of the TPB in contemporary scholarship.
A Brief History of the Theory of Planned Behavior
The Theory of Planned Behavior is an elaboration on the Theory of Reasoned Action (TRA) — a social psychological framework originally developed by Martin Fishbein and Icek Ajzen in the 1970s. Like the Health Belief Model and other innovative social-psychological models of that time period, the intention of the Theory of Reasoned Action was to explain the link between an individual’s cognitive perceptions of the world (their beliefs, attitudes, and intentions) and their behaviors. In the context of health communication, the model has been applied to explain why individuals with negative attitudes toward cancer, for instance, might still fail to participate in regular preventative screenings.
According to the Theory of Reasoned Action, the likelihood that an individual will participate in a given behavior is mediated by their attitudes toward a behavior and their perception of subjective norms regarding that behavior. Together, these constructs dictate an individual’s intention to perform a behavior, which, according to the TRA, is the primary determinant of their likelihood to engage in that behavior.
The TPB is Ajzen’s extension of his work with Fishbein and differs in subtle but significant ways. Specifically, Ajzen adds “perceived behavioral control” as a central construct in the model, arguing it helps mediate the relationship between intention to perform a behavior and the likelihood an individual will engage in that behavior. Perceived behavior control describes an individual’s perception of being able to accomplish the behaviors favored by their attitudes and social norms. An individual may desire to quit smoking, for instance, but perceive themselves as powerless to do so.
Unlike the Health Belief Model, the TPB was not developed with specific attention to health contexts. Nevertheless, health communication scholars were quick to incorporate the model into their research. Scholars and professionals working in health communication also frequently employ the TPB as the foundation for health campaigns and health education initiatives on a global scale. Further, many researchers and health campaigns use models that integrate the constructs and insights of the TPB. As such, understanding the TPB continues to be extremely important for students of health communication decades after its innovation.
Spotlight on Scholarship: Featured Scholars in the Theory of Planned Behavior
Discover contemporary scholars who have employed the Theory of Planned Behavior in their research, from work on health campaigns to research on the role parents play in preventing childhood obesity.
Dr. Karen Freberg is Professor of Strategic Communication in the Department of Communication at the University of Louisville (UL). Dr. Freberg applies a background in strategic communication, crisis communication, and social scientific research on social media to her research on health communication, as in her article, “Using the Theory of Planned Behavior to Predict Intention to Comply with a Food Recall Message,” published in Health Communication, and the co-authored article “Managing and Sharing H1N1 Crisis Information Using Social Media Bookmarking Services.” Dr. Freberg has also worked as a social media communication consultant for companies like Hootsuite and Adobe. Alongside her role as Professor at UL, she also works as Director of the Bird’s Nest Student Agency, a student run marketing agency.
Dr. Syed Ali Hussain is Assistant Professor at the University of Sharjah in the United Arab Emirates. His health communication scholarship includes the recent paper in Health Communication “Nostalgic Emotional Valence and Its Effects on Help-Seeking In Depression: An Application of the Theory of Planned Behavior.” Dr. Hussain’s recent work is aimed at improving attitudes toward Muslim immigrants. His co-authored paper, “Nostalgia Narratives: Can they improve attitudes toward Muslim Immigrants?” won the Top Faculty Paper from the National Communication Association conference in 2019. He was formerly an Assistant Professor in the Walter Cronkite School of Journalism and Mass Communication at Arizona State University.
Dr. Christina Selby is Professor in the Department of Communication, Media and Culture at Coastal Carolina University, where she also serves as Department Chair. Her research in health communication covers a wide range of issues, including how media portrays risky behaviors, substance abuse, elder care, and dental health. Her work has been published in a number of notable journals. For example, her co-authored article, “The Persuasive Power of Oral Health Promotion Messages: A Theory of Planned Behavior Approach to Dental Check Ups Among Young Adults” was published in Health Communication. Health campaign design and the promotion of healthy behaviors, especially for groups facing health inequities, are central to Dr. Selby’s work.
Dr. Kami Silk is Rosenberg Professor and Chairperson of the Department of Communication at the University of Delaware, where she previously served as Senior Associated Dean of Research. Dr. Silk’s scholarship on health communication is diverse, ranging from work on suicide prevention to research aimed at helping young mothers avoid obesity, and has been published in the field’s leading journals. Her research on the TPB, the co-authored piece “Parents as Health Promoters: A Theory of Planned Behavior Perspective of Childhood Obesity,” for example, appeared in the Journal of Health Communication. Dr. Silk currently works as the primary investigator for two research projects at the Breast Cancer and the Environment Research Program, which have been funded by grants from the National Institute of Environmental Health Sciences.
Dr. Yan Tian is Professor of Communication and Media at the University of Missouri - St. Louis. Dr. Tian’s research frequently applies media and technology studies perspectives like media effects theory and audience analysis to the study of health communication, as in her article in Health Communication “Medical Drama Viewing and Medical Trust: A Moderated Mediation Approach.” Dr. Tian’s contribution to research on the Theory of Planned Behavior, “Predictors of Cell Phone Use in Distracted Driving: Extending the Theory of Planned Behavior,” also appears in this journal. Dr. Tian’s scholarship has been funded by a number of grants and earned many accolades, including the Top Paper Award by the Health Communication Division of the National Communication Association in 2010.
Dr. Xiao Wang is Professor in the School of Communication at the Rochester Institute of Technology (RIT), where his research in health communication focuses on health campaign design and its relationship to social media. His publications have appeared in leading journals in the field, such as Health Communication and Communication Research. These include "Predictors of Organ Donation-Related Cognitions and Intentions in China: Communication Variables and Cultural values,” published in Communication Quarterly and “Integrating the Theory of Planned Behavior and Attitude Functions: Implications for Health Campaign Design.” At RIT, Dr. Wang serves as Program Director for the Communication Master of Science Degree program.
Key Constructs in the Theory of Planned Behavior
As discussed in the previous section, the TPB is an elaboration of the Theory of Reasoned Action, which aims to understand the relationship between subjective intention and behavior. The TPB argues that intention is determined by three main constructs: attitudes, subjective norms, and perceived control. Proponents of the TPB argue that these constructs interact to determine an individual’s intention to perform a given behavior, and that intention toward a behavior drives individual action.
The original constructs of the TRA are attitudes and subjective norms. Attitudes describe an individual’s disposition toward the relevant behavior or “target.” An individual’s attitude toward a target behavior is determined by two parts, which operate as independent variables in the model. First is the individual’s “behavioral beliefs,” which include their personal evaluations of the health behavior in question (e.g., is this vaccine safe, is it effective?). The second is the individual’s “evaluation of behavioral outcomes,” which is their perception that the expected outcomes of that behavior are good or desirable (e.g., being protected from this disease is important).
The second construct, subjective norms, describes an individual’s socially-rooted judgments of whether a health behavior is good or bad. The first aspect of this construct is an individual’s normative beliefs, defined as their perception of how an act would be judged by others. Daniel E. Montańo and Danuta Kasprzyk (2008) pose that normative beliefs are determined by “whether important reference individuals approve or disapprove of performing a behavior,” but some scholars include in this construct cultural and social norms that may be modeled less directly, with media discourses being an important example.
The influence of subjective norms also depends on a second factor, which is motivation to comply. In theory, one may have a firmly developed sense of the normative beliefs associated with a given health behavior, but reject the authority of, or fail to be motivated by, the social actors who endorse those beliefs.
Ajzen’s (1985) contribution to the model was to add the third construct of “perceived control,” which is mediated by an individual’s “control beliefs” — that is, their beliefs concerning the existence of obstacles to their performing the desired behavior, weighted by the individual’s perception of the “power” of these factors. An individual with strong “volitional control” may not perceive barriers between themselves and the desired health behavior (maybe the vaccination clinic is down the block and free) or may feel they can overcome those barriers (knowing they have time and money to do so). Conversely, an individual with low volitional control may view a health behavior as highly desirable but feel incapable of surmounting the obstacles necessary to acquire care (Montańo and Kasprzyk 2008).
This is a subtle addition but makes a significant difference. While the TRA holds that it is the individual’s intention that determines their action, the TPB argues that intention and ability are equally important in influencing individual behavior. This is true both in the sense that material barriers to individuals directly influence an individual’s ability to take that action, as well as in the sense that low volitional control over a behavior may impact the individual’s psychological intention to perform that behavior as well. Real control and perceived control work hand-in-hand, but researchers applying the model typically focus on measuring perceived control. The application of the three aforementioned constructs has direct relevance to both health communication research and the development of effective health campaigns and protocols.
The Theory of Planned Behavior in Application
Health communication researchers, medical practitioners, and health campaign workers still frequently turn to the Theory of Planned Behavior to address pressing public health issues and devise strategies for intervening in these problems. Health communication scholars have applied the TPB to understand individual participation in a wide variety of health-related behaviors, with most research focusing on lifestyle health and preventive behaviors. To provide just a few examples, Li Li and John Robert Bautista (2020) use the TPB to study Chinese university students’ consumption of genetically modified food, Christina N. Anderson et al. (2013) use the model to study youth dental health, and Yan Tian and James D. Robinson (2016) examine cell phone use and distracted driving through the TPB.
In application, the TPB helps scholars understand why individuals engage (or do not engage) with health behaviors by measuring their attitudes toward a behavior (dental check-ups, cell phone use), their perception of social norms related to the behavior (support or discipline from parents, peer pressure), and their perceived control over the desired behavior. From the findings of these investigations, health communication researchers will typically recommend communicative interventions that aim to encourage desirable health behaviors by addressing these three main constructs that drive intention.
In this way, the TPB has been important to theoretically-grounded health campaigns, which are an increasingly popular means of addressing public and community health issues on a global scale, as well as in health education efforts. Whether on its own or integrated into more comprehensive models, the TPB helps health communication researchers better understand the attitudes, social norms, and perceived barriers that prevent target health behaviors, and to design strategies for combating those tendencies. The insights of the TPB have influenced health campaigns directed at fighting youth obesity, encouraging H1N1 vaccination in college students, and advancing countless other public and community health initiatives.
Even in circumstances where health communication researchers are not directly working with health campaigns, researchers typically address their findings to campaigns as well as health educators. A number of the studies just discussed find that social norms are one of the primary drivers of behavioral intent and urge for the use of communication strategies like social media messaging campaigns that are designed around shaping social norms. Other authors, following the emphasis of the TPB, have argued the primary importance of perceived behavioral control and advised health campaigns to bolster their target audience’s sense of agency while addressing perceived obstacles.
The Theory of Planned Behavior Today
The TPB has been extremely influential on both health communication scholarship and the design of health campaigns. This being said, there are problems with the model, which many contemporary scholars have moved to address. Methodologically, scholars have sought to refine and extend the TPB to overcome certain ambiguities in its constructs–for example, its failure to differentiate between the different types of attitudes one can have toward a health behavior. Other scholars have responded to criticisms that cognitive models like the TPB minimize issues related to cultural inequalities and socioeconomic barriers by paying greater attention to perceived control, contextual barriers, and intercultural communication dynamics in their analyses.
As discussed in more detail in our Guide to Critical Perspectives in Health Communication, the success of these responses is up for debate. Still, the general approach to understanding health communication and health campaigns remains mostly consistent from its early development. Today, the Theory of Planned Behavior still provides a framework for helping campaigns design interventions, and many scholars have found it especially useful for understanding the influence of mass media and social media on health decisions. In light of this, the TPB will likely remain a central reference point for health communication students and researchers in the future.
Sources and Additional Resources
To learn more about the Theory of Planned Behavior and its applications in health communication, check out the following resources:
- Anderson, Christina N., Seth M. Noar, and Brandi D. Rogers. 2013. “The Persuasive Power of Oral Health Promotion Messages: A Theory of Planned Behavior Approach to Dental Checkups Among Young Adults.” Health Communication 28(3):304–13. https://www.tandfonline.com/doi/abs/10.1080/10410236.2012.684275.
- Andrews, Kyle R., Kami S. Silk, and Ihuoma U. Eneli. 2010. “Parents as Health Promoters: A Theory of Planned Behavior Perspective on the Prevention of Childhood Obesity.” Journal of Health Communication 15 (1): 95–107. https://www.tandfonline.com/doi/abs/10.1080/10810730903460567.
- Ajzen, Icek. 1985. “From Intention to Actions: A Theory of Planned Behavior.” In Action Control: From Cognition to Behavior. Julius Kuhl and Jürgen Beckmann, eds. Springer-Verlag.
- Bae, Hyuhn-Suhck, and Seok Kang. 2008. “The Influence of Viewing an Entertainment–Education Program on Cornea Donation Intention: A Test of the Theory of Planned Behavior.” Health Communication 23(1):87–95. https://www.tandfonline.com/doi/abs/10.1080/10410230701808038.
- Fishbein, Martin and Ajzen, Icek. 1975. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Addison-Wesley.
- Freberg, Karen. 2013. “Using the Theory of Planned Behavior to Predict Intention to Comply With a Food Recall Message.” Health Communication, 28(4):359–65. https://www.tandfonline.com/doi/abs/10.1080/10410236.2012.688657.
- Freberg, Karen, Michael J. Palenchar, and Shari R. Veil. 2013. “Managing and Sharing H1N1 Crisis Information Using Social Media Bookmarking Services.” Public Relations Review 39(3):178–84. https://linkinghub.elsevier.com/retrieve/pii/S0363811113000325.
- Hussain, Syed Ali, and Saleem Alhabash. 2020. “Nostalgic Emotional Valence and Its Effects on Help-Seeking in Depression. An Application of the Theory of Planned Behavior.” Health Communication, https://www.tandfonline.com/doi/full/10.1080/10410236.2020.1794549.
- Li, Li, and John Robert Bautista. 2020. “Incorporating Communication Factors in the Theory of Planned Behavior to Predict Chinese University Students’ Intention to Consume Genetically Modified Foods,” International Journal of Communication, 14:22.
- Montańo, Daniel E. and Danuta Kasprzyk. 2008. “Theory of Reasoned Action, Theory of Planned Behavior, and The Integrated Behavioral Model.” In Health Behavior and Health Education: Theory, Research and Practice. Karen Glanz, Barbara K. Rimer and K. Viswanath, eds. Wiley and Sons.
- Neuberger, Lindsay, and Megan Pabian. 2019. “Understanding Motivations for STI Testing: Comparing Presenters and Non-Presenters Using the Theory of Planned Behavior and Health Belief Model,” Florida Public Health Review 16:10.
- Paek, Hye-Jin, Hyun Jung Oh, and Thomas Hove. 2012. “How Media Campaigns Influence Children’s Physical Activity: Expanding the Normative Mechanisms of the Theory of Planned Behavior.” Journal of Health Communication 17(8):869–85. https://www.tandfonline.com/doi/abs/10.1080/10810730.2011.650832.
- Scheinfeld, Emily, Brittani Crook, and Cheryl L. Perry. 2019. “Understanding Young Adults’ E-Cigarette Use through the Theory of Planned Behavior.” Health Behavior and Policy Review 6(2):115–27.
- Shi, Jingyuan, and Hye Kyung Kim. 2020. “Integrating Risk Perception Attitude Framework and the Theory of Planned Behavior to Predict Mental Health Promotion Behaviors among Young Adults.” Health Communication 35(5):597–606. https://www.tandfonline.com/doi/full/10.1080/10410236.2019.1573298.
- Tian, Yan, and James D. Robinson. 2017. “Predictors of Cell Phone Use in Distracted Driving: Extending the Theory of Planned Behavior.” Health Communication 32(9):1066–75. https://www.tandfonline.com/doi/full/10.1080/10410236.2016.1196639.
- Wang, Xiao. 2009. “Integrating the Theory of Planned Behavior and Attitude Functions: Implications for Health Campaign Design.” Health Communication 24(5):426–34. https://www.tandfonline.com/doi/abs/10.1080/10410230903023477.
- Wang, Yandong, Jiping Liang, Jun Yang, Xingxia Ma, Xiaoqing Li, Jing Wu, Gaihe Yang, Guangxin Ren, and Yongzhong Feng. 2019. “Analysis of the Environmental Behavior of Farmers for Non-Point Source Pollution Control and Management: An Integration of the Theory of Planned Behavior and the Protection Motivation Theory.” Journal of Environmental Management 237(May):15–23. https://www.sciencedirect.com/science/article/abs/pii/S030147971930221X?via%3Dihub.
- Yang, Qinghua, and Shiwen Wu. 2021. “How Social Media Exposure to Health Information Influences Chinese People’s Health Protective Behavior during Air Pollution: A Theory of Planned Behavior Perspective.” Health Communication 36(3):324–33. https://www.tandfonline.com/doi/full/10.1080/10410236.2019.1692486.
- Young, Dannagal G. 2020. “Ideological Health Spirals: An Integrated Political and Health Communication Approach to COVID Interventions,” 17.
- Zhao, Xiaoquan. 2020. “Health Communication Campaigns: A Brief Introduction and Call for Dialogue.” International Journal of Nursing Sciences 7(1):S11–15. https://www.sciencedirect.com/science/article/pii/S2352013220300727?via%3Dihub.
Additional Topics on Research in Health Communication
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