Abstract
Social-cognitive models such as the theory of planned behavior have demonstrated efficacy in predicting behavior, but few studies have examined the theory as a predictor of treatment adherence in chronic illness. We tested the efficacy of the theory for predicting adherence to treatment in chronic illness across multiple studies. A database search identified 27 studies, meeting inclusion criteria. Averaged intercorrelations among theory variables were computed corrected for sampling error using random-effects meta-analysis. Path-analysis using the meta-analytically derived correlations was used to test theory hypotheses and effects of moderators. The theory explained 33 and 9 % of the variance in intention and adherence behavior respectively. Theoretically consistent patterns of effects among the attitude, subjective norm, perceived behavioral control, intention and behavior constructs were found with small-to-medium effect sizes. Effect sizes were invariant across behavior and measurement type. Although results support theory predictions, effect sizes were small, particularly for the intention-behavior relationship.
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References
Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckman (Eds.), Action-control: From cognition to behavior (pp. 11–39). Heidelberg: Springer.
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.
Ajzen, I. (2014). The theory of planned behaviour is alive and well, and not ready to retire: A commentary on Sniehotta, Presseau, and Araújo-Soares. Health Psychology Review. doi:10.1080/17437199.2014.883474
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behaviour. Englewood Cliffs, NJ: Prentice-Hall.
Albarracin, D., et al. (2001). Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychological Bulletin, 127, 142–161.
Alwan, A. (2011). Global status report on noncommunicable diseases 2010. Geneva: World Health Organization.
Armitage, C. J. (2014). Time to retire the theory of planned behaviour? A commentary on Sniehotta, Presseau and Araújo-Soares. Health Psychology Review. doi:10.1080/17437199.2014.892148
Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology, 40, 471–499.
Bagozzi, R. P. (1981). An examination of the validity of two models of attitude. Multivariate Behavioral Research, 16, 323–359.
Bagozzi, R. P., et al. (1992). Development and test of a theory of technological learning and usage. Human Relations, 45, 659–686.
Brandes, K., & Mullan, B. (2014). Can the common-sense model predict adherence in chronically ill patients? A meta-analysis. Health Psychology Review, 8, 129–153.
Campbell, N. C., et al. (2007). Designing and evaluating complex interventions to improve health care. British Medical Journal, 334, 455–459.
Carr, J. Z., et al. (2003). Climate perceptions matter: A meta-analytic path analysis relating molar climate, cognitive and affective states, and individual level work outcomes. Journal of Applied Psychology, 88, 605–619.
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155.
Conner, M. (2014). Extending not retiring the theory of planned behaviour: A commentary on Sniehotta, Presseau and Araújo-Soares. Health Psychology Review. doi:10.1080/17437199.2014.899060
Conner, M., & Sparks, P. (2005). Theory of planned behaviour and health behaviour. In M. Conner & P. Norman (Eds.), Predicting health behaviour (pp. 170–222). Maidenhead: Open University Press.
Cooke, R., & French, D. P. (2008). How well do the theory of reasoned action and theory of planned behaviour predict intentions and attendance at screening programmes? A meta-analysis. Psychology and Health, 23, 745–765.
Costa, V., et al. (2012). Partner support, social-cognitive variables and their role in adherence to self-monitoring of blood glucose in type 2 diabetes. European Diabetes Nursing, 9, 81–86.
Courneya, K. S., et al. (2008). Predictors of supervised exercise adherence during breast cancer chemotherapy. Medicine and Science in Sports and Exercise, 40, 1180–1187.
de Bruin, M., et al. (2012). Self-regulatory processes mediate the intention-behavior relation for adherence and exercise behaviors. Health Psychology, 31, 695–703.
Dickersin, K. (1990). The existence of publication bias and risk factors for its occurrence. JAMA, 263, 1385–1389.
Didarloo, A. R., et al. (2012). Prediction of self-management behavior among iranian women with type 2 diabetes: Application of the theory of reasoned action along with self-efficacy (ETRA). Iranian Red Crescent Medical Journal, 14, 86–95.
DiMatteo, M. R. (2004). Variations in patients’ adherence to medical recommendations: A quantitative review of 50 years of research. Medical Care, 42, 200–209.
DiMatteo, M. R., et al. (2007). Health beliefs, disease severity, and patient adherence: A meta-analysis. Medical Care, 45, 521–528.
DiMatteo, M. R., et al. (2012). Improving patient adherence: A three-factor model to guide practice. Health Psychology Review, 6, 74–91.
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel plot based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.
Easterbrook, P. J., et al. (1991). Publication bias in clinical research. The Lancet, 337, 867–872.
Fan, X., et al. (1999). Effects of sample size, estimation methods, and model specification on structural equation modeling fit indexes. Structural Equation Modeling: A Multidisciplinary Journal, 61, 56–83.
Ferguson, C. J., & Heene, M. (2012). A vast graveyard of undead theories publication bias and psychological science’s aversion to the null. Perspectives on Psychological Science, 7, 555–561.
Fishbein, M., & Ajzen, I. (1975). Belief, attitude, intention and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.
Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. New York: Psychology Press (Taylor & Francis).
Gatt, S., & Sammut, R. (2008). An exploratory study of predictors of self-care behaviour in persons with type 2 diabetes. International Journal of Nursing Studies, 45, 1525–1533.
Godin, G., & Kok, G. (1996). The theory of planned behavior: A review of its applications to health-related behaviors. American Journal of Health Promotion, 11, 87–98.
Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69–119.
Grenard, J. L., et al. (2011). Depression and medication adherence in the treatment of chronic diseases in the United States: A meta-analysis. Journal of General Internal Medicine, 26, 1175–1182.
Hagger, M. S., & Chatzisarantis, N. L. (2009). Integrating the theory of planned behaviour and self-determination theory in health behaviour: A meta-analysis. British Journal of Health Psychology, 14, 275–302.
Hagger, M. S., & Chatzisarantis, N. L. (2014a). An integrated behavior change model for physical activity. Exercise and Sport Sciences Reviews, 42, 62–69.
Hagger, M. S., & Chatzisarantis, N. L. D. (2014b). It is premature to regard the ego-depletion effect as ‘Too Incredible’. Frontiers in Psychology, 5, 1–2.
Hagger, M. S., & Chatzisarantis, N. L. D. (2015). The trans-contextual model of autonomous motivation in education: Conceptual and empirical issues and meta-analysis. Review of Educational Research. doi:10.3102/0034654315585005
Hagger, M. S., & Luszczynska, A. (2014). Implementation intention and action planning interventions in health contexts: State of the research and proposals for the way forward. Applied Psychology: Health and Well-Being, 6, 1–47.
Hagger, M. S., et al. (2002). A meta-analytic review of the theories of reasoned action and planned behavior in physical activity: Predictive validity and the contribution of additional variables. Journal of Sport & Exercise Psychology, 24, 3–32.
Hall, P. A. (2014). Re-establishing momentum in theory development: a commentary on Sniehotta, Presseau and Araújo-Soares. Health Psychology Review. doi:10.1080/17437199.2014.896080
Hall, P. A., & Fong, G. T. (2010). Temporal self-regulation theory: Looking forward. Health Psychology Review, 4, 83–92.
Hardeman, W., et al. (2002). Application of the theory of planned behaviour in behaviour change interventions: A systematic review. Psychology and Health, 17, 123–158.
Haskard-Zolnierek, K. B., & DiMatteo, M. R. (2009). Physician communication and patient adherence to treatment: A meta-analysis. Medical Care, 47, 826–834.
Hausenblas, H. A., et al. (1997). Application of the theories of reasoned action and planned behavior to exercise behavior: A meta-analysis. Journal of Sport & Exercise Psychology, 19, 36–51.
Haynes, R. B., et al. (2008). Interventions for enhancing medication adherence. Cochrane Database Syst Rev, 2, CD000011.
Hebert, E. A., et al. (2010). Attrition and adherence in the online treatment of chronic insomnia. Behavioral Sleep Medicine, 8, 141–150.
Higgins, E. T., et al. (2003). Transfer of value from fit. Journal of Personality and Social Psychology, 84, 1140–1153.
Hooghe, M., et al. (2010). Why can’t a student be more like an average person? Sampling and attrition effects in social science field and laboratory experiments. Annals of the American Academy of Political and Social Science, 628, 85–96.
Horne, R., & Weinman, J. (1999). Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47, 555–567.
Horne, R., et al. (2005). Concordance, adherence and compliance in medicine taking. London: NCCSDO.
Horne, R., et al. (2013). Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: A meta-analytic review of the necessity-concerns framework. PLoS ONE, 8, e80633.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55.
Jackson, C., et al. (2014). Applying COM-B to medication adherence. The European Health Psychologist, 16, 7–17.
Jones, C. J., et al. (2013). Evaluating the effectiveness of health belief model interventions in improving adherence: A systematic review. Health Psychology Review, 8, 1–17.
Kardas, P., et al. (2013). Determinants of patient adherence: A review of systematic reviews. Frontiers in Pharmacology, 4, 91.
Kohler, J. C., & Baghdadi-Sabeti, G. (2011). The world medicines situation 2011. Geneva: World Health Organization.
Langebeek, N., et al. (2014). Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: A meta-analysis. BMC Medicine, 12, 142.
Leventhal, H., et al. (1980). The common sense representation of illness danger. Contributions to Medical Psychology, 2, 7–30.
Loghman-Adham, M. (2003). Medication noncompliance in patients with chronic disease: Issues in dialysis and renal transplantation. American Journal of Managed Care, 9, 155–173.
Manning, M. (2009). The effects of subjective norms on behaviour in the theory of planned behaviour: A meta-analysis. British Journal of Social Psychology, 48, 649–705.
McEachan, R. R. C., et al. (2011). Prospective prediction of health-related behaviours with the theory of planned behaviour: A meta-analysis. Health Psychology Review, 5, 97–144.
McHorney, C. A. (2008). The adherence estimator: A brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease. Current Medical Research and Opinion, 25, 215–238.
McLachlan, S., et al. (2011). The development of a scale measuring integrated regulation in exercise. Br J Health Psychol, 16, 722–743.
Michie, S., et al. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.
Miller, P., et al. (1992). Fishbein’s Model of Reasoned Action and compliance behavior of hypertensive patients. Nursing Research, 41, 104–106.
Moher, D., et al. (2009). Preferred Reporting Items for Systematic reviews and Meta-analyses: The PRISMA statement. Annals of Internal Medicine, 151, 264–269.
Morisky, D. E., et al. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67–74.
Mullan, B., et al. (2011). The role of executive function in bridging the intention-behaviour gap for binge-drinking in university students. Addictive Behaviors, 36, 1023–1026.
Nieuwlaat, R., et al. (2014). Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews, 11, CD000011.
Ockene, I. S., et al. (2002). Task Force #4—adherence issues and behavior changes: Achieving a long-term solution. Journal of the American College of Cardiology, 40, 630–640.
Ogden, J. (2014). Time to retire the theory of planned behaviour? One of us will have to go! A commentary on Sniehotta, Presseau and Araújo-Soares. Health Psychology Review. doi:10.1080/17437199.2014.898679
Osterberg, L., & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine, 353, 487–497.
Peters, G.-J. Y., et al. (2013). Everything should be as simple as possible, but no simpler: Towards a protocol for accumulating evidence regarding the active content of health behaviour change interventions. Health Psychology Review, 9, 1–14.
Peters, J. L., et al. (2007). Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity. Statistics in Medicine, 26, 4544–4562.
Rhodes, R. E. (2014). Will the new theories (and theoreticians!) please stand up? A commentary on Sniehotta, Presseau and Araújo-Soares. Health Psychology Review. doi:10.1080/17437199.2014.882739
Ried, L. D., & Christensen, D. B. (1988). A psychosocial perspective in the explanation of patients’ drug-taking behavior. Social Science and Medicine, 27, 277–285.
Rosenstock, I. (1974). The health belief model and preventive health behaviour. Education Monographs, 2, 354–386.
Sabaté, E. (2003). Adherence to long-term therapies: Evidence for action. Geneva: World Health Organization.
Sainsbury, K., & Mullan, B. (2011). Measuring beliefs about gluten free diet adherence in adult coeliac disease using the theory of planned behaviour. Appetite, 56, 476–483.
Sainsbury, K., et al. (2013). Gluten free diet adherence in coeliac disease. The role of psychological symptoms in bridging the intention–behaviour gap. Appetite, 61, 52–58.
Schulze, R., & Wittmann, W. W. (2003). A meta-analysis of the theory of reasoned action and the theory of planned behavior: The principle of compatibility and multidimensionality of beliefs as moderators. In R. Schulze, H. Holling, & D. Böhning (Eds.), Meta-analysis: New Developments and Applications in Medical and Social Sciences (pp. 219–250). Seattle, WA: Hogrefe & Huber.
Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology, 57, 1–29.
Sheeran, P. (2002). Intention-behavior relations: A conceptual and empirical review. European Review of Social Psychology, 12, 1–36.
Sheeran, P., & Orbell, S. (1998). Do intentions predict condom use? Meta-analysis and examination of six moderator variables. British Journal of Social Psychology, 37, 231–250.
Sheeran, P., & Taylor, S. (1999). Predicting intentions to use condoms: A meta-analysis and comparison of the theories of reasoned action and planned behavior. Journal of Applied Social Psychology, 29, 1624–1675.
Sheeran, P., et al. (2013). Nonconscious processes and health. Health Psychology, 32, 460–473.
Shet, A., et al. (2014). Effect of mobile telephone reminders on treatment outcome in HIV: Evidence from a randomised controlled trial in India. BMJ, 349, g5978.
Sniehotta, F. (2009a). An experimental test of the theory of planned behavior. Applied Psychology: Health and Well-Being, 1, 257–270.
Sniehotta, F. F. (2009b). Towards a theory of intentional behaviour change: Plans, planning, and self-regulation. British Journal of Health Psychology, 14, 261–273.
Sniehotta, F., et al. (2015). On the development, evaluation and evolution of health behaviour theory. Health Psychology Review. doi:10.1080/17437199.2015.1022902
Sniehotta, F. F., et al. (2005). Bridging the intention–behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise. Psychology and Health, 20, 143–160.
Sniehotta, F. F., et al. (2014). Time to retire the theory of planned behaviour. Health Psychology Review, 8, 1–7.
Sterne, J. A., et al. (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. British Medical Journal, 343, 302–307.
Syrjala, A. M. H., et al. (2002). The theory of reasoned action in describing tooth brushing, dental caries and diabetes adherence among diabetic patients. Journal of Clinical Periodontology, 29, 427–432.
Terrin, N., et al. (2005). In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. Journal of Clinical Epidemiology, 58, 894–901.
Todd, J., et al. (2014). Reasoned versus reactive prediction of behaviour: A meta-analysis of the prototype willingness model. Health Psychology Review. doi:10.1080/17437199.2014.922895
Topa, G., & Moriano, J. A. (2010). Theory of planned behavior and smoking: Meta-analysis and SEM model. Substance Abuse and Rehabilitation, 1, 23–33.
Trafimow, D. (2014). On retiring the TRA/TPB without retiring the lessons learned: A commentary on Sniehotta, Presseau and Araújo-Soares. Health Psychology Review. doi:10.1080/17437199.2014.884932
Trafimow, D., et al. (2002). Evidence that perceived behavioural control is a multidimensional construct: Perceived control and perceived difficulty. British Journal of Social Psychology, 41, 101–121.
Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36, 1–48.
Vissman, A. T., et al. (2013). Correlates of HAART adherence among immigrant Latinos in the Southeastern United States. AIDS Care, 25, 356–363.
Viswesvaran, C., & Ones, D. S. (1995). Theory testing: Combining psychometric meta-analysis and structural equations modeling. Personnel Psychology, 48, 865–885.
Wallace, L., et al. (2014). Planning for, implementing and assessing the impact of health promotion and behaviour change interventions: A way forward for health psychologists. Health Psychology Review, 8, 8–33.
Webb, T. L., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132, 249–268.
West, R., & Brown, J. (2013). Theory of addiction. Chichester: Wiley.
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We would like to thank Selena Russo for her assistance with data extraction and analysis, Jemma Todd for her assistance with R Studio and the authors who sent additional data.
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Antonia Rich, Kim Brandes, Barbara Mullan, Martin S. Hagger declare that they have no conflict of interest to disclose
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Rich, A., Brandes, K., Mullan, B. et al. Theory of planned behavior and adherence in chronic illness: a meta-analysis. J Behav Med 38, 673–688 (2015). https://doi.org/10.1007/s10865-015-9644-3
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DOI: https://doi.org/10.1007/s10865-015-9644-3