Annals of Behavioral Medicine

, Volume 33, Issue 2, pp 156–166

Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity

  • Ralf Schwarzer
  • Benjamin Schüz
  • Jochen P. Ziegelmann
  • Sonia Lippke
  • Aleksandra Luszczynska
  • Urte Scholz


Background: Adoption and maintenance of health behaviors are often poorly predicted by behavioral intentions. To bridge the gap between intentions and behavior, strategic planning and recovery self-efficacy have been suggested as proximal predictors.Purpose: The aim was to examine the usefulness of a prediction model that includes planning and self-efficacy as postintentional mediator variables.Methods: Four longitudinal studies were conducted on dental flossing (Study I, N = 157), seat belt use (Study II, N = 298), dietary behaviors (Study III, N = 700), and physical activity (Study IV, N = 365). Dental flossing and seat belt use were assessed in students by paper-and-pencil questionnaires, whereas dietary behavior and physical activity inventories were presented to the general public in the internet.Results: By structural equation modeling, it was found that one common model fits all four data sets well. Results differed in terms of variance accounted for, but the overall patterns of estimated parameters were similar across samples.Conclusions: Self-efficacy and planning seemed to be functional as proximal predictors of health behaviors, whereas health risk perception appeared to be a negligible factor. When predicting health behaviors, self-regulatory variables should be used in addition to the behavioral intention.


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  1. (1).
    Maddux JE, Rogers RW: Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change.Journal of Experimental Social Psychology. 1983,19:469–479.CrossRefGoogle Scholar
  2. (2).
    Ajzen I: Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior.Journal of Applied Social Psycholog. 2002,32:665–683.CrossRefGoogle Scholar
  3. (3).
    Sheeran P: Intention-behavior relations: A conceptual and empirical review. In Stroebe W, Hewstone M (eds),European Review of Social Psychology (Vol. 12). Chichester, England: Wiley, 2002, 1–30.Google Scholar
  4. (4).
    Luszczynska A, Schwarzer R: Planning and self-efficacy in the adoption and maintenance of breast self-examination: A longitudinal study on self-regulatory cognitions.Psychology and Health. 2003,18:93–108.CrossRefGoogle Scholar
  5. (5).
    Scholz U, Sniehotta FF, Schwarzer R: Predicting physical exercise in cardiac rehabilitation: The role of phase-specific self-efficacy beliefs.Journal of Sport & Exercise Psychology. 2005,27:135–151.Google Scholar
  6. (6).
    Lippke S, Ziegelmann JP, Schwarzer R: Initiation and maintenance of physical exercise: Stage-specific effects of a planning intervention.Research in Sports Medicine. 2004,12:221–240.CrossRefGoogle Scholar
  7. (7).
    Sniehotta FF, Scholz U, Schwarzer R: Bridging the intention-behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise.Psychology & Health. 2005,20:143–160.CrossRefGoogle Scholar
  8. (8).
    Ziegelmann JP, Lippke S, Schwarzer R: Adoption and maintenance of physical activity: Planning interventions in young, middle-aged, and older adults.Psychology & Health. 2006,21:145–163.CrossRefGoogle Scholar
  9. (9).
    Marlatt GA, Baer JS, Quigley LA: Self-efficacy and addictive behavior. In Bandura A (ed),Self-Efficacy in Changing Societies. New York: Cambridge University Press, 1995, 289–315.Google Scholar
  10. (10).
    Luszczynska A, Sutton S: Maintenance and recovery self-efficacy beliefs predict maintenance of rehabilitation exercises or recovery from relapse among patients after MI.Rehabilitation Psychology 2006,51:314–321.CrossRefGoogle Scholar
  11. (11).
    Rodgers WM, Hall CR, Blanchard CM, McAuley E, Munroe KJ: Task and scheduling self-efficacy as predictors of exercise behaviour.Psychology and Health. 2002,27:405–416.CrossRefGoogle Scholar
  12. (12).
    Rodgers W, Sullivan MJL: Task, coping and scheduling self-efficacy in relation to frequency of physical activity.Journal of Applied Social Psychology. 2001,31:741–753.CrossRefGoogle Scholar
  13. (13).
    Schwarzer R, Renner B: Social-cognitive predictors of health behavior: Action self-efficacy and coping self-efficacy.Health Psychology. 2000,19:487–495.PubMedCrossRefGoogle Scholar
  14. (14).
    Lewin K: Group decision and social change. In Newcomb TM, Hartley EL (eds),Readings in Social Psychology. New York: Holt, 1947, 330–344.Google Scholar
  15. (15).
    Leventhal H, Singer R, Jones S: Effects of fear and specificity of recommendation upon attitudes and behavior.Journal of Personality and Social Psychology. 1965,2:20–29.CrossRefGoogle Scholar
  16. (16).
    Gollwitzer PM: Implementation intentions: Strong effects of simple plans.American Psychologist. 1999,54:493–503.CrossRefGoogle Scholar
  17. (17).
    Armitage CJ: Evidence that implementation intentions reduce dietary fat intake: A randomized trial.Health Psychology. 2004,23:319–323.PubMedCrossRefGoogle Scholar
  18. (18).
    Arbuckle JL, Wothke W:Amos 4.0 User Guide. Chicago: Small Waters, 1999.Google Scholar
  19. (19).
    Hu L, Bentler PM: Evaluating model fit. In Hoyle RH (ed),Structural Equation Modeling. Concepts, Issues, and Applications. Thousand Oaks, CA: Sage, 1995, 76–99.Google Scholar
  20. (20).
    Rise J, Åstrøm AN, Sutton S: Predicting intentions and use of dental floss among adolescents: An application of the theory of planned behavior.Psychology and Health. 1998,13:223–236.CrossRefGoogle Scholar
  21. (21).
    Schüz B, Sniehotta FF, Wiedemann, A, Seemann R: Adherence to a daily flossing regimen in university students: Effects of planning when, where, how, and what to do in the face of barriers.Journal of Clinical Periodontology 2006,33:612–619.PubMedCrossRefGoogle Scholar
  22. (22).
    McKnight RH, Dawson SK: Seat belt use in Kentucky—a comparison of five measures.The Journal of the Kentucky Medical Association. 1996,94:110–114.PubMedGoogle Scholar
  23. (23).
    Rademacher JDM, Lippke S: Dynamic online surveys and experiments with the free open source software dynQuest.Behavior Research Methods (in press).Google Scholar
  24. (24).
    Jones F, Abraham C, Harris P, Schulz J, Chrispin C: From knowledge to action regulation: Modeling the cognitive prerequisites of sun screen use in Australian and UK samples.Psychology and Health. 2001,16:191–206.CrossRefGoogle Scholar
  25. (25).
    Norman P, Conner M: The Theory of Planned Behavior and exercise: Evidence for the mediating and moderating roles of planning on intention-behavior relationships.Journal of Sport and Exercise Psychology. 2005,27:488–504.Google Scholar
  26. (26).
    Calisir F, Lehto MR: Young drivers’ decision making and safety belt use.Accident Analysis & Prevention. 2002,34:793–805.CrossRefGoogle Scholar
  27. (27).
    Fishbein M, Ajzen I:Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Reading, MA: Addison-Wesley, 1975.Google Scholar
  28. (28).
    Bandura A:Self-Efficacy: The Exercise of Control. New York: Freeman, 1997.Google Scholar
  29. (29).
    Luszczynska A, Mazurkiewicz M, Ziegelmann JP, Schwarzer R: Recovery self-efficacy and intention as predictors of running: A cross-lagged panel analysis over a two-year period.Psychology of Sport and Exercise 2007,8:247–260.CrossRefGoogle Scholar
  30. (30).
    Weinstein ND: Misleading tests of health behavior theories.Annals of Behavioral Medicine (in press, 2006).Google Scholar
  31. (31).
    Miller DJ, Freedson PS, Kline GM: Comparison of activity levels using the Caltrac accelerometer and five questionnaires.Medicine and Science in Sports and Exercise. 1994,26:376–382.PubMedGoogle Scholar
  32. (32).
    Armitage CJ, Conner M: The theory of planned behavior: Assessment of predictive validity and ‘perceived control’.British Journal of Social Psychology. 1999,38:35–54.CrossRefGoogle Scholar
  33. (33).
    Nelson DE: Validity of self-reported data on injury prevention behavior: Lessons from observational and self-reported surveys of safety belt use in the US.Injury Prevention. 1996,2:67–69.PubMedCrossRefGoogle Scholar
  34. (34).
    Luszczynska A, Sobczyk A, Abraham C: Planning to lose weight: RCT of an implementation intention prompt to enhance weight reduction among overweight and obese women.Health Psychology (in press).Google Scholar
  35. (35).
    DiClemente, CC, Prochaska JO: Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance.Addictive Behaviors. 1982.7:133–142.PubMedCrossRefGoogle Scholar
  36. (36).
    Prochaska JO, Velicer WF, Rossi JS, et al.: Stages of change and decisional balance for 12 problem behaviors.Health Psychology. 1994,13:39–46.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2007

Authors and Affiliations

  • Ralf Schwarzer
    • 1
  • Benjamin Schüz
    • 1
  • Jochen P. Ziegelmann
    • 1
  • Sonia Lippke
    • 1
  • Aleksandra Luszczynska
    • 2
    • 3
  • Urte Scholz
    • 4
  1. 1.Health PsychologyFreie Universität BerlinBerlinGermany
  2. 2.University of SussexEngland
  3. 3.Warsaw School of Social PsychologyPoland
  4. 4.Universität ZürichSwitzerland

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