Advancing the Theory of Planned Behavior within Dietary and Physical Domains among Type 2 Diabetics: A Mixed Methods Approach

Many studies have applied the Theory of Planned Behavior (TPB) in predicting health behaviors among unique populations. However, a new paradigm is emerging where focus is now directed to modification and expansion of the TPB model rather than utilization of the traditional theory. This review proposes new models modified from the Theory of Planned Behavior and suggest an appropriate study design that can be used to test the models within physical activity and dietary practice domains among Type 2 diabetics in Kenya. The review was conducted by means of literature search in the field of nutrition behavior, health psychology and mixed methods using predetermined key words. The results identify pre-intention and post intention gaps within the TPB model that need to be filled. Additional psychosocial factors are proposed to be included in the TPB model to generate new models and the efficacy of these models tested using mixed methods design.

Authors:

• D.O. Omondi
• M.K. Walingo
• G.M. Mbagaya
• L.O.A. Othuon

Keywords:

• Physical activity
• diet
• Type 2 diabetes
• behaviorchange theory
• model.

References:

[1] Canadian Diabetes Association Guidelines Expert Committee "Clinical
Practice Guidelines for the Prevention and Management of Diabetes in
Canada," Canadian Journal of Diabetes, Vol.27, no.2, pp. 1-152, 2003.
[2] Ministry of Health "Report on Non-Communicable Diseases 2006
(Unpublished Style)," Unpublished.
[3] World Health Organization (WHO) "Global strategy of diet, physical
activity and health". African Regional Consultation Meeting Report
Harare, Zimbabwe, 28 - 20 March, 2003.
[4] C.C. Mobley and T. Marshall "Impact of dietary quality and nutrition on
general health status," In Nutrition and Oral Medicine C.C. Mobley,
A.D. Sirois and, R. Tougher-Decker Springer: Human Press, 2007, pp.
3-15.
[5] Kenyatta National Hospital Diabetic, "Manual Report (Unpublished
work style)," Unpublished.
[6] I. Ajzen, "The Theory of Planned Behavior," Organizational Behavior
and Human Decision Processes, Vol.50, pp. 179-211, Dec. 1991.
[7] N. A. Åstr├©m and, I. Okullo, "Temporal Stability of the Theory of
Planned Behavior: A Prospective Analysis of Sugar Consumption
among Ugandan Adolescents," Community Dentistry and Oral
Epidemiology, Vol. 32, no.6, pp426-434, Dec. 2004.
[8] J. C. Armitage and M. Conner, "Distinguishing Perceptions of Control
from Self-Efficacy: Predicting Consumption of a Low-Fat Diet Using
the Theory of Planned Behavior," Journal of Applied Social
Psychology, Vol. 29, no. 1, pp. 72-90, 1999.
[9] A. Furnham and J. Lovett, "Predicting the Use of Complementary
Medicine. A test of Theories of Reasoned Action and Planned
Behavior," Journal of Applied Social Psychology, Vol. 31, no.12,
pp.2588-2620, 2001.
[10] P. Norman and S. Hoyle, "The Theory of Planned Behavior and Breast
Self-Examination. Distinguishing between Perceived Control and Self-
Efficiency," Journal of Applied Psychology," Vol.34, no.4, pp. 694-708,
2004.
[11] J. C. Armitage and J. C. Conner, "Extending the Theory of Planned
Behavior: A Review and Avenues for Further Research-" Journal of
Applied Social Psychology, Vol.28, No. 15, pp.1429-1464, 1998.
[12] M. L. Nejad, H. E. Wertheim and M. K. Greenwood, "Predicting
Dieting by Using, Modifying, and Extending the Theory of Planned
Behavior" Journal of Applied Social Psychology, Vol. 34, no.10, pp.
2099-2031, 2004.
[13] I. Ajzen, "Perceived behavioral Control, Self-Efficacy, Locus of
Control, and The Theory of Planned Behavior," Journal of Applied
Psychology, Vol. 3, no. 44, pp 665-683, Jul. 2006.
[14] S. Courneya K., C. E. Plotnikoff and J. N. Birkett, "Social Support and
the Theory of Planned Behavior in Exercise Domain," American
Journal of Health Behaviour, Vol. 249, no.4, pp. 300-308, 2000.
[15] E. R. Gardner and A. H. Housenblas, "Exercise and Diet Beliefs of
Overweight Women Participating in an Exercise and Diet Program. An
Elicitation Study Using the Theory of Planned Behavior," Journal of
Applied Biology Research, Vol. 9, no.3, pp.188-200, Jul. 2004.
[16] L. C. Blue, "Does the Theory of Planned Behavior identify Diabetesrelated
Cognitions for Intention to be Physically Active and Eat a
Healthy Diet?" Public Health Nursing, Vol. 24, no. 2, pp. 141-150,
Feb. 2007.
[17] C. J. Armitage, and M. Conner, "Social cognition models and health. A
structured review," Psychology and Health, Vol. 15, pp. 173-189,
2000.
[18] K. Wallston and C. Armstrong, "Theoretically - based strategies for
health behavior change" In Health promotion in the workplace M.P.
O-Donnell, (3rd ed.). Albany, NY: Delmar, 2002, pp. 182-201.
[19] N. D. Weinstein, "Exploring the links between risk perceptions and
preventive health behavior," In Social psychological foundations of
health and illness, J. Suls and K. Wallston (Eds.). Oxford, England:
Blackwell, 2003, pp. 22-53.
[20] C. M. Blanchard, K. S. Courneya, W. M. Rodgers, B. Daub, and G.
Knapik, "Determinants of exercise intentions and during and after phase
2 cardiac rehabilitation: An application of the Theory of Planned
Behavior," Rehabilitation Psychology, Vol 47, pp308-323, 2002.
[21] P. A. Ades, "Cardiac rehabilitation and secondary prevention of
coronary heart disease," New England Journal of Medicine, Vol. 345,
pp.892-902, Sept. 2001.
[22] F. J. S. Donker, "Cardiac rehabilitation. A review of current
developments," Clinical Psychology Review, Vol.20, no.7, pp.923-943,
Oct. 2000.
[23] F. Falko, S. Sniehotta, Urte, and S. Ralf, "Bridging the intention - gap;
Planning, self - efficacy and action in the adoption and maintenance of
physical exercise," Psychology and Health, Vol.20, no.2, pp. 143-160,
Apr. 2005.
[24] H. Heckhausen, Motivation and action. New York: Springer, 1991.
[25] K. Glanz, B.K, Rimer, and F.M. Lewis, Health and health education.
Theory, Research and Practice. San Fransisco: Wiley & Sons, 2002.
[26] W. J. Creswell, Research Design. Qualitative, quantitative, and mixed
methods approach. SAGE Publications, Inc, California, USA, 2009.
[27] D. Morgan, "Practical strategies for combining qualitative and
quantitative methods: Application to health research," Qualitative
Health Research, Vol.8, no.3, pp.362-376, 1998.
[28] J.W. Creswell, and V.l. Plano Clark, Designing and conducting mixed
methods research. Thousand Oaks, CA: Sage, 2007.
[29] R. Cameron, "A sequential mixed model research design. Design
analytical and display issues-" International Journal of Multiple
Research Approaches, Vol.3, no.2, pp.140-152, 2009.
[30] R. B. Johnson, "Mixed methods research paradigm whose time has
come," Education Researcher, Vol.33, no.7, pp. 14-26, 2004..
[31] P. Clarke, "Understanding the experience of stroke: A mixed method
research agenda," The Gerontologist, Vol. 49, no3, pp. 293-302, Jun.
2009.
[32] C. Day, "Combining qualitative and quantitative methodologies in
research on teachers- lives, work and effectiveness: From integrated to
synergy," Education Researcher, Vol. 37, no.6, pp. 330-342, 2008.