Health Psychology, 2nd Edition

154 MOTIVATION AND BEHAVIOUR

the con templation stage, while self-efficacy was targeted in individuals in the action
stage and this would be reversed in a mismatched intervention. Unfortunately, few
such matched–mismatched studies have produced evidence supportive of stage models
(see Littell and Girvin, 2002 for a systematic review of the effectiveness of interventions
applying the TTM to health-related behaviours). Thus, at present, research findings
do not support the added complexity and increased cost of stage-tailored interventions.
West (2005) in reviewing stage models has recently suggested that work on the TTM
should be abandoned.
It is difficult to usefully categorize people as ‘pre-contemplators’ or those ‘in
preparation’ because people frequently cycle between such states as their motivation
to change shifts. Nonetheless, an individual at a particular time may be more focused
on deciding whether or not to act or on ensuring that they act on a prior decision to
act (i.e. an intention). This is captured by the terms ‘motivational phase’ and ‘volitional
phase’, respectively. This two-phase conception of action readiness suggests that health
promoters need to think about how they can consolidate people’s motivation to act
and how they can help people to enact their intentions (see Chapters 8 and 9). In general,
the social cognition models considered in this chapter have focused on the former. For
example, the TPB does not help us distinguish between intenders who do and do not
take action. Thus there is a need to better theorize the processes that determine which
intentions are translated into action. As Bagozzi (1993) argues, the variables outlined
in the main social cognition models are necessary, but not sufficient, determinants of
behaviour. In other words, they can provide good predictions of people’s intentions
(or motivation) to perform a health behaviour, but not always their actual behaviour.
This area of research has been referred to as the ‘intention–behaviour gap’.

Deciding between social cognition models

Although a great deal of research has been devoted to testing individual social

cognition models, little research has compared the relative predictive power of

different SCMs. For example, Reid and Christensen (1988) found that while the

HBM explained 10 per cent of the variance in adherence among women taking

tablets for urinary tract infections to a tablet regimen, the variance explained

increased to 29 per cent when cognitions specified by the theory of reasoned

action were added.

Another approach to the variety of SCMs is to integrate them. This may be

valuable, especially since many include similar cognitions. For example,

commentators agree that the key cognitions prominently include intention, self-

efficacy and outcome expectancies (or attitudes). An important attempt to integrate

these models was made by Bandura (SCT), Becker (HBM), Fishbein (TRA), Kaufen

(self-regulation) and Triandis (theory of interpersonal behaviour) as part of a

workshop organized by the US National Institute of Mental Health in response to

the need to promote HIV-preventive behaviours. The workshop sought to ‘identify

FOCUS 7.3