outcome expectancies (e.g. ‘stopping smoking will improve my health’), which has a
subset of social outcome expectancies (e.g. ‘other people want me to stop smoking and if
I stop smoking I will gain their approval’);
threat appraisal, which is composed of beliefs about the severity of an illness and
perceptions of individual vulnerability.
According to the HAPA the end result of the HAPA is an intention to act.
The action stage is composed of cognitive (volitional), situational and behavioural
factors. The integration of these factors determines the extent to which a behaviour is
initiated and maintained via these self-regulatory processes. The cognitive factor is
made up of action plans (e.g. ‘if offered a cigarette when I am trying not to smoke I
will imagine what the tar would do to my lungs’) and action control (e.g. ‘I can survive
being offered a cigarette by reminding myself that I am a non-smoker’). These two
cognitive factors determine the individual’s determination of will. The situational fac-
tor consists of social support (e.g. the existence of friends who encourage non-
smoking) and the absence of situational barriers (e.g. financial support to join an
exercise club).
Schwarzer (1992) argued that the HAPA bridges the gap between intentions
and behaviour and emphasizes self-efficacy, both in terms of developing the intention to
act and also implicitly in terms of the cognitive stage of the action stage, whereby self-
efficacy promotes and maintains action plans and action control, therefore contributing
to the maintenance of the action. He maintained that the HAPA enables specific pre-
dictions to be made about causality and also describes a process of beliefs whereby
behaviour is the result of a series of processes.
Support for the HAPA
The individual components of the HAPA have been tested providing some support for
the model. In particular, Schwarzer (1992) claimed that self-efficacy was consistently
the best predictor of behavioural intentions and behaviour change for a variety
of behaviours such as the intention to dental floss, frequency of flossing, effective use of
contraception, breast self-examination, drug addicts’ intentions to use clean needles,
intentions to quit smoking, and intentions to adhere to weight loss programmes and
exercise (e.g. Beck and Lund 1981; Seydal et al. 1990).
Criticisms of the HAPA
Again, as with the other cognition and social cognition models, the following questions
arise when assessing the value of the HAPA in predicting health behaviours: Are
individuals conscious processors of information? And what role do social and environ-
mental factors play? The social cognition models attempt to address the problem of the
social world in their measures of normative beliefs. However, such measures only access
the individual’s cognitions about their social world.
HEALTH BELIEFS 35