emotional factors, such as anxiety, stress, tension and fear;
perceived symptoms, such as pain, breathlessness and fatigue;
the beliefs of the patient;
the beliefs of the health professionals.
Leventhal et al. suggested that a combination of these factors could be used to predict
and promote health-related behaviour.
In fact, most of the research that has aimed to predict health behaviours has
emphasized beliefs. Approaches to health beliefs include attribution theory, the health
locus of control, unrealistic optimism and the stages of change model.
Attribution theory
The development of attribution theory
The origins of attribution theory can be found in the work of Heider (1944, 1958),
who argued that individuals are motivated to see their social world as predictable and
controllable – that is, a need to understand causality. Kelley (1967, 1971) developed
these original ideas and proposed a clearly defined attribution theory suggesting that
attributions about causality were structured according to causal schemata made up of
the following criteria:
Distinctiveness: the attribution about the cause of a behaviour is specific to the
individual carrying out the behaviour.
Consensus: the attribution about the cause of a behaviour would be shared by others.
Consistency over time: the same attribution about causality would be made at any
other time.
Consistency over modality: the same attribution would be made in a different situation.
Kelley argued that attributions are made according to these different criteria and that
the type of attribution made (e.g. high distinctiveness, low consensus, low consistency
over time, low consistency over modality) determine the extent to which the cause of
a behaviour is regarded as a product of a characteristic internal to the individual or
external (i.e. the environment or situation).
Since its original formulation, attribution theory has been developed extensively and
differentiations have been made between self-attributions (i.e. attributions about one’s
own behaviour) and other attributions (i.e. attributions made about the behaviour of
others). In addition, the dimensions of attribution have been redefined as follows:
internal versus external (e.g. my failure to get a job is due to my poor performance in
the interview versus the interviewer’s prejudice);
stable versus unstable (e.g. the cause of my failure to get a job will always be around
versus was specific to that one event);
global versus specific (e.g. the cause of my failure to get the job influences other areas
of my life versus only influenced this specific job interview);
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