PROBLEMS WITH THE MODELS
Cognition and social cognition models provide a structured approach to understanding
health beliefs and predicting health behaviours. However, over recent years several
papers have been published criticizing these models. These problems can be categorized
as conceptual, methodological and predictive.Conceptual problems
Some researchers have pointed to some conceptual problems with the models in terms of
their variables and their ability to inform us about the world. These problems are as
follows:
Each model is made up of different concepts such as perceived behavioural control,
behavioural intentions, perceived vulnerability and attitudes. Norman and Conner
(1996) have argued that there is some overlap between these variables and Armitage
and Conner (2000) have argued for a ‘consensus’ approach to studying health
behaviour, whereby key constructs and integrated across models.
The models describe associations between variables which assume causality. For
example, the TPB describes attitude as causing behavioural intention. Sutton (2002a)
argues that these associations are causally ambiguous and cannot be concluded unless
experimental methods are used. Similarly, Smedlund (2000) criticized the models for
their logical construction and said that assumptions about association are flawed.
A theory should enable the collection of data which can either lead to theory being
supported or rejected. Ogden (2003) carried out an analysis of studies using the
HBM, TRA, PMT and TPB over a four year period and concluded that the models
cannot be rejected as caveats can always be offered to perpetuate the belief that the
model has been supported.
Research should generate truths which are true by observation and require an empir-
ical test (e.g. smoking causes heart disease) rather than by definition (i.e. heart dis-
ease causes narrowing of the arteries). Ogden (2003) concluded from her analysis
than much research using the models produces statements that are true by definition
(i.e. I am certain that I will use a condom therefore I intend to use a condom). She
argues that the findings are therefore tautological.
Research should inform us about the world rather than create the world. Ogden
(2003) argues that questionnaires which ask people questions such as ‘do you think
the female condom decreases sexual pleasure for a man’ may change the way in
which people think rather than just describe their thoughts. This is similar to changes
in mood following mood check lists, and the ability of diaries to change behaviour.Methodological problems
Much research using models such as the TPB, TRA and HBM use cross-sectional designs
involving questionnaires which are analysed using multiple regression analysis.
Researchers have highlighted some problems with this approach.36 HEALTH PSYCHOLOGY