THEORY OF PLANNED

BEHAVIOR

INTRODUCTION
The theory of planned behaviour (TPB) is one of the most widely cited and applied behaviour theories.
It is one of a closely inter-related family of theories which adopt a cognitive approach to explaining
behaviour which centres on individuals attitudes and beliefs. The TPB (Ajzen 1985, 1991; Ajzen and
Madden 1986) evolved from the theory of reasoned action (Fishbein and Ajzen 1975) which posited
intention to act as the best predictor of behaviour. Intention is itself an outcome of the combination of
attitudes towards a behaviour. That is the positive or negative evaluation of the behaviour and its
expected outcomes, and subjective norms, which are the social pressures exerted on an individual
resulting from their perceptions of what others think they should do and their inclination to comply
with these. The TPB added a third set of factors as affecting intention (and behaviour); perceived
behavioural control. This is the perceived ease or difficulty with which the individual will be able to
perform or carry out the behaviour, and is very similar to notions of self-efficacy (see Bandura 1986,
1997; Terry et al. 1993). In addition to attitudes and subjective norms (which make the theory of
reasoned action), the theory of planned behavior adds the concept of perceived behavioral control,
which originates from self-efficacy theory (SET). Self-efficacy was proposed by Bandura in 1977,[1]
which came from social cognitive theory. According to Bandura, expectations such as motivation,
performance, and feelings of frustration associated with repeated failures determine effect and

behavioral reactions. Bandura separated expectations into two distinct types: self-efficacy and outcome
expectancy.[2] He defined self-efficacy as the conviction that one can successfully execute the behavior
required to produce the outcomes. The outcome expectancy refers to a person's estimation that a given
behavior will lead to certain outcomes. He states that self-efficacy is the most important precondition
for behavioral change, since it determines the initiation of coping behavior

The TPB has been used successfully to predict and explain a wide range of health behaviors and
intentions including smoking, drinking, health services utilization, breastfeeding, and substance use,
among others. The TPB states that behavioral achievement depends on both motivation (intention) and
ability (behavioral control). It distinguishes between three types of beliefs - behavioral, normative, and
control.
Using the theory of planned behavior in health services for a high quality care through patient centered
communication: whereby
Behavioral belief: an individual's belief about consequences of particular behavior. The concept
is based on the subjective probability that the behavior will produce a given outcome that is,
through patient centered communication high quality care can be achieved.
Attitude toward behavior: an individual's positive or negative evaluation of self-performance
of the particular behavior. The concept is the degree to which performance of the behavior is
positively or negatively valued. It is determined by the total set of accessible behavioral beliefs

linking the behavior to various outcomes and other attributes thait is whether health care
workers should or should not improve communication skills and how it is valued either
positively or negatively with risks and rewards. For e.g taken positively, improving
communication skills through patient centered communication will definitely leads to smooth
ongoing of processes wherby patient is informed about their diagnosis and why the given
treatment is most appropriate.
Subjective norm: an individual's perception about the particular behavior, which is influenced
by the judgment of significant others (e.g., patients, collegues, other staffs, seniors and
surrounding). There can be pressure from collegues and other staffs like assessing one's way of
communicating with patients to improve communication skills because in so doing we will
acheive patient centered communication which is our main aim therefore the need to adopt a
positive attitude toward the given behavior. Or, all staffs are adopting such a behavior and
acheiving satisfactory so to fit in the group, others should follow.
Perceived behavioral control: an individual's perceived ease or difficulty of performing the
particular behavior.[3] It is assumed that perceived behavioral control is determined by the total
set of accessible control beliefs and measure the confidence toward the probabiltity, feasibility
or likelihood of executing a given behavior that is, it will be easy to improve health care
workers' communication skills, health care workers are in favor for the improvement of the
current communication skills.
Control beliefs: an individual's beliefs about the presence of factors that may facilitate or
impede performance of the behavior.[4] The concept of perceived behavioral control is
conceptually related to self-efficacy. However it can be hindered by constraints such as beliefs
that one's behavior will not have any impact. Health care workers can improve their
communication skills due to motivation from the others, through performance appraisal that is
improving communication skills will increase patient satisfaction and after service has been
provided to them, patients thanks healthcare workers for their oustanding work (wow effect) or
cannot improve because of frustration and stress because a way to assess healthcare workers on
how they are applying their communication skills on each process with a patient is observed by
their superiors which renders their behavior static due to stress.

 Behavioral intention: an indication of an individual's readiness to perform a given behavior. It

is assumed to be an immediate antecedent of behavior.[5] It is based on attitude toward the
behavior, subjective norm, and perceived behavioral control, with each predictor weighted for
its importance in relation to the behavior and population of interest. The readiness to perform
quality communication for patient centered care based on attitude: improving the actual
communication skills, subjective norm: how it is perceived by others and perceived behavioral
control: whether it will be easy for health care workers to improve it or it is loosing time on
something that will have no effect on patients.
Behavior: an individual's observable response in a given situation with respect to a given target. Ajzen
said a behavior is a function of compatible intentions and perceptions of behavioral control in that
perceived behavioral control is expected to moderate the effect of intention on behavior, such that a
favorable intention produces the behavior only when perceived behavioral control is strong. Favorable
intention produce behavior only when perceived behavioral control is strong. Therefore, readiness to
improve communication skills will depend on how easy health care workers find it to improve and
having a positive attitude towards it and implementing this attitude will in turn provide high quality
care in terms of patient centered communication.

Limitations
The theory of planned behavior is based on cognitive processing and level of behavior change.
Compared to affective processing models, the theory of planned behavior overlooks emotional
variables such as threat, fear, mood and negative or positive feeling and assessed them in a limited
fashion.
In particular in the health-related behavior situation, given that most individuals' health behaviors are
influenced by their personal emotion and affect-laden nature, this is a decisive drawback for predicting
health-related behaviors.[6] Poor predictability for health-related behavior in previous health research
may be attributed to the exclusion of this variable. Also, there may be relapse, that is after the attitude
has been adopted and implemented, outcome expectancy is ultimate but later on if there is no improved
knowledge and volitional behavior, the situation will return to as it was earlier.
Furthermore, this theory limits itself to only one particular behavior but rule out other factors which
may be impeding high quality care through patient centered communication like abiding to existing

protocols and guidelines which have flaws and due to lack of awareness from the part of patients
creates misunderstanding and resulting in a negative behavior, therefore the need to revise the actual
protocols and guidelines for quality care.

conclusion
Theory of planned behavior can explain the relationship between behavioral intention and actual
behavior through perceived behavioral control unlike the theory of reasoned action. TPB help better
predict health-related behavioral intention than the theory of reasoned action.[7] The TPB has
improved the predictability of intention in various health-related fields such as condom use, leisure,
exercise, diet, etc.
In addition, the theory of planned behavior as well as the theory of reasoned action can explain the
individual's social behavior by considering "social norm" as an important variable. The theory of
planned behavior model is thus a very powerful and predictive model for explaining human behavior.
That is why the health and nutrition fields have been using this model often in their research studies.
However, the TPB is not considered useful or effective in relation to planning and designing the type of
intervention that will result in behaviour change (Hardeman et al 2002; Taylor et al. 2007; Webb et al.
2010). Using the theory to explain and predict likely behaviour may, however, be a useful method for
identifying particular influences on behaviour that could be targeted for change. As Hardeman et al.
(2002: 149).

REFERENCES
1.Bandura, A. (1977). Self-efficacy: toward a unifying theory of behavioral change. Psychological
review 84 (2): 191.
Bandura, A. (1994). Selfefficacy. John Wiley & Sons, Inc.
2.Bandura, A., Adams, N. E., Hardy, A. B., & Howells, G. N. (1980). Tests of the generality of selfefficacy theory. Cognitive Therapy and Research, 4(1), 39-66.
3.Ajzen, I. (2001). Nature and operation of attitudes. Annual review of psychology, 52(1), 27-58.
4.Ajzen, I. (2002). Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of
Planned Behavior. Journal of Applied Social Psychology, 32, 665-683.
5.Fishbein, M., & Cappella, J. N. (2006). The role of theory in developing effective health
communications. Journal of Communication, 56(s1), S1-S17.
6.Sniehotta, F.F. (2009). An experimental test of the Theory of Planned Behavior. Applied Psychology:
Health and Well-Being, 1, 257270.
7.Dutta-Bergman, M. J. (2005). Theory and Practice in Health Communication Campaigns: A Critical
Interrogation. Health Communication 18:2 pages 103-122
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