The Epidemic of Unhealthy Lifestyle

Introduction

The epidemic of unhealthy lifestyle – related diseases, particularly obesity – related diseases, is the biggest problem facing modern medicine. The prevalence of obesity and obesity – related metabolic diseases has gradually increased over the past two decades to pandemic proportions. It has been proven that obesity and overweight does not only limited to a particular age group, but previous cases have found that children obesity has reached alarming levels in both developed and developing countries.

Approximately 35 million children with overweight live in developing countries and 8 million children with this health problem live in developed countries.

The number is expected to rise to 60 million kids in the next decade. In some parts of Africa, the prevalence of childhood obesity ranges from 30% in America to 2%.

According to a study from (Kelishadi, Haghdoost, Sadeghirad, & Khajehkazemi, 2014), the prevalence of obesity was 42.8% for men and 57% for women as indicating a warning rate for obesity in Iran. In fact, obesity results from a complex interplay between the environment, genetic factors, and human behavior. From among these, environmental factors are the most common causes of the obesity epidemic. In most people, the primary reason for obesity is an unhealthy lifestyle, including inactivity, sedentary habits, and increased calorie intake.

Therefore, the main purpose of conducting this literature review is to understand and develop deeper insights about Theory of Planned Behavior histories, basic structure, cutting – edge TPB studies and evaluation of the development status and future direction of TPB in previous communication studies on child obesity, condom use, brand love, recycling and others.

Historical Growth of Theory Of Planned Behavior

Icek Ajzen has developed his first theory namely the theory of planned behavior in 1985 through his article he wrote “From practical reasons to actions”. The theory of planned behavior was acquired from theory of multi attribute attitude (TMA) and theory of reasoned action (TRA) (Ajzen & Fishbein, 1973). The theory of planned behavior is a theory of psychology that explains human behavior decision – making processes aimed at understanding and predicting individual behaviour, arguing that the successful completion of human behaviors is primarily controlled by individuals. Ajzen’s goal of creating this theory is to increase the scope of the Reason Action speculation.

According to Theory Reasoned Action, individuals ‘ behavioral intent is determined by two attitude and subjective standard factors in which the subjective standard is influenced by society’s normative beliefs and the attitude can be categorized into positive or negative aspects. Ajzen (1985) argued that external and objective factors affect human behavior more frequently than individual will. In addition to the subjective standard and attitude, Ajzen (1985) added the perceived behavioral control variable to add the power in human behavior prediction and TRA explanation.

The construct of the Theory of Planned Behaviour

The psychological theory of planned behavior (abbreviated TPB) is a theory that connects one’s beliefs and behaviour. The theory states that an individual’s behavioral intentions and behaviors are shaped by behavioral attitude, subjective norms, and perceived behavioral control. Icek Ajzen proposed the concept by including perceived behavior control to enhance the predictive power of reasoned action theory. Studies of beliefs, attitudes, behavioral intentions and behavior have been applied in previous research in various fields such as advertising, public relations, advertising campaigns, health care, sport management and sustainability.

The planned behavior theory is based on the assumption that people usually act consciously. They take into account the information available and consider the implications of their actions implicitly or explicitly (Ajzen, 2005). Intention is a function of three basic determinants in conjunction with the theory. One is of a personal nature, one reflects social influence and social pressure, and finally addresses control issues. The personal factor is the attitude towards the behavior of the individual. This attitude is the positive or negative evaluation of the individual’s performance of the particular interest behavior.

The second determinant of intention is subjective norm, consisting of the perception of the person’s social pressure to act the behavior under consideration but to not perform it. Subjective standards are determined by normative beliefs, i.e. the extent to which a person believes that the behavior should be performed by his / her important reference groups (Ajzen, Fishbein 1980). A person will generally perform a certain behavior if he or she is motivated to comply with his or her important referents and perceived social pressure to perform the behavior (Ajzen, Fishbein 1980).

Moreover, in the context of healthy eating from the paper written by young adults (Chan et al., 2009), they interpreted that parents and government advertisements encouraged them to eat healthy food more often than teachers or friends. Another researcher (Cheng et al.,2008) stated the similar point of view that parents play an important role in determining the types of food they eat. He concluded that results showed that children have better guidance in the foods they eat with the influence of parents, which can prevent unhealthy food consumption. Having said that, when it comes to the theory of planned behaviour, adolescents who experience a higher level of social norm will have to face it.

Finally, the principal determinant of intention is the sense of self-efficacy or ability to perform interest actions, termed perceived behavioral control. To summarize the core of the planned behavior theory: people intend to perform behaviour, evaluate it positively, experience social pressure to perform it, and believe they have the means and opportunities to do so (Ajzen 2005). Similarly, Conner et al. (2002)’s research showed that attitudes predicted intentions to eat healthily, perceived behavioral control, and perceived past behavior.

Information from a previous study, has confirmed that physical activity attitude and healthy eating have a significant effect on the intention, which was stronger in the healthy weight group compared to the overweight / obese group. These findings are consistent with the study by Deforche, De Bourdeaudhuij and Tanghe (2006), suggesting that overweight adolescents showed a more negative attitude towards exercise and lower participation in sports compared to normal weight adolescents, which means that overweight / obese behaviors of individuals are more affected by control beliefs and have lower behaviors.

Important Concepts

An objective of motive is the basic concept of planned conduct. Intention is based on the relationships between three factors: behavioral attitude, subjective standards, and perceived control of behaviour. The behavioral attitude refers to the extent to which a person has a favorable or unfavorable assessment or assessment of the behavior concerned (Ajzen 1991). The second intention predictor is a social factor described as a subjective norm that refers to perceived social pressure to perform the behavior or not. Perceived psychological power is the final parameter that predicts desire. The notion of perceived behavioral control develops the perceived ease or difficulty of performing the behavior combined with a reflection of past experiences and expected challenges. Each of the three concepts is independent, but they all form a web of interconnectivity that influences intention.

For instance, the application of the TPB was used in a McConnon study to prevent weight growth in an overweight cohort which has experienced a significant weight loss previously. It was found that the perceived need to control weight is the most positive behavior predictor for weight maintenance using TPB constructs. The TPB model can be used in a cohort of overweight to predict weight gain prevention expectations. Also, another study strongly suggested that TPB has the potential to change interventions to develop health-related behaviors. Godin, Gaston & Kok, Gerjo. (1996) concludes that TPB is an appropriate model for health – related behavior analysis. The literature demonstrates the hypotheses predictive power in smoking (Hassandra, Vlachopoulos, Kosmidou, Hatzigeorgiadis, Goudas, & Theodorakis, 2011; Norman, 1999), health (Karvinen et al., 2007) and safe sexual behavior (Albarracin, 2001).

Assumptions or arguments of the theory

Numerous researchers have many generalizations and argumentation about the theory of planned behavior. In the previous TPB research review, many studies indicated that control intentions and perceptions were combined in an additive way to predict behavior despite the fact that their psychological effects should be modeled as an interaction according to the theory. The linear combination was used as interaction between these two variables usually accounts for little or no additional variance in behavior when taking into consideration desire and perceived influence. There is evidence, however, that the effect of intentions on behavior is actually moderated by perceived control of behaviour, evidence coming from the food consumption domain (Papies et al., 2008).

First of all, the planned behavior theory is based on the assumption that people commonly act passively. They take into account the information available and consider the implications of their actions implicitly or explicitly (Ajzen 2005). TPB is not everything’s theory. Rather, it has a strict application scope. First, rational individual behavior is the object of TPB. Individual behaviors not included in the collective (e.g. protests, parades and community discussions), mental behaviors (e.g., sadness, anger and excitement) and individual collective behaviors (decision making) are not included in the framework of the TPB. (Bagozzi, Mokerjee & Dholakia, 2006).

Second, TPB examines only the specific individual behavior at a given time, in a specific context and with specific goals (such as watching a weekend movie) rather than general behaviors (such as watching movies) (Ajzen & Fishbein, 1977). Third, the principle is consistency. All TPB model elements must concentrate on the same levels that belong to the model. Therefore, the researcher must consider the specific attitude, the specific subjective standard and the corresponding impact on specific behaviour.

Fourth, TPB is generally used in stable contexts to predict new behaviors without incorporating repetitive behaviors and habits (Ouellette & Wood, 1998). Some studies have broadened the scope of the application of TPB by adding a new variable of existing experiences and habits, but this is not the original intention of TPB. Some studies that have failed to support TPB are contrary to this principle, such as predicting general behavior by watching films using the specific attitude of being content to watch a film or unwilling to predict specific behaviors by singing general attitudes (Armitage & Christian, 2003)

Application of theory in contemporary media or communication research

Several studies found that the TPB would help pinpoint better health-related behavioral intent than reasoned action theory. The TPB has improved intention predictability in various health-related fields such as child obesity, condom use, brand love, exercise, diet, etc. Previous studies using the Theory of Planned Behavior with adolescents showed variations in the pattern of gender relations in predicting healthy eating (Baker, Little, and Brownell 2003; Fila and Smith 2006; Chan, Ng, and Prendergast, 20).

Young people who have a more positive attitude towards healthy eating will have a higher intention to engage in eating healthy, as per the Theory of Planned Behaviour. This means that an individual will behave if he / she knows that their behavior can have beneficial effects on him / her or in other words, behavioral belief (Ajzen and Fishbein 1980).

In Povey, Conner, Sparks, James and Shepherd’s paper (2000), which studied TPB and healthy eating in a sample of 235 participants, it was shown that the TPB constructs explained 42 percent of variance in intentions and 15 percent of variance in behavior. Another research involving 735 young adults showed that TPB constructs explained 52% of the decision to eat healthy variance with the most powerful predictors being perceived behavioral control and subjective norm. (Åstrøm & Rise, 2001).

In addition, a study from previous research (Albarracín, Johnson, Fishbein, & Muellerleile, 2001) tested the effectiveness of TPB in predicting condom use behavior among college students in the U.S. reveals that the attitude of participants towards condom use, subjective standards, and perceived behavioral control significantly influences their intent to use condoms and their intention to use condoms is very strong.

Planned behavior theory has also introduced successfully for exercise behavior. (Ajzen, TPB, 1991). The TPB was used to predict and understand exercise behavior in various groups of people (Vallance et al., 2011). Many studies have reported that the TPB construct accounts for 39-44% of the variance in the general population’s exercise behavior (Hausenblas et al., 1997; Armitage & Conner, 2001; Hagger et al., 2002a; Rhodes et al., 2006; Vallance et al., 2011). However, data from multiple sources revealed that the constructs of TPB are more applicable to attempting to explain the intention of older adults to practice. For example, Lucidi et al. (2006); Lin et al. (2012) and Gretebeck et al. (2007) reported that the TPB variables explained 45%, 55% and 72% of the variance in PA in the elderly.

In addition, planned behavior theory also succeeded in acknowledging consumer decision-making (Ajzen, 1991, 2005, 2012). Rather than relying on a product or service’s overall evaluation or utility, this theory focuses on the particular consumer behavior of interest. Examples of food consumption include “”buying low-fat yogurt,”” “”eating genetically modified food over the next six months.

Personal norms also represent consumer perceptions as to whether the feeling of love for a brand is accepted, encouraged and implemented by the social circle of the consumer. Peer reviews and recommendations are increasingly influencing buying decisions of consumers (Karjaluoto etal., 2016). (Carroll and Ahuvia 2006) show that self-expressive brands are leading to increased brand love because self-expressive brands are signaling personal information to significant others. Karjaluoto et al. (2016) argue in the same line that consumers choose brands that they believe they would choose members of their reference or aspiration group. Brands can attract more brand love when they can meet the social needs of consumers (Vernuccio et al., 2015). Thus, a positive relationship between subjective norm and brand love is expected.

Finally, considerable research on recycling behavior using TPB has been carried out. The theory also emphasizes that perceived behavior control (PBC) can influence intention, because the individual must perceive that it is possible and relatively easy to act as intended in order to act a behavior (Ajzen, 1991; McDonald, 2014). An individual may have the intention to recycle, for example, but is unable to recycle because she or he does not know where the recycling bins are. Thus, lack of perceived control of behavior restricts this person’s behavior (Roan, E., & Shrestha, P. (2017)

Strengths

TPB’s strength is that they cover the non-voluntary behavior of people that cannot be explained by reasoned action theory. The theory of planned behavior can explain the relationship between behavioral intention and actual behavior by adding “”perceived behavioral control.”” Moreover, several studies found that the TPB would help to better predict health-related behavioral intent than reasoned action theory. Also in various health-related fields such as condom use, leisure, exercise, diet, etc., the TPB has improved intention consistency. Moreover, the planned behavior theory as well as the reasoned action theory explain the social behavior of the individual successfully by considering “”social norm”” as an important variable.

Theory Limitations

Some scholars claim the planned behavior theory is based on cognitive processing, and on those grounds they have criticized the theory. More recently, some scholars have been criticizing the theory because it ignores one’s needs before engaging in some action, needs that would affect behavior regardless of attitudes expressed. One could have a very positive attitude towards beefsteak, for example, and yet not order a beefsteak because he’s not hungry. Or, one might have a very negative attitude towards drinking and little intention to drink while still engaging in drinking as he seeks membership in the group.

Although one’s emotions are relevant to the model at the interview or decision-making time, they are overlooked as emotions can influence the model’s beliefs and other constructs. Nevertheless, in previous health research, poor predictability for health-related behavior seems to be attributed to poor model application, associated methods and measures

One of theory of planned behavior drawbacks are TPB only includes the role of cognitive proximal factors. Petraitis et al. argued that it is important to adequately predict the use of experimental substances (e.g. tobacco, alcohol, and marijuana) in addition to the proximal factors in the planned behavior theory. They suggested that distal factors by proximal cognitive factors affect the use of experimental substances. Since several studies have shown that parental factors are relevant, Petraitis et al have suggested adding them to a potential set of distal factors.

Last but not least, the planned behavior theory does not take into account parents ‘ influence when predicting the smoking behavior of adolescents, although studies have shown that parents have an influence on adolescent smoking behaviour. To our knowledge, only a study by Flay et al. investigated the mediating effects on the smoking behavior of adolescents by extending the planned behavior theory by including parental factors as distal factors, although the parental factors were limited to the behavior of parental smoking and they did not examine parenting.

Future Direction Suggested

Based on the TPB limitation analysis, we may know that TPB’s framework of application is restricted only to individual rational behavior. However, there can be no human behavior out of emotion from a physiological point of view. The emotional response of the autonomous nervous system sets the tone for the latter before the cognitive reaction. Therefore, the ideal TPB model based on rational individual behavior does not provide a precise explanation for emotion-related individual behavior. A major issue that needs to be explored, therefore, is how to use TPB in the future study to explain the individual behavior related to emotion.

Furthermore, TPB’s implicit premise is that people are ethnically diverse individuals who make behavioral intent decisions based on three modules of attitude, subjective norm, and PBC, excluding differential characteristics in individuals, cultures, and contexts from the theoretical model. TPB weakens or ignores the specifics and differences of human behavior and predicts human behavior.

The future study should take into account the influence of differences between individuals, culture and contexts when studying specific individual behaviors in certain cultural contexts. In short, therefore, the planned behavior model theory is a very powerful and predictive model to explain human behavior despite the limitations of the theory.”

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