Varying cognitive targets and response rates to enhance the question-behaviour effect: An 8-arm Randomized Controlled Trial on influenza vaccination uptake.

RATIONALE: The question-behaviour effect (QBE) refers to the finding that survey questions about a behaviour can change that behaviour. However, little research has tested how the QBE can be maximized in behavioural medicine settings. The present research tested manipulations of cognitive targets (questions about anticipated regret or beneficence) and survey return rates (presence vs. absence of a sticky note requesting completion of the questionnaire) on the magnitude of the QBE for influenza vaccination in older adults. METHOD: Participants (N = 13,803) were recruited from general practice and randomly allocated to one of eight conditions: control 1 (no questionnaire); control 2 (demographics questionnaire); intention and attitude questionnaire (with or without a sticky note); intention and attitude plus anticipated regret questionnaire (with or without a sticky note); intention and attitude plus beneficence questionnaire (with or without a sticky note). Objective records of subsequent influenza vaccination from general practice records formed the dependent variable. RESULTS: Intention-to-treat analyses indicated that receiving an influenza vaccination questionnaire significantly increased vaccination rates compared to the no questionnaire, OR = 1.17, 95% CI = 1.01, 1.36 and combined control conditions, OR = 1.13, 95% CI = 1.01, 1.25. Including the sticky note significantly increased questionnaire return rates, OR = 1.25, 95% CI = 1.04, 1.50. However, there were no differences in vaccination rates between questionnaires containing different cognitive targets, a sticky note or not, and no interactions. There were no significant differences in the per-protocol analyses, i.e. among respondents who completed and returned the questionnaires. CONCLUSION: The QBE is a simple, low-cost intervention to increase influenza vaccination rates. Increasing questionnaire return rates or asking anticipated regret or beneficence questions in addition to intention and attitude questions did not enhance the QBE.

Testing the role of action and inaction anticipated regret on intentions and behaviour.

Anticipated regret (AR) has been suggested as a useful addition to the theory of planned behaviour (TPB) that captures affective influences. However, previous research has generally (1) assessed the impact of AR in relation to one behaviour (action or inaction) when considering TPB variables in relation to the alternative behaviour, (2) not controlled for affective attitudes or past behaviour, and (3) examined only one or two behaviours. In two studies across several behaviours, the present research showed that even when controlling for affective attitudes, past behaviour, and other TPB variables towards action, action and inaction AR each added to the prediction of intentions across multiple behaviours. The two studies also showed that inaction regret was generally the stronger predictor, although action regret was important for some types of behaviour. Implications and issues for further research are discussed.

The Impact of Asking Intention or Self-Prediction Questions on Subsequent Behavior: A Meta-Analysis.

The current meta-analysis estimated the magnitude of the impact of asking intention and self-prediction questions on rates of subsequent behavior, and examined mediators and moderators of this question-behavior effect (QBE). Random-effects meta-analysis on 116 published tests of the effect indicated that intention/prediction questions have a small positive effect on behavior (d+ = 0.24). Little support was observed for attitude accessibility, cognitive dissonance, behavioral simulation, or processing fluency explanations of the QBE. Multivariate analyses indicated significant effects of social desirability of behavior/behavior domain (larger effects for more desirable and less risky behaviors), difficulty of behavior (larger effects for easy-to-perform behaviors), and sample type (larger effects among student samples). Although this review controls for co-occurrence of moderators in multivariate analyses, future primary research should systematically vary moderators in fully factorial designs. Further primary research is also needed to unravel the mechanisms underlying different variants of the QBE.

Why does asking questions change health behaviours? The mediating role of attitude accessibility.

OBJECTIVE: The question-behaviour effect (QBE) refers to the finding that measuring behavioural intentions increases performance of the relevant behaviour. This effect has been used to change health behaviours. The present research asks why the QBE occurs and evaluates one possible mediator-attitude accessibility. DESIGN: University staff and students (N = 151) were randomly assigned to an intention measurement condition where they reported their intentions to eat healthy foods, or to one of two control conditions. MAIN OUTCOME MEASURES: Participants completed a response latency measure of attitude accessibility, before healthy eating behaviour was assessed unobtrusively using an objective measure of snacking. RESULTS: Intention measurement participants exhibited more accessible attitudes towards healthy foods, and were more likely to choose a healthy snack, relative to control participants. Furthermore, attitude accessibility mediated the relationship between intention measurement and behaviour. CONCLUSION: This research demonstrates that increased attitude accessibility may explain the QBE, extending the findings of previous research to the domain of health behaviour.

Using self-generated validity to promote exercise behaviour.

Self-generated validity (SGV) refers to the fact that measurement of cognitions can lead to behaviour change. The present research tested to two predictions in relation to SGV: SGV is stronger when supplementing measures of intentions and other components of the Theory of Planned Behaviour (TPB) with measures of anticipated regret; SGV is only stronger when measuring anticipated regret before measuring intentions and other components of the TPB. A total of 576 18-22-year-old students were randomly allocated to complete one of three questionnaires in relation to exercise: (1) TPB questionnaire in relation to exercising in a sports centre (TPB only); (2) TPB questionnaire including anticipated regret questions that appear after intention items and are mixed in with other items (TPB + regret mixed); (3) TPB questionnaire with anticipated regret questions first (TPB + regret first). Past use of the sports centre was also measured by self-report in all conditions. Use of the sports centre 4 and 5 weeks later was measured based on objective records. Hierarchical regression analyses indicated no effect of measuring anticipated regret compared to only measuring TPB variables, but a significant effect of measuring anticipated regret first compared to the other two conditions on sports centre use. This effect persisted after controlling for TPB variables and past behaviour (PB). The effect was moderated by intention strength but not PB. Implications for understanding SGV and behaviour change are discussed.

Using action planning to promote exercise behavior.

BACKGROUND: Action planning promotes exercise behavior and mediates intention-behavior relationships. PURPOSE: The aim of this study is to provide correlational and experimental tests of action planning as mediator of intention-exercise behavior relationships controlling for Theory of Planned Behavior variables and past behavior. METHODS: In study 1 (N = 777), young adults completed questionnaires assessing Theory of Planned Behavior variables, past behavior, and planning in relation to exercise and 2 weeks later reported exercise behavior. In study 2 (N = 356), young adults were randomly allocated to complete one of two questionnaires and 2 weeks later reported exercise behavior. Both questionnaires contained similar measures to study 1 (Theory of Planned Behavior variables, past behavior in relation to exercise), but one also contained an exercise planning measure. RESULTS: Planning partially mediated intention-behavior relationships and intentions showed a moderated mediation effect: stronger intention-planning-behavior relationships when intentions were strong (study 1). Exercise behavior was higher in planning compared to no planning group, and this difference was greater when intentions were strong (study 2). CONCLUSIONS: Action planning mediates intention-exercise behavior relationships, particularly when exercise intentions are strong. Interventions promoting exercise behavior should jointly target intentions and planning.

A mere measurement effect for anticipated regret: impacts on cervical screening attendance.

The mere measurement of cognitions and in particular intentions has been shown to be sufficient to change behaviour. This study assessed the impact of measuring anticipated regret in addition to intentions and other cognitions on recorded cervical smear attendance rates following invitation in a sample of women. A total of 4,277 women received an invitation for cervical screening and information leaflet: 1,500 of whom also received a standard theory of planned behaviour questionnaire in relation to screening (TPB only group) and a further 1,500 of whom also received a TPB questionnaire plus anticipated regret questions in relation to screening (TPB plus regret group). Total recorded attendance rates indicated significantly higher attendance (ps<.05) in the two experimental groups compared to control (Control, 21%; TPB only, 26%; and TPB plus regret, 26%). However, among those returning questionnaires, there was a significantly increased attendance rate (p<.001) in the TPB plus regret group (65%) compared to the TPB only group (44%). Follow up analyses among those completing questionnaires indicated this effect to be moderated by intentions with a significant difference only apparent among strong intenders. The discussion considers the implications for understanding the 'mere measurement effect' and the use of anticipated regret to change behaviour.

Anticipated regret as an additional predictor in the theory of planned behaviour: a meta-analysis.

This paper details the results of a meta-analysis incorporating all the appropriately augmented TPB studies in order to statistically determine the additive effects of anticipated regret (AR) both to the prediction of intentions after the TPB variables and to the direct impacts on behaviour. Over a number of studies there was a strong AR-intention relationship (r(+)=.47, k=25, N=11,254), and AR significantly and independently added to the prediction of intentions over and above the TPB variables; there was a moderate relationship between AR and behaviour (r(+)=.28, k=8, N=2,035) with AR having a direct and significant impact on prospective behaviour, and there was support for the unique contribution of AR even when accounting for attitude. Implications and issues for further research are discussed.

Role of anticipated regret, intentions and intention stability in adolescent smoking initiation.

OBJECTIVES: To examine the impact of anticipated regret within the theory of planned behaviour (TPB) on intentions of adolescents to initiate smoking. To examine the moderating role of anticipated regret and intention stability on the relationship between intentions and smoking initiation in adolescents. METHODS: We conducted two studies measuring anticipated regret within the TPB applied to adolescent smoking initiation. In the first study, 347 non-smoking adolescents (between 11 and 12 years of age) completed the TPB and anticipated regret measures about smoking initiation. In the second study, 675 non-smoking adolescents (between 11 and 12 years of age) completed the TPB, anticipated regret, and intention stability measures in relation to smoking initiation. Smoking was assessed objectively by carbon monoxide breath monitor 9 months later. RESULTS: In Studies 1 and 2, regret significantly added to predictions of intentions over and above components of the TPB (p < .001). In Study 2, smoking behaviour was predicted by intentions and the relationship of intentions to behaviour was moderated by regret and intention stability. CONCLUSIONS: Regret and intention stability were shown to be important variables within the TPB in understanding intentions and behaviour of smoking initiation in adolescents.