Most people constantly evaluate various aspects of their environment. This process is often behavioral in its focus (e.g., "I like eating fast food"; "Breast self-exam is a waste of my time"; "Condoms are a good way to prevent pregnancy"). Attitudes are formed as a result of this ongoing evaluative process. Thus, attitudes are defined as evaluations of entities, including behavior, that result in perceptions of favor or disfavor (Eagly and Chaiken, 1993). Consequently, attitudes may predispose individuals to adopt or reject specific health-related behaviors.
Substantial evidence suggests that attitudes have an important influence on the adoption of health-related behaviors such as: contraceptive and condom use; being screened for breast, cervical, or colorectal cancer; smoking cessation; and maintenance of a healthy diet. However, the relationship between attitudes and behavior is complex, and understanding how attitudes influence behavior may be enhanced by the use of a theoretical framework.
The theory of planned behavior is based on the premise that attitudes influence behavior in unison with two other factors: perceptions of social norms (e.g., "Is this something my friends think I should do?") and beliefs about one's personal ability to perform a specific behavior. Studies of various health behaviors have found that attitudes, perceived social norms, and perceived ability each contribute, in varying combinations of importance, to predicting behavior and behavioral intent. Thus, it is appropriate to consider attitudes toward a behavior as one of these three broad classes of psychological determinants of health-related behavior.
One common problem encountered in studying attitudes is that attitudes may either influence behaviors or be influenced by behaviors. For example, a favorable evaluation of oral contraception may prompt a woman to rely on the pill for contraception. Alternatively, a woman who begins using the pill because it is popular (social norms) or because it is easy to use (perceived ability) may subsequently infer that she believes the pill is a good thing (an attitude). In the latter case, the behavior preceded the attitude. A. H. Eagly and S. Chaiken (1993) provide a comprehensive view of how people infer their attitudes based on their behavior.
Measurement of attitudes can also be problematic. An attitude typically involves multiple evaluations. For example, an individual's attitude toward drinking may involve evaluations of social benefits, benefits of getting drunk (e.g., escape), risks (e.g., injuries and addiction), and other problems (e.g., alienation of family members, missed days of work). One strategy for measuring an attitude this complex is to sum the evaluations (favorable or not) for each of the beliefs contributing to the overall attitude. Thus, an attitude can be measured with questionnaire items that can be read as a scale. For example, when the Condom Attitude Scale was recently administered to a group of adolescents, favorable attitudes on this scale were associated with lower odds of the adolescents' reporting unprotected vaginal sex during the previous thirty days.
The professional literature in the field of public health contains numerous examples of theorybased investigations that help determine the influence of attitudes on health-related behavior. For example, K. Jennings-Dozier (1999) used the theory of planned behavior to predict intentions among minority women to obtain a Pap smear (a test for cancer of the cervix). Assessed attitudes toward obtaining a Pap smear were the best predictor of this intent among African-American and Latina women. The implication of these findings is that, assuming the services are accessible and affordable, prevention programs can promote first-time Pap testing by providing women with information that favorably influences their evaluation of the test and procedure. In fact, the content of prevention programs is often designed to highlight the benefits of an entity (e.g., high-fiber foods prevent heart disease and some forms of cancer) or a behavior (e.g., breastfeeding helps protect your child from illness).
R. Prislin and colleagues (1998) provided another example of how the study of attitudes can be applied to the field of public health. They found that six beliefs commonly held by parents about childhood immunization predicted the immunization status of their children. The findings suggest that childhood immunization rates could be increased by facilitating parental beliefs in the efficacy and safety of vaccines and dispelling the belief that it is better to acquire immunity by getting sick than by receiving a vaccine. These beliefs contribute to parents' overall evaluation (their attitude) toward having their children immunized. Given that parents have access to affordable vaccination services, a more favorable attitude is likely to influence greater compliance with recommended immunizations.