Teaching Tip Sheet: Attitudes and Behavior Change
Social Psychology Courses
Important Issues or Topic in Psychology
The study of attitudes has had a long and preeminent history in the field of social psychology (Eagly, 1992; Eagly & Chaiken, 1993). The topic of attitudes is intrinsically appealing to psychologists and non-psychologists alike; we all hold attitudes about many different abstract (e.g., ideologies such as democracy and liberalism) and concrete (e.g., people, places, and things) attitude objects. Attitudes are "psychological tendenc[ies] that [are] expressed by evaluating a particular entity with some degree of favor or disfavor" (Eagly & Chaiken, 1993, p. 1).
Although research on attitudes is dispersed among many topics such as the measurement of attitudes, the structures of attitudes and beliefs, and theories of attitude formation and change, research on the relationship between attitudes and behavior has consistently been one of the most prominent and debatable topics in the field of social psychology (Eagly & Chaiken, 1993). Intuitively, the association between a person's attitudes and her or his behavior makes sense. However, contemporary research on attitudes has empirically demonstrated that attitudes correlate most reliably with behaviors when an aggregate of attitudes is related to an aggregate of attitude-relevant behaviors; and when a single attitude is related to a single attitude-relevant behavior (Eagly & Chaiken, 1993). In the context of HIV/AIDS research, an aggregation of condom-relevant behaviors (e.g., using condoms, carrying condoms, purchasing condoms, etc.) would provide a more reliable measure of condom use when these behaviors are matched to an aggregation of a person's attitudes toward condoms (e.g., attitudes about the preventive efficacy of condoms, the ease of use of condoms, attitudes about the enjoyment of condoms, the availability of condoms, etc.).
Because HIV infection is transmitted primarily through behaviors such as unprotected sex and injection drug use, the issue of how peoples' attitudes about HIV/AIDS relate to their HIV/AIDS risk behaviors is an especially important topic in contemporary social psychology. Since the beginning of the epidemic, social scientists have examined how attitudes about a variety of HIV/AIDS related topics (e.g., attitudes towards sex, condoms, the perceived consequences of contracting HIV, etc.) predict or correlate with HIV/AIDS protective behaviors (e.g., using condoms, carrying condoms, changing risky sexual practices, reducing the number of sexual partners, being more selective about sexual partners, etc.). Since most of the cases of HIV/AIDS in the United States have been sexually transmitted, researchers have focused most of their attention on the attitudes and behaviors relevant to condom use.
In general, most of the studies on the attitude-behavior link have not been specifically designed to measure the relationship between HIV/AIDS-related attitudes and behavior. Rather, these studies have often included measures of respondents' attitudes about HIV/AIDS-related topics along with other variables such as knowledge about HIV/AIDS, risk perception, or self-efficacy. Nonetheless, these studies provide social scientists with important lessons about how HIV/AIDS-related attitudes are associated with behaviors to reduce transmission of the virus.
In addition to the aforementioned studies, many studies have applied conceptual models of health-related behavior change to the study of HIV/AIDS risk behaviors. Attitudes toward a specific behavior are a cornerstone of the Theory of Reasoned Action (Fishbein & Azjen, 1975). Other conceptual models such as the Health Belief Model (Becker & Joseph, 1988; Kirscht & Joseph, 1989) often include some attitudinal component. For example, in addition to people's perceptions of the severity of the health threat and their susceptibility to it, the Health Belief Model also focuses on attitudes about behaviors that will reduce the health threat.
Lessons Learned From HIV/AIDS
Social science research on HIV/AIDS has provided some important lessons about how attitudes about specific HIV/AIDS-related attitudes predict or correlate with HIV/AIDS risk behaviors. This section will focus on research on attitudes and behavior relevant to condom use. In 1993, the Centers for Disease Control and Prevention (CDC) declared that (male) condoms when consistently and correctly used, are the most effective way to prevent the sexual transmission of HIV. Even before the federal agency's announcement, many social scientists had already begun examining whether people's attitudes about condoms influence condom use. In general, many of these studies have yielded fairly consistent findings about the condom attitude-behavior link. Specifically, a person's positive evaluation of condoms is likely to be the single greatest predictor of whether he or she will report condom use in the past, current or future (Valdiserri, Arena, Proctor & Bonati, 1988). Similar findings have held for adolescents (Barling & Moore, 1990); racially and ethnically diverse groups of women (Gomez & VanOss-Marin, 1996; Wilson, Jaccard, Endias, & Minkoff, 1993); and Hispanic and White heterosexual men and women (VanOss-Marin, Tschann, Gomez & Kegeles, 1993). These results have important implications for HIV/AIDS prevention messages and interventions targeted to people whose sexual behaviors may place them at risk for the disease. This fact notwithstanding, other studies have found no or weak links between attitudes and HIV/AIDS protective behaviors (Adjukovic, Ajdukovic & Prislin, 1992), suggesting that other variables sometimes may be more predictive of behavioral change than attitudes.
Although the Theory of Reasoned Action is not an HIV/AIDS specific theory, it has emerged as a one of the most successfully applied models of HIV/AIDS-related attitudes and behaviors. Fishbein and Azjen (1975) designed the theory to explain the psychological processes that mediate peoples' attitudes and behaviors. The theory posits that an individual's intention to engage in a certain behavior is the best predictor of that behavior. The theory is composed of three determinants: intention, attitudes, and subjective norms.
Using this theory, social scientists have found that attitudes about condoms, in combination with subjective norms, have strongly predicted intentions to use condoms in populations such as adolescents (Basen-Enquist & Parcel, 1992; Krahe & Reiss, 1995); sexually active heterosexuals (Zimmerman & Olson, 1994); gay men (Cochran, Mays, Ciarletta, Caruso, & Mallon, 1992; Fishbein, Chan, O'Reilly, Shnell, Wood, Beeker, & Cohn, 1992); and African-American women (Jemmott & Jemmott, 1991). The important lesson that these studies have provided is that attitudes alone are insufficient predictors of behavior; subjective norms are also important. For example, although the Fishbein et al. (1992) study demonstrated that gay men's attitudes about safer sex behaviors were the most important determinant of intentions to perform HIV/AIDS protective behaviors, subjective norms varied by city. Specifically, gay men who lived in Seattle, a city with a large and visible gay community had greater intentions to engage in safer sex than gay men who lived in Albany where the gay community was much smaller and more invisible.
Despite the applicability of the Theory of Reasoned Action to HIV/AIDS-related attitudes and behaviors, critics have argued that this theory and other psychosocial models of HIV/AIDS prevention behavior generally have failed to consider how social contextual factors influence HIV/AIDS risk behaviors among women (Amaro, 1995) and people who are poor or members of racial and ethnic minority groups (Cochran & Mays, 1993). According to Cochran and Mays (1993), many of the conceptual theories that social scientists frequently apply to HIV/AIDS prevention behaviors are based on individualistic, middle-class, European-American values that assume that people are motivated to act "rationally" and that people have the resources and skills to make certain decisions about their behaviors. In reality however, social-contextual factors such as poverty and gender roles may mediate the relationship between attitudes about HIV/AIDS prevention practices, and HIV/AIDS risk reduction behaviors.
There are several teaching strategies that psychologists who teach the study of attitudes can use to update and enhance their courses to reflect what social scientists have learned from HIV/AIDS-related research. The following teaching strategies may be used in class discussions or may be assigned as course papers. Each of the strategies is designed to prompt students to think critically about how attitudes relate to behavior within the context of the HIV/AIDS epidemic.
Ask students to compare and analyze how peoples' attitudes about their general health and well-being influence health behaviors across domains (e.g., smoking-cessation or avoidance, exercise, and condom use). This exercise is useful for demonstrating how attitude-behavior correlations are influenced by the aggregation of attitude-relevant behaviors. Neubauer's (1989) findings of a weak link between people's attitudes about HIV/AIDS protective behaviors and other preventive behaviors such as wearing seat-belts and avoiding smoking is a useful article for this topic.
Have students compare and contrast the strengths and limitations of conceptual models that include measures of attitudes and behaviors (e.g., the Theory of Reasoned Action and the Health Belief Model). Next, students can discuss the benefits and drawbacks of applying these models to different health behaviors (e.g., mammography, exercise, and condom use).
HIV/AIDS is an excellent topic for exploring issues relevant to diverse populations such as gay and bisexual men, communities of color, injection drug users, heterosexual women, and low income communities to name just a few. Ask students to examine and analyze how social and contextual factors may mediate the attitude-behavior change link. The Cochran and Mays (1993) article is useful for this topic.
Have students analyze the circumstances under which attitudes predict HIV/AIDS protective behaviors, and when other variables are more significant. The Adjukovic, Ajdukovic and Prislin's (1992) study's findings that attitudes about AIDS were poor predictors of young people's HIV/AIDS behavior changes is useful for this topic.
Cochran, S. D., & Mays, V. M. (1993). Applying social psychological models to predicting HIV-related sexual risk behaviors among African Americans. Journal of Black Psychology, 19 (2), 142-154.
Fishbein, M., Chan, D. K., O'Reilly, K., Schnell, D., Wood, R., Beeker, C., & Cohn, D. (1992). Attitudinal and normative factors as determinants of gay men's intentions to perform AIDS-related sexual behaviors: A Multisite analysis. Journal of Applied Social Psychology, 22(13), 999-1011.
Fishbein, M., Middlestadt, S. E., & Hitchcock, P.J. (1994). Using information to change sexually transmitted disease-related behaviors: An analysis based on the theory of reasoned action. In R. J. DiClemente & J. L. Peterson (Eds.), Preventing AIDS: Theories and methods of behavioral interventions. AIDS prevention and mental health (pp. 61-78). New York, NY: Plenum Press.
Fisher, W. A., Fisher, J. D., & Rye, B. J. (1995). Understanding and promoting AIDS-preventive behavior: Insights from the Theory of Reasoned Action. Health Psychology, 14(3), 255-264.
Levy, J. A., & Albrecht, G. L. (1989). A review of research on sexual and AIDS -related attitudes and behaviors. In M. W. Riley, M. G. Ory & D. Zablotsky (Eds.), AIDS in an aging society: What we need to know (pp. 39-59). New York, NY: Springer Publishing Co., Inc.
Ross, M. W., McLaws, M. L. & Gallilos, C.G. (1994). Attitudes toward condoms and the theory or reasoned action. In D. J. Terry, C. G. Gallios & M. McCamish (Eds.), The theory of reasoned action: Its application to AIDS-preventive behavior. Oxford, England: Pergammon Press, Inc.
Valdiserri, R. O., Arena, V. C., Proctor, D., & Bonati, F. A. (1989). The relationship between women's attitudes about condoms and their use: Implications for condom promotion programs. American Journal of Public Health, 79, 499-501.