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Health action process approach
Health behavior change refers to a replacement of health-compromising behaviors (such as sedentary behavior) by health-enhancing behaviors (such as physical exercise). To describe, predict, and explain such processes, theories or models are being developed. Health behavioural change theories are designed to examine a set of psychological constructs that jointly aim at explaining what motivates people to change and how they take preventive action.〔Conner, M., & Norman, P. (Eds.). (2005). Predicting health behavior: Research and practice with social cognition models (2nd ed.). Buckingham, England: Open University Press.〕〔Sniehotta, F. F. (2009). Towards a theory of intentional behaviour change: Plans, planning, and self-regulation. British Journal of Health Psychology, 14, 261–273.〕 The health action process approach (HAPA) is a psychological theory of health behavior change. It has been developed by Ralf Schwarzer, Professor of Psychology at the Free University of Berlin, Germany. It is an open framework of various motivational and volitional constructs that are assumed to explain and predict individual changes in health behaviors such as quitting smoking or drinking, and improving physical activity levels, dental hygiene, seat belt use, breast self-examination, or dietary behaviors.〔Biddle, S. J. H., & Fuchs, R. (2009). Exercise psychology: A view from Europe. Psychology of Sport and Exercise, 10, 410–419.〕 HAPA suggests that the adoption, initiation, and maintenance of health behaviors should be conceived of as a structured process including a motivation phase and a volition phase. The former describes the intention formation while the latter refers to planning, and action (initiative, maintenance, recovery). The model emphasizes the particular role of perceived self-efficacy at different stages of health behavior change.〔Sutton, S. (2005). Stage models of health behaviour. In M. Conner & P. Norman (Eds.), Predicting health behaviour: Research and practice with social cognition models (2nd ed., pp. 223–275). Maidenhead, England: Open University Press.〕
==Background==
Models that describe health behavior change can be distinguished in terms of the assumption whether they are continuum-based or stage-based.〔Lippke, S., & Ziegelmann, J. P. (2008). Theory-based health behavior change: Developing, testing and applying theories for evidence-based interventions. Applied Psychology: International Review, 57, 698–716.〕 A continuum (mediator) model claims that change is a continuous process that leads from lack of motivation via action readiness either to successful change or final disengagement. Research on such mediator models are reflected by path diagrams that include distal and proximal predictors of the target behavior. On the other hand, the stage approach assumes that change is non-linear and consists of several qualitative steps that reflect different mindsets of people. A two-layer framework that can be applied either as a continuum or as a stage model is HAPA.〔Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviors. Applied Psychology: An International Review, 57(1), 1–29.〕 It includes self-efficacy, outcome expectancies, and risk perception as distal predictors, intention as a middle-level mediator, and volitional factors (such as action planning) as the most proximal predictors of behavior. ''See Self-efficacy.''
Good intentions are more likely to be translated into action when people plan when, where, and how to perform the desired behavior. Intentions foster planning, which in turn facilitates behavior change. Planning was found to mediate the intention-behavior relation.〔Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38, 69–119.〕 A distinction has been made between action planning and coping planning. Coping planning takes place when people imagine scenarios that hinder them to perform their intended behavior, and they develop one or more plans to cope with such a challenging situation.〔Scholz, U., Schüz, B., Ziegelmann, J. P., Lippke, S., & Schwarzer, R. (2008). Beyond behavioural intentions: Planning mediates between intentions and physical activity. British Journal of Health Psychology, 13, 479–494.〕
HAPA is designed as a sequence of two continuous self-regulatory processes, a goal-setting phase (motivation) and a goal-pursuit phase (volition). The second phase is subdivided into a pre-action phase and an action phase. Thus, one can superimpose these three phases (stages) on the continuum (mediator) model as a second layer, and regard the stages as moderators. This two-layer architecture allows to switch between the continuum model and the stage model, depending on the given research question.
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