predicting and explaining intentions and behavior: how well are we doing?

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Predicting and Explaining Intentions and Behavior: How Well Are We Doing? STEPHEN SUTTON’ Health Behavior Unit University College London London, United Kingdom Meta-analyses of research using the theory of reasoned action (TRA) and the theory of planned behavior (TPB) show that these models explain on average between 40% and 50% of the variance in intention, and between 19% and 38% of the variance in behavior. This paper evaluates the performance of these models in predicting and explaining in- tentions and behavior. It discusses the distinction between prediction and explanation, the different standards of comparison against which predictive performance can be judged, the use of percentage ofvariance explained as a measure of effect size, and pres- ents 9 reasons why the models do not always predict as well as we would like them to do. Consider this assessment by Marks (1996) of the contribution of the theory of reasoned action (TRA) to health psychology: “The theory failed as an ex- planatory account of health behaviour or health status, and the dependent vari- able preferred for its convenience by almost all investigators-behavioural intention-proved to be a notoriously poor predictor of health-protective ac- tion” (p. 8). Researchers who use attitude-behavior models such as the TRA are usually more positive about their utility in predicting and explaining intentions and behavior. Nevertheless, even the proponents of such models believe that there is room for improvement, and there are frequent theoreti- cal and empirical attempts to extend existing models by incorporating addi- tional explanatory variables with the aim of accounting for more of the variance. This paper attempts to evaluate the performance of the TRA (Ajzen & Fishbein, 1980;Fishbein 8z Ajzen, 1975)and the closely related theory of planned behavior (TPB; Ajzen, 1988, 1991) in predicting and explaining intentions and behavior. These particular models were chosen because they are widely used, tightly specified, and several meta-analyses have been conducted. The paper briefly discusses the distinction between prediction and explanation, summarizes ‘Correspondence concerning this article should be addressed to Stephen Sutton, Health Behavior Unit, University College London, Brook House, 2-16 Torrington Place, London WClE 6BT, United Kingdom. e-mail: [email protected]. 1317 Journal of Applied Social Psychology, 1998,28, 15, pp. 131 7-1 338. Copyright 0 1998 by V. H. Winston 8, Son, Inc. All rights reserved.

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Page 1: Predicting and Explaining Intentions and Behavior: How Well Are We Doing?

Predicting and Explaining Intentions and Behavior: How Well Are We Doing?

STEPHEN SUTTON’ Health Behavior Unit

University College London London, United Kingdom

Meta-analyses of research using the theory of reasoned action (TRA) and the theory of planned behavior (TPB) show that these models explain on average between 40% and 50% of the variance in intention, and between 19% and 38% of the variance in behavior. This paper evaluates the performance of these models in predicting and explaining in- tentions and behavior. It discusses the distinction between prediction and explanation, the different standards of comparison against which predictive performance can be judged, the use of percentage ofvariance explained as a measure of effect size, and pres- ents 9 reasons why the models do not always predict as well as we would like them to do.

Consider this assessment by Marks (1 996) of the contribution of the theory of reasoned action (TRA) to health psychology: “The theory failed as an ex- planatory account of health behaviour or health status, and the dependent vari- able preferred for its convenience by almost all investigators-behavioural intention-proved to be a notoriously poor predictor of health-protective ac- tion” (p. 8). Researchers who use attitude-behavior models such as the TRA are usually more positive about their utility in predicting and explaining intentions and behavior. Nevertheless, even the proponents of such models believe that there is room for improvement, and there are frequent theoreti- cal and empirical attempts to extend existing models by incorporating addi- tional explanatory variables with the aim of accounting for more of the variance.

This paper attempts to evaluate the performance of the TRA (Ajzen & Fishbein, 1980; Fishbein 8z Ajzen, 1975) and the closely related theory of planned behavior (TPB; Ajzen, 1988, 199 1) in predicting and explaining intentions and behavior. These particular models were chosen because they are widely used, tightly specified, and several meta-analyses have been conducted. The paper briefly discusses the distinction between prediction and explanation, summarizes

‘Correspondence concerning this article should be addressed to Stephen Sutton, Health Behavior Unit, University College London, Brook House, 2-16 Torrington Place, London WClE 6BT, United Kingdom. e-mail: [email protected].

1317

Journal of Applied Social Psychology, 1998,28, 15, pp. 131 7-1 338. Copyright 0 1998 by V. H. Winston 8, Son, Inc. All rights reserved.

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1318 STEPHEN SUTTON

the results of meta-analyses of the TRA/TPB, discusses the different standards of comparison against which predictive performance can be judged, discusses the use of percent variance explained as a measure of effect size, and, with par- ticular reference to the intention-behavior relationship, presents nine reasons why the models do not always predict as well as we would like them to do. Both hypothetical and real data (the latter from studies ofbreast screening and smok- ing cessation) are used to illustrate the main points.

The Theories of Reasoned Action and Planned Behavior

Since both the TRA and the TPB are well known, only a brief exposition of the models is given here. According to the TRA, most behaviors of social rele- vance are under volitional control and, hence, behavioral intention is both the immediate determinant and the single best predictor of behavior. The theory speci- fies two determinants of intention to perform a given behavior: attitude toward the behavior (AB; the person’s overall evaluation of the performing the behav- ior) and subjective norm (SN; the person’s perceived expectations of important others with regard to his or her performing the behavior in question). In an at- tempt to extend the TRA to behaviors that are not entirely under volitional control, the TPB added a third determinant of intention, known as perceived behavioral control (PBC; the extent to which the individual feels he or she has control over performing the behavior, or the perceived ease of performing the behavior). According to the TPB, people will have strong intentions to perform a given ac- tion if they evaluate it positively, believe that important others would want them to perform it, and think that it is easy to perform. The TPB also specifies that, for behaviors that are not completely under volitional control, PBC will add to the prediction of behavior over and above the effect of behavioral inten- tion. (For recent critical commentaries on the TPB, see Conner & Armitage, 1998; Eagly & Chaiken, 1993; Manstead & Parker, 1995; and Sutton, 1997.)

Prediction and Explanation

Prediction and explanation are not the same thing. Explanation means iden- tifying the determinants of intentions and behavior and specifying how these factors combine. The models we use to help us achieve this aim are causal mod- els which can be represented graphically in the form ofpath diagrams or mathe- matically as sets of equations. Both the TRA and the TPB can be regarded as causal models, in this sense.2 If the main aim is to develop a causal model, we

*In relation to behavior, perceived behavioral control has both a causal and a purely predictive role (Ajzen,l991). Overall, then, its causal status is ambiguous.

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need to carefully specify the causal paths (which variables influence which other variables) and the process by which two or more variables may act in combination to influence another variable. If the main aim is to develop a pre- dictive model, we do not need to concern ourselves with identifying the deter- minants of a given construct or with specifying causal processes (although a causal model may suggest suitable predictor variables). We are free to choose convenient predictors and weights. For example, if we were concerned only about maximizing predictive power, there would be a strong argument for in- cluding past behavior as well as intention and PBC in a predictive model, since it often adds substantially to the prediction of both intentions and behavior (Conner & Armitage, 1998; Ouellette & Wood, 1998; Sutton, 1994).

Prediction can be useful without explanation. Even if the underlying causal processes are not well understood, it is useful to be able to predict tomorrow’s weather, who is at high risk for becoming a problem drinker, or who is likely to be a successful doctoral student. In the case of problem drinking, for example, identification of high-risk individuals may enable an early intervention to be made. Prediction enables interventions to be targeted. However, an under- standing of the factors that lead some people but not others to develop a drinking problem (explanation) would be even more useful because it would have implications for the nature and content of the intervention program; it would not only tell us who to target but also what to do to them. An explanatory model should also have wider implications and greater strategic value than a purely predictive model. Although prediction and explanation are not the same, the first is necessary for the second; models that do not enable us to predict be- havior are unlikely to be useful as explanatory models.

Meta-Analyses of the Theories of Reasoned Action and Planned Behavior

Table 1 summarizes the findings from a number of meta-analyses and quan- titative reviews of the TRA/TPB. These reviews vary greatly in terms of the number and type of studies included and the sophistication of the meta-analytic methods used. Table 1 displays the findings in terms of widely used effect size measures: for the bivariate case (the intention-behavior relationship), the product-moment correlation (Y) and its square; and, for the multivariate case (e.g., predicting intention from AB and SN; predicting behavior from intention and PBC), the multiple correlation (R) and its square. Both the squared simple correlation and the squared multiple correlation can be interpreted as the pro- portion of variance explained. For power analysis, where the statistical test in- volves testing multiple correlations, Cohen (1 988, 1992) recommends an effect size index calledf, which is a simple nonlinear function ofR2: .p = R2/( 1 - R2) .

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Table 1

Summary ofFindings From Quantitative Reviews and Meta-Analyses of the Theories ofReasoned Action and Planned Behavior

Effect sizea

Predicting Predicting behavior

from AB+SN or from BI from from AB+SN+PBC only BI+PBC

intention (BI)

Review R R2 f r 9 R R2

Farley et al. (198 1) Sheppard et al. (1 988) Sutton (1 989)b Ajzen (1991) van den Putte (1 993) Randall & Wolff

Godin & Kok (1996)c Conner & Armitage

Sheeran & Orbell

( 1994)

(1 998)

(in pressld

.71

.66

.63

.71

.68

-

.64

.63

-

s o 1.00 - - - -

.44 .79 .53 .28 - -

.40 .67 - - - -

S O 1.00 .45 .20 .51 .26 .46 .85 .62 .38 - -

.45 .20 - - - -

.41 .69 .46 .21 .58 .34

.40 .67 .47 .22 .48 .23

- - .44 .I9 - -

asmall, medium, and large effect sizes are defined by Cohen (1988, 1992) as follows: Product-moment r = .lo, .30, .50. Multiple correlation R: Effect size index is f =R2/ ( 1 - R2): .02, .15, .35. bRestricted to studies of smoking. CRestricted to studies of health- related behaviors. dRestricted to studies of condom use.

Although this effect size index has not been used in studies of the TRA/TPB to date, it is also shown in Table 1.

The findings for behavioral intention show reasonable consistency, with multiple correlations ranging between .63 to .71 (between 40% and 50% of variance explained). For intention, the value of ranges from 0.67 to 1 .OO-well above Cohen’s (1988, 1992) definition of a “large” effect size. Pre- diction of behavior was lower, as expected, and more variable. When behavior was predicted from intention only, the product-moment correlation ranged

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between .44 and .62 (equivalent to explaining between 19% and 38% of the variance). In Cohen’s (1988, 1992) terms, these would all be described as “me- dium” or “large” effects. Three of the reviews examined the prediction of be- havior from intention and PBC in accordance with the TPB (Ajzen, 1991; Conner & Armitage, 1998; Godin & Kok, 1996). The findings fell within the range of those for the intention-behavior relationship. Thef values were me- dium or large.

Should we be impressed or disappointed by the figures in Table I ? On first reaction, it might be judged that we are doing pretty well for intention, but less well for behavior. However, even for intention, we are typically explaining no more than 50% of the variance. This seems disappointing in view of the fact that in the vast majority of studies, intention and its predictors are measured at the same time on the same questionnaire using similar items-conditions that should maximize predictive power.

There are a number of different standards of comparison that can be used in evaluating the percentage of variance explained. One possible standard is the ideal maximum of 100%. Neither the TRA nor the TPB fares well by this stan- dard. In practice, however, the maximum percentage of variance that can be ex- plained in a real application is often substantially less than 100; reasons for this are discussed at length later in this paper.

Another possible benchmark is provided by the effect sizes that are typi- cally found in the behavioral sciences using a diverse range of outcomes and predictors. The simplest way of making such a comparison is to use Cohen’s (1988, 1992) operational definitions. Cohen (1992, p. 156) explains that the values for medium effect sizes were chosen to “represent an effect likely to be visible to the naked eye of a careful observer,” small effect size values were set to be “noticeably smaller than medium but not so small as to be trivial,” and values for large effect sizes were set to be “the same distance above medium as small was below it.” Although Cohen acknowledges that the definitions were made subjectively, he also notes that the values chosen to represent medium ef- fect sizes approximate the average size of observed effects in various fields. As mentioned above, using Cohen’s definitions, the effect sizes in Table 1 are large for intention and medium or large for behavior.

A third possible standard of comparison is the percentage of variance in in- tention and behavior explained by other theoretical models. Here the question is the extent to which one model does better or worse than another model that purports to explain the same dependent variable. The meta-analysis reported by Conner and Armitage (1 998) directly compared the TRA and the TPB. PBC added, on average, 5% to the variance explained in intention, over and above attitude and subjective norm, and 1% to the variance explained in behav- ior, over and above intention. In Cohen’s (1988, 1992) terms, the improvement

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afforded by the TPB was between small and medium for intention, but less than small for behavior.

A fourth standard by which the predictive performance of the TRA/TPB can be judged is in terms of practical utility. This will be briefly considered in relation to the examples discussed in the next section.

In evaluating the predictive performance of a model, the number of predic- tors should be taken into account. At least in terms of their global constructs, the TRA and the TPB are highly parsimonious. The TPB, for example, speci- fies two proximal causes of behavior and three proximal determinants of inten- tion. Other things being equal, we would be more impressed by a model that accounted for 50% of the variance in intentions using two or three predictors than by a model that explained the same amount of variance but required eight or nine predictors to do so.

Percentage of Variance Explained Is a Pessimistic Measure of Effect Size

Percentage of variance explained is a widely used measure of effect size. However, several authors have pointed out that it tends to give a rather pessi- mistic impression (e.g., Abelson, 1985; Rosenthal & Rubin, 1979). This is not the fault of the effect size measure itself; it is more the case that researchers are not always very good at interpreting what the values mean. Different measures of effect size can give a very different impression, as the simple example in Table 2 shows. Suppose we have a new treatment for smoking and we decide to test its effectiveness in a randomized controlled trial in which 200 smokers are randomly assigned to either intervention or control conditions with 100 in each group. Seventy out of 100 smokers in the intervention condition succeed in quitting smoking, compared with 30 out of 100 in the control condition.

Table 2 gives six effect size measures. The difference measure shows that the intervention improved the success rate by 40 percentage points. The odds of successfully quitting smoking were over five times higher in the intervention condition, compared with the control condition. The relative success rate shows that the intervention more than doubled the chances of successfully quit- ting. All of these measures suggest that the new treatment had a substantial and clinically useful effect. However, the percentage of variance explained in the dichotomous outcome measure by the dichotomous independent variable (in- tervention vs. control) was 16%, which seems unimpressive. (Also shown in Table 2 is the value of the effect size measure known as h which is used in power analysis when the significance test to be employed is the normal curve test for the difference between two independent proportions; Cohen, 1988, 1992. In this example, h has a value of 0.82, which is large in Cohen’s terms.)

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Table 2

Example Showing How Different Measures ofEffect Size Can Give a Different Impression

Randomized controlled trial of a new treatment for smoking

Condition N Succeed Fail

Intervention 100 70 Control 100 30

30 70

Note. Difference in success rates = 70 - 30 = 40. Odds ratio = (70 x 70)/(30 x 30) = 5.4. Relative success rate = 70/30 = 2.3. Product-moment r (phi coefficient) = .40. Percent- age of variance explained = 16. Cohen’s (1988, 1992) h = 0.82.

Figure 1 illustrates two real examples. The first is taken from a study of breast screening uptake (part of an ongoing research program on the uptake and psychological impact of mammographic screening; Sutton, Bickler, Sancho- Aldridge, & Saidi, 1994; Sutton, Saidi, Bickler, & Hunter, 1995). The upper curve is based on previously unpublished data from 1,033 women aged be- tween 50 and 64 who responded to a postal questionnaire prior to being sent their first invitation to attend for screening in the U.K. National Breast Screen- ing Program. In the questionnaire, they were asked “If you are invited to go for breast screening, do you think you will attend?” The response categories were Definitely not; Probably not; Not sure; Yes, probably; and Yes, definitely. Strictly speaking, this is a measure of behavioral expectation, rather than be- havioral intention (Warshaw & Davis, 1985). Several months later, informa- tion on attendance was obtained from the computer database maintained by the breast screening center.

The relationship is approximately linear. Of those women who said that they definitely would not accept an invitation for screening, 30% subsequently attended for screening, compared with almost 90% of those who said “Yes, definitely.” The 5-point intention measure explained 10% of the variance in the dichotomous measure of behavior. Although only 10% of variance was ex- plained, inspection of Figure 1 suggests that the relationship was actually quite substantial. If it were possible to produce differences in attendance rate of this magnitude, we would surely consider our intervention to be quite power- ful. This example shows that it is possible to have an effect size that is

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O t- 2 3 4 INTENTION

Figure I. Relationship between intention and behavior for breast screening attendance (upper curve) and attempt to quit smoking (lower curve).

worthwhile from a practical viewpoint without explaining a large proportion of the variance.

In this data set, the distribution of the intention measure was highly skewed, with 90% of women saying “Yes, probably” or “Yes, definitely.” However, even with a uniform distribution on the intention measure (equal numbers of women in each of the five intention categories), the relationship depicted in Figure 1 would still represent no more than 25% of variance explained. Indeed, even if there was a perfect linear relationship between intention and attendance rate, running from 0% attendance among the “Definitely not’s to 100% atten- dance among the “Yes, definitely”s, still only about 50% of the variance in be- havior would be explained. The problem here is the lack of correspondence between the intention scale, which has 5 points, and the behavior measure, which has 2 points. With unequal numbers of scale categories, it is simply not possible to have a linear relationship, even a perfect one, and explain 100% of the variance. The same applies in any situation in which the number of the cate- gories used to measure intention does not equal the number of categories used to measure behavior.

Figure 1 shows a second example, from a study of natural smoking cessation among a sample of 966 smokers in the United Kingdom (Sutton, Marsh, & Matheson, 1987). The lower curve shows the relationship between intention to try to quit smoking (assessed at baseline) and whether or not an attempt was made (based on self-reports obtained 6 months later). Again, the relationship is ap- proximately linear, running from a 16% attempt rate among those smokers with

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very low intention scores to 58% among those with strong intentions to try to quit. About 1 1% of the variance was explained in this case.

The second curve is shifted downward relative to the first. Forty-two per- cent of smokers who expressed very strong intentions to quit failed to translate their intentions into an actual attempt to quit. By contrast, only 11.5% of women who said they would definitely go for breast screening subsequently did not go. Their self-predictions were more accurate. On the other hand, 30% of women in the first study who said that they would definitely not go for screening apparently changed their minds when they received the invitation, compared with 16% of the smokers who reported having tried to quit in spite of having low intentions at baseline. In this case, it was the smokers who made more accurate judgments about their future behavior. However, this compari- son is based on much smaller sample sizes than the first.

A full discussion of the reasons for these differences is beyond the scope of this paper. Two general points can be made, however. First, although the intention-behavior correlation provides an appropriate test of the TRA predic- tion that intention determines behavior (assuming that there is no other factor that influences both intention and behavior), a more fine-grained analysis pro- vides information on how accurately individuals can predict their own behav- ior. I am aware of only a few studies that have examined the intention-behavior relationship in this way (e.g., Davidson & Beach, 1981; Orbell & Sheeran, 1998; Piliavin, 1991). Second, given appropriate measures, studies of the intention-behavior relationship can be used to investigate optimistic (or pessi- mistic) biases in people’s judgments of probability. Most work to date has stud- ied such biases in relation to perceptions of the risk of experiencing future hazards or health problems (for a review, see Hoorens, 1994). Few studies have examined the intention-behavior relationship from this perspective.

Nine Reasons for Poor Prediction

In this section, I discuss nine reasons why our models, in particular the TRA/TPB, often have lower predictive power than we would like. I use as the example the simple case of predicting behavior (measured at Time 2) from in- tention (measured at Time 1). Many of these reasons are well known. Neverthe- less, it seems a useful exercise to collate them. In discussing reasons why the intention-behavior correlation and the percentage of variance explained may sometimes be lower than we might wish or expect, I am not necessarily endorsing the use of linear correlation and regression methods. In some cases, other methods of analysis and other measures of effect size might be considered more appropriate. For example, when the behavior measure is dichotomous, as in the smoking and breast screening examples outlined above, it can be argued

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1326 STEPHEN SUTTON

that nonlinear regression methods such as logistic regression would be more appropriate (e.g., Menard, 1995). The rationale for limiting the present discus- sion to linear correlation and regression is that almost all studies of the TRA/TPB use these methods; in fact, all of the quantitative reviews listed in Table 1 used the correlation coefficient or its square as the measure of effect size. The reasons listed below may be regarded as possible explanations for the heterogeneity in the intention-behavior correlation across studies.

1. Intentions May Change

Fishbein and Ajzen repeatedly make the point that, for maximal prediction, the measurement of the intention should be as close as possible in time to the observation of the behavior (e.g., Ajzen & Fishbein, 1980). They also note that sometimes it may not be feasible to do this (e.g., if the aim is to predict the be- havior of soldiers in battle or people caught up in a natural disaster) or even de- sirable to do so (if the aim is long-range prediction). In most studies that apply the TRA/TPB, however, intentions are measured several days, weeks or months prior to the measurement ofbehavior; there is literally a “gap” between intentions and behavior. If intentions change over time and this change is dif- ferential (i.e., different individuals change by different amounts), a distal measure of intention (i.e., distal with respect to the behavior) will be a poorer predictor of behavior than will a proximal measure of intention.

The longer the interval between the measurement of intention and behavior, the greater the likelihood that unforeseen events will occur that lead to changes in intention. Generally speaking, then, the longer the time gap, the lower the correlation between intention and behavior. In their meta-analysis, Randall and Wolff ( 1 994) present evidence to suggest that the strength of the intention- behavior relationship does not vary as a function of the time interval between the measurement of intention and behavior ( r = -.06, ns). Sheeran and Orbell (in press), however, have argued that the data used by Randall and Wolff were too sparse to draw this conclusion, and that time interval and behavior type were confounded in their analysis. They report the results oftheir own meta-analysis of studies of condom use which showed, as predicted, that shorter time intervals were associated with significantly stronger intention-behavior correlations.

A point not mentioned by Fishbein and Ajzen is that, in general, longer time intervals allow more opportunities for a behavior to be performed and would thus tend to increase the intention-behavior correlation, other things being equal. For example, consider the intention to go for an eye test. Assuming that intentions remain stable, we are likely to obtain a higher intention-behavior correlation if we allow 4 weeks for the behavior to be performed than if we al- low only 24 hr.

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2. Intentions May Be Provisional

Many participants in applications of the TRA/TPB are not engaging in real decision making while they are filling out the questionnaire. Some may have already formed relevant intentions prior to taking part in the study, but for other participants, intentions as expressed on the questionnaire are merely hypotheti- cal or provisional. If intentions are measured after they are actually formed, in the context of a real decision, one would expect to find a stronger relationship between intention and behavior. One way of doing this would be to present par- ticipants with a real decision that had significant personal consequences and to measure their intentions in that situation. This is rarely done, however.

This point relates to the preceding point. Intentions measured proximally are less likely to be provisional than intentions measured distally.

3. Violation of the Principle of Compatibility

The principle of correspondence (Ajzen & Fishbein, 1977; Fishbein & Ajzen, 1975) or compatibility (as it was renamed by Ajzen, 1988) states that in order to maximize predictive power, the predictor (intention) and the criterion (behavior) should be measured at the same level of specificity or generality. The measures should be matched with respect to four components: action, tar- get, time, and context. In practice, since most studies rely on self-report meas- ures of behavior, this means using the same form of wording for the measures of intention and behavior. For example, if the aim is to predict which smokers try to quit smoking in the New Year, it might be appropriate to use the follow- ing two questions: “Do you intend to try to quit smoking in the New Year?” (intention); “Did you try to quit smoking in the New Year?” (behavior). There is substantial empirical support for this idea (Ajzen, 1988; van den Putte, 1993). For example, Ajzen ( 1996) reports data from Ajzen and Driver ( 1992) showing that the amount of money respondents were willing to pay for differ- ent leisure activities (e.g., mountain climbing, boating) was largely unrelated to their intention to engage in these activities, but was strongly predicted by their intention to pay a user fee for doing so.

Most researchers who use the TRA/TPB recognize the importance of using compatible measures, though the principle is frequently violated in empirical applications of the models. Researchers who use other models (e.g., the health belief model, stage models) seem largely unaware of the principle. The theo- retical rationale for the principle of compatibility is presumably that by mea- suring intention and behavior at the same level of specificity, we are matching cause and effect. In other words, according to the TRA, trying (or not trying) to quit smoking in the New Year is directly caused by the intention to try (or not to

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try) to quit smoking in the New Year; it is not caused by the intention to try to quit smoking in the next 5 years or by any other intention.

Matching the wording of self-report measures of intention and behavior, in accordance with the principle, has the potential drawback that the two mea- sures may be correlated partly because of shared method variance; that is, a person may answer the questions in a similar way, in part, because they have the same wording. In some cases, it is possible to get around this by using alter- natives to behavioral self-reports, as in the breast screening example discussed above.

4. Violation of Scale Correspondence

Courneya (1994; Courneya & McAuley, 1993) has noted a related problem that arises when the TRA/TPB is applied to repeated behaviors, such as engag- ing in regular physical activity. A lack of scale correspondence occurs when different magnitudes, frequencies, or response formats are used for the assess- ment of intention and behavior. Consider the following measures of intention and behavior: “I intend to engage in vigorous physical activity at least 15 times during the month of October” (measured on a 7-point scale ranging from definitely to definitely not); “I engaged in vigorous physical activity - times during the month of October.” Courneya ( I 994) points out that the variation obtained by these the two measures is not congruent:

The former variation is in the degree of certainty or commitment with respect to a set amount or frequency of behavior (e.g., exer- cise 15 times in a given month or not), whereas the latter varia- tion is in the actual amount or frequency of a behavior (e.g., number of times exercised in a given month). (p. 584)

Courneya presents data to show that violating scale correspondence results in attenuated correlations.

According to Courneya, the most satisfactory solution to the scale corre- spondence problem is to use either continuous-open or continuous-closed numerical scales for both intention and behavior. Examples of the two for- mats are: “I intend to engage [I engaged] in vigorous physical activity - times during the month of October” (continuous-open); “I intend to engage [I engaged] in vigorous physical activity during the month of October the fol- lowing number of times: 0-4/5-9/10-14/15-19120-24/25-29/30+”(continuous- closed numerical). Courneya also notes that the adoption of these scales may present problems for the TRAITPB since these models treat each differ- ent frequency of engaging in exercise as a different behavior toward which an

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individual may have different attitudes, subjective norms, and intentions. Thus, although the implications for prediction seem clear (to maximize predic- tion, always use correspondent measures), the theoretical issues remain unre- solved.

5. Unequal Number of Response Categories for Intention and Behavior

Although Courneya (1994) focused on repeated behaviors, it should be noted that incompatible or noncorrespondent response formats are used rou- tinely in applications of the TRA/TPB to traditional single-act criteria (e.g., at- tending or not attending for breast screening; voting or not voting for a particular candidate). Indeed, in this case, incompatible response formats are implied by the theory. Thus, intention is conceptualized as a subjective prob- ability continuum running from 0 to 1 (though Fishbein and Ajzen recommend that it be measured on a 7-point likelihood scale), whereas behavior is regarded as a dichotomous YesINo response. As I pointed out in discussing the breast screening example, if the numbers of categories used to assess intention and behavior are not equal, then it is not possible to obtain a correlation of 1 .O, even if the probability of performing the behavior increases linearly across the inten- tion scale.

Although this can be regarded as a purely methodological point, it also makes theoretical sense. The TRA assumes that intention (conceptualized as a continuum but measured on a multipoint scale) is somehow transformed into a dichotomous behavior. Exactly how this transformation occurs is not ex- plained. Attempting to represent the relationship as a straight line (the greater the intention, the greater the probability of performing the behavior) inevitably leads to a lack of fit. Treating the relationship as a step function would poten- tially allow a better fit. It would be possible to amend the model so that it speci- fied that only if intention reached a particular threshold value (e.g., subjective probability equal to .80 or “likely”) would the behavior be performed. Alterna- tively, one could treat intention as an all-or-none phenomenon; either a person has an intention to perform a given behavior or he does not. Treating both in- tention and behavior as genuine dichotomies would allow the possibility of a perfect relationship between the two (but see Point 8 below).

6. Random Measurement Error in the Measures of Intention and/or Behavior

If the measures of intention or behavior are not perfectly reliable, the ob- served correlation will be attenuated relative to that between the true scores

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(e.g., Schmidt & Hunter, 1996). There is a standard formula that can be used for disattenuating the correlation coefficient if estimates of the reliabilities of the two variables are available: The observed correlation is divided by the square root of the product of the two reliability estimates. For example, if the reliabili- ties of the intention and behavior measures are .80 and .90, respectively, the ob- served correlation is disattenuated by dividing it by .85 (= m). Thus, an observed correlation of .SO would become .S9. None of the quantitative re- views listed in Table 1 were based on disattenuated correlations. Thus, the intention-behavior correlations in Table 1 may be regarded as underestimates of the true correlation. The main barrier to routinely correcting observed corre- lations is lack of good information on reliability. Most studies of the TRA/TPB still use single-item measures of intention and behavior.

Using multiple indicators of intention and behavior would be expected to improve reliability and lead to higher observed correlations. It would also en- able reliabilities to be estimated (using Cronbach’s alpha) and would allow the use of structural equation modeling, which adjusts for random measurement er- ror in the observed variables. However, the multiple indicator approach is problematic in the case of highly specific behaviors. It is difficult to think of six different ways of asking people whether they intend to buy a particular brand of toothpaste the next time they go to the local supermarket.

In the bivariate case (e.g., the correlation between intention and behavior), the direction of the bias is predictable; the correlation is biased downward. In the multivariate case, the consequences of random measurement error in one or more of the predictors are difficult to predict.

Reliability and validity are usually discussed together. How does lack of validity affect the intention-behavior correlation? Fife-Shaw ( 1997) notes that use of invalid measures may lower the predictive power of attitude-behavior models. Suppose that behavioral intention does directly cause behavior, as the TRA claims, but our measure of intention is largely tapping the construct of be- havioral expectation which, let us assume, is only moderately correlated with intention and does not have any causal impact on behavior. In this situation, we may underestimate the intention-behavior correlation. Other sources of inva- lidity may inflate the intention-behavior correlation. For example, if people’s responses to the Time 2 behavior measure are based in part on recalling and re- peating their responses to the Time 1 intention measure, the true intention-behavior correlation will be overestimated.

7. Restriction of Range/?ariance in Intention or Behavior

Suppose there exists a strong linear relationship between a particular inten- tion and behavior in the population (using the term in its statistical sense), but

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only those people with fairly or very strong intentions to perform the behavior volunteer for our study. The observed correlation (and percentage of variance explained) in the sample will be lower than that in the population because of the restriction of range or variance; we will underestimate the true size of the rela- tionship (Cohen & Cohen, 1983). The same will be true if the range or variance of the behavior measure is restricted. If, on the other hand, the study attracts people with extreme intention scores (either very high or very low), then the sample correlation will tend to overestimate the population correlation.

Restriction of range arising from sample selection bias should be distin- guished from the situation in which, in a given population, there is little vari- ance in intention assessed at Time 1 but substantial variance in behavior assessed at Time 2 (or, conversely, restricted variance in Time 2 behavior but not in Time 1 intention). Here the variance restriction is not the result of biased sampling. It exists in the population; it is a fact of life. If our study sample is un- biased, the same situation should obtain in our sample, subject to sampling variability. In this case, the low correlation can be interpreted substantively.

8. Marginal Distributions ofthe Measures Do Not Match

A necessary condition for obtaining a correlation of 1.0 (or explaining 100% of the variance) is that the marginal distributions of the measures of in- tention and behavior are equal. Even if the number of categories is equal, if the distributions do not match, then the correlation must be less than perfect (Cohen & Cohen, 1983). Table 3 shows a simple example in which both intention and behavior are dichotomous. There is an 80/20 split on intention but a 50150 split on behavior. The cross-tabulation shows the cell frequencies that yield the larg- est possible correlation between intention and behavior, given these marginal distributions. The correlation (which in this 2 x 2 situation is known as the phi coefficient or the fourfold point correlation) is S O ; thus 25% of the variance is explained. It should be stressed that this is the maximum possible proportion of variance that can be explained, given the marginal frequencies shown. The problem is not that we have dichotomous measures, but that the distributions do not match. (Note that even with dichotomous measures of intention and be- havior, if the marginal distributions are equal, it is possible to obtain a correla- tion of 1.0.)

If intention and behavior can be regarded as genuine dichotomies and inten- tion is assumed to cause behavior (such that those who say “I intend to do X” do it and those who say “I don’t intend to do X” do not), then finding unequal dis- tributions is itself inconsistent with the hypothesis (since the distribution on behavior should be a function of the distribution on intention and the causal ef- fect of intention on behavior). If, on the other hand, one (or both) of the measures

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Table 3

Example Showing Unequal Marginal Distributions

Behavior

Intention Yes No Total

Yes No Total

50 0

50

30 20 50

80 20

100

Note. r = S O ; r2 = .25.

is not a genuine dichotomy but has been created by collapsing a measure that had more than two categories, the marginal frequencies shown in Table 3 may reflect a less than optimal choice of cut point. Although this example used a 2 x 2 table for simplicity, the same argument applies to multicategory measures of intention and behavior.

9. Intention May Not Be the Suficient Cause of Behavior

For behaviors that are completely under volitional control, it follows by definition that proximal intention is the sufficient cause of behavior. (For volitional control, read intentional control.) Assuming optimal measurement (perfectly reliable, valid, and compatible measures with equal numbers of cate- gories), a proximal measure of intention should correlate perfectly with the measure of behavior; there is no room for other factors to influence behavior in- dependently of intention. This is the assumption made by the TRA. The TPB, on the other hand, allows behavior to be influenced by control factors in addi- tion to intention; for example, lack of skills, resources, opportunity, or coop- eration of other people. Thus, according to the TPB, although intention remains an important cause of behavior, it is not the sufficient cause, except where the behavior is entirely under volitional control, in which case the TPB reduces to the TRA.

In the context of the TRA/TPB, a number of other factors have been pro- posed as additional determinants of behavior; that is, as factors whose effects on behavior are not entirely mediated by intention. These include past behav- ior, habit, attitude toward the behavior, and self-identity (see Conner & Armitage, 1998, for a review). Although such factors may have an independent influence

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on behavior, the possibility remains that the findings simply reflect inadequa- cies in the measurement of intention. If intentions were measured proximally using highly reliable measures, the effects of factors such as past behavior may be shown to be mediated entirely through intentions.

If other factors in addition to intention independently influence behavior, even with optimal measurement of intentions and behavior, then this would seem to imply that the relationship between intention and behavior, as meas- ured by the product-moment correlation, will be less than perfect. However, it is important to appreciate that this will be the case only when these other fac- tors are uncorrelated with intention. If behavior is influenced solely by inten- tion and a second factor X (and we assume for simplicity that the effects are linear and additive) and if X is correlated zero with intention in the population, then the expected value of the correlation between intention and behavior must be less than 1 .O. However, if intention and factor X are correlated, it is possible in principle to obtain a perfect correlation between intention and behavior. This is because the intention-behavior correlation is made up of a component due to the causal effect of intention on behavior and a spurious component due to the fact that X is correlated with intention and has an independent effect on behavior.

The last point relates to the distinction made earlier between prediction and explanation. If the aim is simply to predict behavior, there can be no theoretical objection to using intention on its own as a predictor and the correlation coeffi- cient as one possible measure of predictive power. If, on the other hand, the aim is to estimate the size of the causal effect of intention on behavior, then it is es- sential to control for the effects of variables that, according to theory, influence both intention and behavior.

Conclusions and Recommendations

Meta-analyses of the TRA and the TPB show that these models explain, on average, between 40% and 50% of the variance in intention and between 19% and 38% of the variance in behavior. It is important to compare these reviews in detail and to analyze the reasons for the variability in the findings, particularly for behavior. It is also important to examine the variability in findings across studies within a single review to address the question of why the models per- form better in some studies than in others. Whether the overall level of predic- tive power afforded by the TRA/TPB is judged as impressive or disappointing depends on the standard of comparison used. For instance, the models fare poorly by comparison with the ideal maximum of 100% variance explained, but perform well when judged in relation to typical effect sizes in the behav- ioral sciences.

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Percentage of variance explained may give a rather pessimistic impression. An effect size equivalent to explaining 10% of the variance may be extremely worthwhile from a practical viewpoint. This is not to suggest that we should abandon percentage of variance explained as a measure of effect size, but rather that we should learn not to be dismissive of models that explain only 10% of the variance, particularly if they do so with a small number of predic- tors. Different measures of effect size can give a very different impression. Re- searchers should therefore compute a variety of effect size measures. In addition, rather than simply reporting the correlation or the proportion of vari- ance explained, investigators should consider reporting the intention-behavior relationship in more detail, for example by presenting a full cross-tabulation or using a graphical representation such as that used in Figure 1. This would en- able prediction accuracy to be analyzed.

The discussion of reasons for poor prediction makes it clear that explaining 100% of the variance is unlikely to be achievable in practice. It also has a number of implications for maximizing the intention-behavior correlation. Generally speaking, intentions should be measured proximally, after rather than before people have made a real decision, and using compatible measures of intention and behavior based on multiple indicators for high reliability. (These are generalizations; I have noted several exceptions and provisos.) Where it is not possible to use multi-item scales, researchers should at least ex- plore the possible effects of different degrees of reliability on their findings. This is particularly important in multivariate analysis where the consequences of unreliability are difficult to predict.

The principle of compatibility should be extended to include not simply the wording of the question, but also the response format and the number of re- sponse categories. For instance, if the behavioral measure is dichotomous, in- vestigators might consider including a dichotomous measure of intention, as well as the conventional 7-point likelihood rating scale. I have suggested else- where (Sutton, 1994) that behavioral intentions (strictly speaking, behavioral expectations) could be measured by showing respondents the measure of be- havior that will be used in the follow-up questionnaire and asking them to pre- dict how they will answer the question. This method guarantees perfect com- patibility. I am not aware of any studies that have used this approach to date.

Where unequal numbers of response categories are used, researchers should be encouraged to compute the correlation and percentage of variance explained under different assumptions (e.g., linear relationships vs. step functions, different distributions) to explore the effects of such factors on effect size. This can eas- ily be done using standard software.

Where categories of a variable (e.g., a measure of intention) are collapsed for analysis, one consideration that should influence the choice of cut point is

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the extent to which it produces a distribution that approximates the distribution of the behavior measure. Put simply, infrequent behaviors should be predicted infrequently.

The distinction between prediction and explanation is an important one. It should be emphasized that explanation is not simply a matter of maximizing the intention-behavior correlation. Rather, the aim is to obtain an accurate esti- mate of the causal effect of intention on behavior (which is one component of the intention-behavior correlation). Validity issues are therefore particularly pertinent. If the main aim is to predict behavior, then lack of validity in the measure of the predictor(s) is not a problem. It matters little if a scale that is de- signed to measure construct X in fact measures construct Y, so long as it is a good predictor of behavior. However, it is crucial that the criterion is measured validly, otherwise we may not be predicting what we thought we were predict- ing. If the aim is to explain behavior, we need to be concerned about the valid- ity of the measures of both the predictors and the criterion.

Finally, a number of additional suggestions may be made for future research on the intention-behavior relationship. Where possible, studies should include proximal as well as distal measures of intention so that change can be measured and the impact on the intention-behavior relationship assessed. This would en- able a fairer test of the TRA’s sufficiency assumption (i.e., the assumption that all influences on behavior act through proximal intention). Even the effect of past behavior, a variable that often strongly predicts future behavior over and above a distal measure of intention, may be shown to be entirely mediated by a reliable and valid proximal measure of intention. Although Fishbein and Ajzen say little about the role of memory processes, these would seem to be crucial in understanding the relationship between intention and behavior. In order to in- fluence behavior, a distally formed intention has to be retrieved or re-formed when an opportunity to perform the behavior arises. More attention also needs to be paid to situational factors. Intentions may change because the context changes (Ajzen, 1996; Sutton, 1996). For example, when forming an intention to use a condom, a person may fail to accurately predict the circumstances of the next sexual encounter. There are a number of ways in which the TRA/TPB can accommodate situational influences. Indeed, the emphasis on salient be- liefs in these models implies a potentially important role for situational factors in influencing behavior. Finally, method effects should be investigated in fu- ture studies by measuring intentions and behavior using more than one method.

References

Abelson, R. P. (1985). A variance explanation paradox: When a little is a lot. Psychological Bulletin, 97, 129-133.

Page 20: Predicting and Explaining Intentions and Behavior: How Well Are We Doing?

1336 STEPHEN SUTTON

Ajzen, I. (1988). Attitudes, personality, and behavior. Milton Keynes, UK: Open University Press.

Ajzen, I. (199 1). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-2 1 1.

Ajzen, I. (1996). The directive influence of attitudes on behavior. In P. M. Gollwitzer & J. A. Bargh (Eds.), Thepsychology ofaction: Linking cogni- tion and motivation to behavior (pp. 385-403). New York, NY: Guilford.

Ajzen, I., & Driver, B. L. (1992). Contingent value measurement: On the nature and meaning ofwillingness to pay. Journal of Consumer Psychology, 1,297-3 16.

Ajzen, I., & Fishbein, M. (1977). Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychological Bulletin, 84,

Ajzen, I., & Fishbein, M. (1 980). Understanding attitudes andpredicting social

Cohen, J. (1 988). Statistical power analysis for the behavioral sciences (2nd

Cohen, J . (1992). A power primer. Psychological Bulletin, 112, 155-159. Cohen, J., & Cohen, P. (1 983). Applied multiple regressionkorrelation anal-

ysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum. Conner, M., & Armitage, C. J. (1998). Extending the theory of planned behav-

ior: A review and avenues for further research. Journal ofApplied Social

Courneya, K. S. (1994). Predicting repeated behavior from intention: The issue of scale correspondence. Journal ofAppliedSocia1 Psychology, 24,580-594.

Courneya, K. S., & McAuley, E. (1 993). Predicting physical activity from in- tention: Conceptual and methodological issues. Journal ofsport and Ex- ercise Psychology, 15, 50-62.

Davidson, A. R., & Beach, L. R. (1 98 1). Error patterns in the prediction of fer- tility behavior. Journal ofApplied Social Psychology, 11,475-488.

Eagly, A. H., & Chaiken, S. (1993). The psychology of attitudes. Fort Worth, TX: Harcourt Brace Jovanovich.

Farley, J. U., Lehmann, D. R., & Ryan, M. J. (1 98 1). Generalizing from “im- perfect” replication. Journal of Business, 54, 597-6 10.

Fife-Shaw, C. (1 997). Commentary on Joffe (1 996) AIDS research and preven- tion: A social representation approach. British Journal of Medical Psy-

Fishbein, M., & Ajzen, I. (1975). Belief; attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.

Godin, G., & Kok, G. (1996). The theory of planned behavior: A review of its applications to health-related behaviors. American Journal of Health Pro- motion, 11, 87-98.

888-918.

behavior. Englewood Cliffs, NJ: Prentice-Hall.

ed.). Hillsdale, NJ: Lawrence Erlbaum.

Psychology, 28, 1429- 1464.

chology, 70, 65-73.

Page 21: Predicting and Explaining Intentions and Behavior: How Well Are We Doing?

PREDICTING AND EXPLAINING 1337

Hoorens, V. (1 994). Unrealistic optimism in health and safety risks. In D. R. Rutter & L. Quine (Eds.), Social psychology and health: European per- spectives (pp. 153- 174). Aldershot, UK: Avebury.

Manstead, A. S. R., & Parker, D. (1995). Evaluating and extending the theory of planned behavior. In W. Stroebe & M. Hewstone (Eds.), European Re- view ofSocial Psychology (Vol. 6, pp. 69-95). Chichester, UK: John Wiley & Son.

Marks, D. F. (1 996). Health psychology in context. Journal of Health Psychol-

Menard, S . (1995). Applied logistic regression analysis. Thousand Oaks, CA: Sage.

Orbell, S., & Sheeran, P. (1998). “Inclined abstainers ”: A problem for pre- dicting health-related behaviour. Manuscript submitted for publication.

Ouellette, J. A., & Wood, W. (1998). Habit and intention in everyday life: The multiple processes by which past behavior predicts future behavior. Manuscript submitted for publication.

Piliavin, J. A. (199 1). Is the road to helping paved with good intentions? Or in- ertia? In J. A. Howard & P. L. Caller0 (Eds.), The self-society dynamic: Cognition, emotion, and action (pp. 259-279). Cambridge, UK: Cambridge University Press.

Randall, D. M., & Wolff, J. A. (1994). The time interval in the intention- behaviour relationship: Meta-analysis. British Journal of Social Psychol-

Rosenthal, R., & Rubin, D. B. (1979). A note on percent variance explained. Journal of Applied Social Psychology, 9,395-396.

Schmidt, F. L., & Hunter, J. E. (1996). Measurement error in psychological re- search: Lessons from 26 research scenarios. Psychological Methods, 1,

Sheeran, P., & Orbell, S. (in press). Do intentions predict condom use? Meta- analysis and examination of six moderator variables. British Journal of Social Psychology.

Sheppard, B. H., Hartwick, J., & Warshaw, P. R. (1988). The theory of rea- soned action: A meta-analysis of past research with recommendations for modifications and future research. Journal of Consumer Research, 15,

Sutton, S. R. (1989). Smoking attitudes and behavior: Applications of Fishbein and Ajzen’s theory of reasoned action to predicting and understanding smoking decisions. In T. Ney & A. Gale (Eds.), Smoking and human be- havior (pp. 289-3 12). Chichester, UK: John Wiley & Sons.

Sutton, S. R. (1994). The past predicts the future: Interpreting behaviour- behaviour relationships in social psychological models of health behaviour.

ogy, 1, 7-21.

ogy, 33,405-4 18.

199-223.

325-343.

Page 22: Predicting and Explaining Intentions and Behavior: How Well Are We Doing?

1338 STEPHEN SUTTON

In D. R. Rutter & L. Quine (Eds.), Socialpsychology and health: European perspectives (pp. 7 1-88). Aldershot, UK: Avebury.

Sutton, S. R. ( 1 996). Some suggestions for studying situational factors within the framework of attitude-behaviour models. Psychology and Health, 11,

Sutton, S. R. (1997). Theoryofplanned behaviour. In A. Baum, S. Newman, J. Weinman, R. West, & C. McManus (Eds.), Cambridge handbook ofpsy- chology, health and medicine (pp. 177-1 80). Cambridge, UK: Cambridge University Press.

Sutton, S. R., Bickler, G., Sancho-Aldridge, J., & Saidi, G. (1994). Prospective study of predictors of attendance for breast screening in inner London. Journal of Epidemiology and Community Health, 48, 65-73.

Sutton, S. R., Marsh, A., & Matheson, J. (1987). Explaining smokers’ deci- sions to stop: Test of an expectancy-value approach. Social Behaviour, 2, 35-49.

Sutton, S. R., Saidi, G., Bickler, G., & Hunter, J. (1995). Does routine screen- ing for breast cancer raise anxiety? Results from a three wave prospective study in England. Journal of Epidemiology and Community Health, 49,

van den Putte, B. (1993). On the theory of reasoned action. Unpublished doc- toral dissertation, University of Amsterdam, The Netherlands.

Warshaw, P. R., & Davis, F. D. (1985). Disentangling behavioral intention and behavioral expectation. Journal of Experimental Social Psychology, 21,

635-639.

4 13-4 18.

213-228.