Competitive testing of health behavior theories: How do benefits, barriers, subjective norm, and intention influence mammography behavior?

Caitlin C. Murphy, Sally W. Vernon, Pamela M. Diamond, Jasmin A. Tiro

Research output: Contribution to journalArticle

14 Scopus citations


Background: Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories. Purpose: We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior. Methods: We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n = 704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ 2 difference testing. Results: Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers. Conclusions: Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography.

Original languageEnglish (US)
Pages (from-to)120-129
Number of pages10
JournalAnnals of Behavioral Medicine
Issue number1
Publication statusPublished - Feb 2014



  • Health behavior theory
  • Mammography
  • Theory testing

ASJC Scopus subject areas

  • Psychology(all)
  • Psychiatry and Mental health
  • Medicine(all)

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