To our knowledge, this is the first study identifying and understanding personal behavioral determinants of the decision-making behavior that influences municipal decision-making processes to implement community health promotion and to create healthy environments. The aim was to reveal the subjective view of various CAs from local politics and local government in urban and rural communities. Our qualitative study highlights the importance of personal behavioral determinants to explain the decision-making behavior of CAs. We elicited seven essential determinants, namely imprinting, socialization, and biography; experiences and involvement; important issues and aspects; knowledge; emotions; personal benefits; and the perceived influences of others. These determinants might serve as the basis for developing logic models of change [3] in the decision-making behavior of CAs. There are two main findings which generate hypotheses that require further research and will be discussed below:
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The personal behavioral determinants of decision-making are likely the same as the personal behavioral determinants of health behavior; and
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The decision-making behavior of change agents from local politics and local government is both rational and emotional.
The personal behavioral determinants of decision-making are likely the same as the personal behavioral determinants of health behavior
The findings of our study confirm that there are various personal behavioral determinants that affect the decision-making behavior of CAs, and these are likely the same as the personal behavioral determinants of the health behavior of a population, as proposed by IM [3]. In IM these determinants are called knowledge, attitude, (normative) beliefs, outcome expectations, subjective norms, self-efficacy, automatic or impulsive behaviors, and social influences [3]. In our results, we attributed different names to the determinants, but they have the same meanings. Our identified determinants are discussed in the following sections.
In our results, the determinant “imprinting, socialization, and biography” seems to be important for opinion formation and decision-making, but also seems difficult to change, as these aspects are mainly influenced by a person’s past, beliefs, morals, and personality [3]. This determinant was also highlighted in two other studies. When adopting integration technologies, local government decision-makers are affected by their personalities, ethics, and values [26]. Analysis of the determinants of the decision-making process of managers in organizations has revealed that some of the most important determinants are also values, ethics, and personality [27].
The determinant “experiences and involvement” seems to play a role in decision-making. If CAs had a positive experience in a similar situation before (e.g., life or work experience), or if they are personally involved with a certain topic or circumstance (e.g., being a parent, having children), they tend to decide in favor of that topic/situation. This finding matches a study which analyzed the determinants of the decision-making process of managers in organizations. In that study, experience was one of the most important determinants [27].
The determinant “important issues and aspects” seems to be central in the decision-making of CAs. Almost every respondent mentioned the impact on and welfare of the population as important influencing factors. Health promotion and physical activity were not among their issues of top priority; rather education, nature, the environment, and sustainability were more important. The expected implementation outcomes of issues or interventions are also relevant and were often mentioned. This determinant has a great deal in common with attitudes towards and outcome expectations of certain topics (e.g., education or culture), towards impacts on the population or community (e.g., social balance), and towards structural aspects or implementation outcomes (e.g., feasibility, costs, and plausibility). Attitudes are positive or negative reactions to something; however, they can include more specific belief constructs, outcome expectations, evaluations of advantages and disadvantages, self-assessments, and motivations for action [3]. Results from other studies have also indicated that attitudes play a role when implementing health promotion [23], or when voting for a law’s enforcement or tax increase [24, 25].
The determinant “knowledge” seems not to be one of the crucial determinants for the interviewees, but it is a foundation and requirement for most other determinants, such as risk perception, attitudes, and competencies [3]. However, knowledge does not usually lead directly to changes in behavior, nor is it necessarily an easy task to ensure that a target group acquires knowledge [3]. Another study has revealed that, for example, knowledge of integration technologies influences decision-makers of local government authorities when adopting these technologies [26].
Personal benefits do not appear to be mainly relevant in our findings and were mentioned only by one person. The result coincides with the finding above, that almost every respondent mentioned the impact on and welfare of the population as important influencing factors rather than the personal benefits from a decision. However, it could be that the other respondents did not answer truthfully due to social desirability.
The determinant "perceived influences of others," with its subthemes of “overcoming the influences of others” and “yielding to the influences of others,” is of importance in our findings and allows inferences to be made about known determinants from the literature, such as social influences, subjective norms, and self-efficacy expectancies. However, since these constructs were not specifically queried in this study, we should be cautious when interpreting this finding. The social environment is an important determinant of many behaviors and is therefore often used in behavior change. The Theory of Planned Behavior and its extension, the Reasoned Action Approach [40, 41], describe social influences as perceived expectations of people that are important to a person and perceived behaviors of people similar to those of a person [3]. Closely connected to social influences are subjective norms, which refer to the belief that an important person or group of people approves and supports a particular behavior. Subjective norms are determined by the perceived social pressure by others on a person to behave in a certain way and by his or her motivation to conform to the views of those people [42]. Self-efficacy is often a critical factor in behavior change and is about whether motivated individuals are able and convinced to change a behavior. In the context of self-efficacy, a distinction is made between perceptions (e.g., perceived abilities) and reality (e.g., real abilities). Even with sufficient real abilities, individuals may not attempt to implement a new behavior if their perceived abilities are low. And individuals with high perceived abilities may fail because they do not have sufficient real abilities [3]. The subtheme “overcoming the influences of others” can mean overcoming social influences and subjective norms, which indicates a tendency toward higher self-efficacy. Yielding to the influences of others can provide initial indications of low self-efficacy. However, the aim of this study was not to measure social influences, subjective norms, or self-efficacy, but to provide preliminary evidence of personal behavioral determinants of the decision-making behavior of CAs. Our findings about the determinant “perceived influences of others” match the results of other studies. For example, subjective norms played a role among Austrian mayors when implementing health promotion for older people [23], or when voting for a law’s enforcement [24] or tax increases. The same applied to constituent pressure as to social influence [25].
The decision-making behavior of change agents from local politics and local government is both rational and emotional
An interesting finding is how often emotions were mentioned by the respondents. By changing the content of our beliefs, judgments, or ways of thinking, emotions can influence the information processing and the final outcome of a decision. People categorize and evaluate based on emotions. Moreover, making choices leads to the satisfaction of our needs and the experience of expected emotions [43]. This result matches a study which analyzed the determinants of the decision-making process of managers in organizations. The most important psychological determinants were personality, intuition, emotions, mood, feelings, and prejudices [27].
The identified personal behavioral determinants in our study can be divided into more analytical/logical/rational (e.g., knowledge) and more intuitive/affective/emotional (e.g., emotions) determinants. This distinction reflects the classical division of psychology into conscious, slow, and reflective processes and unconscious, fast, and automatic processes [44]. Thus, making a decision involves both rational and irrational/affective processes [45, 46]. Our results also match the theoretical consideration of dual-system models. For example, the Reflective-Impulsive Model (RIM) [47, 48] distinguishes between a reflective and an impulsive system. These two systems together generate behavior. The impulsive system is always active and the reflective system acts according to intentions, so that, for example, conflicts between feelings and knowledge arise [3].
We did not determine whether making more rational or emotional decisions depends on the context/setting (urban or rural), gender, or role/function of a CA. Nor can we say whether more decisions are made rationally or emotionally, or to what extent there is always a mix of both. It can be assumed that it also depends on the decision or the topic and the personality or the character of the CA. However, only tendencies can be identified from the interviews, and a differentiation into rational or emotional decision-making processes was not the aim of the study. For this purpose, more specific questions would have had to be asked and, for example, types/profiles would have had to be determined in the analysis.
Overall, however, it can be stated that personal behavioral determinants cannot be viewed from only one perspective, for example, rational versus emotional; rather, determinants are multi-theoretical and have multiple perspectives. Thus, changing these determinants to achieve a health outcome also follows a multi-theoretical approach (see IM) and the logic of eclecticism (that is, connecting single theories and concepts) [3].