There are few psychological theories which provides theoretically useful tool to measure attitude, behaviors and beliefs. Martin Fishbein and Icek Ajzen developed Theory of Reasoned Action (TRA) (Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975). TRA propose that the most essential element of an individual’s behavior is that individual’s intention to perform the behavior. TRA have four constructs, Intentions refers to the predictions of attitude and subjective norms, and it represents an individual’s motivation in sense of individual’s conscious decision which leads to make efforts to perform behavior (Taylor et al., 2006; Glanz et al., 2002). Subjective norms refer to the normative belief of an individual that people around oneself will and will not approve performing health behavior. An individual’s perception whether the important people like family, peers approve or disapprove engagement in health behavior (Wang et al., 2019).
Secondly, the Health Belief Model is the conceptual framework which is widely used in behavioral researches in health since 1950s. This model is used to explain improvement, maintenance and change in health-related behaviors and also provides better guidelines for the intervention of health behavior. From the last two decades, Health Belief Model has been expended, integrated with other theories, compared to different frameworks and used to help maintaining changes in health behavior (Sulat et al., 2018). In the HBM, the prospect of individual performing health behavior is elucidated in to four perceptions such as perceived severity and susceptibility, perceived benefits and barriers.
Third theory incorporated was the Social Cognitive Theory (SCT) that was proposed by Rotter (1954; 1966) and Bandura (1986). SCT is a subcategory of cognitive psychology. Social Cognitive Theory suggests that the learning of individuals is based on the interaction with their environment with their personal experiences which leads towards the specific behavior (Rotter, 1990). It forms the foundations of the model to measure health behavior (Abraham et al., 1998). According to this approach individual’s motivation is based on social support, self-regulation and self-efficacy. Self-regulation and social support constructs of SCT has been taken in this study (Silveira & Motl, 2019).
Fourthly, the IMB model was also added as it is a detailed and comprehensive model to measure and predict changes in behavior with the explanation of environmental and interpersonal roles. IMB Skills differentiate three factors of performance of health behavior: 1. Health related knowledge and information which could be interpreted into behavior, 2. Social motivation which translate changes in health behavior, 3. Behavioral skills to enable in engagement and commitment to behavior. (Fisher et al., 2003). The IMB model suggests that, the degree of knowledge and information an individual have related to health and motivation to apply that knowledge with the behavioral skills to execute behavior will measure their behavioral engagement (Cornman et al., 2007; Rivet Amico, 2011; Zarani et al., 2012)).
2.1. Subjective Norms and Intention
In Theory of Reasoned Action (TRA) social norm is a determinant of behavioral intention. Subjective norms deal with the feeling of an individual about social perspective and pressure they sense for performing behavior. Furthermore, individual who is having positive subjective norms towards performing certain behavior most likely having the positive intention (Han et al., 2009). In the health behavior context, previous studies have measured subject norms key measure of intention (Cooke & French, 2008). Many studies using TRA and TPA suggested the validation of positive influence of subjective norms on the health behavioral intention to follow the prevention and safety measures (Conner, M., & Norman, 2006; Cooke & French, 2008; Glanz et al., 2002; Nelson et al., 2018)
subjective norms have a positive influence on intention towards safety behavior.
2.2. Attitude and Intention
The construct of attitude in Theory of Reasoned Action (TRA) defined as an individual’s overall valuation of performing behavior (Wang et al., 2019). Attitude measures through individual’s beliefs about the aspects and outcomes of executing behavior weighted by valuation of these aspects (Glanz et al., 2002). Furthermore, attitude leads to measure whether the individual’s behavior is good or bad (Davis et al., 2015). Previous studies about health behavior pointed that attitude also include the consequences related to the perceived behavior (Wang et al., 2019). Chen and Tung (2014) illustrated attitude as a psychological emotion transmitted through individual’s valuation and if it is positive that leads to more positive behavioral intention.
attitude has a positive influence on intention towards safety behavior.
2.3. Perceived susceptibility and Intention
Perceived susceptibility is defined as a perceived subjective perception about risk an individual have to a health state or condition (Sulat et al., 2018). Glanz et al., (2002) defined perceived susceptibility as a belief about getting chances of health risks. Perceived susceptibility is the belief of experiencing health risk it’s a threat of getting sick or having a bad health condition (Taylor et al., 2006; Rahman et al., 2018). The health belief model predicts the perceived threat of health behavior intention. It shows high usefulness, when perceived, the perceived vulnerability and seriousness positively affects health behavior. Moreover, few researches suggested that perceived susceptibility of a health issue is positively related to performing safety behavior for the health threats. (Mou et al., 2016).
Perceived Susceptibility have a positive influence on intention towards safety behavior.
2.4. Perceived Severity and Intention
Perceived severity denotes subjective valuation of severity of the consequences which are allied with the specific health condition (Taylor et al., 2006). Sulat et al., (2018) defined perceived severity as the belief of an individual about seriousness of a health condition. Perceived severity is a belief that how serious is the health state and condition (Glanz et al., 2002). Individuals are appraising the severity and seriousness of COVID-19 and the circumstances associated with it which leads them towards safety measure (washing hands, use of face Mask, sanitizers & goloves) (Carico et al., 2020; Qazi et al., 2020; E. L. Wong, 2020). Consciousness about health condition may influence individual’s positive intention towards safety behavior. Therefore, the current study propose hypothesis as below:
Perceived Severity have a positive influence on intention towards safety behavior.
2.5. Perceived Barriers and Intention
Perceived barriers refer to the perception of negative aspects towards specific action (Sulat et al., 2018). Glanz et al. (2002) defined perceived barriers as a belief of perceptible and psychological cost an individual have to pay for performing an advised action related to health condition. According to Taylor et al. (2006), perceived barriers are all the negative aspects an individual have to face in response to an action or overcoming predictive barriers to take an action. In HBM perceived barriers are the factors an individual has to deal with may stop them to perform advised behavior (Chin & Mansori, 2018; Karimi et al., 2016; Stutts, 2002; Sulat et al., 2018; Talsma et al., 2013; Tshuma et al., 2017) As the barriers would be low the individual’s intention to perform advised behavior would be increased.
Perceived Barriers are positively related to intention towards safety behavior
2.6. Perceived Benefit and Intention
Perceived benefit means a perception and belief about the efficiency of an advised action to be taken to get the health benefit and reduce the risk associated with the seriousness of health problem (Glanz et al., 2002). Previous studies suggested and clarified that if an individual is confident about the positive returns and benefit, they will get by performing advised behavior the intention to have recommended behavior will be high and the individual will be engaged into that advised behavior (Darvishpour et al., 2018). An advised action is not adoptable until that have some advantages (Maiman & Becker, 1977).
Perceived Benefits are positively related to intention towards safety behavior
2.7. Social Support and Intention
Social support refers to the assistance of other people for an individual. This also refers to the individuals believe on the respect and love receive from the other individuals in the society to have social networks (Jeihooni et al., 2016). In the SCT, social support considered a strong predictor to measure the behavior. Social support is associated with emotional reassurance. Researchers have linked social support with the social well-being and positive and significant health. Some researchers relate social support with stress and fewer related social support with intention for example intention to leave job and origination (Lee, 2004).
social support is positively related to intention towards safety behavior.
2.8. Self-regulation and Intention
Self-regulation antecedent refers emotional and cognitive behavioral strategies for change in behavior based on the important goals of individuals. Few studies have suggested that adoption of self-regulation leads to high the chance of adopting recommended health behavior (Hofmann et al., 2008). Previous studies suggested the relationship between self-regulation and intention is significant, Ahn et al. (2016) suggested that self-regulation is highly linked with exercise adherence intention.
Self-regulation is positively related to intention towards safety behavior.
2.9. Knowledge and Self-efficacy
Knowledge refers to the facts about health-related issues such as HIV preventing knowledge, pandemic prevention (Cornman et al., 2007; Rivet Amico, 2011; Zarani et al., 2012). Information is measured through knowledge, previous studies suggested that knowledge about the health issues help individual to belief oneself for executing suggestive behavior. (Cornman et al., 2007; Osborn & Egede, 2010; Rivet Amico, 2011; Zarani et al., 2012). In the context of pandemic of COVID19 if an individual has knowledge about the health risks and benefit involve with this pandemic, that person will have belief on oneself to perform safety behavior.
knowledge is positively related to self-efficacy.
2.10. Self-efficacy and Behavior
Self-efficacy refers to the individual’s belief of executing required behavior (Bandura, 2005). Previously self-efficacy was a construct of Theory of Planned behavior, but it is argued that perceived behavioral control and self-efficacy is exchangeable and directly influenced to behavior (Anderson et al., 2007). Moreover, some researchers suggested that the more powerful predictor of behavior is selfefficacy (Cornman et al., 2007; Esperat et al., 2008; Fleary et al., 2020; Qazi et al., 2020; Sulat et al., 2018; Zarani et al., 2012). In HBM self-efficacy has been recently added. Scholar suggested positive influence of self-efficacy on safety behavior. In COVID-19 context if an individual has belief on oneself for taking all safety measures that individual will intent to have safety behavior.
Self-efficacy is positively related to individual’s safety behavior
2.11. Cue to Action and Behavior
Cue to action defined as the different strategies to get ready for taking health action. This includes approaches to accelerate willingness to take action (Glanz et al., 2002). The information and knowledge received from different sources such as news report, friends and family to follow health measures to overcome the risk of health and the strategies to be followed as advised by different resources defines cue of action (Sulat et al., 2018). Previous studies support positive relation of cue to action and health behavior in different context (Chin & Mansori, 2019; Conner, M., & Norman, 2006; Glanz et al., 2002; Maiman & Becker, 1977).
Cues to action is positively related to individual’s safety behavior.
2.12. Intention and Behavior
An individual’s behavior is measured by the intention. Theory of reasoned action suggests that behavior of an individual is predictable through intention (S. Huang & Chang, 2017). TRA proposed significant relationship between intention and behavior. Rayan & Bonfield (1980) suggested intentions as a predictor and validator to measure actual behavior. It is proposed that if the intention of an individual is stronger to perform behavior, the more likely that individual will execute that behavior (Chin & Mansori, 2018, 2019; Cooke & French, 2008; Shang & Zuo, 2020; Sunmola et al., 2007).
Intention is positively related to individual’s safety behavior.
2.13. Mediating role of Intention
Theory of Reasoned Action (TRA) by Martin Fishbein and Icek Ajzen (Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975) propose that the most essential element of an individual’s behavior is that individual’s intention to perform the behavior. Most researches suggested that the intention play a mediating role in the relationship of constructs of TRA that are; subjective norms, attitude and behavior (X. Huang et al., 2020; Taylor et al., 2006). The literature showed the mediating role of intention between predictors of HBM, SCT, TRA and behavior. Several studies elucidated the partial and full mediation of intention with construct of these theories and behavior (Abraham et al., 1998; Banerjee & Ho, 2019; Chin & Mansori, 2019; Mafabi et al., 2017) In the present study we have integrated four behavioral theories: Health Belief Model, Social Cognitive Theory, Theory of reasoned Action and Information Motivation-Behavioral Skills to study the safety behavior. In the relationship of predictors of HBM, TRA & SCT, behavior intention is taken as mediator to predict actual behavior in COVID-19(X. Huang et al., 2020; Sulat et al., 2018; Taylor et al., 2006). Thus, we allied the constructs of HBM (Perceived susceptibility, perceived severity, perceived barrier and perceived benefits), constructs of TRA (Subjective norms, attitude), and predictors of SCT (Social support, self-regulation) to intention towards safety behavior to investigate individual’s safety behavior. Thus, we propose following hypothesis to study mediating role of intention to study individual’s safety behavior.
2.14. Perceived susceptibility-intention towards safety behavior individuals’ safety behavior.
The integration of HBM and TRA suggested the indirect relation between perceived susceptibility and individual’s behavior. Perceived susceptibility refers to the perception of the risk associated with the health condition (Sulat et al., 2018). Previous studies have suggested the positive associate of perceived susceptibility and behavior for example if an individual knows the risk of getting flu, this perception of risk will motivate him/her to perform specific behavior (Taylor et al., 2006).
Intention towards safety behavior mediates the relationship between perceived susceptibility and individual’s safety behavior.
2.15. Perceived Severity-intention towards safety behavior individuals’ safety behavior.
The integration of HBM and TRA suggested the indirect relation between perceived severity and individual’s behavior. Perceived severity defined as the seriousness associated with the specific health condition, it’s the perception of an individual about the seriousness of a health issue (Sulat et al., 2018). Earlier researches proposed the positive relationship of perceived severity and behavior (Taylor et al., 2006). Scholars suggested that the seriousness stimulus the individual to perform a preventive behavior and intention is a direct dominator of behavior. (Chin & Mansori, 2018; Shang & Zuo, 2020).
Intention towards safety behavior mediates the relationship between perceived severity and individual’s safety behavior.
2.16. Perceived Barriers-intention towards safety behavior individuals’ safety behavior.
An integration of health belief model and theory of reasoned action proposed the direct connotation of perceived barriers and behavior. Perceived barriers are the obstacle an individual have to face while performing specific behavior (Sulat et al., 2018). In the current study we intent to find out the mediating role of intention in the relationship between perceived barriers and individual’s safety behavior.
Intention towards safety behavior mediates the relationship between perceived barriers and individual’s safety behavior.
2.17. Perceived Benefits-intention towards safety behavior individuals’ safety behavior
Perceived benefits are the outcomes which an individual gets after performing the advised behavior it’s the predictor of health belief model, an integration of health belief model and theory of reasoned action suggests conformist association of perceived benefits and behavior (Sulat et al., 2018). Previous researchers suggested that benefits related to the specific behavior supports individual to perform actual behavior which is advised and recommended for the prevention of health issue(Chin & Mansori, 2018; Sulat et al., 2018).
Intention towards safety behavior mediates the relationship between perceived benefits and individual’s safety behavior.
2.18. Attitude-intention towards safety behavior-individuals’ safety behavior
According to TRA, intention towards behavior links individual’s attitude to perform certain behavior (Taylor et al., 2006). This suggests that the association between attitude and behavior may be linked direct or indirect (Torre et al., 2012). The positive valuation of performing preventative behavior makes individual more willing to perform actual safety behavior (Jeihooni et al., 2016) This willingness is a kind of intention towards safety behavior this is also linked with actual safety behavior (Mafabi et al., 2017).
Intention towards safety behavior mediates the relationship between attitude and individual’s safety behavior.
2.19. Subjective norms –intention towards safety behavior individuals’ safety behavior.
The theory of reasoned action postulates that the normative perceptions and beliefs of individual are connected with the willingness to perform actual behavior. (Cooke & French, 2008; Taylor et al., 2006). Subjective norms are the belief of an individual to perform a certain behavior. Previous researchers prosed that the subject norms act like a pressure for the experts and professionals to espouse the behavior of the peers (Witherspoon et al., 2013). Studies proved that the relationship of subjective norms is strong with the intention (Wu and Zhu’s (2012). These researchers further suggested that the normative beliefs are associated with the behavioral intention, which leads to actual behavior. (Cooke & French, 2008; Oni et al., 2017; Taylor et al., 2006).
Intention towards safety behavior mediates the relationship between subjective norms and individual’s safety behavior.
2.20. Social Support –intention towards safety behavior individuals’ safety behavior
Social support is a strong predictor of behavior in social cognitive theory. Social support is a motivation from friend, family and other social circle to perform behavior. Prior studies determined direct relation of social support and behavior. There are a few researches in relationship of social support and intention in the field of communication and health (Lee, 2004).
Intention towards safety behavior mediates the relationship between social support and individual’s safety behavior.
2.21. Self-Regulation –intention towards safety behavior individuals’ safety behavior
Self-regulation is also found with the name of self-evaluation and self-monitoring in the prior studies and is a very important indicator of behavior in social cognitive theory. Previous studies suggested the relationship between self-regulation and intention is significant, for example, a study was conducted on the relationship of self-regulation and exercise adherence intention in 2016, that study suggested that self-regulation is highly linked with exercise adherence intention (Ahn et al., 2016).
Intention towards safety behavior mediates the relationship between self-regulation and individual’s safety behavior.
2.22. Mediating role of self-efficacy
As the current study is intended to integrate behavioral theories the fourth theory we used, is information-motivation-behavioral skills. In IMB theory information and motivation predict behavior to be adopted. Information apprehends knowledge about COVID-19. Motivation is incorporating the core predictors of TRA (attitude & subjective norms) and behavioral skills denotes self-efficacy. Therefore, the knowledge has the direct relation with behavior and indirect relation with mediation of self-efficacy (Cornman et al., 2007; Fisher et al., 2014).
self-efficacy mediates the relationship between knowledge and individual’s safety behavior