ERIC EJ795909: Motivation for Healthy Behavior: A Review of Health Promotion Research

2006·0.28 MB·English

by  ERIC

Feature Articles
Motivation for Healthy Behavior:
A Review of Health Promotion Research
Sarah Dunsmore and Patricia Goodson
ABSTRACT
Authors reviewed the theoretical history of the “motivation” construct, and its utilization within past/current health
behavior research. Textbooks and review articles functioned as sources for the theoretical history review. Research
published within a 10-year period (1993–2002) in four health promotion journals (all with impact factors ≥ 1.0)
comprised the systematically reviewed data. Only empirical studies containing the term “motivation” in the title/
abstract were included. Studies were excluded if they did not examine motivation as a focal variable and/or as-
sessed non-health behaviors. Data abstracted included the definition of motivation; theoretical framework; mea-
surement tool(s) used; type of behavior being studied; and indicators measured. Abstracted data were coded and
organized into a matrix. Data matrixes were qualitatively assessed. Among reviewed studies, only four (9%) pro-
vided a definition of motivation. Only eleven studies specifically measured motivation despite all included studies
having “motivation” in the title/abstract (25%). The most common indicator used to measure motivation was
intention. While seventy-three percent of the studies (n=32) were theory-based, 21 different theories were used.
Eleven of the studies (25%) focused on preventive behaviors (n=11). The studies reviewed varied in the
conceptualization and measurement of motivation. Such variability may significantly affect the development and
evaluation of motivation-focused interventions.
INTRODUCTION accomplishing at least some of their behav- ine the issue, the authors conducted a sys-
Etymologically rooted in the Latin word ioral goals but also remain consistent with tematic review of a decade of health pro-
motive (“to move”), motivation is perceived the principle of individual autonomy—a motion literature and, to sharpen its focus,
and valued—by scholars and practitioners cornerstone value of health promotion couched the review within the context of
alike—as one of the most powerful elements practice.3–5 the historical development of the construct.
in mobilizing individuals to action.1 Health Given the ubiquitous nature and crucial
education, in particular, relies heavily on importance of the construct “motivation” Sarah Dunsmore, PhD, is assistant professor
human motivation to foster healthy both for understanding health behavior and with the Department of Health & Nutrition
behaviors, especially since most health edu- for effecting behavior changes, it becomes Sciences, Idaho State University, Campus Box
cation efforts depend on the voluntary com- imperative to examine the question of how 8109, Pocatello, Idaho 83209; E-mail:
mitment of individuals—as opposed to current health promotion researchers have [email protected]. Patricia Goodson, PhD, is
coerced participation—for behavioral handled the construct. To the best of our an associate professor with the Department of
change to occur.2 Indeed, behavior change knowledge, similar attempts at historically Health & Kinesiology, Texas A&M University,
programs that target motivation as a medi- and empirically organizing this area of re- 4243 TAMU, College Station, TC 77843-4243;
ating factor are not only successful in search have not been undertaken. To exam- E-mail: [email protected].
170 American Journal of Health Education — May/June 2006, Volume 37, No. 3
Sarah Dunsmore and Patricia Goodson
Objective food. In order to restore the desired state of prove, motivation to demonstrate ability,
The purpose of this paper, therefore, is equilibrium, the individual must attend to motivation to either improve or demon-
two-fold: First, to selectively trace the theo- the hunger drive or motive that directs him/ strate ability in order to improve one’s stand-
retical history of “motivation” as the con- her to eat. Stability is regained with the re- ing relative to others, and motivation to ei-
struct was elaborated and applied within duction of this tension. ther improve or demonstrate ability in order
different theoretical perspectives; and sec- If drive theories emphasized a nearly to display a high standing relative to others.11
ond, to review a sample of health promo- direct and organic stimulus-response rela- As this line of thinking stressed achieve-
tion literature to identify how motivation tionship between motivation and behavior, ment-related behaviors, its applicability was
is being defined and measured within health field theories (which more or less followed restricted. This limitation did not preclude,
behavior research. This assessment reviews drive theories in the chronology of moti- however, achievement motivation research
the conceptual and operational definitions vation studies) provided a cognitive model from experiencing a resurgence in the late
offered by researchers to explain and ap- of motivation and behavior. Field theories 1960s—when “…motivational research be-
praise motivation, the theoretical frame- deal primarily with voluntary, action-ori- came almost synonymous with achieve-
works utilized to support the understand- ented decision making. Their primary as- ment motivation research”11—nor did it
ing of the concept, and the measurement sumption is that an individual attempts to preclude achievement motivation’s sus-
tools researchers employed to test the con- enhance satisfaction and minimize discom- tained prestige in areas such as physical edu-
cept and its theoretical relationships. Forty- fort through rational choices of opportuni- cation pedagogy, for instance.12
four studies published in four major health ties that will facilitate satisfactory circum- But the limited applicability of con-
promotion journals between January 1993 stances.8 It is within this category of theories structs such as drive, energy, arousal, and
and December 2002 are reviewed. that choice is first introduced as a factor goal achievements forced researchers to
Theoretical History influencing behavior change. search for a more comprehensive approach
From its nearly simultaneous origins in Perhaps the most influential theory to the study of motivation.13 The 1960s,
the fields of Biology and Psychology, the within this framework is that proposed therefore, saw the development of cognitive
construct of motivation has evolved by Kurt Lewin.9 Lewin suggested that theories of motivation, which dominate the
through multiple iterations and various dis- motivation depends on the value that is field to this day.14
ciplines into its present-day form and func- placed upon a specific goal, as well as the Cognitive models explain the transfor-
tion.5,6 Below is a brief, selective synopsis of probability of achieving that goal. The mation of motivation into behavior as re-
this evolution, including its treatment by greater the value of the satisfactory circum- sulting from the influence of mental pro-
contemporary health behavior theories. stances resulting from the achievement of cesses. Although both environmental and
In the 1930s and 40s, drive theories— the goal, the stronger the level of motiva- biological factors still influence behavior,
still influential in some scientific circles— tion.9 For example, a high school student cognitive theorists understand that influ-
understood motivation as physiological who understands that good grades will en- ence to be indirect, mediated by factors such
deficits or biological needs prompting be- able him/her to get into college and believes as beliefs, emotions, and self-efficacy.15 An
haviors that, when practiced, satisfy those there is a high probability of him/her increased emphasis on intra-personal cog-
deficits.6 Because these theories’ empha- achieving good grades, will be more moti- nitive variables, a heightened interest in in-
sis was mainly on biological factors, con- vated to obtain a good grade on a calculus dividual-level processes such as perception,
cepts such as instinct, arousal, drive and test than someone who does not value the learning and memory, as well as a keen cu-
energy were its central foci, as were the goal of college admission. riosity regarding inter-personal variability,
physical aspects of behavior; cognitive In the latter half of the 1950s, John set the stage for this shift in the focus of
factors, therefore, were largely considered Atkinson introduced Achievement Theory.10 motivational studies.7,14
to be irrelevant.7 The theory focuses on the motivation of Many of the health promotion theories
One of the drive theories of the 1940s, individuals toward achievement-related currently in vogue are descendents of this
attributed to Clark Hull, proposed that tasks varying in levels of difficulty. Within same cognitive tradition, explaining health
people seek to maintain physiological sta- this framework, people are not motivated behaviors themselves as a function of
bility, or “homeostasis” through their be- to achieve in order to obtain extrinsic re- mental (intra-personal) processes. But even
havior.7 An internal tension to remain at this wards such as money or promotions. In- as health behavior theories have also
level of stability produces drive, or the in- stead, the motivation is simply to accom- included elements of social interaction
centive to lessen unpleasant disturbances to plish the specified goal.10 At least four types theories and, to a certain extent, of behav-
equilibrium. An example of drive is human of motivation—each with their own corre- iorist theories (attempting to explain health
hunger. Without food, an individual feels sponding theories—have been identified by behavior comprehensively as a function of
an internal tension signifying the need for achievement theorists: motivation to im- multiple factors at the individual, social and
American Journal of Health Education — May/June 2006, Volume 37, No. 3 171
Sarah Dunsmore and Patricia Goodson
biological levels), it is within the cognitive of Planned Behavior (TPB)29–31 is on reinforcements influence an individual’s
tradition that motivation and health behav- “…theoretical constructs concerned with drive or motivation to behave. He suggested
iors converge. The understanding of specific individual motivational factors as determi- that reinforcements connect certain behav-
health behaviors (such as undergoing pre- nants of the likelihood of performing a spe- iors to certain stimuli, making it more likely
ventive screening) is now greatly enhanced cific behavior.”32 Given that the TPB is, es- that a particular behavior will occur if the
through the study of factors that shape in- sentially, an expansion of the TRA, only the stimulus is present.
dividuals’ motivation for healthy practices. TPB will be described here.33 The notion of reinforcements for behav-
An example of a cognitive approach to Behavioral intention—which is the most ior made its way into Social Cognitive
health behavior, the Health Belief Model important determinant of behavior accord- Theory, which distinguishes between intrin-
(HBM) is a psychosocial framework that ing to these theories—is often equated with sic and extrinsic reinforcements.33 External
attempts to explain individuals’ engagement motivation and is understood within a or extrinsic reinforcement is the occurrence
in preventive behavior as a function of, value-expectancy framework. The value, or of an event that is known to reinforce an
among other factors, motivation.16,17 expectancy, placed on the outcome of a individual’s expectation of that event.
Although not accepted as a well-developed given behavior determines an individual’s Internal or intrinsic reinforcement is a
theory within the field of psychology, HBM attitude, which in turn directly determines person’s expectation that an event will have
is widely used by health behavior research- behavioral intention. If the behavior is a certain important value. According to
ers and practitioners, thus warranting valued and expected to produce favorable social cognitive theorists, individuals per-
inclusion in this review. The model’s basic results, the individual is theorized to be form specific behaviors because they are
assumption is that once an individual is more motivated to behave. This concept is positively reinforced, but much of the learn-
aware of a health risk, an assessment of costs similar to the value-expectancy and the ing of new behavior occurs by observing
and benefits motivates action.18 After assess- costs-benefits analysis proposed by the reinforcements that others receive for
ing the behavior through the perspective Health Belief Model.18 If the benefit result- their behavior.
of each of the six constructs—perceived ing from a particular action is perceived as While the concepts of extrinsic and in-
susceptibility, perceived severity, perceived greater than the cost necessary to obtain it, trinsic reinforcements are widely used
benefits, perceived barriers, cues-to-action, motivation for action occurs.30,33 While within the motivational literature to de-
and health motivation—the individual other factors also influence intention (per- scribe social influences on behavior, they
finds him/herself motivated, or not, ceived norms and perceived behavioral con- are, nonetheless, the center of strong con-
to act.19,20 trol), much of the empirical testing of this troversy among socio-behavioral scientists.
Although motivation is not proposed model has revealed that an individual’s Some scholars suggest that external re-
as a construct within the Transtheoretical attitudes are the strongest predictors of inforcement dampens natural internal mo-
Model (also known as the Stages of Change intention/motivation.34 tivation, while others claim that only inter-
model), an individual’s “readiness” to According to Social Cognitive Theory, nal rewards can foster sustainable
behave functions as an indicator of moti- action is undertaken if a person feels he/ motivation. The health promotion litera-
vation in that model.21,22 “Readiness” is she has control over the outcome, if few ture contains ample evidence to support
organized into stages within this frame- external barriers are present in the environ- both points-of-view. Many argue that “...
work, assessing the probability of actually ment, and if the person has strong self-effi- any external constraint imposed on behav-
changing an individual’s current behavior. cacy.20 According to Bandura, one’s sense of ior may reduce the level of internal moti-
The level of readiness, or stage transition, efficacy (or confidence in the ability to per- vation.”38 But not everyone views external
is an indicator of the level of individual form the behavior) is the single, most nec- reinforcements as detrimental to internal
motivation.23–28 essary motivational element, moving indi- motivation. Eisenberger, Pierce, and
The fundamental constructs of the viduals to action.35,36 Cameron,39 for instance, decry the detri-
TTM—pre-contemplation, contemplation, Originally termed Social Learning mental effects of reinforcement on intrin-
preparation, action, maintenance, and ter- Theory,37 this framework was based on sic motivation as a myth, and as occurring
mination—represent temporal dimensions Hull’s mechanistic drive theories.6 While only in limited circumstances. While rec-
regarding one’s decision to act, that facili- proposing that behavior is motivated by ognizing that certain types of rewards may
tate understanding of an individual’s level physiological drives, not cognitions, Hull reduce intrinsic motivation, they acknowl-
of intention, desire, or “motivation.”21,22 nevertheless suggested that individuals who edge that other types of extrinsic reinforce-
Some researchers have titled the TTM experience such drives learn to respond by ments may have none or even a positive ef-
phases as “motivational stages.”27 observing others’ responses to similar fect upon intrinsic motives.
The focus of both the Theory of Rea- drives, hence the name Social Learning For Self-Determination Theory (SDT),
soned Action (TRA) and the Theory Theory. Hull also maintained that outside individuals have certain basic psychologi-
172 American Journal of Health Education — May/June 2006, Volume 37, No. 3
Sarah Dunsmore and Patricia Goodson
cal needs; if these needs are fulfilled, METHODS percent of the studies were abstracted by
the person is likely to be healthy and both authors.
Data Sources
have a greater sense of well being. Attempts Methodological quality was assessed
In order to focus on the highest-quality
to meet the basic needs of relatedness, specifically as it pertained to the construct
research available to health promoters, only
competence, and autonomy form the basis of interest: motivation. Data abstracted
journals that had an impact factor (IF) of
for motivation—identified, within this from each study included, among others, its
1.0 or higher in 2002, and were available to
framework, as intrinsic, extrinsic, and definition of motivation and the source of
the authors were selected for review. The
amotivation.14,40 the definition; the theoretical framework
impact factor—a proxy measure for jour-
Intrinsic motivation is what moves being applied in the study; the measure-
nal quality and scholarly impact—reflects
people to participate in activities for the ment tool(s) used; whether the data of the
the number of citations a journal receives
sheer enjoyment the activities provide.14 individual studies’ were tested for validity
over time.41 Although subject to debate,
Conversely, extrinsic motivation leads to and reliability; and sample characteristics.
impact factors remain appropriate bench-
performance of a task in response to the Indicators of motivation were also identi-
marks of journal quality.42 Four journals
attainment of an outcome separate from the fied (Table 1). Factors that were used inter-
met these criteria: American Journal of Pub-
activity. Extrinsic motivation still produces changeably with, or in place of motivation
lic Health (IF = 3.2), Health Psychology (IF
intentional behavior, but often results in were considered an indicator of motivation.
= 3.0), Health Education and Behavior (for-
varying levels of autonomy within the in-
merly Health Education Quarterly – IF =
dividual.1 For instance, a female who exer- RESULTS
1.9), and the American Journal of Health
cises regularly because she understands the Figure 1 depicts the number of motiva-
Promotion (IF = 1.0).
value that exercise has for her longevity and tion studies published in each of the four
Inclusion/Exclusion Criteria
well being is extrinsically motivated. Yet selected journals while Figure 2 presents the
Studies from these four journals were
another female who exercises only to com- fluctuations in the number of articles, over
included if they satisfied three require-
ply with her husband’s controlling de- time. Twenty-three studies (52% of re-
ments: (1) had been published between
mands, would also be extrinsically moti- viewed manuscripts) were published in
January 1993 and December 2002; (2) they
vated. Although both are examples of Health Psychology. Eight studies (18%) were
contained the term “motivation” in the title
extrinsic motivation (as opposed to, for in- included in Health Education & Behavior.
or abstract (suggesting that motivation
stance, exercising for pure enjoyment) the The American Journal of Public Health pro-
might be among the study’s focal variables)
former involves an autonomous regulation vided six studies (14%) on motivation,
and; (3) reported an empirical investigation.
of the behavior, while the latter describes while seven (16%) came from The Ameri-
The 10-year time frame was chosen because
its external regulation. Given that autonomy can Journal of Health Promotion. Although
the authors believed it would yield both a
constitutes a basic psychological need, ex- two surges in publication are noted in 1996
manageable set of studies while capturing
trinsic motivation is perceived by theorists and 1998, the apparent trend is one of de-
temporal trends or variations.
as potentially detrimental to an individual’s clining number of publications.
Studies were excluded if they examined
sense of autonomy and should, therefore, Although researchers have tested the
factors such as intention, volition, out-
be less favored than intrinsic motivation. theoretical relationship between motivation
come-expectancies or self-direction, with-
Finally, amotivation is defined as unwilling- and many types of health behaviors, a plu-
out relating or linking them to the concept
ness, lack of intention to behave.14 rality of reviewed studies examined moti-
of motivation and/or they assessed non-
While the historical synopsis above de- vation in relationship to preventive behav-
health behaviors. Non-empirical treatments
picts a rich and complex evolution of the iors (n=11, 25%) such as sunscreen use,44
such as theoretical or review articles also
construct of motivation, the literature re- mammogram utilization,45 and participa-
viewed below documents a snapshot of the were excluded. tion in heart healthy activities.46 The ma-
state-of-the-art regarding health promotion Between 1993 and 2002, a total of 4,676 jority of these studies were published in
researchers’ contemporary use of the con- articles were published in the four selected Health Psychology (n = 7, 63%). Of the
struct. The review examines—within a de- journals. Forty-four studies (N = 44) met studies that focused on motivation and pre-
cade of publications—the conceptual and the inclusion/exclusion criteria and com- ventive behaviors, three studies specifically
operational definitions offered to explain prised the sample for this review. analyzed HIV/AIDS-related behaviors.47-49
and assess motivation, the theoretical Data Extraction and Synthesis Studies focusing on drug use/cessation
frameworks utilized to couch the under- Information from each included study (n=9, 20%) and dietary change/adherence
standing of the concept, and the measure- was abstracted, coded and organized into a (n=8, 18%) were also prevalent. Albeit less
ment tools employed to test the concept and matrix that culminated in Table 1.45 The frequently, motivation also was examined
its theoretical relationships. lead author coded each of the studies. Ten in conjunction with exercise (n=7, 16%),
American Journal of Health Education — May/June 2006, Volume 37, No. 3 173
Sarah Dunsmore and Patricia Goodson
being used in seven studies, respectively.
Figure 1. Number of motivation-related articles within four
While all reviewed studies included the
leading health promotion journals by year of publication
term “motivation” in the title or abstract—
suggesting that motivation might be among
10 the study’s main factors—the majority did

fo
rse not specifically measure motivation. Of the
eblc 5 44 reviewed studies, only eleven (25%) ac-
mit
r
uA tually measured motivation.4,27,53–61 The re-
N
0
maining 75% of reviewed studies often dis-
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
cussed motivation as a factor, but failed to
Year of Publication include it in the methods section as a mea-
sured variable.
While many of these studies may have
Figure 2. Number of motivation-related articles published in four proposed to examine motivation and its
leading health promotion journals, between 1993–2002 relationship to specified behaviors, in prac-
tice they often treated motivation as a la-
s 23 tent variable and attempted, therefore, to
e 25
l measure manifest variables, or indicators.62
c
it 20 This might explain, perhaps, why some
r
A 15
fo 10 8 6 7 sdteusdpiietes ahpapveinagr nmoetn ttoi omneedas umroe tmivaottiiovnat iaosn a,
r
eb 5 focal variable. The most common indica-
m 0 tors used to measure motivation within the
u
N Health Health American American studies were intention (n=19, 43%), and
self-efficacy (n=18, 40%) (Table 1).
Psychology Education & Journal of Journal of
Among the eleven studies that did pro-
Behavior Public Health
pose to measure motivation, only five uti-
Health Promotion
lized pre-tested and published measures. In
Journal the studies utilizing published measures,
three o f the five provided information on
the validity and reliability of the data col-
condom use (n=4, 9%), and reduction of definition of motivation: “Motivation [sic] lected with these instruments. Measures
risk perception (n=4, 9%). Two studies were encompasses self-regulatory processes in- cited included the Smoking Motives Scale63;
dedicated to the motivational implications volving the selection, activation, and sus- the Self-Motivation Inventory64; the Exer-
of chronic pain on such behaviors as goal tained direction of behavior toward certain cise Motivational Stage Measure65; the Os-
pursuit (n=2, 5%).50,51 goals (e.g., Bandura, 1997) [sic].” teoporosis Health Belief Scale66; and the
Studies were included within this review Most researchers within this sample measure of motivation for eating low-fat
only if motivation appeared to be a focal (n=32, 73%) utilized a theoretical frame- foods.67 The remaining six studies devel-
variable of the inquiry. It is curious, then, work to guide both data collection and oped their own assessment tools consisting,
that the majority of the articles included did analysis. For the purposes of this review, a mainly, of self-administered surveys and
not provide a definition of motivation theoretical framework was a set of descrip- Likert-type scaled responses. None of the
(n=40, 91%). The studies that did provide tive statements used to explain the concept studies containing the self-developed tools
a definition of motivation (n=4, 9%), pro- of motivation and its logical association provided any information on the validity
vided a conceptual definition but not an with other behavioral, cognitive or environ- and reliability of the data collected with
operational definition. Three of the four mental/social factors. In all, 21 different these instruments.
definitions provided related specifically to theories were identified (Table 1). Among Twenty-three studies reported measur-
motivation to engage in AIDS preventive studies that utilized a theoretical frame- ing only reliability (n=13, 30%) or both re-
behavior3,47,49 and were all published by the work, Social Cognitive Theory (SCT), the liability and validity (n=10, 23%) within
same leading authors and in the same jour- Health Belief Model (HBM), and the their methods section. Of the twenty-three
nal (Health Psychology). Only Senecal, Transtheoretical Model (TTM) were the studies that reported testing reliability, he
Nouwen, and White52 provided a general theories/models used most frequently, each most common method was computation of
174 American Journal of Health Education — May/June 2006, Volume 37, No. 3
Sarah Dunsmore and Patricia Goodson
Table 1. Summary of Reviewed Motivation Studies Published between 1993 and 2002

Study Behavior Examined / Motivation: Construct Definition Theoretical Framework Measurement / Indicators Assessment of
Population Studied Data’s Validity
& Reliability
Affleck et • Pursuit of health- Not defined • None • Striving Validity: No
al., 1998 fitness and social- • Personal-goal process Reliability: No
interpersonal goals
in the context of
Fibromyalgia
management
• 50 females
• Mean age=44
• 92% Caucasian

Altman et • Participation in Not defined • Social Cognitive Theory • Self-efficacy Validity: No
al., 1998 community activities • Perceived control Reliability:
promoting heart • Perceived incentive value Cronbach
• h2,e6a0lt9h participants • Outcome expectations arelptehsat and test-

• Mean age = 15
• 51% male
• 38% Latino; 30%
Asian

Blalock et • Calcium Not defined • Precaution Adoption Process • Health motivation Validity: No
al., 1996 consumption Model • Perceived severity Reliability: No
• Weight bearing • Health Belief Model • Barriers
exercise • Health concerns
• 452 females • Inconvenience
• Mean age = 40 • Benefits
• 72% Caucasian • Perceived controllability
• Subjective norm
• Perceived susceptibility

Blanton • Perceiving the risk of Not defined • Dissonance Theory • Attitude Validity: No
and STD • Perceptions Reliability: No
Gerrard, • 40 undergraduate • Estimated risk/vulnerability
1 997 males • Motivation
Burn et • Exercise Not defined • Transtheoretical Model • Stage of change Validity: No
al., 1999 • 709 participants • Self-efficacy Reliability: No
• Mean age = 39
• 65% female

Carey et • HIV risk behavior Not defined • Information-Motivation- • Risk perception Validity: factor
al., 2000 • 102 females Behavioral Skills Model • Intention analysis
• Ages 17-46 (X=29.4) • Health Belief Model Reliability:
Cronbach
• 88% African alpha
American

Cooper et • Condom use Not defined • None • Attitude regarding Validity: No
al., 1999 • 2,052 participants condoms Reliability:
• Ages 13-19 • Self-efficacy Cronbach
• Reason for condom use alpha
• Perceived cost
• Vulnerability
•

DeLamater • Condom use Not defined • Self-Regulation Theory • Self-regulation Validity: No
et al., • 562 African • Self-Efficacy Theory • Knowledge Reliability:
2000 American males • Attitude Cronbach
• Ages 15-19 • Self-efficacy alpha
• Intention
• Perceived risk

DiFranceis • Participation in Not defined • Health Belief Model • Risk behavior Validity: factor
co et al., prevention • Outcome expectancy analysis
1998 programs • Self-efficacy Reliability:
•• 1A3g4e sp 1a8rt-i4c5ip (aXn=t3s 3) •• PKnerocweilveeddg ese verity Calrpohnab ach
• 50% female • Perceived risk
• 54% Caucasian

Detweiler • Sunscreen use Not defined • Prospect Theory • Plan Validity: No
et al., • 217 participants • Affective reaction Reliability:
1999 • Ages 18-79 (X=39) • Perceived efficacy Cronbach
alpha
• 76% female • Anticipated effect
• Intention
American Journal of Health Education — May/June 2006, Volume 37, No. 3 175
Sarah Dunsmore and Patricia Goodson
Table 1. Summary of Reviewed Motivation Studies Published between 1993 and 2002 (cont)

Study Behavior Examined / Motivation: Construct Definition Theoretical Framework Measurement / Indicators Assessment of
Population Studied Data’s Validity
& Reliability
• Influence

Dijkstra et • Smoking cessation Not defined • None • Stage transition Validity: No
al., 1998 • 752 participants • Intention Reliability:
• 60% female • Quitting behavior Calrpohnab ach
• Mean age = 39 • Expected outcome
• Self-efficacy

Fisher et • AIDS preventive "In effect, motivation to practice • Social Cognitive Theory • Attitude Validity:
al., 1994 behavior an AIDS-preventive act is assumed • Theory of Reasoned Action • Subjective norm criterion-
• Study 1 = 126 gay to be a function of one's attitudes • Health Belief Model • Intention related
• mStuadleys 2 = 259 (53% t(nAoowarcmat)rs,d ra etnhgdea roAdfI iDrneSgl-e ptvhraeenv Aet nsIDutiSbv-eje catcivt e •• IAnIDfoSr-mRiaskti oRne-dMuocttiivoant ioMno-del RCalerpolihanabb ialitcyh:
female) preventive act (SN)." p. 241. Behavioral Skills Model

Fisher et • AIDS risk behavior “Motivation to engage in AIDS • Information-Motivation- • Attitude Validity: No
al., 1996 • 521 participants preventative behavior – which is a Behavioral Skills Model • Social norm Reliability:
• Mean age = 20 function of attitudes toward • Health Belief Model • Behavioral intention Crnobach
• 88% Caucasian pacetrsf,o sromcaianl cneo ormf AsI DreSg parredvinegn tive alpha
performance of such acts &
perceptions of personal
vulnerability to HIV […]” (p.114)

Fisher et • HIV preventative 1. Personal motivation: favorable • Information-Motivation- • Attitude Validity: No
al., 2002 behavior attitudes toward performance (HIV Behavior Skills Model • Norms Reliability:
• 1hst,iug5d7he7 sn citnhs noeorl city mspuroeptvpievoanrtttia oftonivr: e pp aeecrrftcose)r;imv 2ei.dn Sg so otchciaieals l e acts. • Intention Calrpohnab ach
• 63% female
• 61% African
American
Frame et • Fruit and vegetable Not defined • Transtheoretical Model • Stage of change Validity: No
al., 2001 consumption • Readiness Reliability: No
• 226 participants

Glanz et • Adoption of healthy Not defined • Transtheoretical Model • Self-rated health Validity: No
al., 1994 diets • Self-efficacy Reliability: No
• 17,121 participants • Motivation (personalized
importance)
• Intention
• Readiness

Karoly and • Goal pursuit Not defined • Social Cognitive Theory • Goal assessment Validity: No
Ruehlman, • 227 participants • Goal cognition Reliability: No
1996 • Mean age = 40 • Goal conflict
• 56% male • Depression
• 84% Caucasian • Self-efficacy
• Goal-related value
• Anxiety
• Intention
• Self-regulation

Leslie et • Exercise Not defined • None • Motivation Validity: No
al., 1999 • 2729 participants Reliability: No
• Ages 16-72 (X=25)
• 58% female

McBride et • Relapse smoking Not defined • Transtheoretical Model • Type of motivation Validity: No
al., 1999 after pregnancy • Level of motivation Reliability: No
• Primarily Caucasian
pregnant women

Manfredi • Smoking cessation Not defined • Health Belief Model • Desire Validity: No
et al., • 248 African • Theory of Reasoned Action • Plans Reliability: No
1998 American females • Health beliefs/concern
• Ages 18-39 • Normative perception
• Smoking habit
• Perceived use of smoking
• Education
• Perceived benefit/cost
• Intention

Marcus et • Exercise Not defined • Social Cognitive Theory • Self-efficacy Validity:
al., 1998 • 1559 participants • Transtheoretical Model • Motivational stage concurrent
• Decisional balance Reliability: test-
retest & kappa
176 American Journal of Health Education — May/June 2006, Volume 37, No. 3
Sarah Dunsmore and Patricia Goodson
Table 1. Summary of Reviewed Motivation Studies Published between 1993 and 2002 (cont)

Study Behavior Examined / Motivation: Construct Definition Theoretical Framework Measurement / Indicators Assessment of
Population Studied Data’s Validity
& Reliability
index
Melamed • Hearing protection Not defined • Protection Motivation Theory • Perceived susceptibility Validity:
et al., device use • Perceived severity Cohen’s kappa
1996 •• 2A8g1e sm 1a8l-e6s5 (X=40) •• PPeerrcceeiivveedd ebfaferrcietirv eness RCalerpolihanabb ialictyh:
• Self-efficacy
• Intention

Miller et • Alcohol/drug use Not defined • Self-Regulation Theory • Alcohol pattern Validity: No
al., 2000 • College students Reliability: No

O'Neill et • Smoking cessation Not defined • Transtheoretical Model • Stage of change Validity: No
al., 2000 • 65 participants Reliability: No
• Ages 18-25

Ogden, • Food intake Not defined • Biological • Motivational state Validity: No
1994 • 56 college students Reliability: No
• 75% female

Resnicow • Fruit and vegetable Not defined • "...an amalgamation of • Outcome expectations Validity:
et al., consumption several theoretical • Self-efficacy correlation
2 001 •• 8AA6mg1ee srA i1cfr8aicn-8as7n (X=44) paradigms." (pg. 1687) • Knowledge RCalerpolihanabb ialictyh:
• 73% female

Rose et al., • Smoking cessation Not defined • None • Motive Validity: No
1996 • 700 participants • Attitudinal belief Reliability:
• Ages 24-32 (X=28) • Reason Calrpohnab ach
• 52% female • Social role occupancy
• 96% Caucasian

Rothman • Mammogram Not defined • Attribution theories • Attitude Validity: No
et al., utilization • Reaction Reliability: No
1993 • 197 females • Knowledge
• Ages 41-64 (X=49) • Intention
• 85% Caucasian • Attributions

Royce et • Smoking cessation Not defined • None • Motivation (measures Validity: No
al., 1993 • Sample taken from want/desire) Reliability: No
the Community • Norms and values (social
Intervention Trial for acceptability, attitudes,
Smoking Cessation perceptions of society,
• Ages 25-64 and self-control behavior)
• African American &
non-Hispanic Whites

Schwarzer • Dietary intake Not defined • Social Cognitive Theory • Risk perception Validity:
and • 524 participants • Health Action Process • Outcome expectancy correlation
R2e0n0n0e r, • Mean age = 50 Approach • Self-efficacy RCerolianbbialictyh:
• 52% female • Intention alpha
Sears and • Exercise adherence Not defined • Expectancy value theories • Expectancy value Validity: No
Stanton, • 86 females • Self-efficacy Reliability:
2001 • Ages 18-68 (X=31) • Intention Cronbach
alpha
• 84% White

Senecal et • Diet adherence "Motivation encompasses self- • Social Cognitive Theory • Self-regulation Validity: factor
al, 2000 • 638 participants regulatory processes involving the • Self-Determination Theory • Self-efficacy analysis
• Ages 20-70 sdeirleeccttiioonn, oafc btievhataiovino,r atnowd asurdst ained RCerolianbbialictyh:
certain goals." (p. 452) alpha

Shannon • Making dietary Not defined • Social Cognitive Theory • Self-efficacy Validity:
et al., changes • Self-efficacy theory • Social desirability construct &
1997 • 304 participants factor analysis
• Mean age = 57 RCerolianbbialictyh:
• 50% male alpha
• 50% Caucasian

Sinclair et • Practice of universal Not defined • Protection Motivation Theory • Behavioral intention Validity: No
al., 1996 precautions to • Negative and positive Reliability: No
prevent bloodborne affect
pathogen exposure • Cognition

Skinner et • Mammogram Not defined • Health Belief Model • Mammography stage of Validity: No
al., 1994 utilization change Reliability: No
American Journal of Health Education — May/June 2006, Volume 37, No. 3 177
Sarah Dunsmore and Patricia Goodson
Table 1. Summary of Reviewed Motivation Studies Published between 1993 and 2002 (cont)

Study Behavior Examined / Motivation: Construct Definition Theoretical Framework Measurement / Indicators Assessment of
Population Studied Data’s Validity
& Reliability
• 435 females • Transtheoretical Model • Knowledge
• Ages 40-65 • Belief
• Objective and perceived
risk status and barriers

Smith et • Interpretation of Not defined • None • Perceived vulnerability Validity: No
al., 1997 information about • Perceived efficacy Reliability: No
personal • Attitude
vulnerability to • Risk behavior
health risks
• Study 1 = 125
females (mean age=
19)
• Study 2 = 273
females (mean age=
19)

Sorensen • Fruit and vegetable Not defined • None • Condition in the Validity: No
et al, 1999 consumption workplace Reliability:
Cronbach
alpha
Sturges • Tobacco use Not defined • Protection Motivation Theory • Intention Validity: cluster
and • Group 1=112 9-10 • Self-efficacy analysis
Rogers, year olds • Attitude Reliability:
1 996 • Group 2=67 14-16 • Behavior change Calrpohnab ach
year olds
• Group 3=93 young
adults
• 83% Caucasian

Sutton et • Condom use Not defined • Theory of Reasoned Action • Belief Validity: No
al., 1999 • 949 participants • Theory of Planned Behavior • Outcome evaluation Reliability: No
• 59% female • Attitude
• Ages 16-24 • Normative belief
• Subjective norm
• Perceived control
• Perceived risk
• Intention
• Condom use
• Motivation
• Self-efficacy
Troped • Exercise Not defined • None • Normative belief Validity: No
and • 764 participants • Motivation to comply Reliability: No
Saunders, • Mean age = 40
1998
• 76% female

Unger and • Exercise Not defined • None • Intention Validity: No
Johnson, • 200 participants • Frequency of exercise Reliability: test-
1995 • Ages 21-79 (X=39) • Satisfaction retest
• 52% male • Social variables
• 86% Caucasian

Wilcox • Exercise Not defined • None • Self-Motivation Validity: No
and • 121 females • Self-efficacy Reliability:
Storandt, • Ages 20-85 • Attitude Cronbach
1996 alpha
• 83% Caucasian

Williams et • Smoking cessation Not defined • Self-Determination Theory • Perceived competence Validity: No
al., 2002 • 239 participants • Self-regulation Reliability: No

Witte et • Condom use Not defined • Extended Parallel Process • Danger control response Validity: No
al., 1998 • 219 females Model (attitude, intention, Reliability:
• Ages 17-22 behavior) Cronbach
• 79% Caucasian • Fear control response alpha
(defense avoidance, issue

derogation, and
perceived manipulation)

178 American Journal of Health Education — May/June 2006, Volume 37, No. 3
Sarah Dunsmore and Patricia Goodson
the Cronbach alpha (n=20, 87%). Other lend itself to agreement regarding its key the majority of studies document a posi-
methods included test-retest reliability and facets? Or does it signal territoriality issues tive association between motivation (or its
computation of a kappa index. Five of the among scholars who, in attempts to develop indicators) and health behaviors, reporting
ten studies that reported measuring the va- novel explanatory models for the construct, their findings would have lacked variabil-
lidity of their scores utilized factor analysis employ variable nomenclature and explana- ity and would have resembled a “constant.”
(50%). Additional reported methods of tory schemes for characteristics, dimen- While this constant would add little infor-
measuring validity were criterion, concur- sions, and traits that are essentially similar mation regarding how researchers are ap-
rent, and construct. across theories? And what are the implica- proaching and manipulating the construct
tions of such absence of theoretical consen- of motivation in their research, it might
DISCUSSION sus for practitioners: if scholars define one have, nonetheless, yielded important infor-
The portrait of how contemporary indicator of motivation as intention in one mation regarding the potentially different
health promotion scholars are handling the theory, for example, but define it as desire relationships between various articulations
concept of motivation in their research de- in another theory, what are practitioners to of motivation and the many types of health
picts a complex image of theoretical engage- do? Should their interventions emphasize behaviors studied (exercise, dietary man-
ment but waning enthusiasm. Despite the individuals’ plans for action, or should they agement, smoking cessation, etc.). The con-
relatively small number of motivation-re- try to make the task more “likeable”, so the struct of motivation has deep roots and a
lated publications in the last decade, and individual will desire to do it?70 rich history which may extend beyond the
much to the credit of contemporary schol- The lack of theoretical consensus regard- scope of this paper. The theoretical and his-
ars however, the majority of empirical in- ing theory and conceptual definitions of torical discussion, therefore, is a selective
vestigations reviewed in this study were motivation is also reflected in issues of mea- synopsis of motivation within the health
theory-based. Since many areas of inquiry surement. In this review, a limited number behavior literature. Further examinations
in health promotion have been identified of studies used psychometrically sound into how motivation is being handled theo-
as dangerously a-theoretical,68 it is hearten- measures and, of those, no two employed retically within health behavior research are
ing to find that studies involving motiva- the same tool. Moreover, researchers fre- recommended. Limiting our selection cri-
tion as a focal variable don’t seem to suffer quently failed to provide assessments of the teria only to studies that contained the term
from this problem. data’s validity and reliability, weakening “motivation” in the title or abstract may
If encouraging on the one hand, the even further the possibility of ascertaining have inadvertently caused us to exclude
theory-related picture that emerges from the quality of their measurement tools. Be- studies that address motivation, without
these reviewed studies is, nonetheless, prob- cause validity and reliability are sample spe- naming the construct as such. As is evident
lematic even if not unique. Echoing our cific, they must be re-measured and re- from this review, motivation is so broadly
finding of 21 different theories in 32 stud- ported with each data collection.71 Given defined that it would have been problem-
ies, Gotcham identified 51 theories applied the importance of valid and reliable data atic to not set such exclusions. In recogni-
within 116 theory-based articles studying both for scholarly research and for evaluat- tion that this review is not all encompass-
motivation.69 Portrayed by Bandura35 as a ing program interventions,71 an accurate ing, it should be made clear that this is an
“spawn(ing) [of] cafeteria style research” and psychometrically sound measurement attempt to organize this body of literature.
such proliferation of frameworks is char- of motivation is essential for understand- The question of whether our results can be
acterized by the selection of constructs and ing whether intervention/educational ef- generalized to the entire population of
traits from various theories and their place- forts are actually affecting motivation and, motivation-related health research can only
ment within new frameworks, leading to in turn, behavior change. be answered through the support of con-
redundancy, less predictability, and overall As this review organized a decade of re- tinued reviews.
disconnectedness with the theory of origin. searchers’ dealings with the concept of mo- As the authors attempted to summarize
The use of such a large number of theo- tivation within the health promotion/edu- the historical evolution of the motivation
ries to explain a single construct suggests cation literature, it was embedded, construct and its present-day application
an absence of theoretical consensus regard- nonetheless, in important limitations. The into empirical health promotion research,
ing both the definition of motivation and small number of journals selected, for in- the main strengths of this attempt are found
its measurement. But what may this phe- stance, as well as the decade chosen for study in the manner in which it (a) provides a
nomenon mean and what are its implica- (1992–2002) may have skewed findings in synopsis of how a sample of published
tions? Is such absence of consensus indicat- an uncertain and non-representative direc- health promotion literature within the last
ing that scholars are truly dealing with an tion. Not summarizing the specific hypoth- decade is conceptualizing and discussing
inherently complex, dynamic and multi- eses and findings of the reviewed studies may motivation; (b) distinguishes the definition,
dimensional construct that does not easily also have limited our analysis. Given that theoretical framework, and measurement of
American Journal of Health Education — May/June 2006, Volume 37, No. 3 179