Health Behavior Theories Research Articles

Health Behavior and Motivational Engagement Models Can Explain and Modify Teleaudiology Uptake.

The remote delivery of health care services (i.e., telehealth) has steadily increased across the health care landscape over the past decade with a dramatic increase following the onset of the COVID-19 pandemic. Remote audiology delivery (i.e., teleaudiology), by contrast, has traditionally been characterized by relatively low utilization. While teleaudiology services increased during the COVID-19 lockdown period, most of those services were generally limited to follow-up care and postfitting consultations to existing patients. Furthermore, there is reason to believe that, despite the benefits that remote care provides, the use of teleaudiology services has decreased as in-person care has increased following the lifting of mandatory COVID-related lockdowns. The purpose of this viewpoint article is to posit that existing theories of health behavior, usually applied to patient-specific behaviors (e.g., hearing aid uptake) may explain the reluctance of audiologists to "uptake" a teleaudiology model of care. We also explore the potential of motivational engagement strategies as a means to allow audiologists to examine their sources of ambivalence as they consider adopting a remote service-delivery model. Health behavior models such as the Health Belief, Transtheoretical, and capability, opportunity, motivation, and behavior (COM-B) models represent theories that may help to explain audiologists' resistance to adopting remote delivery services. Motivational engagement strategies, such as decisional balance, can provide useful tools for audiologists to examine their attitudes toward the adoption of teleaudiology.

Using the Theory of Planned Behavior to Explain and Predict Areca Nut Use Among Adolescents in India: An Exploratory Study.

ContextAreca nut, used alone or in combination with tobacco, contributes to the high oral cancer burden in India. Used widely by adolescents, who perceive it as a harmless substance, areca nut is addictive and considered a precursor to tobacco use. Given its serious implications for addictiveness and physical health, urgent preventive interventions for areca nut use are required in India and South-East Asia. Studies examining the role of health behavior theory in explaining and predicting areca nut use and for development of its prevention among adolescents are scarce.AimThis study explored the role of the components of Theory of Planned Behavior (TPB) such as attitudes, subjective norms, perceived behavioral control, and intention in predicting areca nut use among adolescents.Settings and DesignObservational study with cross-sectional design conducted with 1884 male and female adolescents attending low-income schools in Mumbai, India.Methods and MaterialSelf-administered surveys were used to gather data on age, gender, behavioral factors and areca nut use.Statistical Analysis UsedChi-square and Mann Whitney test for bivariate and logistic regression for multivariate analysis.ResultsAround 27.2% of 1884 participants were areca nut users. The mean age of users was 13.75 years. Intention-to-use and perceived behavioral control were statistically significant predictors of actual areca nut use (p<0.001). The components of TPB such as attitude, perceived subjective social norms, and perceived behavioral control had a statistically significant effect on the intention-to-use areca nut (p<0.05).ConclusionThis exploratory study indicates that constructs from TPB could help us understand and predict areca nut use. However, more rigorous future research is required to generate insights that help craft effective theory-based behavioral interventions for areca nut prevention and cessation in adolescents.

Investigating Microtemporal Processes Underlying Health Behavior Adoption and Maintenance: Protocol for an Intensive Longitudinal Observational Study.

BackgroundYoung adulthood (ages 18-29 years) is marked by substantial weight gain, leading to increased lifetime risks of chronic diseases. Engaging in sufficient levels of physical activity and sleep, and limiting sedentary time are important contributors to the prevention of weight gain. Dual-process models of decision-making and behavior that delineate reflective (ie, deliberative, slow) and reactive (ie, automatic, fast) processes shed light on different mechanisms underlying the adoption versus maintenance of these energy-balance behaviors. However, reflective and reactive processes may unfold at different time scales and vary across people.ObjectiveThis paper describes the study design, recruitment, and data collection procedures for the Temporal Influences on Movement and Exercise (TIME) study, a 12-month intensive longitudinal data collection study to examine real-time microtemporal influences underlying the adoption and maintenance of physical activity, sedentary behavior, and sleep.MethodsIntermittent ecological momentary assessment (eg, intentions, self-control) and continuous, sensor-based passive monitoring (eg, location, phone/app use, activity levels) occur using smartwatches and smartphones. Data analyses will combine idiographic (person-specific, data-driven) and nomothetic (generalizable, theory-driven) approaches to build models that may predict within-subject variation in the likelihood of behavior “episodes” (eg, ≥10 minutes of physical activity, ≥120 minutes of sedentary time, ≥7 hours sleep) and “lapses” (ie, not attaining recommended levels for ≥7 days) as a function of reflective and reactive factors.ResultsThe study recruited young adults across the United States (N=246). Rolling recruitment began in March 2020 and ended August 2021. Data collection will continue until August 2022.ConclusionsResults from the TIME study will be used to build more predictive health behavior theories, and inform personalized behavior interventions to reduce obesity and improve public health.International Registered Report Identifier (IRRID)DERR1-10.2196/36666

Marijuana Content on Digital Media and Marijuana Use among Young People in the United States.

Health behavior theory establishes that exposure to media messages about a topic influences related knowledge, attitudes, and behavior. Marijuana-related messages proliferating on digital media likely affect attitudes and behavior about marijuana. Most research studying marijuana-related media effects on behavior relies on self-reported survey measures, which are subject to bias; people find it difficult to recall timing, frequency, and sources of messages. We calculated an exogenous measure of exposure to marijuana-related messages on digital media based on emerging public communication environment (PCE) theory. Aggregated online searches and social media posts related to marijuana for a given place reflect the marijuana-related PCE, where people are exposed to and engage with messages from multiple sources. Exogenous measures overcome bias in self-reported exposure and outcome data: simultaneity bias and endogeneity. The PCE reflects both potential exposure and relative importance of the topic in the local community, which may influence real-world marijuana use. Using 2017 Twitter and Google Search data, we measured the marijuana-related PCE to quantify where opportunities for exposure to marijuana-related posts were high and examined relationships between potential exposure and current marijuana use among youth and young adults in 2018. We found that marijuana-related online search and tweeting at the media market level are associated with offline marijuana use, controlling for demographics and state marijuana policy. The marijuana-related digital media environment may reflect and/or influence youth and young adult marijuana use. Social media and online search data offer platforms to monitor the marijuana-related PCE and supplement survey data to study media exposure and marijuana use behavior.

Trust in Science as a Possible Mediator between Different Antecedents and COVID-19 Booster Vaccination Intention: An Integration of Health Belief Model (HBM) and Theory of Planned Behavior (TPB).

As the literature highlights, many health behavior theories try to explain both social and psychological variables influencing an individual’s health behavior. This study integrates insights relative to the antecedents of getting vaccinated from health behavior theories, particularly including the health belief model (HBM), the theory of planned behavior (TPB), and the different socio-demographic factors. Furthermore, we considered the possible mechanism of impact of distrust in science on individuals’ hesitance and resistance to taking up SARS-CoV-2 vaccination in subjects living in Italy. A correlational study of 1095 subjects enrolled when the national vaccination campaign for the third dose was launched. A questionnaire was used to measure: Italian Risk Perception; subjective norm; trust in science, trust in the vaccine; fear of COVID-19; fear of the vaccine; perceived knowledge about SARS-CoV-2; booster vaccination intention. Principal results show that: (i) the positive relationship provided by HBM theory between perceptions of SARS-CoV-2 risk (vulnerability and severity) and intention to have the vaccine, through fear of COVID-19; (ii) the positive relationship between subjective norms and both trust in science and vaccination intention; (iii) that trust in science plays a crucial role in predicting vaccination intention. Finally, the results provided indications about a positive relationship between subjective norms and fear of COVID-19, and a full mediation role of trust in science in the relationships between determinants of both TPA and HBM, fear of COVID-19, and vaccination intention. In conclusion, an individual’s intention (not) to get vaccinated requires the consideration of a plethora of socio-psychological factors. However, overall, trust in science appears to be a key determinant of vaccination intention. Additional strategies promoting healthy behavior are needed.

Smoking Cessation in Pregnancy within the Framework of Health Behavioral Theories: A Current Review

Hamilelikte sigara kullanımı hem anne hem de bebeğin sağılığını etkilediğinden hamilelikte sigara bırakma önemli bir sağlık davranışı olup sağlık psikolojisinin de önemli konularından biridir. Bu makalenin amacı, hamilelikte sigara bırakma davranışını “sağlık davranış kuramları” çerçevesinde ele alan betimsel çalışmaların ve bu konuda 2000 yılından sonra yürütülmüş kuram temelli müdahale çalışmalarının gözden geçirilmesidir. Bu amaçla çeşitli veri tabanları Şubat-Mart 2021 tarihleri arasında “gebelerde/hamilerde sigara bırakma”, “sağlık davranış modelleri”, “teori temelli müdahaleler” anahtar kelimeleri ile taranmıştır. Bu kapsamda konuyla ilgili yaklaşık 70 makaleye erişilmiş ancak kuram temelli müdahaleler kapsamında sadece 9 çalışma değerlendirmeye alınmıştır. Ulaşılan çalışmaların sosyal bilişsel kuram, planlı davranış teorisi ve transteoretik model kapsamında ele alındığı ve hamilelerde sigarayı bırakma niyetinin önemli yordayıcısının kuramlar üstü bir kavram olan öz-etkinlik olduğu görülmüştür. Konuyla ilgili yürütülen kuram temelli müdahalelerin etkililiklerine dair net bulgulardan bahsetmek zor olsa da, çalışmalar değişim evrelerine uygun müdahalelerin destekleyici olabileceğine işaret etmiştir.

Persepsi Perilaku Kesehatan Pekerja Pengangkut Sampah pada Masa New Normal di Surabaya

This study aims to determine the perception of the health behavior of garbage man during the new normal. Researchers want to see how garbage man perform healthy behavior, starting from disease prevention, healing disease when sick, seeking and using health services. This study uses a qualitative research method because the researcher intends to describe the perception of health behavior of garbage man in the new normal period by using the health behavior theory of Becker. In this study, the informants were workers who transported garbage in Surabaya. The results of the study stated that the health behavior carried out by the garbage man when he felt symptoms of pain, he would use his perception of the pain he felt, then consider various possible advantages and disadvantages of the treatment action to be taken in order to make the right decision in carrying out the treatment. action so that the body returns to health.

Development and Validation of an Attitude Toward Spending Time in Nature Scale

Time spent in nature (TSN) is related to improved health and well-being; however, many adults spend little time in nature. Interventions based on health behavior theories may be effective at increasing TSN. Attitudes toward a behavior have been shown to be a strong predictor of both intention and behaviors, but valid and reliable measures regarding these attitudes are lacking. The study aim was to develop a valid and reliable attitude toward TSN scale. This scale was developed using a sequential procedure: domain identification and item generation, content validity, question pretesting, survey administration, item reduction, factors extraction, dimensionality, reliability, and validity. The investigative team generated 49 unique items. Content validity and pretesting reduced the item set to 21. A countrywide sample of 2109 adults (50.3% male, median age = 58.1; 38.8% non-White) completed an online survey. Using split-half measures, principal components analysis indicated a three-factor solution: positive attitudes, negative attitudes, and concerns about being in nature. The factor structure was upheld in confirmatory factor analyses with strong internal consistency (α = 0.92 positive attitudes; 0.84 negative attitudes; 0.84 concerns). The scales were strongly related to intentions and TSN with large effect sizes. The study resulted in a reliable and valid three-factor attitudes toward spending time in nature scale that could be used to develop interventions to increase TSN.

A comparison of behavioural models explaining cervical cancer screening uptake

BackgroundCervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention.MethodsA survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models.ResultsCCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers.ConclusionHealth behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women’s screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.

Sexually transmitted infection prevention behaviours: health impact, prevalence, correlates, and interventions

Sexually transmitted infections (STIs) remain a major public health threat, disproportionately affecting young people, and men who have sex with men. In this narrative review of the current state of behavioural science research on STI prevention, we consider the definition, health impacts, correlates and determinants, and interventions to promote STI prevention behaviour. Research on STI prevention behaviour has extended from a focus on abstinence, partner reduction and condom use, to also include novel preventive behaviours, notably treatment-as-prevention, pre-exposure prophylaxis (i.e., the preventive use of medicines by uninfected people), and vaccination for some STIs. Social-cognitive factors specified by, for instance the theory of planned behaviour, are critical proximal determinants of STI prevention behaviours, and related interventions can effectively promote STI prevention behaviours. Social-ecological perspectives highlight that individual-level determinants are embedded in more distal environmental influences, with social stigma especially affecting STI prevention behaviours and requiring effective intervention. Further to providing a major domain of application, STI prevention also poses critical challenges and opportunities for health psychology theory and research. We identify a need for health behaviour theory that addresses the processes linking multiple levels of influence on behaviour and provides practical guidance for multi-level behaviour change interventions adapted to specific contexts.

Multimedia health education intervention incorporating health behavior theories for improving parental intention to vaccinate daughters against HPV in Armenia

ABSTRACT Human Papillomavirus (HPV) is a common sexually transmitted disease and causes cervical cancer. Although the HPV vaccine is available in Armenia, the coverage is low, attributed to the lack of parental knowledge and awareness about HPV and vaccine safety. The study aimed to evaluate changes in knowledge, belief and intent to vaccinate their daughters against HPV among parents of school-going girls after a video intervention in Yerevan, Armenia. The study followed a pre- and post-test design with a 10-minute multimedia intervention created using constructs of health belief model and theory of planned behavior. Parents from two randomly selected primary schools who had a daughter(s) not vaccinated against HPV and aged between 9 and 14 years participated in the study. The study used a paired t-test to analyze differences in composite knowledge and beliefs scores, and Wilcoxon signed-rank tests to compare paired responses for intention to vaccinate between the pre-test and post-test measurements. All 39 participants were mothers with a mean age of 38 years (SD = 5.90). The knowledge scores [M1 = 4.51 (SD = 2.92); M2 = 9.31 (SD = 3.15)] and belief scores [M1 = 20.54 (SD = 3.79); M2 = 23.56 (SD = 4.51)] of the participants improved significantly (p < 0.001) after the intervention [by 4.80 (SD = 2.92) and 3.03 (SD = 4.58), respectively]; 34.2% of participants improved their intent to vaccinate their daughter against HPV . In conclusion, multimedia education was well received by parents and could be an efficient tool in HPV education.

Risk-Likelihood Perceptions and Preventive Behaviors Against Infectious Diseases: Testing Different Types of Risk-Likelihood Perceptions in the Context of MERS and COVID-19

ABSTRACT Effective public health communication should take into the consideration how communicated risk perceptions might influence the public. Although many health behavior theories claim that high perceived risk likelihood motivates preventive health behaviors, this general prediction is complicated by different ways of estimating risk likelihood. Our review of 14 previous studies on perceived risk of infectious diseases revealed different measures of risk likelihood and inconsistent findings regarding the relationship between perceived risk likelihood and behavioral intention. Drawn from the review, we examined the predictive power of different types of risk likelihood on intention to prevent infectious diseases. Using two separate data sets, collected during the 2015 outbreak of the Middle East respiratory syndrome (N = 557) and the COVID-19 pandemic of 2021 (N = 1,001), we demonstrated that perceived risk likelihood that specifies future inaction on health behaviors (i.e., conditional absolute risk perception) better predicted behavioral intention than did other types of risk perceptions. When the effect of conditional absolute risk perception was controlled, the behavioral intention and unconditional absolute risk perception showed a negative relationship. The findings have theoretical and practical implications that can inform strategic communication during future outbreaks.

Lessons learned about online engagement and implementation of an intuitive eating programme for university employees.

Background: Intuitive eating (IE) principles present an evidence-based strategy for improving one's relationship with food while reducing the incidence of weight cycling and health risks associated with chronic dieting and weight regain. Offering online programming provides improved access to education while reducing barriers to programme enrollment but is also associated with high rates of attrition. Aim: To examine the process of programme implementation and identify barriers and facilitators of engagement for an online IE programme for employees at a large Midwestern university. Methods: The web-based programme Finding Peace with Food: An Intuitive Eating Approach consisted of an online community with discussion prompts, 10 weekly modules containing videos, activities, and counsellor interviews and was developed using recognized health behaviour theory and evidence-based practices. Participants were university employees (n = 20). Qualitative data were assessed using a phenomenological approach to discern the themes of barriers and facilitators of programme participation. Participation rates were assessed using descriptive statistics. Results: All participants were Caucasian, 85% were female, and their ages ranged from 26-64. The module-based structure was well received. The primary barriers to participation were time constraints, overwhelming amount of information, and aversion to Flipgrid platform use. The quality and usefulness of the programme information were identified as facilitators of participation. Conclusion: Program participation was influenced by the time frame available to complete the programme modules and participants' ease of use of platform applications.

Explaining the intention to get vaccinated against COVID-19: General attitudes towards vaccination and predictors from health behavior theories

ABSTRACT The goal of our study was to examine the intention to get vaccinated using predictors from the 5C Model of vaccination attitudes, the Theory of Planned Behavior (TPB) and the Health Belief Model (HBM). Between August and November 2020, an online survey was delivered to 1428 participants in the UK and Germany (mean age = 40.6; 57% women), assessing socio-demographic and health factors, general vaccination attitudes, TBP and HBM variables, and COVID-19 vaccination intention. Vaccination intentions did not differ by country or survey period. Predictors of intention with the highest explanatory power in a relative weight analysis were confidence, collective responsibility (5C) perceived behavioral control, social norms, attitudes (especially negative affect & TPB cognitions), and perceived benefits (HBM). Women reported lower intention, although the effect size was small. Predictors from the TPB and HBM were effective to explain the intention to receive COVID-19 vaccines over and above socio-demographic variables, health-related factors and general vaccination attitudes. The results are interpreted in the context of current vaccination campaigns. Messages promoting sense of autonomy and control over the decision to get vaccinated, approval from significant others and reassurance that getting vaccinated will not be associated with fear or other negative feelings are important facilitators of vaccine uptake.

Reducing Chronic Disease Risk through Positive Oral Health Practices: A Systematic Review of School-based Dental Health Programs

ABSTRACT Background Dental neglect results in dental caries, gum disease, and contributes to chronic diseases such as heart disease, stroke, diabetes, and cancers. Poor oral health habits developed in childhood persist into adulthood and can contribute to chronic diseases. School settings are a practical platform for teaching oral health skills. Purpose The purpose was to assess the effectiveness of school-based, primary prevention oral health interventions for children and adolescents and to examine these programs for health behavior theory applications. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement and Checklist was used in reporting systematic review data. EBSCOhost database was utilized to search interventions by applying inclusion criteria. Data extraction occurred in four distinct phases to ensure all examined interventions met acceptable standards. Results Eight interventions satisfied the inclusion criteria. Each study utilized oral health knowledge as an outcome variable. Two of the eight interventions stated that they utilized a specific health behavior theoretical framework. Each study applied health behavior concepts. Interventions were efficacious for improving oral health knowledge. Translation to Health Education Practice Oral health education interventions in schools appear to be effective in providing dental skills and oral health knowledge.

Studying wearable health technology in the workplace using the Behavior Change Wheel: a systematic literature review and content analysis

ABSTRACT Wearable Health Technology (WHT) is considered to be fast, feasible, and effective in workplace health promotion programs. This study aims to analyze behavior change strategies applied to WHT products used by employees in health promotion programs. A systematic literature review of WHT in workplace health promotion between 2006 and 2020 was conducted. The Behavior Change Wheel (BCW) was used to undertake the content analysis. We identified 14 articles of WHT in the workplace. First, physical activity and weight management were the most common health issue. Second, using the BCW, we found guidelines, regulation and communication were the most frequently applied policy categories. Third, education, enablement and training were the most common intervention functions. For example, the promoter could provide health education information by WHT. Moreover, encouraging online would motivate employees to improve health behavior. There has been a growing interest in WHT with increasing complexity in research designs and specifications. While using WHT can be an appropriate strategy to adopt as employee health projects, other interventions should be considered, for incentivization and modeling, etc. The results of this study suggest using WHT should take related health behavior theories or variables into consideration to form a comprehensive health promotion programs.

Using machine learning to identify important predictors of COVID-19 infection prevention behaviors during the early phase of the pandemic

SummaryBefore vaccines for coronavirus disease 2019 (COVID-19) became available, a set of infection-prevention behaviors constituted the primary means to mitigate the virus spread. Our study aimed to identify important predictors of this set of behaviors. Whereas social and health psychological theories suggest a limited set of predictors, machine-learning analyses can identify correlates from a larger pool of candidate predictors. We used random forests to rank 115 candidate correlates of infection-prevention behavior in 56,072 participants across 28 countries, administered in March to May 2020. The machine-learning model predicted 52% of the variance in infection-prevention behavior in a separate test sample—exceeding the performance of psychological models of health behavior. Results indicated the two most important predictors related to individual-level injunctive norms. Illustrating how data-driven methods can complement theory, some of the most important predictors were not derived from theories of health behavior—and some theoretically derived predictors were relatively unimportant.

The Theory of Planned Behavior & Bystander Intention: Differences Based on Gender and Heavy Episodic Drinking.

Research indicates that people who engage in heavy episodic drinking (HED) report less intention to intervene and intervention behavior to prevent sexual violence. Researchers have also found gender differences across bystander intention, bystander confidence, and intervention behavior. However, research in this area could benefit from use of an evidence-based health behavior theory. The theory of planned behavior (TPB) posits that personal attitudes, subjective norms, and perceived behavioral control (PBC) predict behavioral intention. Substantial evidence supports the utility of the TPB for predicting behavioral intention in a variety of health-related behaviors, yet few researchers have applied this theory when predicting bystander intention to prevent sexual violence. Undergraduate students (N = 395) from a southern university (77% female; 70% White, Non-Hispanic) completed a modified Sexual Assault Bystander Behavior Questionnaire and the Daily Drinking Questionnaire. Our findings did not reveal significant differences in attitudes, subjective norms, PBC, nor intention based on HED; however, there were significant differences based on gender, with women indicating more positive attitudes and supportive subjective norms regarding bystander intervention. Multiple regression analysis indicated that theoretical antecedents of intention positively predicted bystander intention, however, the relations were not moderated by prior engagement in HED. These findings support the utility of the TPB for predicting bystander intention to intervene; however, they do not support previous research examining how HED influences bystanders' intention to engage in prosocial actions.

Mobile intervention to promote correct hand hygiene at key times to prevent COVID-19 in the Swiss adult general population: study protocol of a multiphase optimisation strategy

IntroductionBehaviour change is key to the public health measures that have been issued in many countries worldwide to contain COVID-19. Public health measures will only take preventive effect if people...

Health Behavior Theory and Hypertension Management: Comparisons Among Black, White, and American Indian and Alaska Native Patients.

In the United States, hypertension is more common among individuals from racial and ethnic minority groups. Hypertension control rates are also lower for minority group members compared with White Americans. However, little research has employed well-established theoretical perspectives on health behavior, such as the Theory of Planned Behavior (TPB) and the Model of Goal-Directed Behavior (MGB), to better understand racial differences in rates of hypertension control. The present study examines the psychological processes involved in efforts to control blood pressure, through the lens of the TPB augmented by the MGB, in hypertensive patients of three racial groups: American Indian/Alaska Native, Black/African American, and White. Participants completed measures of past efforts to control blood pressure, attitudes, norms, perceived behavioral control, intentions, and anticipated emotions. Analyses employed confirmatory factor analysis and cross-groups path analysis. Measurement of the theoretical constructs and core putative mediators of blood pressure control intentions were largely similar across racial groups. With regard to the patterns of relationships among the constructs, differences among the groups were most apparent in pathways from past efforts to both cognitive and affective theoretical antecedents of intentions. These findings contribute to the sparse literature on factors involved in racial differences in hypertension control rates and may inform future interventions aimed at increasing hypertension control behaviors. Trial Registration ClinicalTrials.gov, NCT03028597, registered 23 January 2017, https://clinicaltrials.gov/ct2/show/NCT03028597; ClinicalTrials.gov, NCT04414982, registered 4 June 2020 (retrospectively registered), https://www.clinicaltrials.gov/ct2/show/NCT04414982.