The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: A meta-analysis

Paschal Sheeran, Alexander Maki, Erika Montanaro, Aya Avishai-Yitshak, Angela Bryan, William M.P. Klein, Eleanor Miles, Alexander J. Rothman

Research output: Contribution to journalArticlepeer-review

414 Scopus citations


Objective: Several health behavior theories converge on the hypothesis that attitudes, norms, and self-efficacy are important determinants of intentions and behavior. However, inferences regarding the relation between these cognitions and intention or behavior rest largely on correlational data that preclude causal inferences. To determine whether changing attitudes, norms, or self-efficacy leads to changes in intentions and behavior, investigators need to randomly assign participants to a treatment that significantly increases the respective cognition relative to a control condition, and test for differences in subsequent intentions or behavior. The present review analyzed findings from 204 experimental tests that met these criteria. Method: Studies were located using computerized searches and informal sources and meta-analyzed using STATA Version 11. Results: Experimentally induced changes in attitudes, norms, and self-efficacy all led to medium-sized changes in intention (d+ = .48, .49, and .51, respectively), and engendered small to medium-sized changes in behavior (attitudes-d+ = .38, norms-d+ = .36, selfefficacy- d+ = .47). These effect sizes generally were not qualified by the moderator variables examined (e.g., study quality, theoretical basis of the intervention, methodological characteristics, and features of the targeted behavior), although effects were larger for interventions designed to increase (vs. decrease) behavioral performance. Conclusion: The present review lends novel, experimental support for key predictions from health behavior theories, and demonstrates that interventions that modify attitudes, norms, and self-efficacy are effective in promoting health behavior change.

Original languageEnglish (US)
Pages (from-to)1178-1188
Number of pages11
JournalHealth Psychology
Issue number11
StatePublished - Nov 1 2016

Bibliographical note

Publisher Copyright:
© 2016 American Psychological Association.


  • Attitude
  • Health behavior
  • Interventions
  • Norm
  • Self-efficacy


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