Critical Review of a Paper Investigating the Application of the Theory of Planned Behaviour to Alcohol Consumption During Pregnancy

IntroductionThe paper to be reviewed is an investigation by Duncan, Forbes-McKay and Henderson (2012) into the application of the theory of planned demeanour (TPB, Ajzen, 1988, 1991) and its effectiveness in predicting heading to birth out wellness related deportments. The TPB is a social cognition model, meaning that it seeks to predict intention to escape out a behaviour and to understand why singulars whitethorn fail to adhere to a behaviour to which they were once committed. The theory claims that three variables can be utilise to predict an several(prenominal)s behaviour the individuals strength toward the behaviour, the bearing of epochal others toward the behaviour and the individuals perceive ensure everywhere a behaviour. Perceived control over behaviour is governed by both(prenominal) internal factors such(prenominal) as an individuals skills or available resources, and external factors such as actual opportunities to give birth out the behaviour. Unlike the individuals placement toward the behaviour and the attitude of others, perceived control over the behaviour is believed to influence both the intention to carry out the behaviour and the behaviour itself. In concomitant, the authors were investigating whether the TPB could be employd to predict intention to consume intoxicant during motherhood. Previous research has found the TPB to be useful for predicting a range of other health related behaviours (Godin and Kok, 1996) and alcoholic drink using up behaviours in particular (Marcoux & Shope, 1997 McMillan & Conner, 2003). The authors focused on the aim of TPB in being able to predict the consumption of alcohol during pregnancy. boozing during pregnancy is a major health issue. It has been found to influence a number of outcomes for the child including maladaptive behaviours (Sood et al., 2001) and weight at birth (Mariscal et al., 2006). Despite its relation to negative outcomes for the child, up to 54% of women in the UK fork over claimed to keep consumed alcohol during their pregnancy (Bolling et al., 2007).Study Description130 women base in the Aberdeenshire ara returned a questionnaire that was distributed to them at their 20- workweek pregnancy scan. Of these, analysis was carried out on 116 women. The questionnaire included questions designed to gather info on demographic details, past and present alcohol consumption, and TPB variables. The TPB variables included measuring the participants intention to engage in the behaviour, their attitude toward the behaviour, their beliefs about the subjective norm and their perceived behavioural control. The orbit found that the majority of participants made deviates to their drunkenness behaviour once they found out that they were with child(predicate), with these changes taking the form of a reduction in alcohol consumption. 64.7% abstained from alcohol altogether during their pregnancy, 34.5% continued to insobriety to some level and 0.9% did non answer. Of those women who continued to revel during their pregnancy, 13.4% were imbibing above the recommended maximum levels whereas the rest were drinking one to two units between two and four time per month. It was in like manner found that although most participants received information about drinking during their pregnancy, 12.9% received no information. In relation to the TPB theory, it was found that women who abstained from drinking after finding out they were pregnant had significantly higher gain on the intention scale, suggesting that they had a significantly greater intention to quit alcohol consumption during pregnancy. Abstaining participants also had significantly higher scores on the subjective norm scale, indicating that they felt much pressure from what others opinion about drinking during pregnancy. Abstainers were also found to have significantly lower scores on the attitude scale, suggesting a much less positive attitude toward the behaviour of drinking during pregnancy. In contrast,, the scale that calculated perceived behaviour control did not show any significant differences between those women who abstained and those who continued to drink during their pregnancy.Attitude toward the behaviour and the influence of what others thought of the behaviour were found to be strongly and significantly correlated with intention to carry out the behaviour of abstaining from alcohol during pregnancy. TPB was able to explain 59.3% of variance in intention to drink during pregnancy. Furthermore, the theory was able to correctly classify 91.8% of cases and as a result, was statistically able to key between drinkers and abstainers. The authors concluded that as attitude was found to have the grea try on statistically significant part to predicting intention and to contribute significantly to predicting actual behaviour, it would be an ideal candidate for intervention focus. As perceived behaviour control was the only TPB component found not to contribute, the authors suggest that the model without this component would be appropriate for predicting intention to consume alcohol during pregnancy.Critical ReviewThe reviewed article addressed an important health issue, namely investigating how drinking alcohol during pregnancy could be reduced by understanding what drives or stops women from having the intention to carry out this behaviour. The finding that attitude toward drinking whilst pregnant has a significant encroachment on both intention to drink during pregnancy and actual drinking during pregnancy could have wider clinical and fosterageal applications. Nevertheless, the authors are vague in how their findings could be applied in the real demesne and fail to make useful suggestions based on their data. The finding that some women were not provided with information pertaining to the consumption of alcohol during pregnancy is also an important one because it highlights that some health trusts are failing to serve up women make informed decisions about this subject. However, it is not touched upon in the discussion.The studys introduction is a little weak in that it does not make an overly convincing argument as to why their chosen topic is important and worth investigating. It makes only a brief reference to the negative impact that alcohol consumption can have on both mother and baby, and the literature to which it refers is quite outdated. This suggests that a thorough and recent literature review whitethorn not have been carried out. Furthermore, the study could present a much stronger argument as to why the TPB may be applicable to this health behaviour in particular. There is some justification in that the authors of the paper chose this particular theory on the premise that a socially-based theory such as TPB could highlight risk factors for the consumption of alcohol during pregnancy that could be more easily influenced than previous risk factors that have been identified s uch as drinking habits before pregnancy and socioeconomic status (Stewart & Streiner, 1994 Yamamoto et al., 2008). Risk factors such as these cannot be easily changed. In contrast, risk factors based on attitudes toward a behaviour can be more easily altered through education or government interventions. The discussion does not flow particularly well and the overall conclusions of the study are not entirely clear. An advantage of the TPB is its holistic approach. It attempts to understand the behaviour of an individual in the context of both an individuals attitude toward a behaviour, their perceived control over that behaviour and how they perceive others to umpire the behaviour. However, our intentions to carry out a behaviour or not are the result of an incredibly difficult process during which many variables are taken into account. Although the limitations of the studys methodology are touched upon in the discussion, the authors fail to explore the limitations of the TPB and h ow these may affect their findings. For example, McKeown (1979) argued that negative health behaviours are determined on the individual level by the choices we make to behave in a certain way. Therefore, the theory may dimension too much emphasis on the importance of what others think of a behaviour. Indeed, in the current study, individual attitudes toward a behaviour were found to be more influential than subjective norms.One criticism of this study is its potential lack of representativeness, both culturally and geographically. Ethnic minorities made up only 6.9% of the sample, meaning that the results may not be generalisable to ethnic minorities. Furthermore, the sample was collected from only one geographic area, although the authors argue that their findings are in keeping with previous studies that used samples from a much wider geographical area (Anderson et al., 2007 Bolling et al., 2007). There may also have been a persuade in the way in which participants were recruite d. Women were approached by the researchers whilst awaiting their 20 week antenatal scans in hospital. The scans are designed to screen for any anomalies in the baby and to check that cultivation is normal. These scans are not compulsory, potentially creating a bias in the sample. For example, Alderdice et al. (2007) found that women without qualifications or women from areas of high red were significantly less likely to use of goods and services an offer of a 20 week screen for Downs Syndrome than women from generous areas or women with degree-level qualification. This suggests that the women who were approached by the researchers in the current study may have been under-representative of women from lower socio-economic backgrounds. Furthermore, the study does not provide detail on the demographic information of the women who responded to the questionnaire, which would have been useful in evaluating generalisability.The measure used to ascertain TPB variables was developed usin g guidelines for the development of questionnaires designed to measure TPB behaviours (Francis et al., 2004). However, the measurement used was not a validated questionnaire. Furthermore, the authors do not provide examples of how they measured the three variables of intention, subjective norm and perceived behaviour control. This means that the measure cannot be opened up for scrutiny or re-used in later studies to valuate its validity and reliability. Before the main study, a small pilot study was carried out with seven pregnant women to ensure that the questionnaire was easy to understand. Pilot studies are essential for establishing a sound study design (van Teijilngen & Hundley, 2001). Although, it should be noted that the authors did not report the results of any reliability or validity tests. As part of the test battery, the study did use the Alcohol Use Disorders Identification Test, a reliable and valid measure for gather information on alcohol consumption that was develo ped by the World health Organisation (Saunders et al., 1993, sparing Intercollegiate Guidelines Network, 2004). This measurement has been reported to be superior to other measures designed to collect data on the same subject (Reinert & Allen, 2002).Self-report measures in themselves have a number of limitations. Firstly, they are subject to social pizzazz bias. Social desirability bias acknowledges that participants may report carrying out behaviours that are socially desirable or may cover up being involved in behaviours that are frowned on. Based on the finding that subjective norms had a significant impact on both intention and behaviour, social desirability bias may have affected the results of this study. If participants were so influenced by what others thought of alcohol consumption during pregnancy, then they may have been likely to cover up occasions on which they did drink during their pregnancy. This means that the number of participants who did drink during pregnancy may have been higher than the study reported.Recommendations for Improvement and Future queryIf this study is to be replicated, it could be improved in a number of ways. Firstly, ethnic minorities must be better represented. enceinte Britain is now a multi-cultural country and research must reflect this. The authors must provide more information or a copy of the questionnaire designed to measure TPB variables so that reliability and validity can be assessed. A useful future study would be to assess the impact of an intervention designed to change the attitude of women who do not perceive drinking alcohol during pregnancy to be an issue. As attitude was found to be the most important factor in intention to carry out this behaviour, the currently reviewed study would be strengthened if an intervention based around attitude was found to change behaviour.ReferencesAjzen, I. (1988). Attitudes, personality, and behavior. Milton Keynes, UK fan out University Press.Ajzen, I. (1991). Th e theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211.Alderdice, F., McNeill, J., Rowe, R., Martin, D. & Dornan, J. (2008). Inequalities in the reported offer and uptake of antenatal screening. Public Health, 122(1), 42-52.Anderson, S., Bradshaw, P., Cunningham-Burley, S., Hayes, F. Jamieson, L., MacGregor, A. et al. (2007). Growing up in Scotland A study following the lives of Scotlands children. 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