The health and economic benefits of workplace wellness programs are well founded, but the favorable results only occur when employees choose to participate and adhere to these programs. The objective of this study was to use the Theory of Planned Behavior and Self-Efficacy Theory to predict whether participants adhered to a corporate wellness walking program. The sample consisted of 110 faculty and staff at a private university who enrolled in a walking program through the university’s wellness center. Participants completed surveys at the beginning of the program. The surveys measured self-reported physical activity, as well as theoretical construct of self-efficacy and those related to the Theory of Planned Behavior—attitude, social norms, perceived behavioral control and intention. Sixty percent of participants were found to meet the program’s goals. Self-reported physical activity (p = 0.036), barrier self-efficacy (p = 0.016), walking self-efficacy (p = 0.002), and intention (p < 0.001) were greater in those who met the goals than those who did not meet the goals of the program. Walking self-efficacy (p < 0.001), attitude (p < 0.001) and perceived behavioral control (p = 0.024) were all found to predict intention to walk and intention was a significant predictor of whether or not the participants met goals of the program (p = 0.022). This suggests behavioral interventions aimed at increasing participant self-efficacy and intentions could positively affect program adherence and the successfulness of a workplace wellness program.
KeywordsPhysical ActivityTheoryWorksite HealthSelf-EfficacyTheory of Planned Behavior
Office of Disease Prevention and Health Promotion (2017) Physical Activity | Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity/objectives
Cahalin, L.P., Kaminsky, L., Lavie, C.J., et al. (2015) Development and Implementation of Worksite Health and Wellness Programs: A Focus on Non-Communicable Disease. Progress in Cardiovascular Diseases, 58, 94-101. https://doi.org/10.1016/j.pcad.2015.04.001
Baicker, K., Cutler, D. and Song, Z. (2010) Workplace Wellness Programs Can Generate Savings. Health Affairs, 29, 304-311. https://doi.org/10.1377/hlthaff.2009.0626
Steinbrook, R. (2009) Health Care and the American Recovery and Reinvestment Act. New England Journal of Medicine, 360, 1057-1060. https://doi.org/10.1056/NEJMp0900665
Blumenthal, D. (2006) Employer-Sponsored Health Insurance in the United States-Origins and Implications. New England Journal of Medicine, 355, 82-88. https://doi.org/10.1056/NEJMhpr060703
Berry, L.L., Mirabito, A.M. and Baun, W.B. (2010) What’s the Hard Return on Employee Wellness Programs? Harvard Business Review, 88, 104-112, 142.
Zivin, K., Sen, A., Plegue, M.A., et al. (2017) Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees. American Journal of Preventive Medicine, 252, 347-352. https://doi.org/10.1016/j.amepre.2016.10.006
Dement, J.M., Epling, C., Joyner, J. and Cavanaugh, K. (2015) Impacts of Workplace Health Promotion and Wellness Programs on Health Care Utilization and Costs: Results from an Academic Workplace. Journal of Occupational and Environmental Medicine, 57, 1159. https://doi.org/10.1097/JOM.0000000000000555
Klautzer, L., Mattke, S. and Greenberg, M. (2012) Can We Legally Pay People for Being Good? A Review of Current Federal and State Law on Wellness Program Incentives. International Journal of Health Care Finance and Economics, 49, 268-277.
Goetzel, R.Z., Henke, R.M., Tabrizi, M., et al. (2014) Do Workplace Health Promotion (Wellness) Programs Work? Journal of Occupational and Environmental Medicine, 56, 927. https://doi.org/10.1097/JOM.0000000000000276
Marshall, A.L. (2004) Challenges and Opportunities for Promoting Physical Activity in the Workplace. Journal of Science and Medicine in Sport, 7, 60-66. https://doi.org/10.1016/S1440-2440(04)80279-2
Bandura, A. (1977) Self-Efficacy: Toward a Unifying Theory of Behavioral Change. Psychological Review, 84, 191-215. https://doi.org/10.1037/0033-295X.84.2.191
Ajzen, I. (1985) From Intentions to Actions: A Theory of Planned Behavior. In: Action Control, SSSP Springer Series in Social Psychology, Springer, Berlin, Heidelberg, 11-39. https://doi.org/10.1007/978-3-642-69746-3_2
Ajzen, I. (2005) Attitudes, Personality, and Behavior. 2nd Edition, McGraw-Hill Education, UK.
Fishbein, M. and Ajzen, I. (2011) Predicting and Changing Behavior: The Reasoned Action Approach. Psychology Press, New York. https://doi.org/10.4324/9780203838020
Dishman, R.K., Motl, R.W., Saunders, R., et al. (2004) Self-Efficacy Partially Mediates the Effect of a School-Based Physical-Activity Intervention among Adolescent Girls. Preventive Medicine, 38, 628-636. https://doi.org/10.1016/j.ypmed.2003.12.007
Prodaniuk, T.R., Plotnikoff, R.C., Spence, J.C. and Wilson, P.M. (2004) The Influence of Self-Efficacy and Outcome Expectations on the Relationship between Perceived Environment and Physical Activity in the Workplace. International Journal of Behavioral Nutrition and Physical Activity, 1, 7. https://doi.org/10.1186/1479-5868-1-7
Stutts, W.C. (2002) Physical Activity Determinants in Adults. Perceived Benefits, Barriers, and Self Efficacy. AAOHN Journal: Official Journal of the American Association of Occupational Health Nurses, 50, 499-507.
Sniehotta, F.F., Scholz, U. and Schwarzer, R. (2005) Bridging the Intention-Behaviour Gap: Planning, Self-Efficacy, and Action Control in the Adoption and Maintenance of Physical Exercise. Psychology & Health, 20, 143-160. https://doi.org/10.1080/08870440512331317670
Norman, P. and Conner, M. (2005) The Theory of Planned Behavior and Exercise: Evidence for the Mediating and Moderating Roles of Planning on Intention-Behavior Relationships. Journal of Sport and Exercise Psychology, 27, 488-504. https://doi.org/10.1123/jsep.27.4.488
McAuley, E., Jerome, G.J., Marquez, D.X., Elavsky, S. and Blissmer, B. (2003) Exercise Self-Efficacy in Older Adults: Social, Affective, and Behavioral Influences. Annals of Behavioral Medicine, 25, 1-7. https://doi.org/10.1207/S15324796ABM2501_01
McAuley, E., Courneya, K.S., Rudolph, D.L. and Lox, C.L. (1994) Enhancing Exercise Adherence in Middle-Aged Males and Females. Preventive Medicine, 23, 498-506. https://doi.org/10.1006/pmed.1994.1068
Prapavessis, H., Gaston, A. and DeJesus, S. (2015) Theory of Planned Behavior as a Model for Understanding Sedentary Behavior. Psychology of Sport and Exercise, 19, 23-32. https://doi.org/10.1016/j.psychsport.2015.02.001
Armitage, C.J. (2005) Can the Theory of Planned Behavior Predict the Maintenance of Physical Activity? Health Psychology, 24, 235-245. https://doi.org/10.1037/0278-6133.24.3.235
Godin, G., Valois, P. and Lepage, L. (1993) The Pattern of Influence of Perceived Behavioral Control upon Exercising Behavior: An Application of Ajzen’s Theory of Planned Behavior. Journal of Behavioral Medicine, 16, 81-102. https://doi.org/10.1007/BF00844756
Lee, I.-M. and Buchner, D.M. (2008) The Importance of Walking to Public Health. Medicine & Science in Sports & Exercise, 40, S512-S518. https://doi.org/10.1249/MSS.0b013e31817c65d0
Korownyk, C. and Allan, G.M. (2010) Motivating Patients to Activity: A Light at the End of the Couch? Canadian Family Physician, 56, 887.
Hanson, S. and Jones, A. (2015) Is There Evidence That Walking Groups Have Health Benefits? A Systematic Review and Meta-Analysis. British Journal of Sports Medicine, 49, 710-715. https://doi.org/10.1136/bjsports-2014-094157
Foulds, H.J.A., Bredin, S.S.D., Charlesworth, S.A., Ivey, A.C. and Warburton, D.E.R. (2014) Exercise Volume and Intensity: A Dose-Response Relationship with Health Benefits. European Journal of Applied Physiology, 114, 1563-1571. https://doi.org/10.1007/s00421-014-2887-9
Kelly, P., Kahlmeier, S., Gotschi, T., et al. (2014) Systematic Review and Meta-Analysis of Reduction in All-Cause Mortality from Walking and Cycling and Shape of Dose Response Relationship. International Journal of Behavioral Nutrition and Physical Activity, 11, 132. https://doi.org/10.1186/s12966-014-0132-x
Kelly, P., Williamson, C., Niven, A.G., Hunter, R., Mutrie, N. and Richards, J. (2018) Walking on Sunshine: Scoping Review of the Evidence for Walking and Mental Health. British Journal of Sports Medicine, 52, 800-806. https://doi.org/10.1136/bjsports-2017-098827
Richardson, C.R., Newton, T.L., Abraham, J.J., Sen, A., Jimbo, M. and Swartz, A.M. (2008) A Meta-Analysis of Pedometer-Based Walking Interventions and Weight Loss. The Annals of Family Medicine, 6, 69-77. https://doi.org/10.1370/afm.761
Bravata, D.M., Smith-Spangler, C., Sundaram, V., et al. (2007) Using Pedometers to Increase Physical Activity and Improve Health: A Systematic Review. JAMA, 298, 2296-2304. https://doi.org/10.1001/jama.298.19.2296
Eves, F., Hoppéa, R. and McLaren, L. (2003) Prediction of Specific Types of Physical Activity Using the Theory of Planned Behavior. Journal of Applied Biobehavioral Research, 8, 77-95. https://doi.org/10.1111/j.1751-9861.2003.tb00086.x
Ogilvie, D., Foster, C.E., Rothnie, H., et al. (2007) Interventions to Promote Walking: Systematic Review. BMJ, 334, 1204. https://doi.org/10.1136/bmj.39198.722720.BE
Godin, G. and Shephard, R.J. (1985) A Simple Method to Assess Exercise Behavior in the Community. Canadian Journal of Applied Sport Sciences, 10, 141-146.
McAuley, E. (1992) The Role of Efficacy Cognitions in the Prediction of Exercise Behavior in Middle-Aged Adults. Journal of Behavioral Medicine, 15, 65-88. https://doi.org/10.1007/BF00848378
Monroe, C.M., Bassett Jr., D.R., Fitzhugh, E.C., Raynor, H.A. and Thompson, D.L. (2017) Effect of Adding Online Social Support Tools to an Adult Walking Program: A Pilot Randomized Controlled Trial. Health Promotion Practice, 18, 84-92. https://doi.org/10.1177/1524839915626674
Olson, E.A. and McAuley, E. (2015) Impact of a Brief Intervention on Self-Regulation, Self-Efficacy and Physical Activity in Older Adults with Type 2 Diabetes. Journal of Behavioral Medicine, 38, 886-898. https://doi.org/10.1007/s10865-015-9660-3
McAuley, E. (1993) Self-Efficacy and the Maintenance of Exercise Participation in Older Adults. Journal of Behavioral Medicine, 16, 103-113. https://doi.org/10.1007/BF00844757
Rhodes, R.E., Courneya, K.S., Blanchard, C.M. and Plotnikoff, R.C. (2007) Prediction of Leisure-Time Walking: An Integration of Social Cognitive, Perceived Environmental, and Personality Factors. International Journal of Behavioral Nutrition and Physical Activity, 4, 51. https://doi.org/10.1186/1479-5868-4-51
Symons Downs, D. and Hausenblas, H.A. (2005) The Theories of Reasoned Action and Planned Behavior Applied to Exercise: A Meta-Analytic Update. Journal of Physical Activity & Health, 2, 76-97. https://doi.org/10.1123/jpah.2.1.76
Sun, G., Acheampong, R.A., Lin, H. and Pun, V.C. (2015) Understanding Walking Behavior among University Students Using Theory of Planned Behavior. International Journal of Environmental Research and Public Health, 12, 13794-13806. https://doi.org/10.3390/ijerph121113794
Rhodes, R.E. and de Bruijn, G.-J. (2013) How Big Is the Physical Activity Intention-Behaviour Gap? A Meta-Analysis Using the Action Control Framework. British Journal of Health Psychology, 18, 296-309. https://doi.org/10.1111/bjhp.12032
Rhodes, R.E. and de Bruijn, G.-J. (2013) What Predicts Intention-Behavior Discordance? A Review of the Action Control Framework. Exercise and Sport Sciences Reviews, 41, 201-207. https://doi.org/10.1097/JES.0b013e3182a4e6ed
Williams, S.L., Michie, S., Dale, J., Stallard, N. and French, D.P. (2015) The Effects of a Brief Intervention to Promote Walking on Theory of Planned Behavior Constructs: A Cluster Randomized Controlled Trial in General Practice. Patient Education and Counseling, 98, 651-659. https://doi.org/10.1016/j.pec.2015.01.010
Ekkekakis, P., Hall, E.E., VanLanduyt, L.M. and Petruzzello, S.J. (2000) Walking in (Affective) Circles: Can Short Walks Enhance Affect? Journal of Behavioral Medicine, 23, 245-275. https://doi.org/10.1023/A:1005558025163
Williams, D.M. (2008) Exercise, Affect, and Adherence: An Integrated Model and a Case for Self-Paced Exercise. Journal of Sport and Exercise Psychology, 30, 471-496. https://doi.org/10.1123/jsep.30.5.471
Lee, L.-L., Avis, M. and Arthur, A. (2007) The Role of Self-Efficacy in Older People’s Decisions to Initiate and Maintain Regular Walking as Exercise—Findings from a Qualitative Study. Preventive Medicine, 45, 62-65. https://doi.org/10.1016/j.ypmed.2007.04.011
Marcus, B.H., Selby, V.C., Niaura, R.S. and Rossi, J.S. (1992) Self-Efficacy and the Stages of Exercise Behavior Change. Research Quarterly for Exercise and Sport, 63, 60-66. https://doi.org/10.1080/02701367.1992.10607557
Dawson, J., Hillsdon, M., Boller, I. and Foster, C. (2007) Perceived Barriers to Walking in the Neighborhood Environment: A Survey of Middle-Aged and Older Adults. Journal of Aging and Physical Activity, 15, 318-335. https://doi.org/10.1123/japa.15.3.318
Dunton, G.F. and Schneider, M. (2006) Perceived Barriers to Walking for Physical Activity. Preventing Chronic Disease, 3, A116.
Mailey, E.L., Phillips, S.M., Dlugonski, D. and Conroy, D.E. (2016) Overcoming Barriers to Exercise among Parents: A Social Cognitive Theory Perspective. Journal of Behavioral Medicine, 39, 599-609. https://doi.org/10.1007/s10865-016-9744-8
Rhodes, R.E., Quinlan, A. and Mistry, C.D. (2016) Do Other Goals Influence Physical Activity? A Systematic Review Examining the Relationship between Other Goals and Physical Activity Behavior. Preventive Medicine, 91, 306-317. https://doi.org/10.1016/j.ypmed.2016.08.033
Marcus, B.H., Emmons, K.M., Simkin-Silverman, L.R., et al. (1998) Evaluation of Motivationally Tailored vs. Standard Self-Help Physical Activity Interventions at the Workplace. American Journal of Health Promotion, 12, 246-253. https://doi.org/10.4278/0890-1171-12.4.246
Mackey, M.G., Bohle, P., Taylor, P., Di Biase, T., McLoughlin, C. and Purnell, K. (2011) Walking to Wellness in an Ageing Sedentary University Community: Design, Method and Protocol. Contemporary Clinical Trials, 32, 273-279. https://doi.org/10.1016/j.cct.2010.12.001
Reger-Nash, B., Bauman, A., Cooper, L., et al. (2008) WV Walks: Replication with Expanded Reach. Journal of Physical Activity & Health, 5, 19-27. https://doi.org/10.1123/jpah.5.1.19
Reger-Nash, B., Fell, P., Spicer, D., et al. (2006) BC Walks: Replication of a Communitywide Physical Activity Campaign. Preventing Chronic Disease, 3, A90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1637798/
Reger-Nash, B., Bauman, A., Booth-Butterfield, S., et al. (2005) Wheeling Walks: Evaluation of a Media-Based Community Intervention. Family & Community Health, 28, 64. https://doi.org/10.1097/00003727-200501000-00009