This article, titled “Mechanisms of Health Behavior Change in Persons With Chronic Illness or Disability: The Health Action Process Approach (HAPA)”, was authored by Ralf Schwarzer, Sonia Lippke, and Aleksandra Luszczynska. It was published in Rehabilitation Psychology in 2011, Volume 56, No. 3, pages 161–170. The Digital Object Identifier (DOI) is 10.1037/a0024509.
The article provides an overview of theoretical constructs and mechanisms for health behavior change, particularly for individuals with chronic illness and disability. It emphasizes the importance of theory-guided interventions in rehabilitation settings for drawing valid conclusions and making successful practice recommendations.
The central framework presented is the Health Action Process Approach (HAPA), a self-regulation model that distinguishes between goal setting (motivational phase) and goal pursuit (volitional phase).
Key aspects of the HAPA model include:
- Motivational Phase: This initial phase focuses on developing an intention to act. Predisposing factors in this phase include:
- Risk perception: Seeing oneself at risk for a health issue (e.g., cardiovascular disease). While insufficient alone, it sets the stage for contemplation.
- Outcome expectancies: Balancing the pros and cons of behavioral outcomes, with positive expectancies (e.g., “If I exercise, I will reduce my cardiovascular risk”) being crucial.
- Task self-efficacy (or preactional self-efficacy): Belief in one’s capability to perform the desired action (e.g., “I am capable of adhering to my exercise schedule”). These beliefs work together to form an intention.
- Volitional Phase: This phase begins after an intention is formed and focuses on translating that intention into actual health behavior and maintaining it. Influential factors include:
- Planning: Transforming intentions into detailed instructions on how to perform the action. This includes action planning (when, where, and how) and coping planning (anticipating barriers and designing alternative actions). Planning is a key strategy for “intenders” who are motivated but haven’t acted yet.
- Action control: A concurrent self-regulatory strategy involving continuous evaluation of ongoing behavior against a standard, assessed through self-monitoring, awareness of standards, and self-regulatory effort.
- Maintenance/Recovery self-efficacy: Belief in one’s capability to maintain the behavior despite challenges and to recover from setbacks. This differs from initial self-efficacy as challenges change across phases.
- Social support: A resource that can enable the adoption and continuation of behaviors, acting as a barrier when lacking.
The HAPA model also incorporates a stage layer to segment the audience for tailored interventions, distinguishing between three groups:
- Preintenders: Individuals who are not active and do not yet intend to perform the recommended behavior. They benefit from risk and resource communication and understanding positive outcomes of new behaviors.
- Intenders: Individuals who have formed an intention but have not yet translated it into action. They primarily benefit from planning to bridge the intention-behavior gap.
- Actors: Individuals who are actively performing the health behavior. They need strategies for relapse prevention and coping with setbacks to maintain their behavior.
The article highlights that HAPA’s two-layer architecture, combining a continuum model (for explanation and prediction) with a stage model (for guiding interventions), offers a versatile framework for research and practice. It presents empirical evidence supporting the model’s principles, demonstrating how it works through mediating effects (e.g., planning mediates intention-behavior) and for whom it works through moderating effects (e.g., self-efficacy moderates planning-behavior relation). The authors emphasize the need for more effective, theory- and evidence-based interventions tailored to psychological constructs, especially for people with chronic illness and disability who often face unique barriers to adherence.
Reference: Schwarzer, R., Lippke, S., & Luszczynska, A. (2011). Mechanisms of health behavior change in persons with chronic illness or disability: The Health Action Process Approach (HAPA). Rehabilitation Psychology, 56(3), 161–170. https://doi.org/10.1037/a0024509
