Predicting physical activity in adolescents: the role of compensatory health beliefs within the Health Action Process Approach.

TLDR: It is suggested that CHBs are of particular importance in the process of intention formation, in that higher CHBs were associated with lower intentions to be physically active at T2 and a reduction in intentions from T1 to T2.

Abstract: Objective: Compensatory health beliefs (CHBs), defined as beliefs that healthy behaviours can compensate for unhealthy behaviours, may be one possible factor hindering people in adopting a healthier lifestyle. This study examined the contribution of CHBs to the prediction of adolescents’ physical activity within the theoretical framework of the Health Action Process Approach (HAPA).Design: The study followed a prospective survey design with assessments at baseline (T1) and two weeks later (T2).Method: Questionnaire data on physical activity, HAPA variables and CHBs were obtained twice from 430 adolescents of four different Swiss schools. Multilevel modelling was applied.Results: CHBs added significantly to the prediction of intentions and change in intentions, in that higher CHBs were associated with lower intentions to be physically active at T2 and a reduction in intentions from T1 to T2. No effect of CHBs emerged for the prediction of self-reported levels of physical activity at T2 and change in physic...

Figures

Table 2. Inter-correlations between variables of interest, group-mean centered (N = 430) 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Figure 2. Prediction of physical activity: Fixed effects of variables at student level Note. Unstandardized coefficients in bold, standard errors in parenthesis. Controlled for sex, intervention and school level. **p < .01, *p < .05

Table 1. Means, standard deviations, internal consistency and Intra-class Correlations (ICC) for main variables (N = 430)

Figure 1. Prediction of intentions: Fixed effects of variables at student level Note. Unstandardized coefficients in bold, standard errors in parenthesis. Controlled for sex, intervention and school level. **p < .01, *p < .05

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Year:2014
Predictingphysicalactivityinadolescents:Theroleofcompensatoryhealth
beliefswithintheHealthActionProcessApproach
Berli,Corina;Loretini,Philipp;Radtke,Theda;Hornung,Rainer;Scholz,Urte
Abstract:Objective:Compensatoryhealthbeliefs(CHBs),denedasbeliefsthathealthybehaviours
cancompensateforunhealthybehaviours,maybeonepossiblefactorhinderingpeopleinadoptinga
healthier lifestyle.This study examined thecontribution of CHBsto the predictionof adolescents’
physical activity within the theoretical framework ofthe Health Action Process Approach(HAPA).
Design:Thestudyfollowedaprospectivesurveydesignwithassessmentsatbaseline(T1)andtwoweeks
later(T2).Method: Questionnairedataonphysicalactivity,HAPAvariablesandCHBswereobtained
twicefrom430adolescentsoffourdierentSwissschools.Multilevelmodellingwasapplied.Results:
CHBsaddedsignicantlytothepredictionofintentionsandchangeinintentions,inthathigherCHBs
wereassociatedwithlowerintentionstobephysicallyactiveatT2andareductioninintentionsfromT1
toT2.NoeectofCHBsemergedforthepredictionofself-reportedlevelsofphysicalactivityatT2and
changeinphysicalactivityfromT1toT2.Conclusion: Findingsemphasisetherelevanceofexamining
CHBsinthecontextofanestablishedhealthbehaviourchangemodelandsuggestthatCHBsareof
particularimportanceintheprocessofintentionformation.
DOI:https://doi.org/10.1080/08870446.2013.865028
PostedattheZurichOpenRepositoryandArchive,UniversityofZurich
ZORAURL:https://doi.org/10.5167/uzh-100739
JournalArticle
AcceptedVersion
Originallypublishedat:
Berli,Corina;Loretini,Philipp;Radtke,Theda;Hornung, Rainer;Scholz, Urte (2014).Predicting
physicalactivityinadolescents:TheroleofcompensatoryhealthbeliefswithintheHealthActionProcess
Approach.PsychologyHealth,29(4):458-474.
DOI:https://doi.org/10.1080/08870446.2013.865028

Running head: COMPENSATORY HEALTH BELIEFS AND PHYSICAL ACTIVITY 1
Predicting Physical Activity in Adolescents: The Role of Compensatory Health
Beliefs within the Health Action Process Approach
Corina Berli
*1
, Philipp Loretini
2
, Theda Radtke
3
, Rainer Hornung
2
& Urte Scholz
3
1
University of Bern, Switzerland
2
University of Zurich, Switzerland
3
University of Konstanz, Germany**
*Correspondence should be addressed to: Corina Berli, University of Bern, Department of
Psychology, Health Psychology, Alpeneggstrasse 22, 3012 Bern, Switzerland; E-mail:
corina.berli@psy.unibe.ch; Tel.: +41 31 631 57 97
** Urte Scholz is now at the University of Zurich, Department of Psychology, Applied Social
Psycholgy, Binzmuehlestrasse 14/ Box 14, CH- 8050 Zurich, Switzerland
Acknowledgements: The first author is funded by the Swiss National Science Foundation
(PP00P1_133632 / 1).
Received: 12 June 2013
Accepted: 5 November 2013
This article has been accepted for publication and undergone full peer-review, but has not been through
the copyediting, typesetting, pagination and proofreading process, which may lead to differences
between this version and the Version of Record. Please cite this article as
Doi: 10.1080/08870446.2013.865028
This article is protected by copyrights. All rights reserved.

COMPENSATORY HEALTH BELIEFS AND PHYSICAL ACTIVITY 2
Abstract
Objective: Compensatory health beliefs (CHBs), defined as beliefs that healthy behaviours
can compensate for unhealthy behaviours, may be one possible factor hindering people in
adopting a healthier lifestyle. This study examined the contribution of CHBs to the prediction
of adolescents’ physical activity within the theoretical framework of the Health Action
Process Approach (HAPA).
Design: The study followed a prospective survey design with assessments at baseline (T1)
and two weeks later (T2).
Method: Questionnaire data on physical activity, HAPA variables and CHBs were obtained
twice from 430 adolescents of four different Swiss schools. Multilevel modelling was applied.
Results: CHBs added significantly to the prediction of intentions and change in intentions, in
that higher CHBs were associated with lower intentions to be physically active at T2 and a
reduction in intentions from T1 to T2. No effect of CHBs emerged for the prediction of self-
reported levels of physical activity at T2 and change in physical activity from T1 to T2.
Conclusion: Findings emphasize the relevance of examining CHBs in the context of an
established health behaviour change model and suggest that CHBs are of particular
importance in the process of intention formation.
Keywords: Compensatory health beliefs; Health Action Process Approach; physical activity;
adolescents; intentions; health behaviour

COMPENSATORY HEALTH BELIEFS AND PHYSICAL ACTIVITY 3
Globally, physical activity has declined due to the increasingly sedentary nature of
many forms of work, changing modes of transportation, and increasing urbanization (WHO,
2012). Despite the fact that physical inactivity is the fourth leading cause of death worldwide,
31% of the world’s population aged 15 and more is insufficiently active (Kohl et al., 2012). It
is furthermore well documented that physical activity decreases throughout adolescence, with
the teen years (13-18) as the age of greatest decline (Kahn et al., 2008; Sallis, 2000). The
global recommendations on physical activity for 5- to 17-year olds involve an accumulation
of at least 60 minutes of moderate to vigorous physical activity daily (WHO, 2011). Engaging
in regular physical activity provides essential health benefits for children and adolescents, in
contributing to the development of a healthy cardiovascular system, musculoskeletal tissues,
neuromuscular awareness and facilitating the maintenance of a healthy body weight (WHO,
2011). However, the adoption and maintenance of a health-enhancing behaviour such as
physical activity is a challenging task and even despite the best intentions, many attempts
remain unsuccessful (Sheeran, 2002). Recent research proposes that certain types of beliefs –
compensatory health beliefs – may be an important factor hindering people in adopting a
healthier lifestyle (e.g., Kronick & Knäuper, 2010; Rabiau, Knäuper, Nguyen, Sufrategui, &
Polychronakos, 2009; Radtke, Scholz, Keller, Knäuper, & Hornung, 2011). This study set out
to investigate the role of compensatory health beliefs in the framework of an established
health behaviour change model for intention formation and change in physical activity in
adolescents.
Compensatory health beliefs
Individuals are faced with temptations and desires throughout daily life: eating
delicious but unhealthy food, smoking, taking the car instead of the bike, when at the same
time holding goals with regard to their health. One way to resolve the motivational conflict

COMPENSATORY HEALTH BELIEFS AND PHYSICAL ACTIVITY 4
that arises from giving in to temptations and holding on to health goals, is the activation of
compensatory health beliefs (Rabiau, Knäuper & Miquelon, 2006).
Compensatory health beliefs (CHBs) are beliefs that the negative consequences of an
unhealthy behaviour can be compensated for by engaging in a healthy behaviour (Knäuper et
al., 2004). For example, people who have the intention to keep a healthy weight but also
desire to eat sweets may activate the following belief “I can eat this piece of cake now,
because I will exercise in the evening.” The activation of compensatory health beliefs serves
as a self-regulatory strategy to reduce the mental conflict at the moment of temptation or
subsequently to fulfilling a desire and thus enables individuals to keep the ‘best of both
worlds’: eating the cake, but not feeling guilty about it (Rabiau et al., 2006). Kronick and
Knäuper (2010) provided first empirical evidence that the mental conflict of being torn
between giving in to food temptation (delicious looking, high caloric cookie) or preserving
initial dieting goals elicits the formation of compensatory intentions.
While individuals may intend to engage in the compensatory behaviour, the
compensatory behaviour itself is often not carried out. As time passes, the initially felt
discomfort weakens and eventually the need to compensate for the unhealthy behaviour fades
away. Also, the compensatory behaviour may not effectively compensate for the multiple
negative effects an unhealthy behaviour can bring about and may lead to ill health in the long
run. It can therefore be assumed that holding CHBs is associated with negative health
outcomes over time (Knäuper et al., 2004; Rabiau et al., 2006).
So far, CHBs have been investigated with regard to several health behaviours. These
studies provide evidence that higher CHBs are associated with lower diabetes treatment
adherence in adolescents with type 1 diabetes (Rabiau et al., 2009), greater caloric intake
(Kronick, Auerbach, Stich, & Knäuper, 2011; Kronick & Knäuper, 2010), lower adherence to
self-set dieting rules (Miquelon, Knäuper, & Vallerand, 2012), and less readiness to quit

Frequently asked questions

Q1. What are the contributions in "Predicting physical activity in adolescents: the role of compensatory health beliefs within the health action process approach" ?

This study examined the contribution of CHBs to the prediction of adolescents ’ physical activity within the theoretical framework of the Health Action Process Approach ( HAPA ). The study followed a prospective survey design with assessments at baseline ( T1 ) and two weeks later ( T2 ). No effect of CHBs emerged for the prediction of self-reported levels of physical activity at T2 and change in physical activity from T1 to T2. The first author is funded by the Swiss National Science Foundation ( PP00P1_133632 / 1 ). This article has been accepted for publication and undergone full peer-review, but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as Doi: 10. This article is protected by copyrights. Conclusion: Findings emphasise the relevance of examining CHBs in the context of an established health behaviour change model and suggest that CHBs are of particular importance in the process of intention formation. 

Q2. What were the levels of prediction of intentions at T2?

For the prediction of intentions at T2, risk perception, positive outcome expectancies,self-efficacy and CHBs served as Level 1 predictors. 

Q3. What were the levels of prediction of physical activity at T2?

For the prediction of physical activity at T2, intentions, self-efficacy, action planning, action control and CHBs served as Level 1 predictors. 

Q4. What is the main reason why adolescents are less likely to participate in sport?

Especially self-report measures on physical activity are critical as physical activity is a socially desirable behaviour that is likely to be overreported among adolescents and adults (Sallis & Saelens, 2000). 

Q5. What is the definition of action control?

Action control is a selfregulatory process that involves three subfacets: awareness of standards, self-monitoring and self-regulatory effort (e.g., Sniehotta, Nagy, Scholz, & Schwarzer, 2006). 

Q6. What is the role of self-licensing in behavioural enactment?

Self-licensing has so far been found to lead to more hedonic choices, as seeking and constructing reasons may be part of resolving the decisional conflict, but may not be expected to automatically translate from decision making into hedonic behaviour. 

Q7. What is the purpose of compensatory health beliefs?

One way to resolve the motivational conflictthat arises from giving in to temptations and holding on to health goals, is the activation of compensatory health beliefs (Rabiau, Knäuper & Miquelon, 2006). 

Q8. What was the effect of CHBs on the prediction of intentions?

CHBs emerged as a significant negative predictor of intentions at T2 and change inintentions from T1 to T2, despite the fact that bivariate associations were not significant. 

Q9. What was the effect of CHBs on the prediction of adolescent’?

Findings showed that CHBs emerged as a significant negative predictor of adolescent’s intentions as well as change in intentions over and above standard motivational HAPA predictors. 

Q10. What is the likely explanation for the negative association between risk perception and other HAPA constructs?

One possible explanation might be that the ambigous item phrasing (“If The authorkeep up my level of activity/inactivity…”) in the assessment of risk perception produced a converse effect, in that adolescents with high levels of activity at baseline did not perceive themselves as vulnerable to probable social or health consequences which resulted in low reported levels of risk perception and negative associations with the other HAPA constructs. 

Q11. What is the effect of CHBs on the prediction of intentions?

The negative association indicates that for adolescents holding CHBs is rather counterproductive as higher CHBs go along with lower intentions and a reduction in intentions to be physically active over two weeks. 

Q12. What was the effect of sex on the outcome measures?

Of the socio-demographic variables, sex was significantly associated with both outcome measures in that males reported higher intentions and higher physical activity at T2, and thus, served as control variable in all analyses.