HLTH 6475 Week 4 Planned Behavior Theory Rationale Example

Theory Rationale: Why Mental Health First Aid Training Should Increase Helping Among Mingo County Adults, Argued Through the Theory of Planned Behavior With Each Construct Tied to a Course Element and to Trial Evidence

Student Name

Walden University

HLTH 6475: Health and Wellness Education Program Planning, Implementation and Evaluation

Instructor Name

Month Day, Year

Theory Rationale: Why Mental Health First Aid Training Should Increase Helping Among Mingo County Adults, Argued Through the Theory of Planned Behavior With Each Construct Tied to a Course Element and to Trial Evidence

The Behavior and the Theory

The behavior the program aims to change is specific: an adult in Mingo County, West Virginia, noticing that someone in their life is in mental distress and responding helpfully, by approaching the person, listening without judgment and encouraging appropriate support. The program will train 320 adults in Mental Health First Aid over 12 months. This rationale explains why that training should change the behavior, using the theory of planned behavior.

In Ajzen's account, what a person intends to do is the closest forecast of what they will do, and that intention depends on three things: the person's attitude toward the behavior, the subjective norm, meaning their perception of whether people important to them expect it, and perceived behavioral control, their sense that they can perform it. Perceived behavioral control can also predict behavior directly when it reflects actual ability (Ajzen, 1991).

The theory fits this program because helping someone in distress is a voluntary act that many adults intend in principle but avoid in practice, often because they do not know what to say or fear making things worse. Those barriers map onto the theory's constructs.

Construct 1: Attitude Toward Helping

Attitude here means how favorably or unfavorably a person judges doing the act at all. Adults who believe that mental health problems are a sign of weakness, or that talking about suicide puts the idea in someone's head, will evaluate approaching a distressed person negatively.

Course element: the training addresses common misconceptions about mental disorders and stigma directly, presenting information on how common mental health problems are and how recovery happens.

Evidence: a systematic review of 18 controlled trials of the training found small reductions in stigma and improved beliefs about effective treatments (Morgan et al., 2018). If attitudes toward people with mental health problems improve, attitudes toward helping them should improve as well, though the review measured stigma and treatment beliefs rather than attitude toward helping itself.

Construct 2: Subjective Norm

Subjective norm is the perception that people who matter to the individual think they should, or should not, perform the behavior. In a small county where privacy is valued and mental health is rarely discussed openly, many adults may sense that asking about someone's mental health is intrusive.

Course element: the program trains people in groups drawn from the same settings, such as a school's staff, a congregation's volunteers or an employer's supervisors. Training colleagues together signals that the organization expects them to respond, and it creates a shared language within the group.

Evidence: the review did not measure norms directly. This link rests on the theory and on the program's design choice, and the evaluation should therefore ask trainees whether they believe their colleagues and community expect them to help.

Construct 3: Perceived Behavioral Control

Perceived behavioral control is the person's belief that they are able to perform the behavior. This is the construct the training targets most directly. Adults who would like to help but do not know what to say, or how to respond to talk of suicide, have low perceived control.

Course element: the course teaches a structured action plan for approaching, assessing and supporting someone, practiced through scenarios and role plays, along with local referral information on a wallet card the program adds.

Evidence: the review found improvements in confidence in helping a person with a mental health problem, with effect sizes from 0.21 to 0.58, and in knowledge of mental health first aid, with effect sizes from 0.31 to 0.72 (Morgan et al., 2018). Confidence is a close measure of perceived behavioral control.

From Intention to Behavior

The theory predicts that these three constructs raise intention, and intention in turn raises behavior. The review supports both steps, finding improved intentions to provide first aid, with effect sizes from 0.26 to 0.75, and a modest rise in how much help trainees gave when followed up, with an effect size of 0.23 (Morgan et al., 2018). The step from intention to behavior is where effects shrink, which is consistent with the theory's recognition that actual control, including opportunity, limits what intentions can produce. In this program, a trainee who never encounters someone in distress during the follow-up period cannot help, however strong the intention.

Where the Theory Falls Silent

The theory focuses on the individual's decision. It does not explain whether services exist to which a trainee can refer someone, and with roughly one county adult in four, 24.1%, reporting frequent mental distress in federal 2023 figures (Centers for Disease Control and Prevention [CDC], 2025) suggests that services may be stretched. The program addresses this partly through the local referral card, but the theory offers no account of service capacity, which lies outside the trainee's control. A social ecological view would add those levels; this rationale acknowledges the gap rather than stretching the theory to cover it.

Why Not Another Theory

The health belief model was considered, since it addresses perceived threat and barriers. It fits decisions about one's own health better than decisions to help someone else, and it offers no construct for the social expectations that matter so much in a small community. Social cognitive theory was also considered and shares the emphasis on self-efficacy that perceived behavioral control captures. Planned behavior theory won out because it names the three barriers this program targets, how people feel about helping, what they think others expect and whether they believe they can do it, and because the training's trial evidence was measured on outcomes that map onto those constructs. Choosing one theory also keeps the evaluation focused; measuring every construct from several theories would lengthen the forms trainees complete at the end of a long day.

Implications for the Evaluation

Because the rationale runs through attitude, norm and perceived control to intention and behavior, the evaluation should measure each link: stigma and treatment beliefs, perceived expectations of colleagues, confidence, intention to help and self-reported helping at three months. Measuring only knowledge would test the course content but not the theory.

References

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. https://doi.org/10.1016/0749-5978(91)90020-T

Centers for Disease Control and Prevention. (2025). PLACES: Local data for better health, county data, 2025 release [Data set]. https://data.cdc.gov/d/swc5-untb

Morgan, A. J., Ross, A., & Reavley, N. J. (2018). Systematic review and meta-analysis of Mental Health First Aid training: Effects on knowledge, stigma, and helping behaviour. PLOS ONE, 13(5), Article e0197102. https://doi.org/10.1371/journal.pone.0197102