1

British Journal of Health Psychology (2015)

© 2015 The British Psychological Society
www.wileyonlinelibrary.com

Beyond single behaviour theory: Adding

cross-behaviour cognitions to the health action
process approach
Lena Fleig1,2,3*, Joy Ngo4, Blanca Roman4,5, Evangelia Ntzani6,
Paolo Satta7, Lisa M. Warner1, Ralf Schwarzer8 and Maria L. Brandi7
1
Health Psychology, Freie Universit€at Berlin, Germany
2
Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
3
Department of Family Practice, University of British Columbia, Vancouver, British
Columbia, Canada
4
Nutrition Research Foundation, Barcelona Science Park, Spain
5
EUSES Sports Science, University of Girona, Spain
6
Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology,
University of Ioannina School of Medicine, Greece
7
Department of Surgery and Translational Medicine, University of Florence, Italy
8
Institute for Positive Psychology and Education, Australian Catholic University,
Sydney, New South Wales, Australia

Objectives. Commonly, health behaviour theories have been applied to single

behaviours, giving insights into specific behaviours but providing little knowledge on
how individuals pursue an overall healthy lifestyle. In the context of diet and physical
activity, we investigated the extent to which cross-behaviour cognitions, namely transfer
cognitions and compensatory health beliefs, contribute to single behaviour theory.
Design. A total of 767 participants from two European regions (i.e., Germany n = 351,
southern Europe n = 416) completed online questionnaires on physical activity
and healthy dietary behaviour, behaviour-specific cognitions (i.e., self-efficacy, outcome
expectancies, risk perception, intention, action planning, action control), as well as cross-
behaviour cognitions, namely transfer cognitions and compensatory health beliefs.
Methods. Nested path models were specified to investigate the importance of cross-
behaviour cognitions over and above behaviour-specific predictors of physical activity and
healthy nutrition.
Results. Across both health behaviours, transfer cognitions were positively associated
with intention and self-regulatory strategies. Compensatory health beliefs were
negatively associated with intention. Action planning and action control mediated the
effect of intentions on behaviour.
Conclusions. Cross-behaviour cognitions contribute to single behaviour theory and
may explain how individuals regulate more than one health behaviour.

*Correspondence should be addressed to Lena Fleig, Health Psychology, Freie Universit€at Berlin, PF 10 Habelschwerdter Allee 45,
14195 Berlin, Germany (email: lena.fleig@fu-berlin.de).

DOI:10.1111/bjhp.12144
2 Lena Fleig et al.

Statement of contribution
What is already known on this subject?
 Cross-behaviour cognitions are related to a healthy lifestyle.
 Compensatory health beliefs hinder the adoption of a healthy lifestyle.
 Transfer cognitions encourage the engagement in a healthy lifestyle.

What does this study add?

 Transfer cognitions were positively associated with intentions, action planning, and action control
over and above behaviour-specific cognitions.
 Compensatory health beliefs were related to intentions only.
 Both facilitating and debilitating cross-behaviour cognitions need to be studied within a unified
multiple behaviour research framework.

Physical inactivity and an unhealthy diet are well-established behavioural risk factors for
cardiovascular disease, cancer, and diabetes (WHO, 2010). To maximize health benefits,
health behaviours should be changed in conjunction with each other (Fisher et al.,
2011). Research on changing multiple health behaviour change therefore raises unique
practical and theoretical considerations: A key issue relates to the question of how
individuals regulate two or more health behaviours (Prochaska & Prochaska, 2011). To
move beyond theories of single health behaviours (i.e., theories that focus on a single
behaviour), it is necessary not only to look at interrelations of health behaviours (Fleig,
K€uper, Schwarzer, Lippke, & Wiedemann, 2015; Nigg, Lee, Hubbard, & Min-Sun, 2009)
but to shed light on the cognitions and beliefs that individuals have about those
interrelations. For example, whether or not individuals decide to engage in a healthy diet
may be associated not only with their diet-specific cognitions but also with their
subjective beliefs about how their previous or anticipated physical activity affects their
diet. Two independent lines of research have previously investigated the importance of
such cross-behaviour cognitions1 to explain behaviour: Research on compensatory
health beliefs (CHBs; Kn€auper, Rabiau, Cohen, & Patriciu, 2004), that is beliefs that an
unhealthy behaviour can be compensated for by engaging in a healthy behaviour, and
research on transfer cognitions (Fleig, Kerschreiter, Schwarzer, Pomp, & Lippke, 2014),
that is cognitions and beliefs that performing one behaviour supports an increase in
another behaviour. The health action process approach (HAPA; Schwarzer, 2008) is
among the very few single behaviour frameworks that has served as a theoretical
backdrop to examine the mechanisms of cross-behaviour transfer (Fleig et al., 2014;
Lippke, Nigg, & Maddock, 2012) and compensation (Radtke, Kaklamanou, Scholz,
Hornung, & Armitage, 2014). This study therefore aimed at integrating both lines of
research and to investigate to what extent CHBs and transfer cognitions contribute to the
prediction of physical activity and a healthy diet over and above behaviour-specific
cognitions as is outlined by the HAPA (Schwarzer, 2008).

Moving beyond single health behaviour theory: Cross-behaviour cognitions

The interplay of behaviour-specific cognitions and health behaviour is well described by
single health behaviour theories, such as the HAPA (Schwarzer, 2008). The HAPA

1
This term needs to be differentiated from the term cross-behavioural cognitions which was originally introduced by Rhodes and
Blanchard (2008) to refer to behaviour-specific intentions that stand in conflict with intentions to perform another behaviour (e.g.,
intention to watch TV competes with intention to exercise). In this study, the term cross-behaviour cognitions is used to capture a
wider range of cognitions and beliefs that refer to how individuals perceive the interplay of two or more health behaviours.
 Moving beyond single behaivour theory 3

differentiates between (1) pre-intentional motivation processes that result in a behavio-

ural intention and (2) post-intentional volition processes that ultimately lead to
behavioural enactment. In the initial motivation phase, a person forms an intention to
engage in a health behaviour. In this phase, risk perception is viewed as a distal
antecedent. Risk perception sets the stage for further elaboration of thoughts and feelings
about consequences and competencies. Similarly, positive outcome expectancies are
mainly seen as being important in the motivation phase, when a person balances the
advantages and disadvantages of certain behavioural consequences. Furthermore,
individuals need to believe in their capability to perform a desired health behaviour.
Perceived self-efficacy operates in concert with positive outcome expectancies, both of
which contribute to forming an intention. After persons have decided to change their
behaviour, the behavioural intention has to be translated into action. This process
involves self-regulatory skills such as planning and action control (Hagger & Luszczynska,
2014). In its current version, the HAPA serves as a framework to study and design
interventions targeted at single health behaviours. Adding a cross-behaviour perspective
may extend the models’ applicability to understanding, predicting, and changing multiple
health behaviours.

Compensatory health beliefs

Compensatory health beliefs are defined as convictions that healthy behaviours can
compensate for or neutralize unhealthy behaviours (Kn€auper et al., 2004). For example,
Dohle, Wansink, and Zehnder (2015) found that individuals that exercise regularly tend to
justify their unhealthy food choices (e.g., eating out in a fast food restaurant) with their
being active. Activating such CHBs can help individuals to resolve the mental conflict
between giving in to temptation to self-indulge and sticking to their long-term health goals
(Kronick & Kn€auper, 2010).
Previously, CHBs have primarily been examined in the context of healthy nutrition
revealing negative associations with behaviour. In other words, individuals who hold
higher CHBs showed poorer adherence to diet regulations (Miquelon, Kn€auper, &
Vallerand, 2012) and reported higher caloric intake (Kronick, Auerbach, Stich, &
Kn€auper, 2011), as well as lower fruit and vegetable intake (Kaklamanou & Armitage,
2012). However, these studies may have overestimated the association of CHBs and
healthy nutrition as behaviour-specific cognitions, such as self-regulatory strategies,
were not taken into account. The very few studies that have investigated CHBs in
comparison with other cognitions as is outlined by the HAPA (Schwarzer, 2008) suggest
that CHBs are a negative predictor of intentions to engage in physical activity (Berli,
Loretini, Radtke, Hornung, & Scholz, 2014) and of intentions to stop smoking (Radtke,
Scholz, Keller, & Hornung, 2012), indicating that individuals with higher CHBs are less
motivated to engage in physical activity and to stop smoking, respectively. This holds
true even when behaviour-specific social cognitions (e.g., outcome expectancies, self-
efficacy) are accounted for. However, CHBs were not found to add to the prediction of
behaviour when investigated within the framework of the HAPA (Berli et al., 2014;
Radtke, Kaklamanou, Scholz, Hornung, & Armitage, 2014; Radtke et al., 2012;
Schwarzer, 2008). Based on these findings, we were tested whether CHBs were
negatively associated with physical activity intentions (Berli et al., 2014) and self-
regulatory strategies. If individuals with higher CHBs are less motivated to engage in
health behaviour, this should also translate into a lower engagement in action planning
and action control.
4 Lena Fleig et al.

Transfer cognitions
Contrary to CHBs, the concept of transfer (Barnett & Ceci, 2002) describes the idea that
knowledge or competencies acquired in one context facilitate future learning in another
context (Hammer, Elby, Scherr, & Redish, 2005). Physical activity and healthy nutrition
may represent two such contexts between which psychological resources and strategies
can be transferred (Fleig, Lippke, Pomp, & Schwarzer, 2011; Fleig et al., 2014; Lippke,
2014; Lippke et al., 2012; Nigg et al., 2009). Transfer cognitions, in particular, refer to
cognitions or subjective beliefs that the engagement in one behaviour domain supports an
increase in behaviour in a different domain (Fleig et al., 2014). Individuals may feel more
motivated, because of previous achievements in other domains (i.e., mastery experience;
Bandura, 1997) or they may find it helpful to make use of self-regulatory strategies that
have been proven successful for other behaviours. Initial evidence suggests that
individuals holding high levels of exercise-specific transfer cognitions are more likely to
engage in healthy dietary behaviour (Fleig et al., 2014).

Aims
Using the HAPA (Schwarzer, 2008) as theoretical framework, we aimed at investigating
the extent to which cross-behaviour cognitions contribute to theories of health behaviour
that currently only focus on single behaviours. In detail, we examined whether transfer
cognitions and CHBs were associated with intentions and self-regulatory strategies for
engaging in physical activity and a healthy diet over and above cognitions directed at
behaviour separately (i.e., single behaviour cognitions). Based on previous research, we
hypothesized that CHBs correlate negatively with intentions (Berli et al., 2014; Radtke
et al., 2012) and self-regulatory strategies, respectively. Building on Fleig et al. (2014), we
hypothesized that transfer cognitions correlate positively with intentions as well as self-
regulatory strategies (i.e., action planning and action control).

Method
Design
The cross-sectional online survey targeted adult residents of southern Europe and
Germany. Specifically, data were collected in Italy, Greece, Spain (i.e., southern Europe),
and Germany (i.e., central Europe) between January and April 2014 as part of the EU-
funded Credits4 health project. We obtained ethical approval from the review board of the
Freie Universit€at Berlin.

Participants
Potential survey participants were recruited through web announcements on the official
project web page (www.c4h.it) and local university web pages, as well as through the use
of local mailing lists. Participants did not receive any incentives. Individuals were eligible
to participate if they were aged 17 years and older. Questionnaire data were obtained
from 416 individuals from southern Europe (n = 110 Italian, n = 143 Greek, n = 163
Spanish)2 and 351 individuals from Germany. ANOVAs revealed that participants from

2
The goal of the study was to investigate the importance of cross-behaviour cognitions over and above behaviour-specific
cognitions rather than looking at differences between countries. We therefore only included a dichotomous variable (all Southern
European countries vs. Germany) into our models.
 Moving beyond single behaivour theory 5

Germany were significantly older (MGermany = 42.3, MS.Europe = 34.6) and had a
significantly higher BMI than participants from southern Europe (MGermany = 26.0,
MS.Europe = 24.0).

Measures
Item examples given here are examples translated from German, Italian, Greek, and
Spanish.

Health behaviours
Physical activity was measured with the general practice physical activity questionnaire,
which provides a physical activity index (GPPAQ; Department of Health, 2009).
Participants were asked to think about the last week and indicate how much cycling
and how much leisure-time physical exercise (i.e., jogging, swimming, football, gym, but
not cycling) they had engaged in. Answers were given on a 4-point scale with the
following anchors and corresponding scores (Department of Health, 2009): None (0
points), Less than 1 hr (1 point), 1–3 hrs (2 points), and more than 3 hrs (3 points).
Participants were also asked to indicate their level of occupational physical activity by
choosing one of the following statements (Department of Health, 2009): I am not
working (e.g., retired, retired for health reasons, unemployed, full-time career etc.) (0
points), I spend most of my time at work sitting (such as in an office) (0 points), I spend
most of my time at work standing or working. However, my work does not require
much intense physical effort (1 point), My work involves definite physical effort
including handling of heavy objects (e.g., plumber) (2 points), and My work involves
vigorous physical activity including handling of heavy objects (e.g., scaffolder) (3
points). A higher overall sum score indicated a higher level of physical activity.
The Mediterranean diet includes high consumption of fruits, vegetables, olive oil,
legumes, cereals, moderate to high intake of fish, moderate intake of dairy products, and
low consumption of meat products. It was assessed with the Mediterranean Diet
Adherence Screener adapted from a previously validated 14-item index (MEDAS; Schr€ oder
et al., 2011). The 18-item screener included four additional items. Two of these items
related to food intake routines (‘How many servings of grains did you consume per day?’
and ‘How many servings of dairy did you consume per day?’), and two questions referred
to food consumption frequency (‘How many days per week did you consume whole grain
cereals or cereal products?’ and ‘How many days per week did you consume fat-free or
low-fat dairy products?’). Items on drinking habits were excluded. Higher values on the
MEDAS indicated a healthier diet.

Single health behaviour cognitions

Risk perception, positive outcome expectancies, self-efficacy, intentions, action plan-
ning, and action control were all assessed with items adapted from Sniehotta, Scholz, and
Schwarzer (2005), and the response format was a Likert scale ranging from 1 (not at all
true or very unlikely for risk perception item) to 6 (completely true, very likely for risk
perception item).
Physical activity-specific risk perception was assessed using one item. The stem ‘If you
maintain your current level of activity (or inactivity),. . .’ was followed by a statement
concerning perceived vulnerability to one particular consequence of physical inactivity
6 Lena Fleig et al.

‘. . . what is the likelihood that you will get a cardiovascular disease (such as high blood
pressure or heart attack) over the course your entire life span?’
Diet-specific risk perception was assessed with one item. The stem ‘If you continue with
your present dietary habits . . .’ was followed by a statement concerning perceived
vulnerability to one particular consequence of an unhealthy diet ‘. . . what is the likelihood
that you will get a metabolic disease (such as diabetes, obesity) over the course of your
entire life span?’
Positive physical activity-specific outcome expectancies were measured by four items,
introduced by the stem ‘If I am physically active on a regular basis, to the point that I am
sweating and I am short of breath . . .’ followed by statements regarding positive
consequences such as ‘. . . then I will feel proud of myself’.
Positive diet-specific outcome expectancies were measured with four items, introduced
by the stem ‘If I eat five portions of fruit or vegetable a day . . .’ followed by statements
regarding positive consequences such as ‘. . . then I will feel satisfied and pleased’.
Motivational activity-specific self-efficacy was assessed with two items, namely ‘I am sure
that I can do more regular physical activity, even if I have to force myself to start
immediately’ and ‘I am sure that I can do more regular physical activity, even if I feel a
strong temptation not to exercise’.
Motivational diet-specific self-efficacy was assessed with two items, namely ‘I am sure
that I can improve my daily nutrition, even if I have to force myself to start immediately’
and ‘I am sure that I can improve my daily nutrition, even if I feel a strong temptation to
snack and indulge’.
Physical activity-specific intentions were measured with three items. Participants were
asked to rate three intentional statements: ‘I intend to vigorously exercise regularly, so
that I sweat and become short of breath’, ‘I intend to be regularly and moderately active, so
that I sweat a bit in leisure time’, and ‘I intend to be active in daily life (walking, biking,
house and garden work)’.
Diet-specific intentions were measured using three items: ‘I intend to eat more fruit or
vegetables’, ‘I intend to eat a more balanced diet’, and ‘I intend to adhere to the healthy
Mediterranean diet’.
Physical activity-specific action planning was assessed with two items. The item stem ‘I
have made a detailed plan for . . .’ was followed by statements such as ‘. . . when, where, or
how to exercise’ and ‘. . . how often and with whom to exercise’.
Diet-specific action planning was assessed with two items. The item stem ‘I have made a
detailed plan for . . .’ was followed by statements such as ‘. . . when, where, or how to eat
fruit or vegetables’ and ‘. . . how to maintain an overall balanced diet’.
Physical activity-specific action control was assessed with four items which addressed
the subcomponents of awareness of standards and self-monitoring. Items were, for
example, as follows: ‘In the last 4 weeks, . . .’ (1) ‘. . . I have always been aware of my
concrete exercise plan. It was on my mind’, (2) ‘. . . I have monitored how active I was in
terms of how often, how long, and which intensity’, (3) ‘I have monitored how often and
how long I have not been active (e.g., reading, watching TV)’, and (4) ‘I have kept records
about the amount of my activity (e.g., notes in calendar, or electronic devices)’.
Diet-specific action control was assessed accordingly with the following statements: (1)
‘. . . I have been aware of my concrete dietary plan. It was always on my mind’, (2) ‘. . . I
have monitored how well I have adhered to my planned diet’, (3) ‘I have monitored how
poorly I have adhered to my planned diet (for example, snacking, indulging in tempting
foods)’, and (4) ‘I have kept records regarding the amount of my fruit or vegetable’.
 Moving beyond single behaivour theory 7

Cross-behaviour cognitions
Exercise-specific compensatory health beliefs were measured with two items adapted
from the original 17-item scale by Kn€auper et al. (2004) to assess the extent to which
individuals believed that physical inactivity or reduced activity levels can be compensated
for by healthy diet (Kaklamanou & Armitage, 2012). The item stem ‘If I stick to a balanced
diet on a regular basis . . .’ was followed by two compensatory health cognitions ‘. . . I can
afford to exercise less’ and ‘. . . it’s okay not to be physically active’.
Diet-specific compensatory health beliefs. The item stem ‘If I am physically active on a
regular basis . . .’ was followed by two compensatory health cognitions ‘. . . I can afford to
eat more unhealthy foods’ and ‘. . . it’s okay not to eat any fruit and vegetable’.
Exercise-specific transfer cognitions were measured with a short version of the Transfer
Cognitions Scale (TRACS; Fleig et al., 2014). It measures to what extent the activity in one
domain supports a behaviour increment in a different domain. The item stem ‘If I am
physically active on a regular basis . . .’ was followed by three transfer cognitions ‘. . . it also
becomes easier for me to eat healthier’, ‘. . . I am more motivated to eat healthier’, and ‘. . .
I automatically feel like eating more healthy foods (e.g., fruits or fresh salad)’.
Diet-specific transfer cognitions were measured accordingly and adapted to the nutrition
domain. The stem ‘If I stick to a balance diet on a regular basis . . .’ was followed by three
transfer cognitions ‘. . . it also becomes easier for me to be physically more active’, ‘. . . I am
more motivated to perform vigorous exercise’, and ‘. . . I automatically feel like being
active’.

Statistical procedures
Analyses of variance (ANOVAs) to analyse differences between southern Europe and
Germany were performed with SPSS 20 (IBM, Armonk, NY, USA). Path analyses including
the estimation of indirect effects were conducted with Mplus 7.3. Path coefficients were
estimated using ordinary least squares regressions, and 95% confidence intervals were
determined by bootstrapping. We allowed cross-behaviour cognitions as well as
behaviour-specific predictors of intention to covary. Similarly, action planning and action
control were permitted to covary, as well as the control variables of the according model.
We used the full information likelihood techniques to impute missing values (below <5%).
We specified two nested models to evaluate the importance of transfer cognitions and
CHBs over and above behaviour-specific cognitions. In the full model, all pathways from
cross-behaviour cognitions to dependent variables were freely estimated. In the restricted
model (i.e., nested within the full model), pathways from cross-behaviour cognitions to
dependent variables were constrained to zero. To examine the goodness of model fit, we
used the chi-square test for the baseline model (Kline, 2005). An adequate model fit is
indicated if the chi-square/df ratio is between 2 and 5 (Bollen & Long, 1993). We also
included the comparative fit index (CFI), the Tucker–Lewis index (TLI > .95), and the
root mean square error of approximation (RMSEA < .05, Kline, 2005). Finally, a chi-square
difference test was performed to compare the full model with the restricted model.

Results
Descriptive results
Tables 1 and 2 present means and standard deviations of all measures separately for
physical activity and nutrition. As presented in Table 1, individuals from southern Europe
8 Lena Fleig et al.

reported higher levels of physical activity-specific action planning, outcome expectan-

cies, as well as transfer cognitions and CHBs than individuals from Germany. There were
also significant differences in physical activity intentions and self-efficacy, with individuals
from Germany scoring higher than individuals from southern Europe. As shown in
Table 2, there were significant differences in diet, transfer cognitions, CHBs, action
planning, and outcome expectancies, with individuals from southern Europe scoring
higher on all variables. With regard to diet-specific self-efficacy, individuals from Germany
reported higher values than individuals from southern Europe. We therefore included
European region as a control variable in the analyses.
Table 3 presents intercorrelations of physical activity variables and sociodemographic
variables. BMI showed a small, but significant positive association with physical activity.
Gender and age were not associated with any of the outcome variables. European region
showed small but significant associations with intention and action planning and was,
together with BMI, included as covariate in the physical activity model. Table 4 presents
the intercorrelations among the main dietary variables. BMI and European region were
associated with action planning and diet. Gender was associated with all main model
variables, whereas age was not. European region, BMI, and gender were included as
covariates in the diet model.

Hypothesized model integrating cross-behaviour cognitions into the HAPA

We specified two nested path models for each behaviour domain, adjusting for according
covariates. The full model specified behaviour-specific self-efficacy, outcome expectan-
cies, and risk perception as predictors of behavioural intentions. In line with HAPA, action
planning and action control were specified as correlates of intentions, which were
assumed to correlate with behaviour. We specified the indirect effect of intention on
behaviour via action planning and action control for both target behaviours. To test
whether cross-behaviour cognitions contribute to the prediction of intentions, action
planning, and action control over and above behaviour-specific variables, the full model
was compared to the restricted model.
Figure 1 presents the parameter estimates of the full physical activity model
integrating cross-behaviour cognitions into the HAPA, v2full model (15.49, N = 776) = 10;
p = .11; CFI = .99, TLI = .98, RMSEA = .03. A significant chi-square difference test
revealed that the full model should be favoured to the restricted model, v2restricted (79.48,
N = 776) = 16; p = .02; CFI = .94, TLI = .93, RMSEA = .05. In line with hypotheses,
intention was associated with outcome expectancies and self-efficacy. Contrary to
expectations, risk perception was negatively related to the intention to be physically
active. Whereas diet-specific transfer cognitions were positively related to the intention to
be physically active over and above behaviour-specific variables, CHBs were negatively
related to physical activity intention (Figure 1). Similarly, transfer cognitions were
associated with action planning over and above single health behaviour cognitions,
whereas no associations could be revealed for CHBs. European region was negatively
associated with intentions (b = .27) and positively associated with action planning
(b = .13). BMI did not show any significant associations with the model variables.
Results from bootstrapping provided evidence that the effect of intention on physical
activity was mediated via action planning (b = .04, SE = .02; p < .05, 95% CI [0.01, 0.06])
and action control (b = .04, SE = .02; p < .05, 95% CI [0.02, 0.06]). Overall, the full model
explained 26% of variance in physical activity.
Table 1. Means, standard deviations, and internal consistency for physical activity-specific variables (N = 767)

Southern Europe (n = 416) Germany (n = 351)

Cronbach’s Cronbach’s Mean

M SD Range alpha M SD Range alpha comparisons t(765)

Transfer cognitions 4.42 1.41 1–6 .88 3.21 1.58 1–6 .89 SE = GER ns
Compensatory 2.40 1.33 1–6 .601 1.82 1.01 1–6 .401 SE > GER 6.61**
health beliefs
Risk perception 3.02 1.54 1–6 – 3.11 1.54 1–6 – SE = GER ns
Outcome 4.53 1.02 1–6 .65 4.33 1.02 1–6 .60 SE > GER 2.79**
expectancies
Self-efficacy 3.62 1.43 1–6 .561 4.22 1.35 1–6 .811 SE < GER 5.96**
Intention 4.04 1.23 1–6 .50 4.35 1.20 1–6 .55 SE < GER 4.25**
Action planning 3.62 1.53 1–6 .90 3.17 1.59 1–6 .90 SE > GER 4.2**
Action control 2.93 1.44 1–6 .78 3.07 1.38 1–6 .78 SE = GER ns
Physical activity 2.01 1.71 0–8 – 2.25 1.72 0–9 – SE = GER ns

Notes. SE = southern Europe; GER = Germany.

1
Based on bivariate correlation between two items.
**p < .01.
Moving beyond single behaivour theory
9
 10
Lena Fleig et al.

Table 2. Means, standard deviations, and internal consistency for diet-specific variables (N = 767)

Southern Europe (n = 416) Germany (n = 351)

Cronbach’s Cronbach’s
M SD Range alpha M SD Range alpha Mean comparisons t(765)

Transfer cognitions 4.31 1.52 1–6 .91 3.18 1.32 1–6 .88 SE > GER 21.96**
Compensatory health beliefs 1.94 1.09 1–6 .451 1.81 0.81 1–6 .551 SE > GER 6.61**
Risk perception 2.50 1.36 1–6 – 2.65 1.22 1–6 – SE = GER ns
Outcome expectancies 4.54 1.18 1–6 .75 4.33 1.20 1–6 .77 SE > GER 2.36**
Self-efficacy 3.73 1.47 1–6 .431 3.92 1.27 1–6 .481 SE < GER 2.12**
Intention 4.32 1.23 1–6 .76 4.16 1.27 1–6 .77 SE = GER ns
Action planning 3.22 1.41 1–6 .84 2.42 1.43 1–6 .85 SE > GER 5.23**
Action control 2.71 1.21 1–6 .73 2.55 1.14 1–6 .70 SE = GER ns
Diet 5.23 2.07 1–18 – 4.51 1.92 1–14 – SE > GER 4.69**

Notes. SE = southern Europe; GER = Germany.

1
Based on bivariate correlation between two items.
**p < .01.
Table 3. Intercorrelations between physical activity-specific variables (N = 767)

1 2 3 4 5 6 7 8 9 10 11 12

1. Transfer cognitions
2. Compensatory health beliefs .10
3. Risk perception .01 .07
4. Outcome expectancies .37** .03 .03
5. Self-efficacy .03 .08 .01 .06
6. Intention .15* .17** .27** .24** .19**
7. Action planning .31** .05 .32** .22** .11* .48**
8. Action control .24** .06 .31** .24** .07 .42** .54**
9. Physical activity .01 .10* .40** .06 .10* .34** .31** .33**
10. Age .20** .18* .03 .09 .01 .03 .03 .02 .06
11. Body mass index .12* .04 .29** .02 .02 .03 .10 .04 .13* .30**
12. European region .38** .23** .02 .11* .21* .15* .15* .05 .05 .30** .19*
13. Gender .01 .06 .02 .08 .03 .08 .02 .03 .05 .13* .12* .08

Notes. Gender: 1 = male, 0 = female; European region: 0 = southern Europe, 1 = Germany.

*p < .05; **p < .01.
Moving beyond single behaivour theory
11
 12
Lena Fleig et al.

Table 4. Inter-correlations between diet-specific variables (N = 767)

1 2 3 4 5 6 7 8 9 10 11 12

1. Transfer cognitions
2. Compensatory health beliefs .16*
3. Risk perception .12* .01
4. Outcome expectancies .23** .06 .02
5. Self-efficacy .04 .01 .17* .14*
6. Intention .22** .02 .03 .40** .20*
7. Action planning .36** .11* .14* .26** .05 .40**
8. Action control .23** .09 .12* .20* .07 .31** .57**
9. Diet .24** .01 .30** .22** .09 .06 .27** .29**
10. Age .33** .18* .08 .05 .10* .05 .02 .01 .02
11. Body mass index .22* .04 .39** .11* .06 .01 .10* .04 .14* .30**
12. European region .52** .23** .06 .08 .08 .06 .19* .07 .17* .30** .19*
13. Gender .01 .06 .01 .18* .14* .14* .08 .15* .17* .12* .18* .08

Notes. Gender: 1 = male, 0 = female; European region: 0 = southern Europe, 1 = Germany.

*p < .05; **p < .01.
 Moving beyond single behaivour theory 13

Figure 1. Model of transfer cognitions and compensatory health beliefs within the health action process
approach for physical activity. Note. Standardized solution of the full path model. *p < .05; **p < .01. BMI
and European region were entered as control variables. European region was negatively associated with
intentions (b = .27) and positively associated with action planning (b = .13). BMI did not show any
significant associations.

Figure 2 presents the parameter estimates of the full diet model integrating cross-
behaviour cognitions into the HAPA, v2full model (47, N = 776) = 10; p = .01; CFI = .95,
TLI = .94, RMSEA = .04. A significant chi-square difference test revealed that the full
model should be favoured over the restricted model, v2restricted (75, N = 776) = 16; p = .02;
CFI = .91, TLI = .85, RMSEA = .05. In line with hypotheses, intention was associated
with outcome expectancies and self-efficacy. Contrary to expectations, risk perception
was not related to the intention to eat healthily. Whereas diet-specific transfer cognitions
were positively related to the intention to eat healthily over and above behaviour-specific
variables, CHBs were negatively related to the intention to eat healthy (Figure 2).
Similarly, transfer cognitions were associated with action planning and action control
over and above single behaviour cognitions, whereas no associations could be revealed for
CHBs. European region was positively associated with diet (b = .11). Gender and BMI
did not show any significant associations with the model variables. Results from
bootstrapping provided evidence that the effect of intention on diet was mediated via
action planning (b = .04, SE = .01; p < .05, 95% CI [0.02, 0.06]) and action control
(b = .04, SE = .01; p < .05, 95% CI [0.02, 0.06]). Overall, the full model explained 18% of
variance in diet.

Discussion
The aim of the present study was to include cross-behaviour cognitions into a health
behaviour change framework that looks at individual behaviours only (i.e., single
behaviour framework, HAPA; Schwarzer, 2008). This was done to examine their
contribution to explain behaviour. To the best of our knowledge, this study is one of the
first that investigates transfer cognitions and CHBs together, thereby integrating two
previous separate lines of research. Overall, results demonstrate the usefulness of adding
cross-behaviour cognitions into a single behaviour framework. Across the two health
14 Lena Fleig et al.

Figure 2. Model of transfer cognitions and compensatory health beliefs within the health action process
approach for diet. Note. Standardized solution of the full path model. *p < .05; **p < .01. Gender, BMI,
and European region were entered as control variables. European region was positively associated with
diet (b = .11). Gender and BMI did not show any significant associations.

behaviours, physical activity and healthy nutrition, transfer cognitions were positively
associated with intention and self-regulatory strategies. CHBs were associated with
intention only.
In more detail, exercise-specific CHBs were negatively associated with individuals’
physical activity intentions over and above activity-specific variables. The negative
association indicates that individuals, who believed that they can compensate for their
sedentary behaviour with healthy eating were less motivated to engage in regular physical
activity. For healthy dietary behaviour, we found a similar pattern: Individuals, who
believed that they can compensate their unhealthy diet with regular exercise (i.e., diet-
specific CHBs), reported lower intentions to stick to a healthy diet. This corroborates prior
research findings among adolescents in the domain of physical activity (Berli et al., 2014),
diet (Radtke et al., 2014), and smoking (Radtke et al., 2012) and suggests that CHBs may
be particularly relevant when it comes to forming an intention. In contrast to the
compromising effects of CHBs, transfer cognitions were positively associated with
intentions to engage in physical activity and with intentions to eat healthy. The positive
association indicates that individuals, who believed that regular exercise supports their
engagement in healthy dietary behaviour (i.e., exercise-specific transfer cognitions) were
more motivated to stick to a healthy diet. Similarly, individuals who felt that their healthy
diet supported their physical activity (i.e., diet-specific transfer cognitions) were more
motivated to engage in regular physical activity. This facilitating effect of transfer
cognitions did not only hold true for intention formation, but also for the use of self-
regulatory strategies. Individuals with higher transfer cognitions reported a higher use of
self-regulatory strategies, adding to the notion that transfer cognitions facilitate multiple
behaviour engagement (Fleig et al., 2014).
Results indicated a small association between transfer cognitions and CHBs. This may
provide initial support that both types of cross-behaviour cognitions belong to one overall
concept, but still measure distinct features of how individuals perceive the interplay
between diet and physical activity. On average, individuals reported consistently higher
levels of transfer cognitions than CHBs. In other words, individuals appeared to believe
that regular physical activity supported their healthy nutrition (and vice versa; Fleig et al.,
 Moving beyond single behaivour theory 15

2014; Lippke et al., 2012) rather than using physical activity as a justification to eat
unhealthy. Summing up, results demonstrate the usefulness of adding cross-behaviour
cognitions to a single health behaviour framework. Our results further generate new
hypotheses as to whether CHBs and transfer cognitions are relevant in different phases of
behaviour change.
Results further confirmed the applicability of the HAPA in predicting physical activity
and adherence to eating a healthy diet. Individuals with higher positive outcome
expectancies and self-efficacy reported higher intentions to engage in physical activity
and consume a healthy diet. Contrary to the assumptions of the HAPA, conditional risk
perception to engage in physical activity was negatively associated with the intention to
engage in physical activity. This corroborates previous findings in the domain of physical
activity (Berli et al., 2014) and might be attributed to the measurement of the construct.
Individuals who had already been quite active at the time of participation may not have felt
as vulnerable to suffering from a heart attack or high blood pressure.
In line with previous studies in the smoking (Radtke et al., 2012) and diet context
(Radtke et al., 2014), the association between conditional risk perception and the
intention to adhere to a healthy diet was not significant. Risk perception is considered to
be only a distal antecedent of the intention formation process and may, thus, not be as
important in comparison with other motivational variables. Taking into account that
participants may have been rather healthy, the inclusion of long-term health outcomes,
such as diabetes and obesity, might not have been as relevant to them at their current stage
of life (Radtke et al., 2012). Supporting the HAPA, individuals who reported higher levels
of intention to engage in physical activity and healthy dietary behaviours also reported
higher levels of action planning and action control. In line with previous research,
participants appeared to make use of both self-regulatory strategies, planning and action
control, to translate their dietary (Godinho, Alvarez, Lima, & Schwarzer, 2014) and
physical activity intentions (Sniehotta et al., 2005) into behaviour.

Limitations
The study was subject to several limitations. A first possible limitation is that the content
validity of some items might have been reduced due to the translation of items to Spanish,
Italian, and Greek. However, all questionnaires were translated from English to all study
languages and were checked by bilingual native speakers to ensure that the items
correctly captured each construct. Similar to the findings by Radtke et al. (2014) and
Kaklamanou, Armitage, and Jones (2013), correlations of CHB items were rather low,
especially the diet-specific CHB items. This might have been due to the fact that we
included very heterogeneous subfacets of unhealthy dietary behaviours (i.e., eat more
unhealthy foods, not to eat fruits and vegetables). Low internal consistency does not
mean, however, that heterogeneous constructs are less valid (Dunn, Baguley, & Brunsden,
2013). In contrast to former research (Poelman, Vermeer, Vyth, & Steenhuis, 2013), we
included the healthy behaviour (i.e., compensatory behaviour) in the item stem and asked
for different unhealthy behaviours. Although this reversed measurement is very similar to
outcome expectancies, bivariate correlations between CHBs and outcome expectancies
suggest that both constructs share only little variance.
In addition to such general measurement of CHBs and transfer cognitions, future
research may measure cross-behaviour cognitions in situations when individuals are
actually faced with temptations (e.g., laboratory-based experimental manipulations of
tempting situations, Radtke et al., 2014; or ecological momentary assessment in natural
16 Lena Fleig et al.

environments). If measured more specifically (Radtke, Inauen, Rennie, Orbell, & Scholz,
2014), individuals may be more likely to experience a mental conflict and, as a result, show
higher endorsement of CHBs. On the other hand, activation of transfer cognitions may
help individuals to resist temptations and stick to their original healthy intentions.
Similarly, awareness of overarching life goals, such as ‘losing weight’ might be
instrumental in tackling health-compromising temptations. Finally, due to the cross-
sectional research design, inferences as to cause and effect are limited. To accumulate
more evidence on the role of cross-behaviour cognitions in health behaviour change,
prospective longitudinal designs in which the social-cognitive variables, cross-behaviour
cognitions, and behaviours are investigated at more frequent measurement points in time
are needed. A future research goal may be to investigate whether changes in, for example,
physical activity affect subsequent changes in healthy nutrition through changes in cross-
behaviour cognitions.
In conclusion, the present study demonstrated that transfer cognitions and CHBs
contribute to the understanding of why individuals engage in physical activity and
consume a healthy diet. The study facilitates an innovative and refined theoretical
perspective on the relationship of different types of cross-behaviour cognitions and its
added value to single health behaviour theory. Other multiple behaviour cognitions such
as goal conflict (Presseau, Tait, Johnston, Francis, & Sniehotta, 2013), irrational health
beliefs (Christensen, Moran, & Wiebe, 1999), concurrent self-regulatory efficacy (Jung &
Brawley, 2013), and goal facilitation (Presseau et al., 2013) are promising candidates to be
included in such a multiple behaviour framework. Examining this perspective on multiple
health behaviour change has a high potential for insights into promoting multiple health
behaviours. Targeting cross-behaviour cognitions in complex behaviour change inter-
vention can potentially achieve uptake of a healthy lifestyle.

Acknowledgement
The research leading to these results has received funding from the European Union’s Seventh
Framework Programme (FP7/2007–2013) under grant agreement no. 602386.

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Received 8 September 2014; revised version received 5 May 2015