The dynamic theory of reasoned action: evidence for a reverse causal process in the context of WHO handwashing guidelines.

Objective: This study provided a first empirical test of the Reverse Dynamic Theory of Reasoned Action (RDTRA) developed by Boster et al.
Design: In a longitudinal experiment, 169 participants were exposed to a WHO handwashing-guidelines behavioural induction, followed by an immediate posttest and a follow-up one week later.
Main Outcome Measures: The study measured attitudes and norms about WHO handwashing guidelines, as well as self-reported handwashing behaviour.
Results: The experimental induction produced variance in self-reported handwashing behaviour, allowing a test of the RDTRA using path analysis and structural equation modelling (SEM). Results were consistent with the RDTRA, with a positive effect of behaviour on both the attitude and norm coupled with excellent model fit. Results were inconsistent with behaviour as an outcome of attitudes and norms in this context.
Conclusion: For health behaviours, such as the WHO handwashing technique, initial behavioural adoption may promote subsequent shaping of attitudes and perceived norms. Boundary conditions for this effect may include the degree of spontaneity and consent involved in behaviour adoption.