Building intentions with the Theory of Planned Behaviour: the mediating role of knowledge and expectations in implementing new pharmaceutical services in Malaysia

Main Article Content


Pharmaceutical Services, Qualitative Research, Behavior Observation Techniques, Models, Theoretical, Health Knowledge, Attitudes, Practice, Health Plan Implementation, Malaysia


Background: Pharmacy value added services (PVAS) was introduced as a matter of public health policy by Malaysia’s Ministry of Health to improve health outcomes through public healthcare services. For example, drive through pharmacy services is a major policy implementation of the Ministry. However, adoption rates are low and therefore hampering the achievement of national health policy goals.

Objective: Our objective is to explore the key determinants and mediators of successful implementation of new public pharmaceutical services by investigating the cognitive perspectives of patients’ intentions to adopt with the Theory of Planned Behavior as the theoretical framework.

Methods: A two phase mixed methodology involving first a qualitative exploration and the second a quantitative phase was conducted in public health facilities in Negeri Sembilan, Malaysia. Multiple regression and mediation analysis were performed.

Results: Subjective norms, perceived behavioural control, knowledge and expectations are found to be significant predictors of intentions to adopt PVAS. Knowledge and expectations are found to exert significant indirect effects on intentions.

Conclusion: Overall, we suggest that patient knowledge be enhanced through appropriate channels and expectations of service quality be met to increase intentions.

Abstract 2331 | PDF Downloads 1091 online appendix Downloads 743 Figure 1 Downloads 329 Tables 1-3 Downloads 205 Appendix 1-3 Downloads 331 Appendix 4-6 Downloads 344 Title page Downloads 375


1. Lin YF, Lin YM, Sheng LH, Chien HY, Chang TJ, Zheng CM, Lu HP. First drive-through pharmacy services in Taiwan. J Chin Med Assoc. 2013;76(1):37-41. doi: 10.1016/j.jcma.2012.10.001

2. McMillan SS, Sav A, Kelly F, King MA, Whitty JA, Wheeler A. Is the pharmacy profession innovative enough?" meeting the needs of Australian residents with chronic conditions and their carers using the nominal group technique. BMC Health Serv Res. 2014;14:476. doi: 10.1186/1472-6963-14-476

3. Whitty JA, Kendall E, Sav A, Kelly F, McMillan SS, King MA, Wheeler AJ. Preferences for the delivery of community pharmacy services to help manage chronic conditions. Res Social Adm Pharm. 2015;11(2):197-215. doi: 10.1016/j.sapharm.2014.06.007

4. Valluri S, Seoane-Vazquez E, Rodriguez-Monguio R, Szeinbach SL. Drug utilization and cost in a Medicaid population: A simulation study of community vs mail order pharmacy. BMC Health Serv Res. 2007;7:122. doi: 10.1186/1472-6963-7-122

5. MOH Malaysia. Annual Report Ministry of Health Malaysia. Malaysia 2011.

6. Chen CJ, Huang JW. Strategic human resource practices and innovation performance-The mediating role of knowledge management capacity. J Busines Res. 2009;62(1):104-114. doi: 10.1016/j.jbusres.2007.11.016

7. Simsek Z, Heavey C. The mediating role of knowledge-based capital for corporate entrepreneurship effects on performance: A study of small-to-medium sized firms. Strategic Entrepreneurship J. 2011;5(1):81-100. doi: 10.1002/sej.108

8. Vinodkumar MN, Bhasi M. Safety management practices and safety behavior: Assessing the mediating role of safety knowledge and motivation. Accid Anal Prev. 2010 Nov;42(6):2082-2093. doi: 10.1016/j.aap.2010.06.021

9. Davis-Kean PE. The influence of parent education and family income on child achievement: the indirect role of parental expectations and the home environment. J Fam Psychol. 2005 Jun;19(2):294-304.

10. Segerstrom SC, Taylor SE, Kemeny ME, Fahey JL. Optimism Is associated with mood, coping, and immune change in response to stress. J Pers Soc Psychol. 1998;74(6):1646-1655.

11. Shaffer PA, Vogel DL, Wei M. The Mediating Roles of Anticipated Risks, Anticipated Benefits, and Attitudes on the Decision to Seek Professional Help: An Attachment Perspective. J Couns Psychol. 2006;53(4):442-452. doi: 10.1037/0022-0167.53.4.442

12. Abraham C, Sheeran P. Acting on intentions: The role of anticipated regret. Br J Soc Psychol. 2003;42(Pt 4):495-511.

13. Ajzen I. The Theory of Planned Behavior. Organ Behav Hum Dec Processes. 1991;50:179-211.

14. Tashakkori A, Teddlie C. Integrating Qualitative and Quantitative Approaches to Research. In: Bickman L, Rog DJ, eds. The Sage Handbook of Applied Social Research Methods. 2nd ed. Thousand Oaks: Sage Publications; 2009.

15. Tan CLH, Hassali MA, Saleem F, Shafie AA, Aljadhey H, Gan VBY. Building intentions with the Theory of Planned Behavior: a qualitative assessment of salient beliefs about pharmacy value added services in Malaysia. Health Expect. 2016;19(6):1215-1225. doi: 10.1111/hex.12416

16. Francis J, Eccles MP, Johnston M, Walker AE, Grimshaw JM, Foy R, Kaner EFS, Smith L. Bonetti D. Constructing questionnaires based on the Theory of Planned Behaviour: A manual for health services researchers. Newcastle upon Tyne, UK: Centre for Health Services Research, University of Newcastle upon Tyne. Available at: (accessed September 8, 2016).

17. Nunnally J. Psychometric theory. New York: McGraw-Hill; 1978.

18. Kass RA, Tinsley HEA. Factor analysis. J Leisure Res. 1979;11:120-138.

19. Comrey AL, Lee HB. A First Course in Factor Analysis. 2nd ed. Hillsdale, NJ: Erlbaum; 1992.

20. DeVellis RF. Scale development: Theory and applications. 2nd ed. Thousand Oaks, California: Sage; 2003.

21. Gwet KL. Intrarater Reliability. Wiley Encyclopedia of Clinical Trials. 2008: ISBN: 9780471462422. doi: 10.1002/9780471462422

22. Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice Hall Health; 2000.

23. Field A. Discovering Statistics Using SPSS. 2nd (and sex, drugs and rock 'n' roll) ed. London: Sage; 2005.

24. Statistics Solutions. Confirmatory Factor Analysis. 2013. Available at: (accessed March 9, 2015).

25. Hair JFJ, Black WC, Babin BJ, Anderson RE. Multivariate Data Analysis: A Global Perspective. Upper Saddle River, New Jersey: Pearson Education; 2010.

26. Kim JO, Mueller CW. Factor Analysis: Statistical Methods and Practical Issues. Newburry Park: Sage Publications; 1978.

27. Tan CL, Hassali MA, Saleem F, Shafie AA, Aljadhey H, Gan VB. Development, test-retest reliability and validity of the Pharmacy Value-Added Services Questionnaire (PVASQ). Pharm Pract (Granada). 2015;13(3):598. doi: 10.18549/PharmPract.2015.03.598

28. Efron B. Bootstrap methods:Another look at the jackknife. Ann Stat. 1979;7(1):1-28.

29. Efron B. Better bootstrap confidence intervals. J Am Stat Assoc. 1987;82:171-185.

30. Efron B, Tibishirani RJ. An introduction to the bootstrap. Boca Raton: Chapman & Hall; 1993.

31. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879-891.

32. Sobel ME. Asymptotic confidence intervals for indirect effects in structural equations models. In: Leinhart S, ed. Sociological Methodology. San Francisco: Jossey-Bass; 1982.

33. Sobel ME. Some new results on indirect effects and their standard errors in covariance structure models. In: Tuma N, ed. Sociological Methodology. Washington DC: American Sociological Association; 1986.

34. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behav Res. 2004;39(1):99. doi: 10.1207/s15327906mbr3901_4

35. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36(4):717-731.

36. Kaiser HF. A second-generation little jiffy. Psychometrika. 1970;35:401-415. doi:10.1007/BF02291817

37. Kaiser HF. An index of Factorial Simplicity. Psychometrika. March 1974;39(1):31-36. doi:10.1007/BF02291575

38. Carpenter J, Bithell J. Bootstrap confidence intervals: when, which, what? A practical guide for medical statisticians. Stat Med. 2000;19(9):1141-1164.

39. Dancey C, Reidy J. Statistics without maths for psychology: using SPSS for Windows. London: Prentice Hall; 2004.

40. Javeline D. Response effects in polite cultures. a test of acquiescence in Kazakhstan. Public Opinion Quarterly. 1999;63(1):1-28. doi: 10.1086/297701

41. Harzing AW. Response styles in cross-national survey research: a 26-country study. Int J Cross Cult Manag. 2006;6(2):243-266. doi: 10.1177/1470595806066332

42. Michie, S, van Stralen, M. M, West, R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6:42. doi: 10.1186/1748-5908-6-42

43. Ramayah T, Rouibah K, Gopi M, Rangel GJ. A decomposed theory of reasoned action to explain intention to use Internet stock trading among Malaysian investors. Comput Hum Behav. 2009;25(6):1222-1230. doi: 10.1016/j.chb.2009.06.007

Most read articles by the same author(s)

1 2 > >>