Model of the Consumer Switching Behavior Related to Healthy Food Products

Abstract

This study aimed to examine the effect of customers’ attitudes, subjective norms, and perceived behavior control on their intention to switch to healthy food products. This research also tested brand awareness as a moderator of customers’ behavioral choices to switch to healthy food products by switching behavior. The study was conducted by distributing a questionnaire. It involved 318 participants and employed partial least square regression as the data analysis method. This study shows the significant influence of customers’ attitudes on their switching intentions toward healthy food products, and perceived behavior control significantly influences customers’ switching intentions toward healthy food products. Customers’ perceived behavior control, as well as their intentions to switch toward healthy food products, significantly influences their switching behavior. Brand awareness has a moderate influence on customers’ intentions to switching behavior on healthy food products. This study contributes to developing the model of customer behavior in switching from fast food products to healthy food products. This study reveals that subjective norms do not significantly influence the switching behavior of customers.

1. Introduction

The demand of healthy food products has grown rapidly over the past decade in Indonesia. Its growth has risen by about 10 percent [1]. Despite the high growth rate of healthy food products in Indonesia, their overall market share is still small. Additionally, consumers who purchase healthy food continue to purchase fast food products and services for their leading daily food requirements. Awareness of health factors has a role in consumers’ purchasing decisions, especially in healthy food products [2]. Even when they are away from their daily routine, consumers want to maintain a healthy lifestyle [3]. Moreover, if an individual is concerned with nutrition, they are less likely to eat out frequently [4]. Casini et al. [5] found that people tend to search more about healthy food products and make them personalized. Consumers tend to purchase healthy food products because of the values associated with them, such as health benefits and nutritional value [6]. Therefore, to gain more insight into the consumer penetration of healthy food in Indonesia, this subject requires a deeper understanding.

People with nutritional awareness will carefully select the specific ingredients they want to avoid [3]. Because of buyers’ ecological learning and compelling health efforts, awareness of health benefits is the fundamental reason people buy healthy food [7]. One of the driving forces is that the purchase of healthy food products and services is still unpopular, and there is no appropriate incentive for the public from healthy food product owners to influence them to switch from fast food to healthy food products and services. Previous studies have shown that many consumers have tried to eat healthy food products in order to have a healthy lifestyle [7,8]. This behavior describes healthy practices brought by necessities and health-related inspiration [9]. It still requires a comprehensive understanding of factors that may encourage people to switch from fast food to healthy food products and services. To explore these factors, we need to understand the prior behavior of consumers using the theory of planned behavior from Ajzen [10], who were willing to switch to healthy food products and services. Pookulangara et al. [11], Madahi and Sukati [12] argued that the theory of planned behavior is relevant in studying consumer behavior, especially in the context of switching behavior. Moreover, each components’ planned behavior may differ; some planned behavior components may or may not significantly influence consumer switching behavior [11]. Therefore, this research aimed to investigate the consumer switching behavior of healthy food products and services from Indonesia’s perspective using the theory of planned behavior. The advantage of the theory of planned behavior (TPB) is predicting specific behavior [13]; in this case, it concerns not only general consumption behavior but also healthy food. TPB is also appropriate in assessing behavior change, with aspects of behavior control mediated by changes in behavior intention. The formation of intentions can be explained by the theory of planned behavior, which assumes that humans always have a purpose in their behavior [14]. Ajzen [13] states that in the theory of planned behavior, it is necessary to consider other aspects that can complement this model’s explanation—namely, background (personal, social, and information) factors. This research considers aspects of consumer awareness in the study of changes in healthy food consumer behavior.

Consumer awareness plays an essential part in food preferences [15,16]. In the sense of healthy food, Cant et al. [17] conducted research related to changing attitudes to food products and services in the food industry in South Africa. They found that healthy foods can encourage consumers to switch to healthy foods. Chen [18] found that a healthy lifestyle affects consumers’ attitudes to turn to healthy food products and services. Suki [7] also found that the effect of a healthy lifestyle allows clients to turn to healthy food products and services. In the context of healthy food in South Korea, [3] also found that a healthy lifestyle, a variety of nutritious foods, and the nutritional quality of food products and services significantly impacted consumers’ changing behavior. A study on healthy food in the context of Indonesia from Yuniarni [19] found that the awareness of Indonesian people about healthy food increases when they change their eating habits to become healthier because of their activities, especially people who live in cities.

The number of fast-food products has increased, but consumers of healthy food products understand the benefits of nutritious food for their bodies. Consumers’ food decisions affect their health and the success or failure of food products in the direction of the food market [18]. Consequently, many owners of fast-food restaurant also serve healthy food. Healthy food products in Indonesia have begun to develop due to the positive public perception of a healthy lifestyle as a result of eating healthy foods. Eating a healthy food is the foundation for a healthy diet [20]. Eighty percent of Indonesians start their diet by restricting or prohibiting their consumption of certain foods or drinks [21]. This phenomenon shows that Indonesia’s people are beginning to implement a healthy lifestyle to solve their health problems. In this analysis, we discuss the impact of healthy food on people’s lifestyles in products and services.

However, there is still limited comprehensive research that understands the possibility of consumer switching behavior to healthy food products and services. Research related to consumer switching behavior focuses more on industrial services [22], such as customers’ switching behavior for bank services, e.g., Manrai and Manrai [23], Gerrard and Cunningham [24], and Chakravarty et al. [25]. Additionally, Irianto et al. [26] examined consumers’ behavior, moving from fast foods to organic foods with experimental research designs. The study shows that the factors forming the intention to switch to organic food are the variables switching attitudes and motivation to elaborate on information. Even so, organic food is different from healthy food. According to American Academy of Pediatrics [27], healthy food includes organic food and natural food that have undergone less processing than usual.

Healthy food product marketers need to understand the concepts and factors that influence healthy food’s consumer switching behavior to formulate communication strategies, product development, and quality of service that do not only focus on consumers’ demographic preferences and characteristics. The development of information technology has helped people, especially the Millennial generation, seek healthy food products in terms of food safety and nutrition, which has caused Millennials to buy more nutritious food than previous generations [28,29]. This research extends our knowledge about healthy food products using the theory of planned behavior. Brand awareness has benefits in determining market segmentation [30]. Brand awareness plays essential role in consumers’ decision-making about a brand. Brand awareness connects a brand with a product consumers want to own [31], so high brand awareness will weaken the likelihood of brand switching. Consumers’ judgment is based on what they know about a brand [32]. Furthermore, brand awareness can have a sizable effect on customer purchasing decisions through close brand associations [33]. This research is essential because Indonesia has a diverse cultural, quality, and demographic background, particularly in terms of healthy food products and services.

Specifically, this study aims to examine the antecedents of customer switching behavior—namely, (a) the influence of customers’ attitudes on customers’ switching intentions toward healthy food products; (b) the impact of customers’ subjective norms on customers’ switching intentions toward healthy food products; (c) the influence of customers’ perceived behavior control on customers’ intention of switching to healthy food products; (d) the influence of customers’ perceived behavior control on customers’ changing behavior; (e) the influence of customers’ switching intentions toward healthy food products on customers’ switching behavior; and (f) role of brand awareness, which moderates the influence of customers’ switching intentions toward healthy food products, in customers’ switching behavior.

2. Literature Review

Ajzen [10] provides an overview of the research on behavioral attitudes. According to this concept, the primary determinant of behavioral motive or intention is the most important factor influencing someone’s behavior. Individuals intend to act based on a mixture of attitudes toward behaviors, social norms, and perceived behavioral control. Attitude is an individual’s propensity to determine whether the good or bad of an object or environment outside the individual [33]. According to the theory of planned behavior model, one’s attitude toward a particular behavior is not directly related to actions, but mediated by the overall prevailing values correlated with attitude and consumer confidence evaluation. A subjective norm is a consumer’s perception based on specific references. When a person is generally motivated to obey group references (e.g., friends, family), they may be obedient even though their expectations are different [14]. Perceived behavioral control can have a direct and indirect effect on behavior. It is based directly on the intensity of the individual’s belief about the presence or absence of factors that make it easier or difficult for an individual to behave, assuming that they have the same purpose [10].

The determinant of actual behavior is behavioral intention. Intention to do something is defined as an individual’s ability to engage in behavior and is a function of three components: attitudes, subjective norms, and perceived control over their actions. Behavioral intentions describe the required incentive to perform such actions, representing a person’s determination to pursue an action, and are an indicator of how hard people are willing to try to execute a behavior [34]. With time, intentions may change. This means that intention prediction accuracy typically decreases as more measurements and observations of behavioral intentions are carried out [35]. The theory of planned behavior has been used in studying various health products, such as organic products [36,37] and related brands [38]. This research also adopts the model theory of planned behavior described above to develop and modify a model related to shifting customer behavior and foodservice products. In this research, we will examine the switching behavior of customers from fast food to healthy food.

2.1. Attitudes, Subjective Norms, and Perceived Behavioral Control in Consumers’ Intentions to Switch to Healthy Food

Intentions are formed by attitudes, subjective norms, and perceived behavioral control [10]. Three determinants of behavioral intention are based on the underlying belief structure: behavioral, normative, and control beliefs. Behavioral beliefs produce favorable or unfavorable attitudes toward behavior, normative beliefs include perceived social pressure or subjective norms, and control beliefs describe a person’s perceived control of their behavior. Taken together, attitudes toward behavior, subjective norms, and perceived behavioral control translate into behavioral intentions, which are direct determinants of actual behavior. Behavioral beliefs are determined by behavioral beliefs, which are related to behavior output and other attributes. Generally, attitude is viewed as an essential determinant of intention. This research’s focus is the customer’s attitude toward healty food products and their intentions regarding switching healty food products. Attitudes toward an object can positive or negative; hence, someone’s relationship with certain items cannot be said to be impartial [39]. Intention has a strong relationship with behavioral intention in the planned behavior model theory [40].

Subjective norms are the result of belief, which is related to how a person believes in another and their motivation to follow the referrer’s assertion [14]. In the planned behavior model theory, subjective norms influence customers’ intention to carry out their behavior. Therefore, we can conclude that customer’s subjective norms can influence their intentions to switch to healthy food products and services. Perceived behavior control refers to customers’ beliefs about whether they have the resources or chance to carry out a behavior. The more a person believes that they have the resources, abilities, and opportunities needed to behave in a certain way, the more powerful the person’s intentions to carry out their desired behaviors and actions will be [34]. Even if someone has the right attitude, their perceived control over their behavior will influence their intention to switch to healthy food products and services.

Moreover, perceived behavior control functions as a determinant of behavior. Customers’ intentions mediate their perceived behavioral control and actual behavior. This relationship means there is an indirect association between customers’ decisions to switch healty food products and control behavior. However, perceived behavioral control is also thought to directly relate to behavior that is not mediated by intentions when such behavior does not violate individual control and the person has a high perception of their control [35]. When a person believes that a engaging in a behavior is beyond their ability, the direct relationship between perceived behavioral control and actual behavior grows weaker [41]. Therefore, customers’ perceived behavior control influences their actual behavior toward healthy food products. Based on previous literature studies and the concept of planned behavior theory, the following hypotheses are derived.

H1. 

Customers’ attitudes influence their intention of switching to healthy food products.

H2. 

Customers’ subjective norms influence their intention of switching to healthy food products.

H3. 

Customers’ perceived behavior control influences their intention of switching to healthy food products.

H4. 

Customers’ perceived behavior control influences their switching behavior.

2.2. Intention for Behavior of Switching toward Healthy Food

Intention to behave in a certain way is defined as the unique possibility to engage in an interest and is a function of three components: attitudes, subjective norms, and perceived behavior control. Behavioral intentions can predict individual behavior accurately [13]. Previous research studies on this topic indicate a robust direct relationship and a significant correlation between behavior and behavioral intentions, both in the Theory of Reasoned Action (TRA) and TPB contexts. In these research contexts, the customer’s intention to switch to healthy food products and services will strongly influence their behavior towards switching to healthy food products and services.

H5. 

Customers’ intentions to switch to healthy food products influence their switching behavior.

2.3. Moderation towards Intention Relationship and Behavior

In the case of behavior toward switching food products, it is suspected that customers have strong intentions to move to healthy food products and services. However, they do not carry out this intended behavior. According to Ajzen [13], this conclusion does not acknowledge behavior that consumers intend to carry out when they are influenced by factors beyond their control. Therefore, the researcher assumes that brand awareness has an influence that causes behavioral intentions to not translate to actual behavior.

The main factors in brand awareness are whether a customer has ever seen or heard of a brand or can clearly identify a brand [32]. This means that brand awareness has a vital role in customers’ decisions regarding a brand. Customers obtain brand awareness from effective marketing communication strategies, such as using smartphones, online advertising, and media advertising. Brand awareness describes how customers connect a brand with a product they want to have [31]. Therefore, it is essential in this area to know the extent of a customer’s brand awareness regarding healthy food products and services. The great brand awareness of a customer can influence their intention to switch to healthy food products and services.

H6. 

Brand awareness influences the relationship between customers’ intention of switching to healthy food products and their switching behavior.

All the above hypotheses in the proposed research framework are represented in Figure 1.

3. Research Methodology

The type of research we conducted was a survey. Empirical field observations, which also contained environmental information, were initiated in this study. This research was conducted with a quantitative approach to explore the factors that encourage customers to change their products and services to healthy food products and services. This research aimed to investigate customers’ intentions to switch from fast food products to healthy food products. The analysis unit in this research is customers who buy healthy food who previously used fast food products. This study’s population is respondents who have ever bought food products and services in the Special Region of Yogyakarta, Indonesia. Before the researcher collected data, a focus group discussion (FGD) was conducted to gain insight into the questionnaire’s clarity before it was sent to respondents. After the focus group discussion (FGD), the next step was to collect data using a questionnaire as the survey technique. The questionnaire contained three parts: demographic questions, variable measurement questions, and an exploration of shifting motives.

4. Results and Discussion

4.1. Result

The total number of responses collected was 318 responses; the respondents have different characteristics, based on their gender, age, highest level of education, purchasing of fast food, and frequency of buying fast food in a week.

Table 1. Respondent characteristics.

Variable	Category	N	(%)
Gender	Men	127	39.9
	Women	191	60.1
Age	>40 years	11	3.5
	≤20 years	67	21.1
	21–25 years	158	49.6
	26–30 years	72	20.6
	31–35 years	10	3.1
Buying Fast Food Frequencies	>3 times	43	13.6
	Once	160	50.4
	2–3 times	115	36.0
Buying Healthy Food Frequencies	>3 times	109	34.2
	2–3 times	129	40.8
	1 time	80	25.0

shows the characteristics of the respondent.

There were six variables to be measured in this research: attitudes towards switching behavior, subjective norms, perceived behavior control, switching behavior intentions, brand awareness, and actual switching behavior. Each variable’s was measured using a 1–5 scale to obtain interval data or a numerical semantic differential scale. Interviews were also conducted with respondents to explore their intentions to switch to healthy food products and services.

The questionnaire items used to measure each variable were adapted from previous research, taken from Ajzen and Madden [35], and Nguyen and Johnson [36]. The subjective norm scale measure was adapted from Ajzen [13], and Ajzen and Madden [35]. Our four-item questionnaire concerning perceived behavior control was adapted from Ajzen and Madden [35], and Taylor and Todd [42]. The switching behavior intention scale measure was adapted from Ajzen and Madden [35]. The brand awareness scale measure was adapted from Severi and Ling [43]. The switching behavior scale measure was adapted from Malhotra and Kubowich [44]. The instrument was also tested by conducting a pilot test of 80 respondents. Question items need to be tested to find out how valid they are. Based on suggestions from Hair et al. [45] for the factor loading value of each item, it was recommended to be above 0.5. As shown in

Table 2. Constructs, items, and model results.

Constructs, Items, and Model Result		Factor Loading	p-Value
Attitude (CR = 0.864; AVE = 0.614; Cronbach’s Alpha = 0.789)
ATT1	My attitude toward healthy food is positive.	0.845	<0.001
ATT2	Generally, I think it is good to buy a healthy food.	0.746	<0.001
ATT3	I honestly like to buy a healthy food.	0.761	<0.001
ATT4	Buy healthy food is a wise idea.	0.78	<0.001
Subjective norm (CR = 0.876; AVE = 0.638; Cronbach’s Alpha = 0.81)
SN1	Most people who are important to me think it is good to buy healthy food.	0.747	<0.001
SN2	Most people who are important to me would buy a healthy food.	0.852	<0.001
SN3	Most people who have the same value as me would buy a healthy food.	0.78	<0.001
SN4	People whose opinions I value would prefer that I try to buy healthy food.	0.813	<0.001
Perceived behavior control (CR = 0.872; AVE = 0.631; Cronbach’s alpha = 0.802)
PBC1	I feel free to buy healthy food if I like to.	0.828	<0.001
PBC2	Buying healthy food is entirely within my control.	0.875	<0.001
PBC3	I believe that my decision to buy healthy food is a good decision.	0.767	<0.001
PBC4	I have the resources and the knowledge, and the ability to buy a healthy food.	0.697	<0.001
Switching behavior intention (CR = 0.906; AVE = 0,763; Cronbach’s alpha = 0.844)
SBI1	I would gradually decrease my use of everyday foods.	0.839	<0.001
SBI2	I would like to try a healthy food.	0.909	<0.001
SBI3	Generally, I want to buy a healthy food.	0.871	<0.001
Brand awareness (CR = 0.901; AVE = 0.696; Cronbach’s alpha = 0.851)
BA1	I have no difficulty in imagining healthy food in my mind	0.706	<0.001
BA2	Healthy food is the only food I recall whenever I need to decide on consuming food.	0.833	<0.001
BA3	When I think of my favorite food, healthy food comes to mind quickly.	0.875	<0.001
BA4	When someone talks about food, healthy food always comes to mind.	0.909	<0.001
Switching behavior (CR = 0.915; AVE = 0.782; Cronbach’s alpha = 0.86)
SB1	I spend more time buying healthy food than my previous food.	0.899	<0.001
SB2	I buy healthy food more frequently than my previous food.	0.883	<0.001
SB3	I spend more money on a healthy food.	0.87	<0.001

, the values of all the loading factors are above 0.5. The loading factor value of the items will likely increase when the number of samples is increased. The next stage was to conduct a construct reliability test. This stage was carried out to measure the consistency of the question items in measuring a construct [45]. The reliability test was used to measure the consistency of the measuring instrument when used twice or more for the same symptoms. The construct reliability test can be performed by looking at the value of composite reliability and Cronbach’s alpha. Based on Table 2, the composite reliability and Cronbach’s alpha values of each variable are above 0.7; this indicates that the result has a good reliability. Furthermore, we analyzed the data using the partial least square method.

This research found that there were five supported hypotheses, and one hypothesis that was not supported. Figure 2 and

Table 3. Hypothesis testing.

Hypothesis	Path	Standardized Path Coefficients	p-Values
H1	Attitude → Switching Behavior Intention	0.444	<0.001
H2	Subjective Norm → Switching Behavior Intention	0.086	0.098
H3	Perceived Behavior Control → Switching Behavior Intention	0.235	<0.001
H4	Perceived Behavior Control → Switching Behavior	0.202	0.001
H5	Switching Behavior Intention → Switching Behavior	0.428	<0.001
H6	Switching Behavior Intention * Brand Awareness → Switching Behavior	0.204	<0.001
R2 (Switching Behavior Intention) = 0.418 R2 (Switching Behavior) = 0.406

summarize the results of the research. The supported hypotheses are Hypothesis 1, with a value of β = 0.44 and p-value < 0.01; Hypothesis 3 with a value of β = 0.24 and p-value < 0.01; Hypothesis 4 with a value of β = 0.2 and p-value < 0.01; Hypothesis 5 with a value of β = 0.43 and p-value < 0.01; Hypothesis 6 with a value of β = 0.2 and p-value < 0.01. The hypothesis that was not supported was Hypothesis 2, with a value of β = 0.09 and p-value = 0.098. This means that the variables of attitude and perceived behavioral control positively influence the respondent’s switching behavior intentions. Perceived behavioral control positively influences a respondent who buys fast food products to switch to buying healthy food. Switching behavior intentions positively influence a respondent who buys fast food to switch to buying healthy food products. This research also found that brand awareness moderates the relationship between switching behavior intentions and switching behavior. These findings indicate that brand awareness reinforces the relationship between switching behavior intentions and behavior switching, meaning that the intention to move from fast food to healthy food will have a stronger effect on switching behavior when a customer’s brand awareness is high.

4.2. Discussion

Attitude is an individual beliefs and evaluations on related objects and situations [33]. The object will be associated with a particular attribute of faith. An object of attitude is determined by subjective values of object attributes interacting with relationships that stand out. Although anyone can have different beliefs about an object, it is assumed that only trust is easily able to influence attitude [46]. Generally, attitude is known as an essential determinant of intention. Attitude strongly relates to behavioral intentions [47] in the theory planned behavior model. Apart from concern for the consumer’s environment, attitude is another important factor influencing consumer brand preferences [48]. As explained in the previous section, consumers’ attitudes toward switching to healthy food products and services influence their intentions of switching to healthy food products and services. This result is supported by a study from George [49] that argued that a positive attitude to a product significantly influences consumer purchasing intention. Madahi and Sukati [12] found that when consumer attitudes toward a product are positive, there is a higher possibility that a consumer will intend to switch products. Therefore, customers’ attitudes toward switching to healthy food products and services will influence their intentions of switching to healthy food products.

Contrary to the expected result, our result shows that the influence of subjective norms is not significant in switching behavior intentions. This finding, which is supported by Pookulangara et al. [11], stated that the results for planned behavior theory components might differ; in this research, the component was the subjective norm. This finding is interesting because our respondents were mostly young, between 21 and 25 years. The researchers assume that they were not influenced by their values regarding healthy food products but primarily by others. A study from Lu et al. [28] supports these reasons; the development of information technology helps people, especially the Millennial generation, seek out food products that are healthy regarding food safety and nutrition. This has caused Millennials to buy more nutritious food products than previous generations did [29]. This finding gives new insight into the research regarding the impact of subjective norms on healthy food product switching intentions.

These findings showed that customers’ perceived behavior control significantly influences their intentions to switch to healthy food products and services. These findings are supported by Bansal and Taylor [50], who stated that the more a person believes that they have the resources, abilities, and opportunities needed to behave in a certain way, the more powerful that person’s intentions to carry out their desired behaviors and actions will be. Another reason for this direct connection is that perceived behavior control can be used to measure actual control [10]. Perceived behavioral control can be determined from two things—namely, control beliefs and perceived strength. A controls belief is the perception of obstacles or resources that can affect behavior. Perceived behavior control describes customers’ belief that there are no resources or chances to engage in a certain behavior. Perceived behavioral control is also thought to directly relate to behavior without being mediated by intention when such behavior does not violate individual control and the person has a high perception of their control [35]. When believed behavior exceeds their control, then the direct relationship between perceived behavioral control and actual behavior grows weaker [41]. Therefore, perceived behavior control influences customers’ intentions to switch to healthy food products and services.

Ajzen [13] stated that there was a possibility a behavior that has intended can happen when it is influenced by factors beyond that person’s control and cannot be compromised. The main factors required in brand awareness are when the customer has ever seen or heard of a brand to clearly identify that brand [32]. This suggestion means that brand awareness has a vital role in customers’ decision-making regarding a brand. Customers obtain brand awareness from effective marketing communication strategies, such as through smartphone, online, and media advertising. Brand awareness is how customers relate a brand with a product they want to have [31]. Therefore, a consumer’s awareness of brands can influence their intention to switch to healthy food products and services.

5. Conclusions and Suggestion

5.1. Conclusions

This study contributes to developing the model of customers’ switching behavior from fast food products and services to healthy food products and services. This study revealed that the majority of our hypotheses have a significant influence, except for one hypothesis, which concerns subjective norms around healthy food switching behavior intentions. Attitude is found to have a positive and significant effect on switching behavior intentions. Perceived behavior control also had a positive and significant effect on switching behavior intentions. This study also revealed that switching behavior intentions could directly influence switching behavior and are moderated by brand awareness. Contrary to the expected result, the result shows that the influence of subjective norms is not significant in switching behavior intentions.

5.2. Suggestion

Based on these results, the theory of subjective norms is not supported. Previous studies show that many customers try to eat healthy food products because they want to have a healthy lifestyle. Likewise, this behavior can be portrayed as healthy practices caused by necessities and inspiration to be healthy [9]. Another consideration is that the research was conducted in Indonesia, which has a culture of collectivism, and general decision-making is often based on the environment. This is perhaps due to the ease with which young people can obtain information, so they are more independent in making decisions. Marketers engaged in the healthy food sector must be able to adapt to consumer switching behavior. Efforts to build brand awareness can be designed by teaching people about the importance of healthy food, providing relevant and rational information about healthy food products, and engaging consumers emotionally. This research also has limitations. Other aspects that have not been studied also influence the behavior of healthy food consumers, such as consumer knowledge [37], communication pattern and family decision [51]. Future research can consider these aspects in the model of the theory of planned behavior.