Fig. 1

Theory of Planned Behaviour (Ajzen, [27]). Legend: Three variables (attitudes; subjective norms; and perceived behavioural control) which the theory suggests will predict the intention to perform a behaviour. Intentions are the precursors of behaviour. External variables - these might influence intention (from literature). The theory of planned behaviour applies to behaviour that one strives to perform. The intention to achieve a goal (in this case to perform a gynecological examination) is not the same as to actually perform it. Attitude is one of the three variables that the theory suggests predicts intention. Attitude towards the act (performance) is the precursor (mental event) of intention. Intention is the pathway attitudes take towards actually performing the act/behaviour (observable action). But intention is not action. Intention is what immediately precedes the behavior: someone has the intention to perform a specific behaviour, and shortly thereafter, the behaviour is performed, unless some unexpected situations occur. Attitude is more distal and a more ‘global’ concept. In the Theory of Planned Behaviour, the expectation of what a certain behaviour will result in and the value attributed to that expected result, determine the attitude. E.g.: when a gynaecologist expects that performing a medical exam in a woman with vaginal complaints will help this woman, the gynaecologist has a positive expectation of performing that exam. When the gynaecologist expects that doing a medical exam will make no difference, or even harm the woman, he/she has a negative expectation of performing that exam. When the gynaecologist also values a favourable outcome for the woman as important, he/she has a positive value. A positive expectation combined with a positive value, will lead to a positive attitude, which in turn, will lead to a bigger chance that he/she will have the intention to perform a medical exam