International Journal of Spa and Wellness ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/rspa20 Healthy lifestyle and behavioural intentions: the role of self-identity, self-efficacy, subjective norms, and attitudes Emmanuel S. Quaye, Leeford Edem Kojo Ameyibor, Kgaiso Mokgethi & Yvonne Kabeya Saini To cite this article: Emmanuel S. Quaye, Leeford Edem Kojo Ameyibor, Kgaiso Mokgethi & Yvonne Kabeya Saini (2024) Healthy lifestyle and behavioural intentions: the role of self- identity, self-efficacy, subjective norms, and attitudes, International Journal of Spa and Wellness, 7:2, 176-196, DOI: 10.1080/24721735.2024.2374588 To link to this article: https://doi.org/10.1080/24721735.2024.2374588 Published online: 12 Jul 2024. 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Quayea, Leeford Edem Kojo Ameyibor a,b, Kgaiso Mokgethia and Yvonne Kabeya Sainia aWits Business School, University of the Witwatersrand, Johannesburg, South Africa; bMarketing Department, University of Professional Studies, Accra, Ghana ABSTRACT This study aims to investigate the influence of health self-identity, self-efficacy beliefs, and subjective norms on healthy lifestyles and, in turn, behavioural intentions. Health attitude is also considered a crucial underlying mechanism for understanding health-promoting behaviours. The study used a covariance-based structural equation modelling to test the proposed conceptual model with 493 South African consumers. The results show that health self-identity and self-efficacy beliefs influence healthy lifestyles and, in turn, influence behavioural intentions (e.g. smartwatch use, healthy eating, and physical exercise). Further, the results show that a healthy lifestyle mediates the relationship between healthy self-identity and behavioural intentions. Subjective norms do not directly influence a healthy lifestyle but behavioural intentions. The lack of mediational influence of a healthy lifestyle between subjective norms and behavioural intentions suggests that subjective norms independently predict health-promoting behaviours. Finally, healthy lifestyles predict health attitudes, but health attitudes do not explain behavioural intentions. The results suggest that social marketers and brand managers should focus more on personal attributes (i.e. health self-identity and self-efficacy beliefs) than social factors (e.g. subjective norms) to improve healthy lifestyles and health-promoting behaviours. This study adds to the growing body of knowledge on healthy lifestyles by highlighting its underlying mechanisms. ARTICLE HISTORY Received 22 August 2023 Accepted 19 June 2024 KEYWORDS Healthy lifestyle; healthy self- identity; subjective norms; self-efficacy; health attitudes; behavioural intentions 1. Introduction The growing demand for health-related products globally is a testament to consumers’ desire and efforts to attain general well-being (Malcorps, 2019). Globally, unhealthy life- styles have led to a public health crisis with serious health issues ranging from obesity, high blood pressure and strokes (World Health Organization, 2014a). For example, the direct cost of obesity-related illness in the United States was estimated to be as high as $147 billion (Finkelstein et al., 2009). Similarly, the European Union has observed a 52% surge in adult obesity and urged member states to take drastic steps to reduce pressures on health systems through unhealthy lifestyle behaviour changes (Euro Commerce, 2018). © 2024 Informa UK Limited, trading as Taylor & Francis Group CONTACT Leeford Edem Kojo Ameyibor leeford99@gmail.com This article has been corrected with minor changes. These changes do not impact the academic content of the article. INTERNATIONAL JOURNAL OF SPA AND WELLNESS 2024, VOL. 7, NO. 2, 176–196 https://doi.org/10.1080/24721735.2024.2374588 http://crossmark.crossref.org/dialog/?doi=10.1080/24721735.2024.2374588&domain=pdf&date_stamp=2024-08-13 http://orcid.org/0000-0001-8076-3443 mailto:leeford99@gmail.com http://www.tandfonline.com In Sub-Saharan Africa, unhealthy lifestyles have significantly affected a vulnerable health system (World Health Organisation, 2014b). The increased alcohol-related trauma cases in South African hospitals during COVID-19 lockdowns further amplifies these vulnerable health systems (Barron et al., 2020). In South Africa, the cost of treating the consequences of diabetes, hypertension, and hypercholesterolemia is estimated at $34.2 billion a year, representing roughly 10% of South Africa’s Gross Domestic Product (Davies & Wagner, 2019). The surge in lifestyle-related diseases has created a national Healthy Lifestyle Day dedicated to intensive media awareness on the dangers of unhealthy eating and sedentary lifestyles (South African Department of Health, 2020). Despite these efforts to create awareness and promote healthy living, there seems to be a paucity of research on the impacts of a healthy lifestyle on health products’ purchase intentions as a baseline for promoting healthy living (Odunitan-Wayas et al., 2018). Healthy behavioural intentions are described as a person’s willingness to participate in physical activity, monitor their health and healthy diet. Previous studies explain why life- style diseases prevail, with reasons ranging from unhealthy diet, physical inactivity, stress, environmental factors, lack of health education and demographic variables such as age. These factors cumulatively predict the consequences of an unhealthy lifestyle such as heart disease, diabetes, chronic liver disease, hypertension and stroke (Sharma & Majum- dar, 2009). To reverse this trend, prior studies suggest that psychological motivational drivers can lead to healthy lifestyles positive health attitudes and intended behavioural outcomes (Melzner et al., 2014). Yet few studies have considered the role of such factors as health self-self-identity, healthy lifestyle, health attitudes and subjective norms as an effective mechanism for promoting healthy behavioural outcomes. For example, Chen (2009) found that a healthy lifestyle served as a crucial route for health consciousness and environmental attitudes to predict attitudes towards organic food pre- ference. More recently, Quaye et al. (2021) empirically established that health self-identity was a crucial force promoting health consciousness, consumer knowledge of healthy living, self-efficacy and normative beliefs guiding healthy behavioural outcomes. Although health self-identity and self-efficacy are important determinants of healthy living, deficits remain in our understanding of how a healthy lifestyle serves as an impor- tant route to influence healthy behavioural intentions. There is a need to further under- stand how a healthy lifestyle promotes health attitudes to health target behaviours. To our knowledge, combining healthy self-identity, self-efficacy, subjective norms, healthy lifestyle and health attitudes in a constellation of factors to successfully impact healthy behavioural intentions is presently lacking. The foregone phenomena necessitate a holis- tic view of other personal factors that have the potential to enhance healthy living and overcome such barriers to consumers’ intention to purchase healthy foods and partake in health-promoting activities (see: Ali et al., 2018). We draw on the theory of planned behaviour (TPB) and self-concept theory to account for the outcomes in this study. TPB is usually adopted as a useful framework for explaining behavioural intentions. Key among its predictions is that people’s intentions are influenced by their attitudes, social norms and perceived behavioural control (Ajzen & Fishbein, 1977). Self-concept theory also describes an individual’s sense of their identity out of which flows their cogni- tions and behaviour (Reed, 2002). Therefore, the current study offers a significant contribution to the existing literature on predictors of healthy lifestyles and behavioural intentions. First, we demonstrate the INTERNATIONAL JOURNAL OF SPA AND WELLNESS 177 possibility of enriching the theory of planned behaviour by including healthy self-identity and healthy lifestyle in an organised framework for predicting healthy behavioural inten- tions. We add to the literature by showing that healthy self-identity and self-efficacy are powerful predictors of a healthy lifestyle. A crucial insight found in this study is that con- trary to expectations, normative influence through subjective norms did not explain a healthy lifestyle, pointing to the need to offer contextual underpinnings to often taken- for-granted cultural drivers of behaviour. Practically, the results should inform health com- munities, practitioners and marketers that health self-identity can improve healthy behav- ioural intentions when healthy lifestyles are carefully promoted. 2. Conceptual background and hypothesis 2.1. Extended theory of planned behaviour The theory of planned behaviour (TPB) by Ajzen and Fishbein (1980) describes how behaviour is determined by a combination of a person’s intentions to behave in a certain way and their perception of control over the behaviour. According to the theory, intentions are the single most vital determinant of human behaviour and inten- tions are held to be predicted by three factors. First, attitudes towards the behaviour explain a person’s overall positive or negative evaluation towards performing the behav- iour (Povey et al., 2000). Second, subjective norms describe a person’s view of whether others would want them to engage in the behaviour (Povey et al., 2000). Third, perceived behavioural control describes a person’s consideration of the degree to which internal or external factors may prevent or enhance behavioural performance (Povey et al., 2000). Furthermore, Ajzen (1991) suggested that TPB was amenable to further extensions if additional predictors, when added could account for significant variance, over and above the TPB factors. Increasingly, studies extend the TPB with new variables to improve its predictive power (Jackson et al., 2003). Therefore, this study includes self-iden- tity and healthy lifestyle in predicting health behavioural intentions. Also, a clear distinc- tion is usually made between self-efficacy, which explains faith in one’s ability to perform the behaviour, and perceived behavioural control, which explains the extent to which a person perceives whether or not the performance of a behaviour is within their control. Previous studies show that self-efficacy is a better predictor of behavioural inten- tions than perceived behavioural control (Povey et al., 2000; Norman, 2011; Ram & Laxmi, 2017), hence self-efficacy is utilised in this study. Ultimately, TPB has become a useful framework for examining the influence of personal determinants and social influences as well as non-volitional predictors of intention for healthy living just like other behaviours (Jackson et al., 2003; Norman, 2011; Rex et al., 2015). 2.2. Self-concept theory The concept of self may be traced back to the 3000-year-old Ahamkara philosophy, which explains the totality of opinions and social factors individuals use for ascription and self- identification (Mehrad, 2016). Self-concept and identity are often used interchangeably; although self-concept serves as a theory of who a person is and may become, it is often activated through various personal and social identities (see Craven & Marsh, 178 E. S. QUAYE ET AL. 2003; Marsh et al., 2012; Oyserman, 2009). Thus, identity-based motivations are assumed to underlie many behaviours (Oyserman et al., 2012). People who integrate specific iden- tities into their self-concept are likely to behave consistently (Bandura, 1990; Oyserman et al., 2012). Shavelson et al. (1976) conceptualised self-concept as a person’s perception constructed through experience within an environment or an ecosystem. Shavelson et al. (1976) also highlighted the influence of close relatives on self-concept reinforcements. Far from static, self-concept acts as an assumed dynamic construct for explaining actions measured through peer and significant others’ influence, physical ability, and physical appearance (Shavelson et al., 1976). Multicultural views are an essential element of the external environment that greatly influences self-concept (Fazli-Salehi et al., 2021). The prevailing culture, primarily driven by societal norms, promotes self-using social referent groups as vehicles of norm enforce- ment and conformance (Cislaghi & Heise, 2020). For example, most individuals perceive themselves as part of the collective in Africa, Latin America, and Asia. The forgone means interdependent on social networks due to closed cultures influencing self-con- cepts more than in distance cultures such as in Europe and North America where indivi- duality and independence of self are amplified (Swann et al., 2012). 2.3. Self-concept and healthy-lifestyle A healthy lifestyle is conceptualised as people’s actions to maintain health-promoting behaviours, their rationale, and the ramifications of those actions (Giles & Brennan, 2015). It is usually measured contextually based on specific healthy lifestyle choices such as eating healthy and exercising (Chen, 2011; Mai & Hoffmann, 2015). The self- concept construct is vital to individuals’ psychological well-being; hence, its association with individuals’ awareness of their qualities and limitations (World Health Organisation, 2014b). Individuals who feel good about themselves and their abilities are largely con- sidered resilient to everyday living challenges. Their positive self-concept promotes posi- tive affective emotions such as happiness, motivation, and reduced anxiety (Lohbeck et al., 2018). We should consider Shavelson et al. (1976) general self-concept on non-aca- demic domains and other subdomains when linking self-concept to a behavioural attri- bute such as a healthy lifestyle. Non-academic domains represent social and affective self-concepts. According to Shavelson et al. (1976), physical self-concepts (physical per- ceptions) are divided into perceived physical ability and perceived physical appearance. Perceived physical ability catalyses various social cognitive concepts such as self-deter- mination (Weiss, 2000). In physical activity, for example, the perceived ability is operatio- nalised as performing a specific rigorous sports activity that exerts energy (Harter, 1982). Similarly, perceived physical appearance drives the intention to purchase healthy pro- ducts to enhance self-image (Hanspal & Devasagayam, 2017). Indeed numerous studies have established the link between the concept of self and different forms of healthy life- styles, such as physical activity, healthy food choices, dieting, and quitting social vices such as smoking and alcohol consumption (see: 2020; Godrich et al., 2019; Ibrahim et al., 2022; Lindgren et al., 2017). This paper uses self-concept theory, TPB and healthy lifestyle concepts as overarching theoretical foundations to develop a unified conceptual framework (see Figure 1). In the conceptual framework, we expect a healthy self-identity, self-efficacy, and subjective standards to predict a healthy lifestyle. A healthy lifestyle INTERNATIONAL JOURNAL OF SPA AND WELLNESS 179 would predict health attitudes and behavioural intentions in a mediating mechanism. We discuss all the hypotheses in the following sections. 2.4. Hypotheses development 2.4.1. Health self-identity and behavioural intentions An individual array of habits formed over time is linked to self-concept (Verplanken, 2018). Developing these habits implies that people who self-identify with a healthy lifestyle prac- tice healthy habits over time (Gardner, 2015). There is a plethora of evidence on the influence of healthy self-identity on the intention to act healthy. For example, Gao et al. (2020) recently found that individuals with a history of diabetes took to physical activities more frequently, driven by the motivation to stay healthy. Earlier, Sánchez- Miguel et al. (2017) similarly identified self-identity as a good predictor of intentions to exercise, although they found significant gender differences in self-identity. In 2012, de BruijnBas and Putte also found self-identity to predict behaviour intentions, albeit within a non-African context. Sharma et al. (2020) also report that consumers who main- tain a green self-identity and self-concept are likelier to purchase green products. Even though the extant empirical literature suggests that health self-identity predicts behaviour intentions, contextually, it may offer varying effects on the intention to engage in health-promoting behaviour due to localised constraints. For example, in South Africa, there are many barriers to engaging in health-promoting activities, such as the high cost of organic foods, fruits and vegetables and access to gyms. We suspect that those who self-identify with health would persist amidst these barriers and hence hypothesise that: H1a: Self-identity has a positive effect on behavioural intentions. 2.4.2. Health self-identity and lifestyle Healthy lifestyles have been conceptualised as efforts to achieve holistic well-being (Mokdad et al., 2005). People who desire healthy outcomes such as staying fit and main- taining a healthy body image are observed to strive to attain these health goals (Jin et al., Figure 1. Conceptual framework. 180 E. S. QUAYE ET AL. 2017). The existing studies on the linkage between self-concept and healthy lifestyles tend to focus on specific health-related lifestyles, such as healthy food choices (Bisogni et al., 2002; Korn et al., 2013). Therefore, Oyserman et al. (2012) called for more empirical evidence on generic healthy lifestyle behaviours on the individual concept of self. Hanspal and Devasagayam (2017) found that consumers with healthy self-images differ in how they perceive themselves regarding both body image and preference for healthy labelled food. Dominick and Cole (2020) also found that people who think of their health goals as identities are more likely to engage in healthy goal-consistent beha- viours. Similarly, Korn et al. (2013) found a high correlation between positive self-body image, health perception, and appropriate nutrition, akin to a healthy lifestyle. In contri- buting to the growing literature on generic healthy lifestyle behaviours and the influence of self-identity, this study hypothesises that: H1b: Self-identity has a positive effect on a healthy lifestyle. 2.4.3. Self-efficacy and a healthy lifestyle Self-efficacy is “people’s belief about their capabilities to exercise control over their level of functioning and over events that affect their lives” (Bandura,1991, p. 257). Concerning a healthy lifestyle, self-efficacy plays a dominant role in healthy lifestyle behaviour uptake (Padden et al., 2012). Previous studies (Muturi et al., 2016) found a positive correlation between self-efficacy and healthy food choices. Mai and Hoffmann (2012) explain that consumers with nutrition self-efficacy engage deeply with health-related information to influence their healthy lifestyles. Jackson et al. (2014) reported that health self-efficacy predicted higher engagement in a healthy lifestyle. Similarly, Ram and Laxmi (2017) also found self-efficacy to positively influence healthy lifestyle promotion. In gauging the effect of self-efficacy within an African social context, this study believes that it will play a vital role in determining healthy lifestyle behaviour; hence hypothesises that: H2: Self-efficacy has a positive effect on a healthy lifestyle. 2.4.4. Subjective norms, healthy lifestyle, and behavioural intentions Subjective norms are the perceived social pressure to engage or not engage in a particular behaviour (Norman, 2011). The theory of planned behaviour specifies that subjective norms predict behavioural intentions and actual behaviour (Ajzen, 1991). Subjective norms describe “the extent to which important others would approve or disapprove of the performance of given behaviour” (Ajzen, 1991, p. 195). The social pressures to conform may come from family, friends or colleagues, driven by collective social group interest (Martin et al., 2008). Pressures exerted by close relatives or social groups may encourage individuals to emulate healthy lifestyle behaviours or green consumption habits (Khare, 2014; Paul et al., 2016; Singh & Verma, 2017). The influence of subjective norms in driving the performance of healthy lifestyle behaviour is contingent on the social context (Pasick et al., 2009). In consumer behaviour research, subjective norms are associated with various behavioural intentions, such as organic food consumption (Dean et al., 2012), environmentally conscious consumption (Khare, 2014), and intentions to purchase green products (Paul et al., 2016). Twene- boah-Koduah et al. (2019) found that subjective norms, perceived usefulness and ease INTERNATIONAL JOURNAL OF SPA AND WELLNESS 181 of use explained the adoption of physical activity. Hansen et al. (2013) also report subjec- tive norms expressed through peer pressure influenced the choice of purchased snacks for adolescents. In this study, we expect subjective norms to strongly affect healthy life- style behaviour in conformance to the expectations of significant others. Hence, we hypothesise that: H3a: Subjective norm has a positive effect on a healthy lifestyle. H3b: Subjective norm has a positive effect on behavioural intentions. 2.4.5. Healthy lifestyle and healthy attitude According to Giles and Brennan (2015), people disposed to a healthy lifestyle take to phys- ical activity and other efforts that promote well-being. Disposition makes for easier lifestyle changes and adaptations towards well-being (Schwarzer, 2008). Attitude toward a behav- iour describes the “degree to which a person has a favourable or unfavourable evaluation of the behaviour in question” (Ajzen, 1991, p. 188). Health attitudes highlight people’s likes or dislikes, positive or negative, and favourable or unfavourable evaluations of health-pro- moting beliefs. Indeed, healthy lifestyles and healthy attitudes are two concepts that have reverse causality tendencies (Krishnan & Zhou, 2019). For example, the existing healthy life- style literature shows that people who live healthy lifestyles inherently adopt an attitude that promotes such behaviours (see: Andrade et al., 2017; Krishnan & Zhou, 2019; Santiago et al., 2017), conversely, a positive attitude towards healthy living is exhibited in daily rou- tines that gurantees the execution and sustenance of such behaviours (Pandey et al., 2021). Previous studies have established the effect of a healthy lifestyle disposition on the ability to act on improving health attitudes. Pickard et al. (2018) found that adopting a healthy life- style predicts a positive attitude towards health activities. Blake et al. (2017) also found that pre-registered nurses exhibited poor attitudes towards health promotional activities due to their poor healthy lifestyle disposition. Also, Chen (2009) reported that Taiwanese consu- mers with a healthy lifestyle expressed positive attitudes towards organic foods. Thus, we anticipate that healthy people will favourably evaluate health-promoting behaviours and act according to such beliefs. Thus, we hypothesise that: H4: Healthy lifestyle has a positive effect on a healthy attitude. 2.4.6. Health attitude and behavioural intention Attitude represents the individual’s negative or positive evaluation of healthy lifestyle behaviour (Rex et al., 2015). The attitude construct strongly predicts behavioural inten- tions in many domains (Ajzen & Fishbein, 2005). A person’s readiness to plan may vary with more or less positive expectations regarding healthy lifestyle choices (Hankonen et al., 2014). Previous studies have found a healthy attitude to predict health-related behavioural intentions. Specifically, Poobalan et al. (2012) established a strong positive effect of attitude on engagement in physical activity. Similarly, Nguyen et al. (2020) also depicted attitude as a strong predictor of consu- mers’ intention to buy functional, healthy foods. Generally, in the physical activity domain studies, attitude is relatively low in sustaining momentum, thus accounting for the high relapse rate among people who initiate physical activities (Kwasnicka et al., 182 E. S. QUAYE ET AL. 2016). Paul et al. (2016) confirmed a strong link between attitude and green product pur- chase intentions. Thus, we expect a positive health attitude to increase favourable behav- ioural intentions for healthy choices. H5: Health attitude has a positive effect on behavioural intentions. 2.4.7. Healthy lifestyle and behavioural intentions Within social marketing, healthy lifestyles are a balance of healthy food intake, avoiding social vices such as smoking and alcohol consumption, and engaging in physical activities (Ali et al., 2018). Individuals who adopt healthy lifestyles have gone through several motions of overcoming barriers to lifestyle changes, such as marketing promotional activities and negative social norm pressures (Hastings et al., 2000). Once individuals have accepted healthy lifestyle behaviour, they are motivated by the gains of staying healthy. They try to eat healthily, engage in physical activity, and avoid health-related social vices (Donovan, 2011). Research into healthy lifestyle dispositions and the intention to engage in health- related behaviours have targeted different health-related behaviours such as smoking, alcohol consumption and physical activity. Still, healthy lifestyle behaviour studies have generally been limited (Truong, 2014). However, previous studies have established the nexus between specific healthy lifestyle dispositions and behavioural intention (Chen, 2011). For example, Giles and Brennan (2015) observed that young people would take action on their current lifestyles if the benefits were tangible and realistic. Chen et al. (2011) reported that consumers with healthy lifestyles were more willing to use functional foods than their less healthy counterparts. Psouni et al. (2016) also found the desire to maintain a healthy body and physical appearance as a good predictor of engaging in physical activity and healthy eating. This study contributes to existing studies on general lifestyle and intention to act and also believes that consumers’ inten- tion to live healthily would influence intentions to act and therefore hypothesise that: H6: Healthy lifestyle has a positive effect on behavioural intentions. 3. Methods 3.1. Data collection and sample characteristics The suitable sample for this study were adult consumers aged 18 years and over. The study adopts a cross-sectional research design and utilises a convenience sampling approach for data collection. Data for the study was obtained through online data collec- tion among South Africans using the Qualtrics survey platform. The online questionnaire data collection method was used to reach a wide geographic area and diverse consumers on social media in a cost-effective manner. The data was collected over one week. The social media platforms used were Facebook and Instagram. After cleaning the responses of excessive missing data, 493 responses were used for the analysis. Responses with more than 60% missing data were deleted from the dataset. The remainder of responses with missingness completely at random were handled with full information maximum likeli- hood estimation approach, which was implemented in subsequent structural equation modelling analysis. Table 1 depicts the demographic profile of respondents. INTERNATIONAL JOURNAL OF SPA AND WELLNESS 183 Compared to males (10.55%), the sample was predominantly females (89.25%). The data further shows that respondents aged between 18 to 44 years were about 40.97% of the sample. This data is consistent with the general population of South Africa, which shows that as of 2022, 41% of the population were aged between 20 to 44 years old (Statista, 2022). Yet an equally higher percentage of the respondents were over 55 years (33.90%) and between 45–54 years (23.12%). Also, the participants were diverse in their educational achievement (matric [22.72%], Diploma [28.20%], Bachelor’s degree [22.31%], and Postgraduate degree [24.95]), highlighting that the majority of the respondents had a diploma certificate. Lastly, a higher percentage of the respondents earned more than R30,000 monthly income (26.98%), followed by those making as little as 0 – R4,999 (22.72%). The foregone suggests that the sample has a good spread of participants across relatively low and high-income brackets. Finally, about half of the respondents confirmed that they were employed (50.30%), while others indicated they were either entrepreneurs/self-employed (18.86%) or stu- dents (8.11%), with few employed (9.94%). 3.2. Measures Table 2 contains all constructs and scale items used for this study based on well-estab- lished and validated scales. Health self-identity was measured with four items from Brenner et al. (2018). Self-efficacy was measured with four items from Ben-Ami et al.’s (2014) scale, and subjective norms were measured with items four items from Khare (2015). Healthy lifestyle was measured with five items by Hearty et al. (2007). Moreover, Table 1. Profile of respondents (N = 493). Factors Frequency % Gender Male 53 10.55 Female 440 89.25 Age 18–24 47 9.53 25–34 79 16.02 35–44 76 15.42 45–54 114 23.12 Over 55 177 35.90 Education Matric 119 24.14 Diploma 139 28.20 Bachelor’s degree 110 22.31 Post graduate degree 123 24.95 Income R0 – R4,999 112 22.72 R5000 – R9,999 48 9.74 R10,000 – R19, 999 104 21.10 R20,000 – R29,000 94 19.07 Over R30,000 133 26.98 Employment status Employed 248 50.30 Entrepreneur 12 2.43 Student 40 8.11 Unemployed 49 9.94 Self employed 81 16.43 Other 63 12.78 184 E. S. QUAYE ET AL. healthy lifestyle attitudes were measured with the semantic differential scale with four items from Wardle and Stepoe (2003). The measure had bipolar adjectives: “negative/ positive,” “very bad/very good,” “unfavourable/favourable,” and “unpleasant/pleasant.” Lastly, behavioural intentions for smartwatch use, organic foods, and physical activity were measured with three items from Parkinson et al. (2017). Except for healthy lifestyle attitudes, all measures used a seven-point Likert scale format (from 1 = strongly disagree to 7 = strongly agree). Participants also reported their demographics. Gender, age, income, and education were used as control variables. 4. Data analysis 4.1. Measurement model validation Confirmatory factor analysis (CFA) was used to estimate the measurement model for deter- mining the psychometric properties of the models, using Mplus 8.3. Following Anderson and Gerbing (1988), the construct’s reliability and validity were examined by establishing the fit of the measurement model. The fit statistics of the measurement model demonstrate Table 2. Constructs and measurement items. Items λ CR AVE Health self-identity In general, being a healthy eater is an important part of my self-image .74 .84 .51 Being athletic and sporty reflects who I am. .70 I have come to think of myself as a health-conscious person. .81 I identify with a community of health-conscious people. .65 Membership + in health clubs such as running, jogging, or cycling is part of my identity. .66 Self-efficacy I believe I can exercise non-stop for 30 minutes, 3–4 times a week. .77 .81 .52 I believe that I can engage in exercise even if I am not in such a good mood .73 I believe that performance is important when I exercise .64 I believe that I have it in me to commit to an exercise and eating routine .73 Subjective norms When I am not familiar with a product or brand, I often ask for opinions from the people that are important to me .80 .84 .58 When I am exploring brand options, I enjoy consulting with the people that I am close to .87 I often gather information from my family and friends about brands .78 To make sure I buy the right brand, I sometimes observe what other people are buying. .56 Healthy lifestyle I’ve made a conscious decision to live a healthier lifestyle .78 .86 .55 I am conscious of my fat and sugar intake daily .67 I enjoy healthier lifestyle-oriented brands such as Bodyshop, Weight Watchers and Sportsman’s Warehouse .70 I have a favourable attitude towards health-oriented lifestyle brands .76 Living a healthier lifestyle is fun, and I enjoy it .80 Health attitudes Negative/ Positive .91 .95 .84 Very bad/ Very good .91 Unfavorable/ Favourable .93 Unpleasant/ Pleasant .91 Behavioural intentions I intend to buy a smartwatch to monitor my health in the near future. .72 .77 .53 I plan to buy and eat fruits and vegetables often. .74 I intend to do physical activity such as running, cycling, gym, swimming, etc. on a regular basis. .73 CFA model fit: X2 (350) = 685.858, RMSEA = 0.04, X2/df = 1.96, CFI = 0.95, TLI = 0.94, SRMR = 0.05; λ = standardised factor loading, CR = composite reliability, AVE = average variance extracted. INTERNATIONAL JOURNAL OF SPA AND WELLNESS 185 a good fit to the data: χ2 = 685.858, p < .001; df = 350, χ2/df = 1.96; RMSEA = .04, CFI = .95, TLI = .94, and SRMR= .05. In addition, all scale indicators loaded significantly on their respective latent construct (p < .001), with loadings ranging from .56 to .93. The average var- iance extracted (AVE) indices for each construct exceed the recommended minimum of .50, demonstrating good convergent validity (Table 2) (Bagozzi & Yi, 1988). Finally, the discriminant validity of the scales were determined by comparing the square root of the AVE with the correlation of latent constructs. As shown in Table 3, the square root of each construct’s AVE is greater than the correlation between any paired constructs, demonstrating strong evidence of discriminant validity (Fornell & Larcker, 1981). data and correlation matrix for all variables are shown in 3. Podsakoff et al. (2003) caution about the presence of common method variance (CMV) when conducting cross-sectional research since CMV can artificially alter the results. To minimise CMV, several procedural and statistical remedies are recommended including the use of well-established scales and ensuring anonymity of respondents and careful design of questionnaires to reduce response bias (Podsakoff et al., 2003). Statistical reme- dies were implemented through Harman’s single-factor test. According to this test, if a single factor accounts for a greater percentage of variance in the scales used, then CMV is present. Our analysis showed that the highest variance of any scales used did not exceed 38%, which sits below the 50% threshold (Podsakoff et al., 2003). Furthermore, a confirmatory factor analysis following Harman’s single-factor test was used to ascertain the potential threat of CMV. This test suggests that if CMV is present, then a single latent factor should have a better fit compared to the multifactor solution. The single-factor CFA produced poor fit: χ2 (230) = 2760.84, χ2/df = 12.00, RMSEA = .15, CFI = .47, TLI = .42, SRMR = .14 when compared to the multifactor solution, collectively showing that CMV seems not to be a problem linked to the data. 4.2. Tests of hypotheses The tests of the various hypotheses continued with an estimation of the structural path model. The model also showed satisfactory fit to the data: χ2 (304) = 673.56, χ2/df = 2.22, RMSEA = .05, CFI = .93, TLI = .92, SRMR= .06. The results show that healthy self-identity sig- nificantly influences a healthy lifestyle (β = .70, t = 10.42, p < .01), supporting H1a. However, the influence of health self-identity on behavioural intentions towards healthy living was not supported (β = .08, t = .51, p > .05). Self-efficacy beliefs have a significant positive influence on healthy lifestyle (β = .22, t = 3.16, p < .01). The more individuals perceive that they can maintain healthy living, the more likely they will lead a healthy lifestyle. Although Table 3. Descriptive statistics and correlation matrix. # Constructs Mean SD 1 2 3 4 5 6 1 Health self-identity 2.96 .73 .71 2 Self-efficacy 4.40 1.30 .70 .72 3 Subjective norms 2.91 1.21 .47 .45 .76 4 Healthy lifestyle 3.33 .76 .32 .31 .17 .74 5 Healthy lifestyle attitudes 8.09 5.46 .86 .72 .40 .47 .92 6 Behavioural intentions 2.85 .52 .63 .90 .30 .27 .79 .73 Note. N = 493; SD = standard deviation; values off the diagonal are square root of average variance extracted (AVE) 186 E. S. QUAYE ET AL. subjective norms are seen not to influence healthy lifestyle (β = -.01, t = -.29, p > .05), the influence of subjective norms on behavioural intentions towards healthy living is significant and positive (β = .11, t = 2.18, p < .01). Healthy lifestyle has a significant positive influence on attitudes toward healthy living (β = .46, t = 8.77, p < 0.01) and behavioural intentions (β = .67, t = 4.01, p < .01), thus supporting H4 and H6, respectively. However, attitudes toward healthy living does not have effect on behavioural intentions (β = .08, t = 1.33, p > .05). This implies that a healthy lifestyle can independently influence behavioural inten- tions towards healthy choices regardless of attitudes towards healthy living— Table 4 and Figure 2 highlight all these findings. 4.3. Test of mediation To examine the mediating mechanism in the conceptual model of Figure 1, we performed a mediation analysis following Baron and Kenny (1986) and the advanced bootstrapping Table 4. Results of the structural equation modeling. Hypothesis/path analysis λ t-value Hypothesis Supported H1a Health self-identity → Healthy lifestyle .70 10.42** Yes H1b Health self-identity → Behavioural intentions .08 .51 No H2 Self-efficacy beliefs → Healthy lifestyle .22 3.16** Yes H3a Subjective norms → Healthy lifestyle −.01 −.29 No H3b Subjective norms → Behavioural intentions .11 2.18* Yes H4 Healthy lifestyle → Health attitudes .46 8.77** Yes H5 Health attitudes → Behavioural intentions .08 1.33 No H6 Healthy lifestyle → Behavioural intentions .67 4.01** Yes Covariates Gender → Behavioural intentions −.08 −1.87+ Age → Behavioural intentions −.30 −5.70** Income → Behavioural intentions .15 3.26** Education → Behavioural intentions .02 .54 SEM model fit: X2 (304) = 673.56, X2/df = 2.21, RMSEA = .05, CFI = .93, TLI = .92, SRMR = .06; λ = standardised factor loading; +p < .10; **p < .01. Figure 2. Path model depicting coefficients of estimation. +p < .10; *p < .05, **p < .01. INTERNATIONAL JOURNAL OF SPA AND WELLNESS 187 method by Preacher and Hayes. Specifically, we adopted the bootstrapping bias-cor- rected confidence interval procedure in SEM (Mplus), with 95% confidence intervals and 2,000 samples (Xie et al., 2016). Table 5 shows a summary of the mediation results. The findings confirm that a healthy lifestyle fully mediates the relationship between healthy self-identity and healthy behavioural intentions (β = .47, t = 3.00, p < .01). The results suggest that healthy self-identity affects healthy behavioural intentions mainly through the route of healthy lifestyles. However, a healthy lifestyle does not show a med- iating effect between subjective norms and healthy behavioural intentions; neither do health attitudes mediate the relationship between a healthy lifestyle and behavioural intentions. When combined, a healthy lifestyle and healthy attitudes do not mediate the link between healthy self-identity and subjective norms to behavioural intentions. 5. Discussion and conclusion Understanding the key antecedents and consequences of healthy lifestyle adoption is essential for effectively deploying behaviour change strategies among social marketers and brand manufacturers who use healthy lifestyle positioning concepts. This study will substantially help efforts targeted at developing healthy lifestyles and encouraging health-promoting behaviours and related products. Several theoretical and practical implications are discussed in the following sections. 5.1. Theoretical implications Drawing on self-concept theory, TPB and identity-based motivations, the findings show that individuals who maintain a strong healthy identity maintain a strong, healthy life- style. This finding is consistent with previous empirical (Hanspal & Devasagayam, 2017; Korn et al., 2013; Oyserman et al., 2012). However, the findings did not support the pre- diction that healthy self-identity will lead to behavioural intentions for healthy living. The Table 5. The mediation role of healthy lifestyle and health attitudes. Bootstrap bias-corrected method 95% Path Standardised estimate t-value Lower Upper p-value Effects from Health self-identity to behavioural intentions HSI → BI (total) .52 7.89** .39 .65 .00 HSI → BI (total indirect) .44 2.97** .19 .77 .00 Specific indirect effect HSI → HL → BI .47 3.00** .20 .81 .00 HSI → HL → ATT → BI −.02 −1.22 −.07 .01 .22 Effects from Subjective norms to behavioural intentions SN → BI (total) .10 1.89+ −.00 .20 .06 SN → BI (total indirect) −.01 −.27 −.06 .04 .79 Specific indirect effect SN → HL → BI −.01 −.27 −.07 .04 .79 SN → HL → ATT → BI .00 .22 −.00 .01 .82 Effects from Healthy lifestyle to behavioural intentions HL → BI (total) .63 3.56** .29 .98 .00 HL → BI (total indirect) −.03 −1.23 −.09 .02 .22 Specific indirect effect HL → ATT → BI −.03 −1.23 −.09 .02 .22 **p < .01; *p < .05; +p < .10; Abbreviation: HSI = health self-identity, HL = healthy lifestyle, SN = subjective norms, ATT = health attitudes, BI = behavioural intentions. 188 E. S. QUAYE ET AL. forgone is inconsistent with prior empirical results, which found strong links between self- identity and purchase intentions (de BruijnBas & Putte, 2012; Von Essen & Englander, 2013; Sánchez-Miguel et al., 2017; Sharma et al., 2020). Self-efficacy beliefs also emerged as a significant predictor of healthy lifestyles in South Africa. This finding con- tributes to the literature that perceived self-efficacy improves a healthy lifestyle (Abadil et al., 2017; Ram & Laxmi, 2017). The finding suggests that consumers with positive self-efficacy beliefs exert more cognitive resources to engage in health-improving life- styles (Jackson et al., 2014; Mai & Hoffmann, 2012). Relative to the role of interpersonal influences on healthy behaviour, we find that sub- jective norms do not influence a healthy lifestyle, but rather influence behavioural inten- tions. This result is inconsistent with the observation that subjective norms are the weakest link in the intention model (Paul et al., 2016). This finding suggests that consu- mers do not maintain a healthy lifestyle to impress others or do not observe or conform to what others are doing before maintaining healthy lifestyles (Khare, 2014). Besides, friends, family, and peer groups may have failed to provide proper examples con- cerning maintaining a healthy lifestyle (Paul et al., 2016). This finding contradicts previous empirical studies where subjective norms strongly impact a healthy lifestyle (Hansen et al., 2013; Khare, 2014; Tweneboah-Koduah et al., 2019). The plausible explanation of this finding may be that personal characteristics such as self-identity and self-efficacy beliefs are more paramount in driving healthy lifestyles than subjective norms. Yet, we show that subjective norms influence favourable behavioural intentions towards healthy living. In line with literature on interpersonal influences, people may exercise indi- vidual responsibility while in a group but look to others to enact socially appropriate behaviours such as eating healthy foods, maintaining sustainable consumption practices, and exercising. Extant studies report a strong influence of subjective norms on intentions and actual purchase of organic food (Singh & Verma, 2017). The study also shows that healthy lifestyles and health attitudes do not mediate the relationship between subjective norms and healthy behavioural outcomes, suggesting that subjective norms indepen- dently influence behavioural intentions. Furthermore, the findings support previous studies that report consumers who main- tain healthy lifestyles have a positive attitude towards healthy living and tend to engage in health-promoting behaviours (Blake et al., 2017; Chen, 2009; Pickard et al., 2018; Schwarzer, 2008). The study shows that individuals with strong, healthy lifestyles and habits are more likely to engage in activities such as physical exercise, joining a gym, and eating healthily (Chen et al., 2011; Psouni et al., 2016). Significantly, healthy lifestyles effectively mediated the relationship between healthy self-identity and healthy behaviour outcomes. The forgone discussions suggest that South Africans with strong health iden- tities should be encouraged to improve their healthy lifestyles to achieve positive health outcomes such as physical activity. The mediation role of a healthy lifestyle also means individuals identifying with healthy behaviours ought to practicalise it to achieve the intended results (Chen, 2009). Health attitudes, however, did not directly explain behavioural outcomes. Instead, the route from healthy lifestyles to behavioural outcomes was positive and significant. While attitudes are evaluative and domain-specific (Ajzen & Fishbein, 2005), lifestyles are habit- ual, describing the patterns of actions, their rationale, and what those actions constitute for those enacting them (Chen, 2011; Dean et al., 2016; Mai & Hoffmann, 2015). Thus, INTERNATIONAL JOURNAL OF SPA AND WELLNESS 189 strategies promoting healthy living should focus more on encouraging positive, healthy lifestyles than attitude formation. 5.2. Practical implications The findings of this study offer practical implications for social marketers and brand man- agers who rely on healthy consciousness and healthy lifestyles as key differentiators. The study will enable them to understand the factors and underlying mechanisms impacting consumers’ healthy consumption choices. As predicted, health self-identity and self-efficacy beliefs strongly contribute to a healthy lifestyle among South African consumers. Thus, social marketers should evoke healthy self-identity to encourage the public to maintain healthy lifestyles and health-pro- moting habits. They should provide avenues for people to construct the health identity they desire to align with their healthy lifestyles effectively. Brand managers should also use health identity cues to position their brands to attract consumers seeking healthy life- styles. Message appeals should contain “I can do it” affirmations to evoke perceived self- efficacy beliefs that can benefit healthy lifestyles. Although previous studies confirm that subjective norms influence people’s healthy lifestyles due to pressure to conform and avenues to observe others perform similar behaviour; this study does not support such prediction. Many brand communications portray individuals in groups and enact health-promoting behaviours such as exercising, eating healthy, following a natural diet, and attending gyms. This study, however, encourages social marketers and brand managers to focus more on personal factors, i.e. self-identity and self-efficacy beliefs, to achieve the greatest outcome in promoting healthy lifestyles. Furthermore, a healthy lifestyle is an important mechanism for stimulat- ing health-promoting behaviour. Health self-identity can influence consumers’ positive behavioural intentions for healthy living. Therefore, social marketers and brand managers should make healthy lifestyle promotions a vital element of any strategy that aims to develop and maintain health-promoting behaviours. Regarding promotions, word-of-mouth communications may be an effective tool for social marketers to encourage healthy attitudes and actions (Rana & Paul, 2017). However, opinion leaders and reference groups should promote healthy behaviours such as physical exercise, a natural diet, and joining a gym. Recommendations from sig- nificant others and effective reference groups are highly influential, especially for people struggling to follow a healthy living regime and wanting a nudge. Social organisations and brands that position themselves as promoters of a healthy life- style have enormous implications for behaviour change. This strategy will help them promote positive health attitudes and healthy behavioural intentions. Marketing com- munications should highlight how such brands promote healthy lifestyles since they sig- nificantly contribute to favourable health attitudes and health-promoting behaviours. Policymakers must develop particular interventions in South Africa to encourage healthy lifestyles. Interventions may include billboards and social media ads showcasing information about maintaining healthy lifestyles and potentially improving health atti- tudes and healthy behavioural choices. Such interventions may promote campaigns where people’s health or green self-identity are stressed as routes to practice healthy life- styles (Paul et al., 2016). 190 E. S. QUAYE ET AL. 6. Limitations and direction for future research The study highlights the following limitations for consideration in future research. First, this study conceptualises the behavioural intentions of healthy living, broadly regarding the future use of wearable watches, gym membership, and physical activity. The above observation departs from the preponderance of research findings on organic food con- sumption. However, future studies should consider the various domains of expression of healthy living, including recycling, functional food consumption, green-certified foods, natural diet adherence, etc., to ascertain differences in healthy lifestyle choices. Second, a comparative that focuses on differences between young and older people regarding their health self-identity, healthy lifestyles, susceptibility to reference group influences, and how they intend to affect their behavioural health intentions will be a valuable addition to the literature. Motivations to engage in healthy lifestyles may differ from older consumers. As a result, a multigroup analysis of these cohorts should help us go forward with research and methods for reaching these consumer cohorts. Third, there is a lack of consensus on the role of subjective norms in accounting for many behavioural outcomes (e.g. Smith, 2015). Thus, future studies should consider the relationship between subjective norms and the cultural context (e.g. low vs. high cultural contexts) and how they condition healthy lifestyles and behavioural outcomes—focusing on different norms (e.g. prescriptive, descriptive, pragmatic). Also, studies in conjunction with national cultures may be more salient than relying on generalised subjective norms alone (Smith, 2015). Fourth, this study further recommends that future research consider identity construction more broadly to include personal and social identities in health self- conception (e.g. Brenner et al., 2018). Finally, online data collection through convenience sampling helped test our hypoth- eses which has implications for the generalisation of the findings. Secondary data such as recorded healthy lifestyles and self-reporting opinions and attitudes is an important research avenue to gauge links between intentions and actual health behaviours. Disclosure statement No potential conflict of interest was reported by the author(s). Notes on contributors Emmanuel S. Quaye, PhD is a lecturer in marketing and consumer behaviour at the Wits Business School, University of the Witwatersrand, Johannesburg, South Africa. Leeford Edem Kojo Ameyibor PhD is a lecturer with the Marketing department at the University of Professional Studies, Accra, Ghana. Kagaiso Mokgethi is a Graduate research student in Marketing at the Wits Business School. Yvonne Kabeya Saini, PhD is a senior lecturer in Marketing at the Wits Business School, University of the Witwatersrand, Johannesburg, South Africa. ORCID Leeford Edem Kojo Ameyibor http://orcid.org/0000-0001-8076-3443 INTERNATIONAL JOURNAL OF SPA AND WELLNESS 191 http://orcid.org/0000-0001-8076-3443 References Abadil, M., Hurwitz, D., & Brown, S. (2017). Influence of context on item-specific self- efficacy and competence of engineering students. International Journal of Engineering Education, 33, 1297–1306. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T Ajzen, I., & Fishbein, M. (1977). Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychological Bulletin, 84(5), 888. Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Prentice- Hall. Ajzen, I., & Fishbein, M. (2005). The influence of attitudes on behavior. In D. Albarracin, B. T. Johnson, & M. P. Zanna (Eds.), Handbook of attitudes and attitude change: Basic principles (pp. 173–221). Erlbaum. Ali, T., Alam, A., & Ali, J. (2018). Factors affecting consumers’ purchase behaviour for health purchase behaviour for health and wellness food products in an emerging market. Global Business Review, 1–18. Anderson, J. C., & Gerbing, D. W. (1988). Structural equation modeling in practice: A review and rec- ommended two-step approach. Psychological Bulletin, 103(3), 411. Andrade, L., Zazpe, I., Santiago, S., Carlos, S., Bes-Rastrollo, M., & Martínez-González, M. A. (2017). Ten-year changes in healthy eating attitudes in the SUN cohort. Journal of the American College of Nutrition, 36(5), 319–329. https://doi.org/10.1080/07315724.2016.1278566 Bagozzi, R. P., & Yi, Y. (1988). On the evaluation of structural equation models. Journal of the Academy of Marketing Science, 16, 74–94. Bandura, A. (1990). Perceived self-efficacy in the exercise of the control over AIDS infection. Evaluation and Programme Planning, 13, 9–17. https://doi.org/10.1016/0149-7189(90)90004-G Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational behavior and human decision processes, 50, 248–287. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychologi- cal research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173. Barron, K., Bradshaw, D., Parry, C. D., Dorrington, R., Groenewald, P., Laubscher, R., & Matzopoulos, R. (2020). Alcohol and short-run mortality: Evidence from a modern-day prohibition. Available at SSRN 3744031. Ben-Ami, M., Hornik, J., Eden, D., & Kaplan, O. (2014). Boosting consumers’ self-efficacy by reposition- ing the self. European Journal of Marketing, 48(11/12), 1914–1938. Bisogni, C., Connors, M., Devine, C., & Sobal, J. (2002). Who we are and how we eat: A qualitative study of identities in food choice. Journal of Nutrition and Education and Behaviour, 34(3), 128–139. https://doi.org/10.1016/S1499-4046(06)60082-1 Blake, H., Stanulewicz, N., & Griffiths, K. (2017). Healthy lifestyle behaviors and health promotion atti- tudes in pre-registered nurses: A questionnaire study. Journal of Nursing Education, 56(2), 94–103. https://doi.org/10.3928/01484834-20170123-06 Brenner, P. S., Serpe, R. T., & Stryker, S. (2018). Role-specific self-efficacy as precedent and product of the identity model. Sociological Perspectives, 61(1), 57–80. Chen, M. F. (2009). Attitude toward organic foods among Taiwanese as related to health conscious- ness, environmental attitudes, and the mediating effects of a healthy lifestyle. British Food Journal, 111(2), 165–178. Chen, M. F. (2011). The joint moderating effect of health consciousness and healthy lifestyle on con- sumers’ willingness to use functional foods in Taiwan. Appetite, 57(1), 253–262. Chen, J. L., Weiss, S., Heyman, M. B., Cooper, B., & Lustig, R. H. (2011). The efficacy of the web-based childhood obesity prevention program in Chinese American adolescents (Web ABC study). Journal of Adolescent Health, 49(2), 148–154. Cislaghi, B., & Heise, L. (2020). Gender norms and social norms: Differences, similarities and why they matter in prevention science. Sociology of Health & Illness, 42(2), 407–422. https://doi.org/10. 1111/1467-9566.13008 192 E. S. QUAYE ET AL. https://doi.org/10.1016/0749-5978(91)90020-T https://doi.org/10.1080/07315724.2016.1278566 https://doi.org/10.1016/0149-7189(90)90004-G https://doi.org/10.1016/S1499-4046(06)60082-1 https://doi.org/10.3928/01484834-20170123-06 https://doi.org/10.1111/1467-9566.13008 https://doi.org/10.1111/1467-9566.13008 Craven, R., & Marsh, H. (2003). The centrality of the self-concept construct for psychological well- being and unlocking human potential: Implications for child and educational psychologists. Education Child Psychology, 25(2), 104–118. https://doi.org/10.53841/bpsecp.2008.25.2.104 Cruz-Sáez, S., Pascual, A., Wlodarczyk, A., & Echeburúa, E. (2020). The effect of body dissatisfaction on disordered eating: The mediating role of self-esteem and negative affect in male and female ado- lescents. Journal of Health Psychology, 25(8), 1098–1108. https://doi.org/10.1177/1359105317748734 Davies, J., & Wagner, R. (2019). The Conversation. [Online] Available at: https://theconversation.com/ weighing-up-the-costs-of-treating-lifestyle-diseases-in- south-africa-110456 [Accessed Tuesday July 2020]. Dean, E., Greig, A., Murphy, S., Roots, R., Nembhard, N., Rankin, A., … & Garland, S. J. (2016). Raising the priority of lifestylerelated noncommunicable diseases in physical therapy curricula. Physical therapy, 96(7), 940–948. Dean, M., Raats, M. M., & Shepherd, R. (2012). The role of self-identity, past behavior, and their inter- action in predicting intention to purchase fresh and processed organic food 1. Journal of Applied Social Psychology, 42(3), 669–688. de BruijnBas, G., & Putte, B. (2012). Exercise promotion: An integration of exercise self- identity beliefs, intention, and behaviour. European Journal of Sport Science, 12, 1–13. Dominick, J., & Cole, S. (2020). Goals as identities: Boosting perceptions of healthy-eater identity for easier goal pursuit. Motivation and Emotion, 44, 410–426. https://doi.org/10.1007/s11031-020- 09824-8 Donovan, R. (2011). The role for marketing in public health change programs. Australian Review of Public Affairs, 10, 23–40. E. C. (2018). Retail and wholesale working for healthy lifestyle. European Commerce. Fazli-Salehi, R., Torres, I. M., Madadi, R., & Zúñiga, MÁ. (2021). Multicultural advertising: The impact of consumers’ self-concept clarity and materialism on self-brand connection and communal-brand connection. Journal of Business Research, 137, 46–57. https://doi.org/10.1016/j.jbusres.2021.08. 006 Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual medical spending attribu- table to obesity: Payer- and service-specific estimates: Amid calls for health reform, real cost savings are more likely to be achieved through reducing obesity and related risk factors. Health Affairs, 28(Suppl1), w822–w831. Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50. Gao, M., Chen, X., Sun, X., Wang, F., Fan, L., & Sun, X. (2020). Predicting stage of exercise among patients with type 2 diabetes: A test of the extended theory of planned behavior. Patient Preference and Adherence, 14, 277–285. Gardner, B. (2015). A review and analysis of the use of ‘habit’ in understanding, predicting and influencing health-related behavior. Health Psychology Review, 9, 277–295. https://doi.org/10. 1080/17437199.2013.876238 Giles, E., & Brennan, M. (2015). Changing the lifestyles of young adults. Journal of Social Marketing, 5 (3), 206–225. https://doi.org/10.1108/JSOCM-09-2014-0067 Godrich, S. L., Loewen, O. K., Blanchet, R., Willows, N., & Veugelers, P. (2019). Canadian children from food insecure households experience low self-esteem and self-efficacy for healthy lifestyle choices. Nutrients, 11(3), 675. https://doi.org/10.3390/nu11030675 Hankonen, N., Kinnunen, M., Absetz, P., & Jallinoja, P. (2014). Why do people high in self-control eat more healthily? Social cognitions as mediators. Annals of Behaviour Medicine, 47(2), 242–248. https://doi.org/10.1007/s12160-013-9535-1 Hansen, K., Nørgaard, M., & Grunert, K. (2013). Peer influence on adolescent snacking. Journal of Social Marketing, 3(2), 176–194. https://doi.org/10.1108/JSOCM-06-2012-0028 Hanspal, S., & Devasagayam, P. (2017). Impact of consumers’ self-image and demographics on pre- ference for healthy labeled foods. SAGE Open, 1–18. Harter, S. (1982). The perceived competence scale for children. Child Development, 87–97. INTERNATIONAL JOURNAL OF SPA AND WELLNESS 193 https://doi.org/10.53841/bpsecp.2008.25.2.104 https://doi.org/10.1177/1359105317748734 https://theconversation.com/weighing-up-the-costs-of-treating-lifestyle-diseases-in- https://theconversation.com/weighing-up-the-costs-of-treating-lifestyle-diseases-in- https://doi.org/10.1007/s11031-020-09824-8 https://doi.org/10.1007/s11031-020-09824-8 https://doi.org/10.1016/j.jbusres.2021.08.006 https://doi.org/10.1016/j.jbusres.2021.08.006 https://doi.org/10.1080/17437199.2013.876238 https://doi.org/10.1080/17437199.2013.876238 https://doi.org/10.1108/JSOCM-09-2014-0067 https://doi.org/10.3390/nu11030675 https://doi.org/10.1007/s12160-013-9535-1 https://doi.org/10.1108/JSOCM-06-2012-0028 Hastings, G., McDermott, L., & Anderson, S. (2000). Whose behavior is it anyway? The broader poten- tial of social marketing. Social Marketing Quarterly, 6(2), 46–58. https://doi.org/10.1080/15245004. 2000.9961102 Hearty, A. P., Mccarthy, S. N., Kearney, J. M., & Gibney, M. (2007). Relationship between attitudes towards healthy eating and dietary behaviour, lifestyle and demographic factors in a representa- tive sample of Irish adults. Appetite, 48(1), 1–11. Ibrahim, M. F., Wan Ismail, W. S., Nik Jaafar, N. R., Mohd Mokhtaruddin, U. K., Ong, H. Y., Abu Bakar, N. H., & Mohd Salleh Sahimi, H. (2022). Depression and its association with self-esteem and lifestyle factors among school-going adolescents in Kuala Lumpur, Malaysia. Frontiers in Psychiatry, 13, 913067. https://doi.org/10.3389/fpsyt.2022.913067 Jackson, C., Smith, R. A., & Conner, M. (2003). Applying an extended version of the theory of planned behaviour to physical activity. Journal of Sports Sciences, 21, 119–133. https://doi.org/10.1080/ 0264041031000070976 Jackson, T., Wang, Y., Wang, Y., & Fan, H. (2014). Self-efficacy and chronic pain outcomes: a meta- analytic review. The Journal of Pain, 15(8), 800–814. Jin, N., Line, N., & Lee, S. (2017). The health conscious restaurant consumer: Understanding the experiential and behavioral effects of health concern. International Journal of Contemporary Hospitality Management, 29(8), 2103–2120. https://doi.org/10.1108/IJCHM-03-2016-0170 Khare, A. (2014). Consumers’ susceptibility to interpersonal influence as a determining factor of eco- logically conscious behaviour. Marketing Intelligence & Planning, 32(1), 2–20. https://doi.org/10. 1108/MIP-04-2013-0062 Khare, A. (2015). Influence of green self-identity, past environmental behaviour and income on Indian consumers’ environmentally friendly behaviour. Journal of Global Scholars of Marketing Science, 25(4), 379–395. Korn, L., Gonen, E., Shaked, Y., & Golan, M. (2013). Health perceptions, self and body image, physical activity and nutrition among undergraduate students in Israel. PLoS One, 8(3), 1–7. https://doi. org/10.1371/journal.pone.0058543 Krishnan, A., & Zhou, X. (2019). Modeling the effect of health antecedents and social media engage- ment on healthy eating and quality of life. Journal of Applied Communication Research, 47(4), 365–380. https://doi.org/10.1080/00909882.2019.1654124 Kwasnicka, D., Dombrowski, S., White, M., & Sniehotta, F. (2016). Theoretical explanations for main- tenance of behaviour change: A systematic review of behaviour theories. Health Psychology Review, 10, 277–296. Lindgren, K. P., Neighbors, C., Gasser, M. L., Ramirez, J. J., & Cvencek, D. (2017). A review of implicit and explicit substance self-concept as a predictor of alcohol and tobacco use and misuse. American Journal of Drug Alcohol Abuse, 43(3), 237–246. https://doi.org/10.1080/00952990. 2016.1229324 Lohbeck, A., Hagenauer, G., & Frenzel, A. C. (2018). Teachers’ self-concepts and emotions: Conceptualization and relations. Teaching and Teacher Education, 70, 111–120. https://doi.org/ 10.1016/j.tate.2017.11.001 Mai, R., & Hoffmann, S. (2012). Taste lovers versus nutrition fact seekers: How health consciousness and self-efficacy determine the way consumers choose food products. Journal of Consumer Behaviour, 11(4), 316–328. https://doi.org/10.1002/cb.1390 Mai, R., & Hoffmann, S. (2015). How to combat the unhealthy= tasty intuition: The influencing role of health consciousness. Journal of Public Policy & Marketing, 34(1), 63–83. https://doi.org/10.1509/ jppm.14.006 Malcorps, D. (2019, October 10). Nurturing Innovative health and well-being solutions. Puratos. https:// www.puratos.com/news/nurturing_innovative_Health_and_Well-Being_solutions. Marsh, H., Xu, K., & Martin, A. (2012). Self-concept: A synergy of theory, method, and application. In K. R. Harris, S. Graham, T. Urdan, C. B. McCormick, G. M. Sinatra, & J. Sweller (Eds.), APA educational psychology handbook (Vol. 1, pp. 427–458). American Psychological Association. Martin, B., Wentzel, D., & Tomczak, T. (2008). Effects of susceptibility to normative influence and type of testimonial on attitudes toward print advertising. Journal of Advertising, 37(1), 29–43. https:// doi.org/10.2753/JOA0091-3367370103 194 E. S. QUAYE ET AL. https://doi.org/10.1080/15245004.2000.9961102 https://doi.org/10.1080/15245004.2000.9961102 https://doi.org/10.3389/fpsyt.2022.913067 https://doi.org/10.1080/0264041031000070976 https://doi.org/10.1080/0264041031000070976 https://doi.org/10.1108/IJCHM-03-2016-0170 https://doi.org/10.1108/MIP-04-2013-0062 https://doi.org/10.1108/MIP-04-2013-0062 https://doi.org/10.1371/journal.pone.0058543 https://doi.org/10.1371/journal.pone.0058543 https://doi.org/10.1080/00909882.2019.1654124 https://doi.org/10.1080/00952990.2016.1229324 https://doi.org/10.1080/00952990.2016.1229324 https://doi.org/10.1016/j.tate.2017.11.001 https://doi.org/10.1016/j.tate.2017.11.001 https://doi.org/10.1002/cb.1390 https://doi.org/10.1509/jppm.14.006 https://doi.org/10.1509/jppm.14.006 https://www.puratos.com/news/nurturing_innovative_Health_and_Well-Being_solutions https://www.puratos.com/news/nurturing_innovative_Health_and_Well-Being_solutions https://doi.org/10.2753/JOA0091-3367370103 https://doi.org/10.2753/JOA0091-3367370103 Mehrad, A. (2016). Mini literature review of self-concept. Journal of Educational, Health and Community Psychology, 5, 62–64. Melzner, J., Heinze, J., & Fritsch, T. (2014). Mobile health applications in workplace health promotion: an integrated conceptual adoption framework. Procedia Technology, 16, 1374–1382. Mokdad, A., Marks, J., Stroup, D., & Gerberding, J. (2005). Actual causes of death in the United States. JAMA, 291, 1238–1245. Muturi, N., Kidd, T., Khan, T., Kattelmann, K., Zies, S., Lindshield, S., & Adhikar, K. (2016). An examin- ation of factors associated with self-efficacy for food choice and healthy eating among low income adolescents in three US states. Frontiers in Communication, 1, 1–9. Nguyen, N., Nguyen, H. V., Nguyen, P. T., Tran, V. T., Nguyen, H. N., Nguyen, T. M. N., Cao, T. K., & Nguyen, T. H. (2020). Some key factors affecting consumers’ intentions to purchase functional foods: A case study of functional yogurts in Vietnam. Foods, 9, 2–15. Norman, P. (2011). The theory of planned behavior and binge drinking among undergraduate stu- dents: Assessing the impact of habit strength. Addictive Behaviors, 36(5), 502–507. https://doi.org/ 10.1016/j.addbeh.2011.01.025 Odunitan-Wayas, F., Okop, K., Dover, R., Alaba, O., Micklesfield, L., Puoane, T., … & Lambert, E. V. (2018). Food purchasing characteristics and perceptions of neighborhood food environment of South Africans living in low-, middle-and high-socioeconomic neighborhoods. Sustainability, 10 (12), 4801. Oyserman, D. (2009). Identity-based motivation and consumer behavior. Journal of Consumer Psychology, 19(3), 276–279. https://doi.org/10.1016/j.jcps.2009.06.001 Padden, D. L., Connors, R. A., Posey, S. M., Ricciardi, R., & Agazio, J. G. (2012). Factors influencing a health promoting lifestyle in spouses of active duty military. Health Care for Women International, 34(8), 674–693. https://doi.org/10.1080/07399332.2012.736572 Pandey, S., Ritz, C., & Perez-Cueto, F. J. A. (2021). An application of the theory of planned behaviour to predict intention to consume plant-based yogurt alternatives. Foods, 10(1), 148. https://doi. org/10.3390/foods10010148 Parkinson, J., David, P., & Rundle-Thiele, S. (2017). Self-efficacy or perceived behavioural control: Which influences consumers’ physical activity and healthful eating behaviour maintenance?. Journal of Consumer Behaviour, 16(5), 413–423. Pasick, R. J., Barker, J. C., Otero-Sabogal, R., Burke, N. J., Joseph, G., & Guerra, C. (2009). Intention, sub- jective norms, and cancer screening in the context of relational culture. Health Education Behaviour, 36(5), 91–110. https://doi.org/10.1177/1090198109338919 Paul, J., Modi, A., & Patel, J. (2016). Predicting green product consumption using theory of planned behavior and reasoned action. Journal of Retailing and Consumer Services, 29, 123–134. Pickard, A. S., Jalundhwala, Y. J., Bewsher, H., Sharp, L. K., Walton, S. M., Schumock, G. T., & Caskey, R. N. (2018). Lifestyle-related attitudes: Do they explain self-rated health and life-satisfaction? Quality of Life Research, 27, 1227–1235. Podsakoff, P. M., Mackenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of applied psychology, 88(5), 879. Poobalan, A., Aucott, L., Clarke, A., & Smith, W. (2012). Physical activity attitudes, intentions and behaviour among 18–25 year olds: A mixed method study. BMC Public Health, 12, 1471–2458. Povey, R., Conner, M., Sparks, P., James, R., & Shepherd, R. (2000). Application of the Theory of Planned Behaviour to two dietary behaviours: Roles of perceived control and self-efficacy. British Journal of Health Psychology, 5(2), 121–139. Psouni, S., Chasandra, M., & Theodorakis, Y. (2016). Exercise and healthy eating intentions and beha- viors among normal weight and overweight/obese adults. Psychology, 7(4), 598–611. https://doi. org/10.4236/psych.2016.74062 Quaye, E. S., Mokgethi, K., & Ameyibor, L. E. K. (2021). Health self-identity-based motivations and behavioral intentions: a predictive model and segmentation analysis. Social Marketing Quarterly, 27(4), 347–369. Ram, T., & Laxmi, X. (2017). Effect of perceived self-efficacy on health promoting lifestyle of female employees. Amity Journal of Healthcare Management, 2, 21–35. INTERNATIONAL JOURNAL OF SPA AND WELLNESS 195 https://doi.org/10.1016/j.addbeh.2011.01.025 https://doi.org/10.1016/j.addbeh.2011.01.025 https://doi.org/10.1016/j.jcps.2009.06.001 https://doi.org/10.1080/07399332.2012.736572 https://doi.org/10.3390/foods10010148 https://doi.org/10.3390/foods10010148 https://doi.org/10.1177/1090198109338919 https://doi.org/10.4236/psych.2016.74062 https://doi.org/10.4236/psych.2016.74062 Rana, J., & Paul, J. (2017). Consumer behavior and purchase intention for organic food: A review and research agenda. Journal of Retailing and Consumer Services, 38, 157–165. Reed, A. (2002). Social identity as a useful perspective for self-concept-based consumer research. Psychology and Marketing, 19(3), 235–266. Rex, J., Lobo, A., & Leckie, C. (2015). Evaluating the drivers of sustainable behavioral intentions: An application and extension of the theory of planned behavior. Journal of Nonprofit and Public Sector Marketing, 27(3), 263–284. https://doi.org/10.1080/10495142.2015.1053342 S. A. D. o. H. (2020). National Healthy Lifestyles Day 2020. [Online] Available at: https://www.gov.za/ NationalHealthyLifestylesDay2020 [Accessed 21 July 2020]. Sánchez-Miguel, P., Leo, F. M., Amado, D., Pulido, J. J., & Sánchez-Oliva, D. (2017). Relationships between physical activity levels, self-identity, body dissatisfaction and motivation among Spanish high school students. Journal of Human Kinetics, 59, 29–38. https://doi.org/10.1515/ hukin-2017-0145 Santiago, S., Zazpe, I., Gea, A., de la Rosa, P. A., Ruiz-Canela, M., & Martinez-Gonzalez, M. A. (2017). Healthy-eating attitudes and the incidence of cardiovascular disease: The SUN cohort. International Journal of Food Sciences and Nutrition, 68(5), 595–604. https://doi.org/10.1080/ 09637486.2016.1265100 Schwarzer, R. (2008). Modeling health behavior change: How to predict and modify the adoption and maintenance of health behaviours. Applied Psychology, 57(1), 1–29. https://doi.org/10. 1111/j.1464-0597.2007.00325.x Sharma, M., & Majumdar, P. K. (2009). Occupational lifestyle diseases: An emerging issue. Indian Journal of Occupational and Environmental Medicine, 13(3), 109–112. Sharma, N., Saha, R., Sreedharan, V. R. (2020). Relating the role of green self-concepts and identity on green purchasing behaviour: An empirical analysis. Business Strategy and the Environment, 29(8), 3203–3219. Shavelson, R., Hubner, J., & Stanton, G. (1976). Self-concept: Validation of construct interpretations. Review of Educational Research, 46(3), 407–441. https://doi.org/10.3102/00346543046003407 Singh, A., & Verma, P. (2017). Factors influencing Indian consumers’ actual buying behaviour towards organic food products. Journal of Cleaner Production, 167, 473–483. Smith, G. (2012). Self, self-concept, and identity. Handbook of Self and Identity, 2, 69–104. Smith, P. (2015). Yes, subjective norms are important, but let’s not lose sight of cultural differences. Journal of Cross-Cultural Psychology, 46(10), 1311–1312. Statista. (2022). Demographics of South Africa - Statistics & facts. https://www.statista.com/topics/ 7956/demographics-of-south-africa/ on 18 January 2024. Swann, W. B., Jetten, J., Gómez, Á., Whitehouse, H., & Bastian, B. (2012). When group membership gets personal: a theory of identity fusion. Psychological Review, 119(3), 441. Truong, V. (2014). Social marketing: A systematic review of research 1998–2012. Social Marketing Quarterly, 20(1), 15–34. Tweneboah-Koduah, E., Adams, M., & Acheampong, G. (2019). The role of theories in social marketing in predicting physical activity behavior among the youth. Journal of Social Marketing, 9, 398–417. Verplanken, B. (2018). The psychology of habit: Theory, mechanisms, change, and contexts. Springer. Von Essen, E., & Englander, M. (2013). Organic food as a healthy lifestyle: A phenomenological psychological analysis. International Journal of Qualitative studies on Health and Well-being, 8 (1), 20559. Wardle, J., & Steptoe, A. (2003). Socioeconomic differences in attitudes and beliefs about healthy lifestyles. Journal of Epidemiology and Community Health, 57(6), 440–443. Weiss, M. R. (2000). Motivating kids in physical activity. President’s Council on Physical Fitness and Sports Research Digest. World Health Organisation. (2014a). Media centre obesity and overweight. WHO. World Health Organisation. (2014b). The health of the people: What works, The African regional report. WHO. Xie, W., Nelson, B. L., & Barton, R. R. (2016). Multivariate input uncertainty in output analysis for sto- chastic simulation. ACM Transactions on Modeling and Computer Simulation (TOMACS), 27(1), 1– 22. 196 E. S. QUAYE ET AL. https://doi.org/10.1080/10495142.2015.1053342 https://www.gov.za/NationalHealthyLifestylesDay2020 https://www.gov.za/NationalHealthyLifestylesDay2020 https://doi.org/10.1515/hukin-2017-0145 https://doi.org/10.1515/hukin-2017-0145 https://doi.org/10.1080/09637486.2016.1265100 https://doi.org/10.1080/09637486.2016.1265100 https://doi.org/10.1111/j.1464-0597.2007.00325.x https://doi.org/10.1111/j.1464-0597.2007.00325.x https://doi.org/10.3102/00346543046003407 https://www.statista.com/topics/7956/demographics-of-south-africa/ https://www.statista.com/topics/7956/demographics-of-south-africa/ Abstract 1. Introduction 2. Conceptual background and hypothesis 2.1. Extended theory of planned behaviour 2.2. Self-concept theory 2.3. Self-concept and healthy-lifestyle 2.4. Hypotheses development 2.4.1. Health self-identity and behavioural intentions 2.4.2. Health self-identity and lifestyle 2.4.3. Self-efficacy and a healthy lifestyle 2.4.4. Subjective norms, healthy lifestyle, and behavioural intentions 2.4.5. Healthy lifestyle and healthy attitude 2.4.6. Health attitude and behavioural intention 2.4.7. Healthy lifestyle and behavioural intentions 3. Methods 3.1. Data collection and sample characteristics 3.2. Measures 4. Data analysis 4.1. Measurement model validation 4.2. Tests of hypotheses 4.3. Test of mediation 5. Discussion and conclusion 5.1. Theoretical implications 5.2. Practical implications 6. Limitations and direction for future research Disclosure statement Notes on contributors ORCID References << /ASCII85EncodePages false /AllowTransparency false /AutoPositionEPSFiles false /AutoRotatePages /PageByPage /Binding /Left /CalGrayProfile () /CalRGBProfile (Adobe RGB \0501998\051) /CalCMYKProfile (U.S. Web Coated \050SWOP\051 v2) /sRGBProfile (sRGB IEC61966-2.1) /CannotEmbedFontPolicy /Error /CompatibilityLevel 1.5 /CompressObjects /Off /CompressPages true /ConvertImagesToIndexed true /PassThroughJPEGImages false /CreateJobTicket false /DefaultRenderingIntent /Default /DetectBlends true /DetectCurves 0.1000 /ColorConversionStrategy /sRGB /DoThumbnails true /EmbedAllFonts true /EmbedOpenType false /ParseICCProfilesInComments true /EmbedJobOptions true /DSCReportingLevel 0 /EmitDSCWarnings false /EndPage -1 /ImageMemory 524288 /LockDistillerParams true /MaxSubsetPct 100 /Optimize true /OPM 1 /ParseDSCComments false /ParseDSCCommentsForDocInfo true /PreserveCopyPage true /PreserveDICMYKValues true /PreserveEPSInfo false /PreserveFlatness true /PreserveHalftoneInfo false /PreserveOPIComments false /PreserveOverprintSettings false /StartPage 1 /SubsetFonts true /TransferFunctionInfo /Remove /UCRandBGInfo /Remove /UsePrologue false /ColorSettingsFile () /AlwaysEmbed [ true ] /NeverEmbed [ true ] /AntiAliasColorImages false /CropColorImages true /ColorImageMinResolution 150 /ColorImageMinResolutionPolicy /OK /DownsampleColorImages true /ColorImageDownsampleType /Bicubic /ColorImageResolution 300 /ColorImageDepth -1 /ColorImageMinDownsampleDepth 1 /ColorImageDownsampleThreshold 1.50000 /EncodeColorImages true /ColorImageFilter /DCTEncode /AutoFilterColorImages false /ColorImageAutoFilterStrategy /JPEG /ColorACSImageDict << /QFactor 0.90 /HSamples [2 1 1 2] /VSamples [2 1 1 2] >> /ColorImageDict << /QFactor 0.40 /HSamples [1 1 1 1] /VSamples [1 1 1 1] >> /JPEG2000ColorACSImageDict << /TileWidth 256 /TileHeight 256 /Quality 15 >> /JPEG2000ColorImageDict << /TileWidth 256 /TileHeight 256 /Quality 15 >> /AntiAliasGrayImages false /CropGrayImages true /GrayImageMinResolution 150 /GrayImageMinResolutionPolicy /OK /DownsampleGrayImages true /GrayImageDownsampleType /Bicubic /GrayImageResolution 300 /GrayImageDepth -1 /GrayImageMinDownsampleDepth 2 /GrayImageDownsampleThreshold 1.50000 /EncodeGrayImages true /GrayImageFilter /DCTEncode /AutoFilterGrayImages false /GrayImageAutoFilterStrategy /JPEG /GrayACSImageDict << /QFactor 0.90 /HSamples [2 1 1 2] /VSamples [2 1 1 2] >> /GrayImageDict << /QFactor 0.40 /HSamples [1 1 1 1] /VSamples [1 1 1 1] >> /JPEG2000GrayACSImageDict << /TileWidth 256 /TileHeight 256 /Quality 15 >> /JPEG2000GrayImageDict << /TileWidth 256 /TileHeight 256 /Quality 15 >> /AntiAliasMonoImages false /CropMonoImages true /MonoImageMinResolution 1200 /MonoImageMinResolutionPolicy /OK /DownsampleMonoImages true /MonoImageDownsampleType /Average /MonoImageResolution 300 /MonoImageDepth -1 /MonoImageDownsampleThreshold 1.50000 /EncodeMonoImages true /MonoImageFilter /CCITTFaxEncode /MonoImageDict << /K -1 >> /AllowPSXObjects true /CheckCompliance [ /None ] /PDFX1aCheck false /PDFX3Check false /PDFXCompliantPDFOnly false /PDFXNoTrimBoxError true /PDFXTrimBoxToMediaBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXSetBleedBoxToMediaBox true /PDFXBleedBoxToTrimBoxOffset [ 0.00000 0.00000 0.00000 0.00000 ] /PDFXOutputIntentProfile (None) /PDFXOutputConditionIdentifier () /PDFXOutputCondition () /PDFXRegistryName () /PDFXTrapped /False /Description << /ENU () >> >> setdistillerparams << /HWResolution [600 600] /PageSize [595.245 841.846] >> setpagedevice