HLSC 1F90 Lecture Notes - Lecture 3: Health Belief Model, Health Promotion, Social Cognitive Theory

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Theory at a Glance: A Guide for Health Promotion Practice
Part One + Part Two
Part One: Foundations of Theory in Health Promotion and Health Behaviour
Why is Theory Important to Health Promotion and Health Behaviour Practice
Effective public health, health promotion, and chronic disease management programs
help people maintain and improve health, reduce disease risks, and manage chronic
illness. They can improve the well-being and self-sufficiency of individuals, families,
organizations, and communities. Usually, such successes require behavior change at
many levels, (e.g., individual, organizational, and community).
Not all health programs and initiatives are equally successful, however. Those most likely to
achieve desired outcomes are based on a clear understanding of targeted health
behaviours, and the environmental context in which they occur.
What is Theory
A theory presents a systematic way of understanding events or situations. It is a set of
concepts, definitions, and propositions that explain or predict these events or situations by
illustrating the relationships between variables. Theories must be applicable to a broad
variety of situations. They are, by nature, abstract, and don’t have a specified content or
topic area.
oConcepts: Are the building blocks---the primary elements---of a theory.
oConstructs: Are concepts developed or adopted for use in a particular theory. The
key concepts of a given theory are the constructs.
oVariables: Are the operational forms of constructs. They define the way a construct
is to be measured is a specific situation. Match variables to constructs when
identifying what needs to be assessed during evaluation of a theory driven program.
oModels: May draw on a number of theories to help understand a particular problem
in a certain setting or context. They are not always as specified as theory.
Most health behaviour and health promotion theories were adapted from the social and
behavioural sciences, but applying them to health issues often requires that one be familiar
with epidemiology and the biological sciences.
Health behaviour and health promotion theories draw upon various disciplines, such as
psychology, sociology, anthropology, consumer behaviour, and marketing. Many are not
highly developed or have not been rigorously tested. Because of this, they often are called
conceptual frameworks or theoretical frameworks., here the terms are used
interchangeably.
How Can Theory Help Plan Effective Programs?
Theory gives planners tools for moving beyond intuition to design and evaluate health
behaviour and health promotion interventions based on understanding of behaviour. It helps
them to step back and consider the larger picture. Like an artist, a program planner who
grounds health interventions in theory creates innovation ways to address specific
circumstances. He or she does not depend on a “paint-by-numbers” approach, re-hashing stale
ideas, but uses a palette of behaviour theories, skillfully applying them to develop unique,
tailored solutions to problems.
Using theory as a foundation for program planning and development is consistent with
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the current emphasis on using evidence based interventions in public health, behavioral
medicine, and medicine.
Theory provides a road map for studying problems, developing appropriate interventions, and
evaluating their successes. It can inform the planner’s thinking during all of these stages,
offering insights that translate into stronger programs.
Theory can also help to explain the dynamics of health behaviors, including processes for
changing them, and the influences of the many forces that affect health behaviors, including
social and physical environments.
Theory can also help planners identify the most suitable target audiences, methods for fostering
change, and outcomes for evaluation. Theory also helps to identify which indicators should be
monitored and measured during program evaluation.
Researchers and practitioners use theory to investigate answers to the questions of “why,”
“what,” and “how” health problems should be addressed. By seeking answers to these
questions, they clarify the nature of targeted health behaviors. behaviors. That is, theory
guides the search for reasons why people do or do not engage in certain health behaviors; it
helps pinpoint what planners need to know before they develop public health programs; and it
suggests how to devise program strategies that reach target audiences and have an impact.
Explanatory Theory and Change Theory
Explanatory theory describes the reasons why a problem exists. It guides the search for factors
that contribute to a problem (e.g., a lack of knowledge, self-efficacy, social support, or
resources), and can be changed. Examples of explanatory theories include the Health Belief
Model, the Theory of Planned Behavior, and the Precaution Adoption Process Model.
Change theory guides the development of health interventions. It spells out concepts that can
be translated into program messages and strategies, and offers a basis for program evaluation.
Change theory helps program planners to be explicit about their assumptions for why a program
will work. Examples of change theories include Community Organization and Diffusion of
Innovations.
Fitting Theory to the Field of Practice
No single theory dominates health education and promotion, nor should it; the problems,
behaviors, populations, cultures, and contexts of public health practice are broad and varied.
Some theories focus on individuals as the unit of change. Others examine change within
families, institutions, communities, or cultures. Adequately addressing an issue may require
more than one theory, and no one theory is suitable for all cases.
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Because the social context in which behavior occurs is always evolving, theories that were
important in public health education a generation ago may be of limited use today. At the same
time, new social science research allows theorists to refine and adapt existing theories.
oEffective practice depends on using theories and strategies that are appropriate to a
situation. (Institute of Medicine)
One of the greatest challenges for those concerned with behavior change is learning to analyze
how well a theory or model “fits” a particular issue. A working knowledge of specific theories,
and familiarity with how they have been applied in the past, improves skills in this area.
Selecting an appropriate theory or combination of theories helps take into account the multiple
factors that influence health behaviors. The practitioner who uses theory develops a nuanced
understanding of realistic program outcomes that drives the planning process.
Choosing a theory that will bring a useful perspective to the problem at hand does not begin
with a theory. Instead, this process starts with a thorough assessment of the situation: the units
of analysis or change, the topic, and the type of behavior to be addressed. Because different
theoretical frameworks are appropriate and practical for different situations, selecting a theory
that “fits” should be a careful, deliberate process.
A Good Fit: Characteristics of a Useful Theory
A useful theory makes assumptions about a behaviour, health problem, target population, or
environment that are:
oLogical
oConsistent with everyday observations
oSimilar to those used in previous successful programs; and
oSupported by past research in the same area or related ideas.
Using Theory to Address Health Issues in Diverse Populations
An increasing body of research shows health disparities exist among various ethnic and socio-
economic groups. These findings highlight the importance of understanding the cultural
backgrounds and life experiences of community members, though research has not yet
established when and under what circumstances targeted or tailored health communications
are more effective than generic ones.
oTargeting involves using information about shared characteristics of a population
subgroup to create a single intervention approach for that group.
o In contrast, tailoring is a process that uses an assessment to derive information about
one specific person, and then offers change or information strategies for an outcome of
interest based on that person’s unique characteristics.
Most health behavior theories can be applied to diverse cultural and ethnic groups, but health
practitioners must understand the characteristics of target populations (e.g., ethnicity,
socioeconomic status, gender, age, and geographical location) to use these theories correctly.
There are several reasons why culture and ethnicity are critical to consider when applying
theory to a health problem.
oFirst, morbidity and mortality rates for different diseases vary by race and ethnicity.
oSecond, there are differences in the prevalence of risk behaviors among these groups.
oThird, the determinants of health behaviors vary across racial and ethnic groups.
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