•A theory is a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by specifying relations among variables in order to explain and predict the events or situations.

•Theories are tools to help health educators/professionals better understand what influences health.

•Concepts are the elements of theories

•Constructs are synthesized thoughts of key concepts or theories.

•Variables are operational forms of a construct – define a construct and determine how it will be measured.

•Models are use to represent how constructs work towards behavior change. 

•An Impact model consists of causal hypotheses that specify the behavioral change expected from exposure to your program, including relationships between dependent variables that your are intervening to change.

Some useful health promotion theories:

•Social Ecology Model

•Social Cognitive/Learning Theory

•Theory of Reasoned Action/ Planned Behavior

•Empowerment Theory

•Health Belief Model

•Transtheoretical Model of Change

•Relapse Models (Marlatt’s)

•Social Marketing

•Diffusion of Innovation

Review of Health Behavior Models and Theories

SOCIAL ECOLOGICAL MODEL

Five sources of influence on behavior:

•Intrapersonal factors: Knowledge, attitudes, beliefs, and personality traits.

•Interpersonal factors: Individuals and groups that provide social identity, support and role definition (family, friends, work, school).

•Institutional factors: Rules, regulations, policies and informal structures that constrain or promote behavior.

•Community factors: Social networks and norms, or standards which exist among individuals, groups and individuals (cultural norms).

•Public Policy: Policies and laws that regulate or support healthy actions and practices.

SOCIAL MARKETING THEORY

Use of Marketing principles to promote behavior change.

•Product: (Product, behavior, or idea) that is being promoted?

•Place: Where it is offered?

•Price: What costs are involved?

•Promotion: What are the benefits? How are these benefits conveyed/communicated to consumer?

•Exchange: Consumers are encouraged to exchange costs for benefits.

MEDIA ADVOCACY

The use of the media to make social change. Objectives for a media advocacy campaign:

•Sway public opinion to see the problem or issue in a broader view, not just as an individual level issue.

•Create a sound bite so people can understand the issue and how to solve it.

•Make the issue newsworthy – use of celebrities, big events ….

•Identify people or groups who have the power to make your desired policy change.

•Determine who in the community can be mobilized to draw attention

•Determine what types of media would you use to deliver your message

DIFFUSION OF INNOVATION

Describes how new ideas, opinions, attitudes, and behaviors spread throughout a community.

•Classification of Individuals:

•Innovators - Early Adopters - Early Majority - Late Majority –Laggards

•Stages of Adoption:

•Awareness –Learn more – Decision  to try it– Obtain it – Adopt behavior

•  Factors influencing Adoption

•Relative advantage, trailability, compatibility, observability, and simplicity. 

STAGES OF CHANGE: READINESS TO CHANGE
Developed from studying how to help people quit smoking, but now used to help people initiate health behaviors, like walking.

Stages

•Pre-contemplation: Unaware of problem, hasn’t thought about changing.

•Contemplation: Thinking about change in the near future

•Preparation: Making a plan to change.

•Action: Implementation of specific action plans.

•Maintenance: Continuing to change behavior over 6 months of time.

•Focuses on cognitive states in early stages, and behavioral changes in later stages. 

•Movement through stages occurs through processes of change:

•Examples: consciousness raising, dramatic relief, self-reevaluation, self-liberation helping relationships,  reinforcement. Processes mediate movement through stages.

THEORY OF PLANNED ACTION

Constructs:

•Beliefs

•Attitudes

•Social norms

•Behavioral Intentions

•Perceived Behavioral Control

•Self-Efficacy

•Attitude toward a behavior depends on belief about outcome and evaluation of outcome

•Subjective norms toward a behavior depend on  influential others’ attitudes about behavior and individual’s motivation to comply.

•Attitudes and subjective norms influence one’s behavioral intention.

•Perceived Behavioral Control and Self-Efficacy have an affect on behavioral intentions.

SOCIAL COGNITIVE/LEARNING THEORY
People learn behavior from imitating role models

Some Concepts:

Behavioral Capacity: Knowledge and skills to influence behavior.

Expectations: Beliefs about likely results –like perceived benefits in HBM.

Self-Efficacy: Confidence in ability to take action and perform necessary skills.

Observational Learning: Observing others like self and seeing visible physical results.

Reinforcements: Consequences of behavior that lead to support or lack of support for continued behavior.

4 stages leading to adoption:

•Attention (getting it)

•Retention (remembering)

•Reproduction (repetition of modeling)

•Motivation (practice will lead to this)

Characteristics of Good Role Models

•Be Similar to audience

•Demonstrate behavior

•Be Rewarded for Practicing Behavior.

HEALTH BELIEF MODEL
Accounting for readiness to Action

Constructs:

•Perceived Susceptibility: Perception of getting condition

•Perceived Severity: Perception of the seriousness, or risk of the condition

•Perceived Benefits: Perception of the efficacy of advised actions to reduce risk

•Cues to Action: Strategies to activate readiness

•Self-Efficacy: Confidence in one’s ability to take action, or take recommended steps.

•Behavior changes when people think that they are at risk for a condition, it is perceived as severe, and the action needed is cost-beneficial.

•The intervention is a cue to action.

•Measure the health belief index (sum of susceptibility, severity, and cost-benefits)