Explain the importance of theory to health education/promotion

Explain the importance of theory to health education/promotion.

Theories and Planning Models

Chapter 4

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Chapter Objectives – 1

Define and explain the difference among theory, concept, construct, variable, and model

Explain the importance of theory to health education/promotion

Explain what is meant by behavior change theories and planning models

Describe how the concept of socio-ecological approach applies to using theories

Chapter Objectives – 2

Explain the difference between continuum theories and stage theories

Identify and briefly explain the behavior change theories, and their components, used in health education/promotion:

Health Belief Model

Theory of Planned Behavior

Elaboration Likelihood Model of Persuasion

Information-Motivation-Behavioral Skills Model

Transtheoretical Model of Change

Precaution Adoption Process Model

Social Cognitive Theory

Social Network Theory

Social Capital Theory

Diffusion Theory

Community Readiness Model

Chapter Objectives – 3

Identify and briefly explain the planning models, and their components, used in health education/promotion:

PRECEDE-PROCEED

Multilevel Approach to Community Health (MATCH)

Intervention Mapping

CDCynergy

Social Marketing Assessment and Response Tool (SMART)

Mobilizing for Action through Planning and Partnerships (MAPP)

Generalized Model (GM)

Definitions

theory – “a set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables in order to explain and predict the events of the situations” (Glanz et al., 2008, p. 26)

concept – primary elements of theories (Glanz et al., 2008)

construct – a concept developed, created, or adopted for use with a specific theory (Kerlinger, 1986)

variable – the operational (practical use) form of a construct; (Rimer & Glanz, 2005, p. 4); how a construct will be measured (Glanz et al., 2008)

model – is a composite, a mixture of ideas or concepts taken from any number of theories and used together (Hayden, 2009, p. 1)

Importance of Using Theory in Health Education/Promotion

Theories provide direction and organizes knowledge

Theories can help in planning, implementing, and evaluating programs

Indicates reasons why people are not behaving in healthy ways

Identifies information needed for intervention development

Provides a conceptual framework

Gives insight for delivery

Identifies measurements needed for evaluation

Help provide focus and infuses ethics and social justice into practice

Programs based upon sound theory more likely to succeed

Behavior Change Theories

Multiple theories to design interventions

Levels of influence are key parts of socio-ecological approach

Socio-ecological approach helps to recognize importance of the larger social system of behaviors and social influences

Figure 4.1 The socio-ecological model

Source: Simons-Morton, B. G., McLeroy, K. R., & Wendel, M. L. (2012). Behavior theory in health promotion practice and research. Burlington, MA: Jones & Bartlett Learning. p. 45.

Focus on factors within individuals (e.g. knowledge, attitudes, beliefs, self-concept, developmental history, past experiences, motivation, skills, and behaviors)

Health Belief Model (HBM), Theory of Planned Behavior (TPB), Elaboration Likelihood Model of Persuasion (ELM), Information-Motivation-Behavior Skills Model (IMB), Transtheoretical Model of Change (TMC), Precaution Adoption, Process Model (PAPM)

Continuum theories identify variables that influence action and combine them in a prediction equation

Intrapersonal (Individual) Theories – 1

Intrapersonal (Individual) Theories – 2

Stage Theory

Comprised of ordered set of categories into which people can be classified

Identifies factors that could induce movement from one stage to another

Four principle elements

Category system to define stages

Ordering of stages

Barriers to change that are common among people in same stage

Different barriers to change, facing people in different stages

Intrapersonal (Individual) Theories – 3

Health Belief Model (Rosenstock)

Explains the likelihood of an individual to take action to prevent a disease or injury based upon:

Sufficient motivation to make the issue relevant (perceived susceptibility and perceived seriousness)

The perceived threat of the health issue

The perceived benefits of a given action

The perceived barriers to taking the necessary action

Cues to actions may also impact on the individual’s likelihood of taking action

Self-efficacy – to feel competent to overcome perceived barriers to take action

Intrapersonal (Individual) Theories – 4

Figure 4.2 Health Belief Model as a predictor of preventive health behavior

Source: Becker, M. H., et al., from “A new approach to explaining sick-role behavior in low income populations,” American Journal of Public Health 64, March 1974: 205–216, Fig 1. Used by permission of Sheridan Press.

Intrapersonal (Individual) Theories – 5

Theory of Planned Behavior (Fishbein & Ajzen, 1975)

Individuals’ intention to perform a given behavior is a function of their attitude toward the behavior, their belief of what others think they should do, and their perception of level of ease or difficulty of the behavior in which they are considering action

Attitude toward the behavior

Subjective norm

Perceived behavioral control

Actual behavioral control

Intrapersonal (Individual) Theories – 6

Figure 4.3 Theory of Planned Behavior (TPB)

Source: “Theory of Planned Behavior Diagram” (TPB Diagram) by Dr. Icek Ajzen, http://www.people.umass.edu/aizen/tpb.diag.html. Reprinted by permission.

Intrapersonal (Individual) Theories – 7

Elaboration Likelihood Model of Persuasion

Developed to explain inconsistencies in research results from the study of attitudes (Petty, Barden, & Wheeler, 2009)

Attitudes form via two routes

The two routes usually leads to attitudes with different consequences

The model specifies how variables have an impact on persuasion

elaboration – refers to the amount of cognitive processing (i.e., thought) that a person puts into receiving messages

Intrapersonal (Individual) Theories – 8

Figure 4.5 The Elaboration Likelihood Model of Persuasion (ELM)

Source: From Petty, R. E., Barden J., & Wheeler, S. C., “The Elaboration Likelihood Model of Persuasion: Developing health promotions for sustained behavioural change” in Emerging theories in health promotion practice and research, 2nd ed.; DiClemente, R. J., Crosby, R. A., & Kegler, M. (Eds.), p. 196. Copyright © 2009 John Wiley & Sons, Inc. Reproduced with permission of John Wiley & Sons, Inc.

Intrapersonal (Individual) Theories – 9

Information-Motivation-Behavioral Skills Model

Created to address the critical need for a strong theoretical basis for HIV/AIDS prevention efforts

Information

Motivation

Behavioral skills

Preventive behaviors

Figure 4.6 The Information-Motivation-Behavioral Skills Model of HIV Prevention Health Behavior

Source: From Fisher, J. D., & Fisher, W. A., “Changing AIDS risk behavior,” Psychological Bulletin 111 (3), 455–474, 1992. Published by American Psychological Association (APA). Reprinted by permission.

Intrapersonal (Individual) Theories – 10

Transtheoretical Model of Change (TMC) (Prochaska, 1979)

People make behavior change through a series of different stages related to the behavior

Stages of change

Precontemplation—stage people are in before they are ready to change and are not intending to change

Contemplation—stage when individuals are considering making a behavior change within the next 6 months

Preparation—stage where the individual is actively planning change

Action—the effort to make the change in behavior

Maintenance—sustaining the change and resisting relapse

Termination

Intrapersonal (Individual) Theories – 11

Precaution Adoption Process Model (PAPM) (Weinstein & Sandman, 2002)

Explains how a person comes to the decision to take action, and how the decision is translated into action

Figure 4.7 Stages of the Precaution Adoption Process Model (PAPM)

Source: From Weinstein, N. D., Sandman, P. M., & Blalock, S. J., “The Precaution Adoption Process Model” in Health behavior and health education: Theory, research, and practice, 4th ed., K. Glanz, B. K. Rimer, and K. Viswanath, (Eds.), p. 127. Copyright © 2008 John Wiley & Sons, Inc. Reproduced with permission of John Wiley & Sons, Inc.

Interpersonal Theories – 1

Theories that “assume individuals exist within, and are influenced by, a social environment. The opinions, thoughts, behavior, advice, and support of people surrounding an individual influence his or her feelings and behavior, and the individual has a reciprocal effect on those people” (Rimer & Glanz, 2005, p. 19)

These theories help to explain

Social norms

Social learning

Social power

Social integration

Social networks

Social support

Social capital

Interpersonal communication

Interpersonal Theories – 2

Social Cognitive Theory (Bandura, 1986)

Learning is a reciprocal interaction between the individual’s environment, cognitive process, and behavior

Behavioral capability

Expectations

Expectancies

Locus of control

Reciprocal determinism

Observational learning

Reinforcement

Self-control

Self-efficacy

Emotional coping response

Interpersonal Theories – 3

Social Network Theory

Explains the web of social relationships that surround people

Key component – relationship between and among individuals and how those relationships influences beliefs and behaviors

When assessing a network’s role, considers –

Centrality vs. Marginality

Reciprocity of relationships

Complexity or intensity of relationships in the network

Homogeneity or diversity of people in the network

Subgroups, cliques, and linkages

Communication patterns in the network

Interpersonal Theories – 4

Social Capital Theory

Does not provide theories of change

Does not guarantee empirical outcomes

Does have an impact on health

Type of network resources

Bonding

Bridging

Linking

Trust and reciprocity

Norms and expectations

Figure 4.9 Social capital

Source: From Hayden, J., Introduction to Health Behavior Theory, 1st ed., Fig 9-3, p. 125. Copyright © 2009, Jones and Bartlett Publishers, Sudbury, MA. http://www.jblearning.com. Reprinted by permission.

Community Theories – 1

Group of theories includes three of the ecological perspective levels

Institutional (e.g., rules & regulations)

Community (e.g., social norms)

Public policy (e.g., legislation)

Community Theories – 2

Diffusion Theory (Rogers, 1983)

Explains diffusion of innovations in a population

Categorizes individuals based upon when they adopt a new behavior, idea, or program

Innovators – first to adopt.

Early adopters – influential and open to trying innovations, but are more grounded than innovators

Early majority individuals – wary and watchful about their involvement in new ideas

Late majority – get involved through peers or mentors programs and more skeptical and adopt after most people

Laggards – last to be involved and interested in change

Health educators will need to modify marketing strategies to attract individuals from each of the different categories

Community Theories – 3

Figure 4.10 Bar chart depicting percentages of persons adopting an innovation over time

Community Theories – 4

Community Readiness Model (Edwards et al., 2000)

Stage model to explain the nine stages of community readiness to change

No awareness

Denial

Vague awareness

Preplanning

Preparation

Initiation

Stabilization

Confirmation/expansion

Professionalism

Community Theories – 5

Table 4.3 Community readiness stages and goals

Planning Models – 1

Sound health promotion programs are organized around a well-thought-out and well-conceived model

Models serve as frames from which to build; structure & organization for the planning process

Many models

Many have common elements but may have different labels

No perfect model

Planning Models – 2

PRECEDE-PROCEED (Green & Kreuter, 1991)

Best known & often used model

Developers: Larry W. Green & Marshall W. Kreuter

PRECEDE—predisposing, reinforcing, and enabling constructs in educational / ecological diagnosis & evaluation

PROCEED—policy, regulatory, and organizational constructs in educational & environmental development

Planning Models – 3

PRECEDE

Social assessment

Epidemiological assessment

Educational and ecological assessment

Intervention alignment and administrative and policy assessment

PROCEED

Implementation

Process evaluation

Impact evaluation

Outcome evaluation

Planning Models – 4

Figure 4.14 PREDEDE-PROCEED model for health program planning

Source: From Green, L. W., & Kreuter, M. W., Health program planning: An educational and ecological approach, 4th ed., p. 17, Fig 1.5. Copyright © 2005 The McGraw-Hill Companies, Inc. Reprinted by permission.

Planning Models – 5

Multilevel Approach to Community Health (MATCH) (Simons-Morton et al., 1995)

Ecological planning perspective

Recognizes that intervention activities should be aimed at a variety of objectives and individuals

Phases

Phase 1: health goal selection

Phase 2: intervention planning

Phase 3: program development

Phase 4: implementation

Phase 5: evaluation

Planning Models – 6

Intervention Mapping (Bartholomew et al.,1998)

Based upon the importance of theory and evidence in the development of health promotion programs

Step 1: needs assessment

Step 2: matrices of change objectives

Step 3: theory-based methods and practical strategies

Step 4: program development

Step 5: adoption and implementation

Step 6: evaluation planning

Planning Models – 7

CDCynergy (CDC, 1998)

Developed for public health professionals at the Centers for Disease Control and Prevention

Used by professionals who have responsibilities for health communication

Six phases

Phase 1: describe problem

Phase 2: analyze problem

Phase 3: plan intervention

Phase 4: develop intervention

Phase 5: plan evaluation

Phase 6: implement plan

Content specific editions of the software are available

Planning Models – 8

Social Marketing Assessment and Response Tool (SMART) (Neiger, 1998)

Central focus is the consumer

Composed of seven phases:

Phase 1: preliminary planning

Phase 2: consumer analysis

Phase 3: market analysis

Phase 4: channel analysis

Phase 5: develop intervention, materials, and pretest

Phase 6: implementation

Phase 7: evaluation

Planning Models – 9

Mobilizing for Action through Planning and Partnerships (MAPP) (NACCHO, 2001)

Blends the strengths of other planning models

Six phases

Phase 1: organizing for success and partnership development

Phase 2: visioning

Phase 3: conducting the four MAPP assessments

Phase 4: identify strategic issues

Phase 5: formulate goals and strategies

Phase 6: the action cycle

Planning Models – 10

Figure 4.13 Mobilizing for Action through Planning and Partnerships (MAPP) model

Source: National Association of Country and City Health Officials, “Mobilizing for Action through Planning and Partnerships (MAPP) Model” from http://www.naccho. org/topics/infrastructure/mapp/upload/ MAPP_Handbook_fnl.pdf. Reprinted by permission.

Planning Models – 11

Generalized Model for Program Planning (GMPP) (McKenzie et al., 2009).

Five tasks:

Assessing needs

Setting goals and objectives

Developing interventions

Implementing interventions

Evaluating results

Planning Models – 12

Figure 4.14 Generalized model

Source: From McKenzie, J. F., Neiger, B. L., & Thackery, R., Planning, implementing and evaluating health promotion programs: A primer, 6th ed., p. 45, Fig. 3.1. Copyright © 2013. Reproduced by permission of Pearson, Boston, MA.

Summary

Health education/promotion is a multidisciplinary profession & has evolved from the theory & practice of other disciplines

Many of the theories & models used in health education/promotion also have evolved from these other disciplines

Key terms: theory, concept, construct, variable, & model

There are many behavior change theories that can be categorized using the five levels (intrapersonal, interpersonal, institutional, community, & public policy) of the socio-ecological approach

There is a distinction between continuum theories & stage theories

Planning models provide a framework on which to build programs

Theories and Planning Models

Chapter 4: The End

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