Foundations Of Health. Chapter 4

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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, Lewis, & Rimer, 2002, p. 25)

Example: Social Cognitive Theory

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Theory

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primary elements of theories or building blocks of theory (Glanz et al., 2002)

Example: Personal beliefs

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Concept

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

Example: Perceived benefit

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Construct

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The operational (practical use) form of a construct; (Rimer & Glanz, 2005, p. 4); how a construct will be measured (Glanz et al., 2002)

Example: Ona scale of 1 to 10 with 1 being least important and 10 being most important, how important is good health to you?

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Variable

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is a subclass of theory (McKenzie et al., 2009, p. 160); “draws upon a number of theories to help people understand a specific problem in a particular setting or context” (Rimer & Glanz, 2005, p. 4)

Example: Health Belief Model

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Model

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it helps guide the practice of health educators


“…provides a platform for understanding why people engage in health-risk or health-compromising behavior and why (as well as how) they adopt health-protective behavior” (Crosby et al., 2002, p. 1)


“Using theory…is consistent with the current emphasis on using evidence-based interventions in public health, behavioral medicine, and medicine” (Rimer & Glanz, 2005, p. 5)

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Importance of Using Theory in Health Education/Promotion

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

No perfect model

Many different theories & models; many have common elements but may have different labels

Types
Planning Models (Theories/Models of Implementation)
Theories and Models Focusing on Health Behavior Change (Change Process Theories); sometimes referred to as behavior change models

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An Overview of the of Theories and Models Used

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Best known & often used model

Larry W. Green & Marshall W. Kreuter

PRECEDE - predisposing, reinforcing, and enabling constructs in education / ecological diagnosis & evaluation

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

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PRECEDE–PROCEED - 1

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First 4 phases are assessment phases; social, epidemiological, behavioral & environmental, educational & ecological, administrative & policy and intervention alignment

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PRECEDE created in early 1970s

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Last 4 phases; implementation, and process, impact, & outcome evaluation

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PROCEED created in the 1980s

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begin by identifying the desired outcome, to determine what causes it, & then design an intervention to reach the desired outcome

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Underlying approach PRECEDE–PROCEED - 2

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Developed in late 1980s

Used by U.S. Government

Applied when behavioral & environmental risk & protective factors for disease / injury are known & general priorities determined

Includes ecological planning – levels of influence

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Multilevel Approach To Community Health (MATCH) - 1

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Phase 1 - Health Goals Section - Select health status goals & population, identify health behavior & environmental factor goals

Phase 2 - Intervention Planning - Select intervention objectives, identify targets of intervention, select intervention approaches

Phase 3 - Development - Create program units or components, create plans

Phase 4 - Implementation - Adoption, implementation, maintenance

Phase 5 - Evaluation - Process, Impact, Outcome

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MATCH - 2

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Relatively new– 1998

Based upon the importance of planning programs that are based on theory & evidence

Draws on both the PRECEDE–PROCEED and MATCH models

Steps –
1) Needs assessment,
2) Matrices of Change Objectives
3) Theory-based methods and practical strategies,
4) Program,
5) Adoption and Implementation,
6) Evaluation Planning

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Intervention Mapping

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Developed by the Office of Communication at the CDC in 1997

First issued in 1998

Developed initially for public health professionals at CDC with responsibilities for health communication

Developed for health communication but can be used with all health promotion planning

Available on CD-ROM

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CDCynergy

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P 1: Describe Problem (identify & define)

P 2: Analyze Problem (causes, goals, intervention strategies

P 3: Plan Intervention (Is communication dominant or supportive?)

P 4: Develop Intervention

P 5: Plan Evaluation

P 6: Implement Plan

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CDCynergy Phases of Action

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SMART, created by Neiger & Thackeray (1998), is a social marketing planning framework

Social marketing - “the application of commercial marketing technologies to the analysis, planning, and execution, and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve personal welfare and that of their society” (Andreasen, 1995, p. 7)

SMART has 7 phases

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Social Marketing Assessment & Response Tool (SMART)

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P 1: Preliminary
Planning [problem, name in terms of
behavior, develop goals, project costs

P 2:
Consumer Analysis [segment
priority population
& determine needs,
wants, & preferences]; also
secondary & tertiary audiences

P 3: Market
Analysis [4Ps,
competitors,
& partners]

P 4: Channel
Analysis [interpersonal,
small group,
organizational,
community,
mass media]

P 5: Developing Interventions, Materials, & Pretesting

P 6: Implementation

P 7: Evaluation

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Phases of SMART

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Relatively new; created by NACCHO for use by local public health agencies

Phases
Organizing for Success & Partnership Development
Visioning
Four MAPP Assessments
Identify Strategic Issues
Formulate Goals & Strategies
The Action Cycle ( Implement & Evaluate)

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Mobilizing for Action through Planning & Partnerships (MAPP)

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1) Assessing needs
2) Setting goals and objectives
3) Develop an intervention
4) Implementing the intervention
5) Evaluating the results

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A Generalized Model for Program Planning (GMPP)

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Comprehensive Health Education Model (Sullivan, 1973)
Model for Health Education Planning (Ross & Mico, 1980)
Model for Health Education Planning & Resource Development (Bates & Winder, 1984)
Planned Approach to Community Health (CDC, no date)
Generic Health/Fitness Delivery System (Patton et al., 1986)
Assessment Protocol for Excellence in Public Health (APEX-PH) (NACCHO, 1991)
Healthy Plan-It (CDC, 2000)
Healthy People in Healthy Communities (USDHHS, 2001)
The Health Communication Model (NCI, 2002)
The Planning, Program Development, and Evaluation Model (Timmreck, 2003)

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Other Planning Models

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Many different change process theories

First need to decide on what level to intervene

Consider the ecological perspective (McLeroy et al., 1988; Rimer & Glanz, 2005)
Intrapersonal level
Interpersonal level
Community levels
Institutional factors
Community factors
Public policy

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Theories and Models Focusing on Health Behavior Change

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Continuum theories – use an approach that identifies variables that influence action & combines them into a prediction equation (e.g., HBM, TPB)


Stage theories – are comprised of an ordered set of categories into which people can be classified, & which identifies factors that could induce movement from one category to the next (e.g., TTM, PAPM, HAPA)

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Change Process Theories - Intrapersonal Level

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The HBM “addresses a person’s perceptions of the threat of a health problem and the accompanying appraisal of a recommended behavior for preventing or managing a problem” (Rimer & Glanz, 2005, p. 12)

History - Developed by a group of psychologists in 1950 to help explain why people used or did not use health services

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Health Belief Model (HBM

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Constructs
Perceived susceptibility

Perceived seriousness

Perceived barriers

Perceived benefits

Cues to action

Self-efficacy

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Health Beleif Model (HBM)

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The TTM “ is an integrative framework for understanding how individuals and populations progress toward adopting and maintaining health behavior change for optimal health” (Prochaska, Johnson, & Lee, 1998, p. 59)

Has four major constructs – 1) Stages of change (this is why some call it the “Stages of Change Model”), 2) Processes of change, 3) Self-efficacy, and 4) Decisional balance

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Transtheoretical Model (TTM)

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TTM has been useful explaining gradual development habitual patterns, e.g., diet & exercise

PAPM explains how people come to the decision to take action, & how they translate that decision to action

Most useful when a deliberate action is required, e.g., screening or immunization

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Precaution Adoption Process Model (PAPM)

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Describes behavior change over time

Has two phases–motivation to change & self-regulatory processes– and five stages: intention, planning, initiative, maintenance, & recovery

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Health Action Process Approach (HAPA)

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This group of theories is comprised of 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)

Examples
Social learning, social power, interpersonal communication, social networks, & social support

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Change Process Theories - Interpersonal Level

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SCT describes learning as a reciprocal interaction among an individual’s environment, cognitive processes, and behavior (Parcel, 1983)

People are thinkers; expectations of consequences

Reinforcement
Direct reinforcement
Vicarious reinforcement (observational learning or social modeling)

Self-reinforcement

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Social Cognitive Theory (SCT)

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Often used constructs
Behavior capability
Expectations
Expectancies
Locus of control
Reciprocal determinism
Self-control or self-regulation
Emotional coping response
Self-efficacy

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SCT

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This group of theories includes three of the ecological perspective levels- institutional (e.g., rules & regulations), community (e.g., social networks & norms), & public policy (e.g., legislation).

Examples
Theories associated with these factors include theories of community organizing and community building

Bell-shaped curve

Priority population
Innovators (-2 sd from mean) (2-3%)
Early adopters (-2 to -1 sd from mean) (14%)
Early majority (-1 sd to mean) (34%)
Late majority (mean to +1 sd) (34%)
Laggards (> +1 sd) (16%)

Each group has its own set of characteristics

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Change Process Theories - Community Level

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This theory provides an explanation for the diffusion of innovations (something new) in populations.

Or stated a little differently, it explains the pattern of adoption of the innovations.

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Diffusion Theory

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A stage model for communities

Like individuals, communities are at various stages of readiness for change

Nine stages– 1) No awareness, 2) Denial, 3) Vague awareness, 4) Preplanning, 5) Preparation, 6) Initiation, 7) Stabilization, 8) Confirmation/Expansion, and 9) Professionalism

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Community Readiness Model

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Some feel that the theories/models are not as useful as they should/could be

Logical positivism

Current theories/models adequate?

Need for other theories/models

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Some Final Thoughts about Theories & Models