Theoretical Foundations Chapter 4

Introduction to theories & models: Key Terms 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, Lewis, & Rimer, 2002, p. 25) Concept – primary elements of theories or building blocks of theory (Glanz et al., 2002)

Introduction to theories & models: Key Terms (con’t.) Construct – a concept developed, created, or adopted for use with a specific theory (Kerlinger, 1986); synthesized thoughts Variable – the operational (practical use) form of a construct; how a construct will be measured (Glanz et al., 2002) Model – is a subclass of theory; “draws upon a number of theories to help people understand a specific problem in a particular setting or context” (Glanz et al., p. 27)

Examples Concept Personal beliefs Construct Perceived benefit Variable Model Theory Personal beliefs Perceived benefit Rank order incentives Health Belief Model Social Cognitive Theory

The Importance of Using Theory in Health Education/Promotion 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) greatly enhances the chances for effective health education/promotion practice (Glanz et al., 2002)

Types of Theories/Models Theories / models of implementation (for planning, implementation, & evaluation) referred to as planning models Change process theories (for use in behavior change) referred to as behavior change models

Planning Models: Background Information Models serve as frames from which to build, structure & organization for the planning process Many different models Common elements, but different labels No perfect model

PRECEDE - PROCEED PRECEDE - predisposing, reinforcing, and enabling constructs in education / ecological diagnosis & evaluation PROCEED - policy, regulatory, and organizational constructs in educational & environmental development

PRECEDE - PROCEED (con’t.) Best known & often used model Larry Green & Marshall Kreuter PRECEDE created in early 1970s First 5 phases are assessment phases: social, epidemiological, behavioral & environmental, educational & ecological, administrative & policy PROCEED created in the 1980s Last 4 phases: implementation and process, impact, and outcome evaluation Underlying approach begin by identifying the desired outcome, determine what causes it, & design an intervention to reach the desired outcome

MATCH Multilevel Approach to Community Health 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

MATCH PHASES Health Goals Selection Intervention Planning Development Select health status goals and population, identify health behavior & environmental factor goals Intervention Planning Select intervention objectives, identify targets of intervention, select intervention approaches Development Create program units or components, create plans Implementation Adoption, implementation, maintenance Evaluation Process, impact, & outcome

About CDCynergy 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 education Developed for health communication but…

CDCynergy P 2: Analyze Problem (causes, goals, intervention strategies P 4: Develop Intervention P 6: Implement Plan P 1: Describe Problem (identify & define) P 3: Plan Intervention (Is communication dominant or supportive?) P 5: Plan Evaluation

Social Marketing Assessment & Response Tool (SMART) (Neiger, 1998) SMART is a social marketing planning framework Social marketing – “a process for influencing human behavior on a large scale, using marketing principles for the purpose of societal benefit rather than commercial profit” (Smith, 2000, p. 11) SMART has 7 phases

SMART 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 Implementation Evaluation

MAPP (Mobilizing for Action through Planning & Partnerships) 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)

Generalized Model for Program Planning Includes the six primary tasks incorporated in the other five planning models already presented

Other Planning Models 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) The Health Communication Model (NCI, 2002) The Planning, Program Development, and Evaluation Model (Timmreck, 2003)

Change Process Theories Many different change process theories First need to decide on what level to intervene Consider the ecological perspective (McLeroy et al., 1988) Intrapersonal, or individual, factors Interpersonal factors Institutional, or organizational, factors Community factors Public policy factors

Change Process Theories - Intrapersonal Level 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, and which identify factors that could induce movement from one category to the next (e.g., TTM, PAPM)

Health Belief Model (HBM) 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” (Glanz & Rimer, 1995, p. 17) History – Developed by a group of psychologists in 1950 to help explain why people used or did not use health services

Constructs of the HBM Perceived susceptibility Perceived seriousness Perceived barriers Perceived benefits Cues to action Self-efficacy

Theory of Planned Behavior Attitude toward the behavior Do I really think the behavior will be good for me? How important is the behavior to me? Subjective norm Do others think I should behave this way? How much do I care what others think? Intention Behavior Perceived behavioral control Added to TRA Do I have any control over this behavior? May be direct link with behavior

Transtheoretical Model (TTM) 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) Stages of change (“Stages of Change Model”) – precontemplation, contemplation, preparation, action, maintenance, relapse, termination

How to stage a person Do you exercise regularly? No Yes Do you intend to in the next 30 day? Have you been doing so for more than 6 months? Yes No Yes No Do you intend to in the next six months? Preparation Action Maintenance Yes No Precontemplation Contemplation

Major Constructs of the Transtheoretical Model Stages of change Decisional balance Pros Cons Self-efficacy Confidence Temptation Processes of Change

Precaution Adoption Process Model (PAPM) 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

Stages of PAPM Stage 1 - Unaware of issue Stage 2 - Unengaged by issue Stage 3 - Deciding about acting Stage 4 - Decided not to act Stage 5 - Decided to act Stage 6 - Acting Stage 7 - Maintenance

Change Process Theories – Interpersonal Level This group of theories “includes factors related to individuals’ experience and perceptions of their environments in combination with their personal characteristics” (Glanz & Rimer, 1995, p. 22) Examples Social learning, social power, interpersonal communication, social networks, & social support

Social Cognitive Theory (SCT) 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

Often Used Constructs of the SCT Behavior capability Expectations Expectancies Locus of control Reciprocal determinism Self-control or self-regulation Emotional coping response Self-efficacy

Change Process Theories - Community Level 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

Diffusion Theory (Rogers, 1962) 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.

Diffusion Theory (con’t.) 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

Some Final Thoughts about Theories & Models Some feel that the theories/models are not are useful as they should/could be Logical positivism Current theories/models adequate? Need for other theories/models?

Theoretical Foundations Chapter 4 – The End