Why Theory Matters Jackie Green “There is nothing so practical as a good theory.” (Kurt Lewin)

Concerns Seen by some as Reductionist Incompatible with holism and empowerment Inconsistent with respect for human agency and voluntarism

Theory practice gap Attributed to a narrow view of theory – linked to natural sciences and positivism and attempts to offer universal explanations (Buchanan, 1994)

But ……… A broader view of theory can and should: Enhance understanding of complex situations Consider the influence of contextual factors Include the experience of practitioners and communities

Evidence based practice Empirical evidence necessary but not enough. Need to extract THEORETICAL PRINCIPLES to avoid drowning in a mass of information

Definitions Theories – offer explanations of how or why something happens by identifying key variables and establishing the relationship between them Concepts are the main elements of theories Constructs operationalise concepts for use in building theory Models provide a looser, possibly untested, framework to help understand reality and the relationship between concepts. They may draw on one or more theories.

Two broad types of theory Explanatory theory theory of the problem – identifies key variables which need to be addressed Change theory theory of the solution – identifies the best means of changing key variables

Theory can …… Ensure that all relevant variable are addressed and key elements of a programme are in place Take account of contextual factors It therefore avoids Type III error – an intervention failing to achieve successful results when it was so poorly designed that it could not possibly have had the desired effect (Basch and Gold, 1986: 300-1)

or he has only the skills of a cafeteria line worker. Like an expert chef, a theoretically grounded health education professional does not blindly follow a cookbook recipe, but constantly recreates it anew, depending on the circumstances. Without a theory, she or he has only the skills of a cafeteria line worker. (National Cancer Institute, 1997)

Ecological approach – levels of influence Intra-personal Interpersonal Institutional or organisational Community Public policy (National Cancer Institute, 2005)

Examples of relevant theory Intrapersonal Interpersonal Community Health Belief Model Stages of Change Theory of Planned Behaviour Health Action Model Social Cognitive Theory Community organisation e.g. Locality (Community) Development Social Planning, Social Action Diffusion of innovations Communication Theory (based on National Cancer Institute, 2005)

The challenge …… Not an absence of theory but Which theory to select from the plethora available or rather Which combination of theories to cope with the complexity of health issues How to select theory

Which theory Does it include all relevant variables? Does it not contain redundant variables? Does it logically make sense to use it in a particular situation? Has it been used by others for similar purposes? Are there published studies supporting its use for similar purposes? Is it consistent with the values integral to the work? (Tones and Green (2004)

behavioural intention The Health Action Model HAM ROUTINE Environment Physical Socio-economic Socio-cultural HEALTH ACTION Skills Psycho-motor Social interaction Self-regulatory relapse confirmation behavioural intention Knowledge belief motivation normative self personality

Community organisation Community capacity Social capital Participation Control and Empowerment Critical consciousness Awareness Motivation

Diffusion of Innovations The characteristics of the innovation relative advantage compatibility - with values, previous experience and current needs complexity trialability observability Communication channels Time The social system

THEORY Analysing the determinants of health issues Understanding what needs to be changed THEORY Identifying what needs to be done Programme planning and development SYSTEMATIC REVIEWS Outcomes: short, medium and long term Predicting likely effects Establishing how to assess effects Selection of process and outcome indicators Contextual factors Community insights Practitioner insights Evaluation

References Basch, C.E. and Gold, R.S. (1986) ‘Type V errors in hypothesis testing’, Health Education Research, 1(4): 299-305 Buchanan (1994) ‘Reflections on the relationship between theory and practice’, Health Education Research, 9(3): 273-283 Green, J. (2000) ‘The role of theory in evidence-based health promotion practice’, Health Education Research, 15(2): 125-129 National Cancer Institute (2005) Theory at a Glance: a Guide for Health Promotion Practice (2nd edition) (Website: http://www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf-5aa48ee1da4d/TAAG3.pdf) Nutbeam, D. and Harris, E. (2004) Theory in a Nutshell. Sydney: McGraw-Hill Tones, K. and Green, J. (2004) Health Promotion Planning and Strategies. London: Sage