1. Theoretical Models in Behavioral Science
Joseph A. Greer, Ph.D.
Assistant Professor of Psychology, Harvard Medical School, Associate Director of Cancer Outcomes Research Program, Massachusetts General Hospital Cancer Center

2. Presentation Overview
Purpose of theoretical models
Common theoretical models in behavioral science
Integration of theoretical models into research protocols

3. Purpose of Theoretical Models
Theory is a statement (or model) about causal relationships that help to explain a phenomenon.
Validity of a theory is based on:
Observation
Reasoning
Experimentation
Theories often help to describe behavior and make predictions of future behavior.

4. Purpose of Theoretical Models
Deduction: Theory to Prediction
Induction: Observation to Theory

5. Purpose of Theoretical Models
Explanatory versus change models
For intervention studies, theory helps to:
formulate study hypotheses
guide selection of target population
design intervention components
clarify study methods, such as
identifying variables of interest
operationalizing key outcomes
determining timing and format of data collection

6. Common Theoretical Models in Behavioral Science
Intrapersonal Level
Interpersonal Level
Community/Organizational Level
Cancer-Specific Models

7. Intrapersonal Level Example: Health Belief Model7

8. Other Intrapersonal Level Examples
Theoretical Model
Description
Key Elements
Self-Regulation Model
Behavior is based on setting goals and monitoring responses which then impact movement towards or away from those goals
Environmental cues
Understanding illness
Generating coping
strategies
Monitor and appraise
coping
Transtheoretical Model of Behavior Change (Stages of Change)
Behavior change is influenced by level of readiness, pros and cons, confidence, and behavioral and experiential factors related to the goal behavior.
Stages of Change
Decisional Balance
Self-Efficacy
Processes of Change
Information-Motivation-Behavioral Skills Model
Combined affective, cognitive, and ability approach to evaluate and shape behavior change.
Assessment of
information
Personal and social
motivation
Ability and self-efficacy 8

9. Interpersonal Level Example: Theory of Planned Behavior9

10. Other Interpersonal Level Examples
Theoretical Model
Description
Key Elements
Theory of Reasoned Action
Attitudes, values, and beliefs influence intention, and intention predicts behavior.
Normative cultural
influences
Attitude
Subjective norm
Behavioral goal
Social Cognitive Theory
Behavior is influenced by confidence to complete the behavior and expectations that actions will lead to desired behavior change.
Observational learning
Incentives
Outcome expectations
Efficacy expectations
Model of Disease Self-Management
Disease management is influenced by beliefs, weighing the benefits and consequences of a behavior, and external factors such as social context.
Predisposition
Self-regulation
Desired goal 10

11. Community Level Example: Social Ecological Model11

12. Other Community Level Examples
Theoretical Model
Description
Key Elements
Chronic Care Model
Relations between an “informed, activated patient” and a “prepared, proactive practice team” leads to desired outcomes.
Planned care
Proactive care
Population-based care
Patient centered care
Community (Allies) Coalition Model
Individuals or groups that act together to enhance systems and improve practices to meet community health goals.
Continuous & interrelated
Improvement
Re-evaluation
Shared vision
Resources
Readiness
The Folk Model
Behavior is influenced by covert and overt cultural factors.
Cultural beliefs
Personal experiences
Interpretive frameworks 12

13. Cancer-Specific Example: Biobehavioral Model of Cancer Stress13

14. Other Cancer-Specific Examples
Theoretical Model
Description
Key Elements
A Cognitive Model of Adjustment to Cancer
Thoughts, feelings, and behaviors are interrelated and impact the meaning of and coping with cancer.
Survival Schema
Self Schema
Cognition
Emotion and physiology
Behavior
Confirmation
Model for Psychosocial Intervention Effects on Cancer Outcomes
Psychosocial interventions that target cognitive, behavioral and interpersonal processes help modulate stress response which may affect cancer pathogenesis.
Psych. intervention
Psychological adaptation
Biobehavioral processes
Cancer pathogenesis
Clinical outcomes
Early Palliative Care Model
An integrated and comprehensive approach to improve QOL, illness knowledge and understanding, coping, health behaviors, and survival in patients with advanced cancers.
Team approach
Illness understanding
Decision-making
Education and support
Focus on patient/family 14

15. Integrating Theoretical Models into Research Protocols
Choosing an appropriate theoretical model
Identify the problem
Specify the goal or outcome
Clarify the unit of practice (i.e., individual, group, organization)
Several factors determine adequacy of theory
Logic (or internal consistency)
Parsimony
Plausibility
Ecological validity 15

16. Integrating Theoretical Models into Research Protocols
Background & Significance
Describe theoretical model (including diagram) and detail the ways it guides and supports the study aims/hypotheses
Innovation
State whether underlying model is novel or if aspects of the model are innovative with respect to variables of interest, method of assessment, and analytic approach (e.g., SEM, tests of mediation/moderation, etc.)
Approach
Describe how model informed selection of target population, variables of interest, timing and methods of assessments, outcomes, and proposed analyses
You do not need to measure and test all relationships in model, but specify which aspects of model you are confirming 16

17. Integrating Theoretical Models Into Research Protocols
Test of Mediation 17

18. Integrating Theoretical Models Into Research Protocols
Test of Moderation
Moderator
Intervention
Quality of Life 18

19. Integrating Theoretical Models Into Research Protocols
What if no conceptual model exists to support my proposed study? (e.g., Early Palliative Care Model)
Creating novel models:
Draw on scholarly literature to form tentative hypotheses among proposed relationships
Use preliminary data to substantiate components of proposed model
Note whether the model is comprehensive or narrow conceptualization
Identify the specific relationships you will test in the proposed study 19

20. Early Palliative Care Model
The early palliative care model 20

21. Helpful NCI Resource http://cancercontrol. cancer21

22. Helpful NIH Resource http://www. esourceresearch22

23. References
Glanz K, Bishop D The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health 31: Glanz K, Rimer BK, Viswanath K, eds Health Behavior and Health Education: Theory, Research, and Practice (4th ed). San Francisco: Jossey-Bass. Shumaker SA, Ockene JK, Riekert KA, eds The Handbook of Health Behavior Change (3rd ed). New York: Springer Publishing Company. 23