1. Theoretical Foundations
Chapter 4

2. 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)

3. 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)

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

5. 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)

6. 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

7. 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

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

9. 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

10. 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

11. 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

12. 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…

13. 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

14. 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

15. 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

16. 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)

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

18. 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)

19. 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

20. 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)

21. 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

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

23. 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

24. 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

25. 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

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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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.

34. 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

35. 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?

36. Theoretical Foundations
Chapter 4 – The End