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

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

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

4. 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

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

6. 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.

7. 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

8. 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)

9. 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)

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

11. 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)

12. 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

13. 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)

14. 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

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

16. 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

17. 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

18. References
Basch, C.E. and Gold, R.S. (1986) ‘Type V errors in hypothesis testing’, Health Education Research, 1(4):
Buchanan (1994) ‘Reflections on the relationship between theory and practice’, Health Education Research, 9(3):
Green, J. (2000) ‘The role of theory in evidence-based health promotion practice’, Health Education Research, 15(2):
National Cancer Institute (2005) Theory at a Glance: a Guide for Health Promotion Practice (2nd edition) (Website:
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