Define and explain the difference among theory, concept, construct, variable, and model

Health promotion concept
Theories and Planning Models
Chapter 4

Chapter Objectives – 1
Define and explain the difference among theory, concept, construct, variable, and model
Explain the importance of theory to health education/promotion
Explain what is meant by behavior change theories and planning models
Describe how the concept of socio-ecological approach applies to using theories

Chapter Objectives – 2
Explain the difference between continuum theories and stage theories
Identify and briefly explain the behavior change theories, and their components, used in health education/promotion:
Health Belief Model
Theory of Planned Behavior
Elaboration Likelihood Model of Persuasion
Information-Motivation-Behavioral Skills Model
Transtheoretical Model of Change
Precaution Adoption Process Model
Social Cognitive Theory
Social Network Theory
Social Capital Theory
Diffusion Theory
Community Readiness Model

Chapter Objectives – 3
Identify and briefly explain the planning models, and their components, used in health education/promotion:
PRECEDE-PROCEED
Multilevel Approach to Community Health (MATCH)
Intervention Mapping
CDCynergy
Social Marketing Assessment and Response Tool (SMART)
Mobilizing for Action through Planning and Partnerships (MAPP)
Generalized Model (GM)

Definitions
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 et al., 2008, p. 26)
concept – primary elements of theories (Glanz et al., 2008)
construct – a concept developed, created, or adopted for use with a specific theory (Kerlinger, 1986)
variable – the operational (practical use) form of a construct; (Rimer & Glanz, 2005, p. 4); how a construct will be measured (Glanz et al., 2008)
model – is a composite, a mixture of ideas or concepts taken from any number of theories and used together (Hayden, 2009, p. 1)

Importance of Using Theory in Health Education/Promotion
Theories provide direction and organizes knowledge
Theories can help in planning, implementing, and evaluating programs
Indicates reasons why people are not behaving in healthy ways
Identifies information needed for intervention development
Provides a conceptual framework
Gives insight for delivery
Identifies measurements needed for evaluation
Help provide focus and infuses ethics and social justice into practice
Programs based upon sound theory more likely to succeed

Behavior Change Theories
Multiple theories to design interventions
Levels of influence are key parts of socio-ecological approach
Socio-ecological approach helps to recognize importance of the larger social system of behaviors and social influences

Figure 4.1 The socio-ecological model
Source: Simons-Morton, B. G., McLeroy, K. R., & Wendel, M. L. (2012). Behavior theory in health promotion practice and research. Burlington, MA: Jones & Bartlett Learning. p. 45.

Focus on factors within individuals (e.g. knowledge, attitudes, beliefs, self-concept, developmental history, past experiences, motivation, skills, and behaviors)
Health Belief Model (HBM), Theory of Planned Behavior (TPB), Elaboration Likelihood Model of Persuasion (ELM), Information-Motivation-Behavior Skills Model (IMB), Transtheoretical Model of Change (TMC), Precaution Adoption, Process Model (PAPM)
Continuum theories identify variables that influence action and combine them in a prediction equation
Intrapersonal (Individual) Theories – 1

Intrapersonal (Individual) Theories – 2
Stage Theory
Comprised of ordered set of categories into which people can be classified
Identifies factors that could induce movement from one stage to another
Four principle elements
Category system to define stages
Ordering of stages
Barriers to change that are common among people in same stage
Different barriers to change, facing people in different stages

Intrapersonal (Individual) Theories – 3
Health Belief Model (Rosenstock)
Explains the likelihood of an individual to take action to prevent a disease or injury based upon:
Sufficient motivation to make the issue relevant (perceived susceptibility and perceived seriousness)
The perceived threat of the health issue
The perceived benefits of a given action
The perceived barriers to taking the necessary action
Cues to actions may also impact on the individual’s likelihood of taking action
Self-efficacy – to feel competent to overcome perceived barriers to take action

Intrapersonal (Individual) Theories – 4

Figure 4.2 Health Belief Model as a predictor of preventive health behavior
Source: Becker, M. H., et al., from “A new approach to explaining sick-role behavior in low income populations,” American Journal of Public Health 64, March 1974: 205–216, Fig 1. Used by permission of Sheridan Press.

Intrapersonal (Individual) Theories – 5
Theory of Planned Behavior (Fishbein & Ajzen, 1975)
Individuals’ intention to perform a given behavior is a function of their attitude toward the behavior, their belief of what others think they should do, and their perception of level of ease or difficulty of the behavior in which they are considering action
Attitude toward the behavior
Subjective norm
Perceived behavioral control
Actual behavioral control

Intrapersonal (Individual) Theories – 6

Figure 4.3 Theory of Planned Behavior (TPB)
Source: “Theory of Planned Behavior Diagram” (TPB Diagram) by Dr. Icek Ajzen, http://www.people.umass.edu/aizen/tpb.diag.html. Reprinted by permission.

Intrapersonal (Individual) Theories – 7
Elaboration Likelihood Model of Persuasion
Developed to explain inconsistencies in research results from the study of attitudes (Petty, Barden, & Wheeler, 2009)
Attitudes form via two routes
The two routes usually leads to attitudes with different consequences
The model specifies how variables have an impact on persuasion
elaboration – refers to the amount of cognitive processing (i.e., thought) that a person puts into receiving messages

Intrapersonal (Individual) Theories – 8

Figure 4.5 The Elaboration Likelihood Model of Persuasion (ELM)
Source: From Petty, R. E., Barden J., & Wheeler, S. C., “The Elaboration Likelihood Model of Persuasion: Developing health promotions for sustained behavioural change” in Emerging theories in health promotion practice and research, 2nd ed.; DiClemente, R. J., Crosby, R. A., & Kegler, M. (Eds.), p. 196. Copyright © 2009 John Wiley & Sons, Inc. Reproduced with permission of John Wiley & Sons, Inc.

Intrapersonal (Individual) Theories – 9
Information-Motivation-Behavioral Skills Model
Created to address the critical need for a strong theoretical basis for HIV/AIDS prevention efforts
Information
Motivation
Behavioral skills
Preventive behaviors

Figure 4.6 The Information-Motivation-Behavioral Skills Model of HIV Prevention Health Behavior
Source: From Fisher, J. D., & Fisher, W. A., “Changing AIDS risk behavior,” Psychological Bulletin 111 (3), 455–474, 1992. Published by American Psychological Association (APA). Reprinted by permission.

Intrapersonal (Individual) Theories – 10
Transtheoretical Model of Change (TMC) (Prochaska, 1979)
People make behavior change through a series of different stages related to the behavior
Stages of change
Precontemplation—stage people are in before they are ready to change and are not intending to change
Contemplation—stage when individuals are considering making a behavior change within the next 6 months
Preparation—stage where the individual is actively planning change
Action—the effort to make the change in behavior
Maintenance—sustaining the change and resisting relapse
Termination

Intrapersonal (Individual) Theories – 11
Precaution Adoption Process Model (PAPM) (Weinstein & Sandman, 2002)
Explains how a person comes to the decision to take action, and how the decision is translated into action

Figure 4.7 Stages of the Precaution Adoption Process Model (PAPM)
Source: From Weinstein, N. D., Sandman, P. M., & Blalock, S. J., “The Precaution Adoption Process Model” in Health behavior and health education: Theory, research, and practice, 4th ed., K. Glanz, B. K. Rimer, and K. Viswanath, (Eds.), p. 127. Copyright © 2008 John Wiley & Sons, Inc. Reproduced with permission of John Wiley & Sons, Inc.

Interpersonal Theories – 1
Theories that “assume individuals exist within, and are influenced by, a social environment. The opinions, thoughts, behavior, advice, and support of people surrounding an individual influence his or her feelings and behavior, and the individual has a reciprocal effect on those people” (Rimer & Glanz, 2005, p. 19)
These theories help to explain
Social norms
Social learning
Social power
Social integration
Social networks
Social support
Social capital
Interpersonal communication

Interpersonal Theories – 2
Social Cognitive Theory (Bandura, 1986)
Learning is a reciprocal interaction between the individual’s environment, cognitive process, and behavior
Behavioral capability
Expectations
Expectancies
Locus of control
Reciprocal determinism
Observational learning
Reinforcement
Self-control
Self-efficacy
Emotional coping response

Interpersonal Theories – 3
Social Network Theory
Explains the web of social relationships that surround people
Key component – relationship between and among individuals and how those relationships influences beliefs and behaviors
When assessing a network’s role, considers –
Centrality vs. Marginality
Reciprocity of relationships
Complexity or intensity of relationships in the network
Homogeneity or diversity of people in the network
Subgroups, cliques, and linkages
Communication patterns in the network

Interpersonal Theories – 4
Social Capital Theory
Does not provide theories of change
Does not guarantee empirical outcomes
Does have an impact on health
Type of network resources
Bonding
Bridging
Linking
Trust and reciprocity
Norms and expectations

Figure 4.9 Social capital
Source: From Hayden, J., Introduction to Health Behavior Theory, 1st ed., Fig 9-3, p. 125. Copyright © 2009, Jones and Bartlett Publishers, Sudbury, MA. http://www.jblearning.com. Reprinted by permission.

Community Theories – 1
Group of theories includes three of the ecological perspective levels
Institutional (e.g., rules & regulations)
Community (e.g., social norms)
Public policy (e.g., legislation)

Community Theories – 2
Diffusion Theory (Rogers, 1983)
Explains diffusion of innovations in a population
Categorizes individuals based upon when they adopt a new behavior, idea, or program
Innovators – first to adopt.
Early adopters – influential and open to trying innovations, but are more grounded than innovators
Early majority individuals – wary and watchful about their involvement in new ideas
Late majority – get involved through peers or mentors programs and more skeptical and adopt after most people
Laggards – last to be involved and interested in change
Health educators will need to modify marketing strategies to attract individuals from each of the different categories

Community Theories – 3

Figure 4.10 Bar chart depicting percentages of persons adopting an innovation over time

Community Theories – 4
Community Readiness Model (Edwards et al., 2000)
Stage model to explain the nine stages of community readiness to change
No awareness
Denial
Vague awareness
Preplanning
Preparation
Initiation
Stabilization
Confirmation/expansion
Professionalism

Community Theories – 5

Table 4.3 Community readiness stages and goals

Planning Models – 1
Sound health promotion programs are organized around a well-thought-out and well-conceived model
Models serve as frames from which to build; structure & organization for the planning process
Many models
Many have common elements but may have different labels
No perfect model

Planning Models – 2
PRECEDE-PROCEED (Green & Kreuter, 1991)
Best known & often used model
Developers: Larry W. Green & Marshall W. Kreuter
PRECEDE—predisposing, reinforcing, and enabling constructs in educational / ecological diagnosis & evaluation
PROCEED—policy, regulatory, and organizational constructs in educational & environmental development

Planning Models – 3
PRECEDE
Social assessment
Epidemiological assessment
Educational and ecological assessment
Intervention alignment and administrative and policy assessment
PROCEED
Implementation
Process evaluation
Impact evaluation
Outcome evaluation

Planning Models – 4

Figure 4.14 PREDEDE-PROCEED model for health program planning
Source: From Green, L. W., & Kreuter, M. W., Health program planning: An educational and ecological approach, 4th ed., p. 17, Fig 1.5. Copyright © 2005 The McGraw-Hill Companies, Inc. Reprinted by permission.

Planning Models – 5
Multilevel Approach to Community Health (MATCH) (Simons-Morton et al., 1995)
Ecological planning perspective
Recognizes that intervention activities should be aimed at a variety of objectives and individuals
Phases
Phase 1: health goal selection
Phase 2: intervention planning
Phase 3: program development
Phase 4: implementation
Phase 5: evaluation

Planning Models – 6
Intervention Mapping (Bartholomew et al.,1998)
Based upon the importance of theory and evidence in the development of health promotion programs
Step 1: needs assessment
Step 2: matrices of change objectives
Step 3: theory-based methods and practical strategies
Step 4: program development
Step 5: adoption and implementation
Step 6: evaluation planning

Planning Models – 7
CDCynergy (CDC, 1998)
Developed for public health professionals at the Centers for Disease Control and Prevention
Used by professionals who have responsibilities for health communication
Six phases
Phase 1: describe problem
Phase 2: analyze problem
Phase 3: plan intervention
Phase 4: develop intervention
Phase 5: plan evaluation
Phase 6: implement plan
Content specific editions of the software are available

Planning Models – 8
Social Marketing Assessment and Response Tool (SMART) (Neiger, 1998)
Central focus is the consumer
Composed of seven phases:
Phase 1: preliminary planning
Phase 2: consumer analysis
Phase 3: market analysis
Phase 4: channel analysis
Phase 5: develop intervention, materials, and pretest
Phase 6: implementation
Phase 7: evaluation

Planning Models – 9
Mobilizing for Action through Planning and Partnerships (MAPP) (NACCHO, 2001)
Blends the strengths of other planning models
Six phases
Phase 1: organizing for success and partnership development
Phase 2: visioning
Phase 3: conducting the four MAPP assessments
Phase 4: identify strategic issues
Phase 5: formulate goals and strategies
Phase 6: the action cycle

Planning Models – 10

Figure 4.13 Mobilizing for Action through Planning and Partnerships (MAPP) model
Source: National Association of Country and City Health Officials, “Mobilizing for Action through Planning and Partnerships (MAPP) Model” from http://www.naccho. org/topics/infrastructure/mapp/upload/ MAPP_Handbook_fnl.pdf. Reprinted by permission.

Planning Models – 11
Generalized Model for Program Planning (GMPP) (McKenzie et al., 2009).
Five tasks:
Assessing needs
Setting goals and objectives
Developing interventions
Implementing interventions
Evaluating results

Planning Models – 12

Figure 4.14 Generalized model
Source: From McKenzie, J. F., Neiger, B. L., & Thackery, R., Planning, implementing and evaluating health promotion programs: A primer, 6th ed., p. 45, Fig. 3.1. Copyright © 2013. Reproduced by permission of Pearson, Boston, MA.

Summary
Health education/promotion is a multidisciplinary profession & has evolved from the theory & practice of other disciplines
Many of the theories & models used in health education/promotion also have evolved from these other disciplines
Key terms: theory, concept, construct, variable, & model
There are many behavior change theories that can be categorized using the five levels (intrapersonal, interpersonal, institutional, community, & public policy) of the socio-ecological approach
There is a distinction between continuum theories & stage theories
Planning models provide a framework on which to build programs

Theories and Planning Models
Chapter 4: The End

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