Theories and models in health promotion

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Theories and models in health promotion

• Anu Kasmel
• Institute of Public Health
• University of Tartu

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(No Transcript)
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The main objectives of the lecture

• To know, what is a THEORY
• To find out, why we need theories
• To get overview of the
• INTERPERSONAL,
• INTRAPERSONAL
• ORGANIZATIONAL
• COMMUNITY and
• POLITICAL theories.

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Health behavior Why is it that...

• many people brush their teeth every morning
  night but wont floss?
• college students will repeatedly drink so much
  alcohol in a single evening that they will get
  sick not remember anything about the evening?
• some people exercise aerobicly others do not?

• young people begin to smoke use spit tobacco?
• adults who are fully aware of risks associated
  with smoking continue to do so?
• people will go to an all-you-can-eat buffet
  eat until they are uncomfortably full?
• some people throw trash out their car window?

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Theory defined

• A theory is 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 or predict the event or situation

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Why use theories and models?

• A theory based approach provides direction and
  justification for program activities and serves
  as the basis for processes that are to be
  incorporated into the health promotion program
  (Cowdery et al., 1995, p. 248)
• Theories can provide answers to program
  developers questions regarding why people arent
  engaging in a desirable behavior of interest, how
  to go about changing their behaviors, and what
  factors to look at when evaluating a programs
  focus (van Ryn Heaney, 1992, p. 326).

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Why use theories

• Helps to focus on the target behavior and the
  environmental context
• Helps to answer the WHY? WHAT? and HOW? questions
  by program planning

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Why use theories 2

• Helps to understand the nature of the targeted
  behavior (explanation theory)
• Helps to identify the most suitable targets per
  program (change theory)

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Why use theories 3

• Helps you focus on the big picture
• Helps others replicate successful program

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Multiple levels of theories and models

• - Intrapersonal
• - Interpersonal
• - Organizational
• - Community
• - Public Policy

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Intrapersonal factors

• Individual characteristics that influence
  behavior, such as knowledge, attitudes, beliefs,
  and personality traits

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Interpersonal factors

• Interpersonal processes, and primary groups
  including family, friends, peers that provide
  social identity, support, and role definition

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Organizational factors

• Rules, regulations, policies, and informal
  structures, which may constrain or promote
  recommended behaviors.

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Community factors

• Social networks and norms, or standards, which
  exist as formal or informal among individuals,
  groups and organizations.

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Population factors

• Local, state, federal policies and laws that
  regulate or support healthy actions and practices
  for disease prevention, early detection, control,
  and management

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Intrapersonal theories

• Individual - most basic unit of health promotion
• Individual-level models components of
  broader-level theories and approaches
• Models
• Health Belief Model
• Theory of reasoned action

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Health belief model
Belief in benefits or effectiveness
Beliefs about barriers
PERCEIVED SUCCEPTIBILITY TO RISK
PERCEIVED MOBIDITY RISK
PROBABILITY OF CHANGED BEHAVIOUR
PERCEIVED THREAT
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Health belief model

• Perceived susceptibility and severity of ill
  health
• Perceived benefits and barriers to action
• Cues to action
• Self-efficacy
• ?

Source Irwin M. Rosenstock et al., Social
Learning Theory and the Health Belief Model,
Health Education Quarterly 15, no. 2 (1988)
175-85.
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Theory of reasoned actions
Ajzen, Fishbein, 1970
PERCEIVED OUTCOMES
ATTITUDES
INTENTIONS
BEHAVIOUR
IMPORTANT OTHERS
SUBJECTIVENORMS
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Theory of planned behaviour
Ajzen, 1988
BELIEF IN OUTCOMES OF CHANGED BEHAVIOUR
ATTITUDES
EVALUATION OF THE EXPECTED OUTCOMES
BEHAVIOUR
INTENTIONS
SUBJECTIVE NORMS
NORMATIVE BELIEFS
MOTIVATION TO COMPLY OTHERS
PERCEIVED BEHAVIORAL CONTROL
BELIEF INTO OWN CONTROL ABILITY
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Transtheoretical Model
(Prochaska DiClemente, 1992)
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Interpersonal LevelSocial learning theory

• Interaction of individual factors, social
  environment, and experience
• Reciprocal dynamic
• Observational learning
• Capability of performing desired behavior
• Perception of self-efficacy

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Social learning theory 2 Albert Bandura, 1986

• Three strategies for increasing self-efficacy
• - Setting small, incremental goals
• - Behavioral contracting specifying goals and
  rewards
• - Self-monitoring feedback can reinforce
  determination to change (keep a diary)
• Positive reinforcement encouragement helps
• ?

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Social learning theory (Bandura, 1986)
BEHAVIOUR
ENVIRONMENT
INDIVID
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Doctor-patient relationship prototypes
High doctoral control
PATERNALISM RECIPROCITY
NON-FULFILMENT OF THE
CONSUMERISM RESPONSIBILITIES

High patient control
Low patient control
Low doctoral control
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Organizational change theories
Organizational Stage Theory
Organizational Development Theory
Organizational structures
Worker behavior and motivation
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Community organization models

• Analyze how social systems function
• Mobilize communities, organizations, and
  policymakers
• Use sound conceptual frameworks
• - Community Mobilization
• Community development
• Social Audit
• Social Action Theory
• - Diffusion of Innovations Theory

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A framework for the process community development
for health Green, Kreuter,
1991
Needs assessment
Identification of goals and objectives
Evaluation
Strategy building
Implementation
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Community mobilization

• Encompasses wider social and political contexts
• Community members assess health risks, take
  action
• Encourages empowerment, building on cultural
  strengths and involving disenfranchised groups

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Diffusion of innovations theory E.M. Rogers, 1995

• How new ideas, products, and behaviors become
  norms
• All levels individual, interpersonal, community,
  and organizational
• Success determined by nature of innovation,
  communication channels, adoption time, social
  system

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Diffusion of innovations 2

• Nature of innovation
• Relative advantage over what is being replaced
• Compatible with values of intended users
• Easy to use
• Opportunity to try innovation
• Tangible benefits

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Diffusion of innovations 3

• Communication channels
• Mass media (enhanced by listening groups, call-in
  opportunities, and face-to-face approaches)
• Peers
• Respected leaders

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Diffusion of innovations 4

• Adoption time
• Awareness Intention Adoption Change
• Gradual
• Movement through groups
• Pioneers
• Early adopters
• Masses

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Diffusion of innovations 4

• Social system
• Identify influential networks to diffuse
  innovation health systems, schools, religious
  and political groups, social clubs, unions, and
  informal associations
• Identify opinion leaders, peers, and targeted
  media channels to diffuse innovations

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Innovatsiooni difusiooni mudel uuendustega
kaasaminemise protsess (Rogers, 1995).
varajased
heakskiitjad innovaatorid
varajane hiline
enamus
enamus


viivitajad 2,5 13,5
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aeg
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Socio-political theories

• Theory of the political agenda development
• Theory of the political window
• Theory o rationality

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Theory of the political agenda development

• Issue raised outside the government
• Issue raised in the government and there is no
  need for support from outside government
• Issue raised in the government and there is need
  for support from outside government.

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The main aim of the lecture was

• To know, what is a THEORY
• To find out, WHY we need theories
• To get overview of the
• INTERPERSONAL,
• INTRAPERSONAL
• ORGANIZATIONAL
• COMMUNITY and
• POLITICAL theories.

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