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THEORY. What is theory? “… a set of interrelated concepts, definitions, and propositions that...

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THEORY
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Page 1: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

THEORY

Page 2: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

What is theory?

Page 3: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Theory

Page 4: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Theory

Generality

Testability

Shape and boundaries, but not specific topic or content

Variables

Page 5: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Theories are used to …

Guide the search for why people behave in certain ways

Help pinpoint information needed before developing and organizing an intervention program

Provide insight as to how to shape strategies to reach people

Help identify what should be monitored, measured, and compared

Page 6: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Concepts & Constructs

Concepts: Major ideas

Constructs: Concepts that have been developed and

defined for use in a particular theory

Page 7: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Models

Page 8: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

More theory

Page 9: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Planning Models

Like a road map Present all possible routes you might take

to develop, implement, and evaluate a program.

Page 10: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Planning Models

PRECEDE/PROCEED

MATCH

CDCynergy

Page 11: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

PRECEDE/PROCEED Model

Page 12: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

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

Page 13: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

MATCH

Figure 4.16: MATCH: Multilevel Approach To Community Health

(Pearson Ed, 2012)

Page 14: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

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 communication

• Developed for health communication but can be used with all health promotion planning

• Available on CD-ROM; many versions

(Pearson Ed, 2012)

Page 15: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

P 1: Describe Problem (identify & define)

P 2: Analyze Problem (causes, goals, intervention strategies

P 3: Plan Intervention (Is communication dominant or supportive?)

P 4: Develop Intervention

P 5: Plan Evaluation

P 6: Implement Plan

CDCynergy

(Pearson Ed, 2012)

Page 16: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Generalized Model for Program Planning (GMPP)

Figure 4.18: Generalized Model for Program Planning

(Pearson Ed, 2012)

Page 17: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Theories and Levels of Influence Behavior is very complex

Influenced and supported in multiple ways

Page 18: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

The Ecological Model

Emphasizes the links and relationships among multiple factors (or determinants) affecting health

Page 19: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Ecological Model

Individual

Interpersonal

Institutional orOrganizational

Community

Public Policy

Page 20: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Individual / Intrapersonal factors Knowledge, attitudes, beliefs (KAB) Skills Motivation Self-concept Age, gender, genetics

Page 21: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Interpersonal factors

Social support / social networks Social norms, cultural environment Religious affiliation Access to social and health services

Page 22: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Institutional or organization factors Educational system

Access to health care

Social Interactions

Page 23: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Community factors

Living and working conditions Public safety Local public health Housing Economic development Environment

Page 24: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Public Policy Factors

Federal, State & Local Policy and Law Zoning Taxes

Public Health System Educational System

Page 25: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Behavior Change Theories

The specific route(s) you will take to reach your destination – they suggest a road to follow.

Page 26: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Behavior change theories with individual focus

The Health Belief Model (HBM) **

The Transtheoretical Model (TTM) **

Theory of Planned Behavior (TPB) **

Other Theories: Elaboration Likelihood Model of Persausion Information – Motivation – Behavioral Skills Model Health Action Process Approach

Page 27: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Health Belief Model (HBM)

Developed in the early 1950’s by social psychologists in the U.S. Public Health Service.

Hochbaum & Rosenstock

TB screening

Page 28: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Constructs of HBM

Perceived threat Perceived susceptibility

Beliefs about one’s chances of getting a condition

Perceived severity Beliefs about how serious the condition might

be

Page 29: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Constructs of HBM

Outcome Expectations Perceived Benefits

Beliefs that the advised action will reduce risk or seriousness of the condition.

Perceived risks/barriers Beliefs about the “costs” of taking the advised

action

Page 30: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Constructs of HBM

Cues to Action Strategies to activate one’s “readiness”

Self-Efficacy Confidence in one’s ability to take action

Page 31: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Health Belief Model

Perceived Susceptibility & Perceived Seriousness

Perceived Threat

Likelihood of taking recommended action

Cues to Action

Modifying Factors: age, race, ethnicity, SES, personality

Outcome Expectations: Perceived Benefits vs.

Perceived Risks/Barriers

Self-efficacy

Page 32: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Theory of Reasoned Action (TRA) Constructs:

Attitude toward the behavior Beliefs about the behavior Evaluation of behavioral outcomes

Subjective norms What others think about your behavior How motivated you are to comply with the

expectations of others

Page 33: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

TRA Cont.

Beliefs and Subjective Norms help predict Intentions

Your Intentions predict your actual Behavior

Page 34: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

TRA

Attitude toward behavior

Subjective Norm

Intention Behavior

Page 35: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Theory of Planned Behavior (TPB) Developed by Fishbein & Ajzen

An extension of the Theory of Reasoned Action (TRA)

Page 36: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

TPB versus TRA

Adds the construct: Perceived Behavioral Control

Belief about personal control in combination with belief about the one’s ability to do what needs to be done.

Actual Behavioral Control: have the skills and resources needed to quit.

Page 37: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

TPB Cont.

People will perform a behavior if: They believe the advantages of success

outweigh the disadvantages of failure.

They believe that other people with whom they are motivated to comply, think they should perform the behavior.

They have sufficient control over the factors that influence success or ability to perform the behavior.

Page 38: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

TPB

Attitude toward the behavior

Subjective Norm

Intention Behavior

Perceived Behavioral

Control

Actual Behavioral

Control

Page 39: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Transtheoretical Model (TTM) AKA: Stages of Change Developed by Prochaska & DiClemente Major Constructs:

Precontemplation Contemplation Preparation Action Maintenance Decisional Balance Self-Efficacy

Page 40: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Precontemplation

“The shoes are still at the store”

Not thinking about changing behavior in the next six months.

May be unaware of risks or problems. Needs some work “under the hood.”

Page 41: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Contemplation

“Shoe shopping”

Seriously thinking about making a behavior change, but have not yet made a commitment to action

Page 42: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Preparation

“You bought the shoes”

Ready to take action in the very near future (next 30 days)

Have a plan of action Experimenting with new behaviors

Page 43: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Action

“Wearing your shoes on a regular basis”

Actively engaged in new behavior(s) for less than six months.

Efforts are sufficient to reduce risk of disease

Page 44: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Maintenance

“Shoes go on every day.”

Sustaining the behavior change for over 6 months.

Page 45: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Decisional Balance

The costs and benefits of changing.

Page 46: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Self-Efficacy

Confidence that one can be successful in the new behavior across different challenging situations.

Page 47: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Relapse

More likely when you are stressed, anxious, or feeling depressed.

More likely if you lack social support or are experiencing interpersonal conflicts

More likely if you return to a setting (environment) that “cues” your old behavior(s)

Page 48: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Precontemplation

Contemplation

Preparation

Action

Maintenance

Decisional Balance

Decisional Balance

Self-Effic

acy

Self-Effic

acy

Transtheoretical Model (TTM)

Page 49: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Pro’s of TTM

Encourages less “labeling” terms. (Precontemplation rather than “loser” or

“lost cause”) Must accept people “where they are” Behavior change is not viewed as linear It is easy to stage clients It is not based on an instant gratification

mentality Allows for stage-matched interventions

Page 50: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

How to stage a person using TTMDo you exercise regularly?

No Yes

Do you intend to in the next 30 days?

Have you been doing so for more than 6 months?

No Yes No Yes

Do you intend to in the next six months?

No Yes

Precontemplation

Contemplation

Preparation Action Maintenance

(Pearson Ed, 2012)

Page 51: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Adapted from:

Autobiography in Five Short Chaptersby Portia Nelson

II walk down the street.

There is a deep hole in the sidewalk.I fall in

I am lost … I am helplessIt takes forever to find a way out.

Page 52: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

III walk down the same street.

There is a deep hole in the sidewalk.I pretend I don’t see it.

I fall in again.I can’t believe I am in the same place.

It still takes a long time to get out.

Page 53: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

IIII walk down the same street.

There is a deep hole in the sidewalk.I see it is there.

I still fall in … it’s a habit.My eyes are open.I know where I am.

I get out immediately.

Page 54: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

IVI walk down the same street.

There is a deep hole in the sidewalk.I walk around it.

VI walk down another street.

Page 55: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Behavior change theories with interpersonal focus

Social Cognitive Theory (SCT) **

Social Network Theory (SNT)

Social Capital Theory

Page 56: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Social Cognitive Theory (SCT) A behavior change theory with an

Interpersonal / Social network focus.

Page 57: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Reciprocal Determinism

Characteristics

of the Person

Environment in which the behavior is performed Behavior of

the person

Page 58: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Constructs of SCT

Behavior Capacity

Expectations

Expectancies

Self-Control / Self-Regulation

Self-Efficacy

Reinforcement

Observational Learning

Emotional Coping Responses

Page 59: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Principles of Modeling

Attention

Remembering

Repetition

Motivation

Model Similarity

Age Gender Status Competence

Page 60: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Reinforcement

Any action or event that increases the desired behavior

Present something positive Money New clothes

Remove something negative Nagging Teasing

Page 61: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Punishment

Any action or event that decreases the likelihood that the desired behavior will occur.

Present something negative Criticize Policies or laws

Remove something positive Praise Privilege

Page 62: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Framework:Social Determinants of Health

Community

Social Networks Interpersonal

Individual

Organizational/Institutional

PoliticalPopulation Level

Ecological ModelEcological Model

Page 63: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Behavior theories with community focus

Diffusion of Innovation Theory (DF) ** AKA: Diffusion Theory

Community Readiness Model (CRM)

Page 64: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Diffusion of Innovations Theory Rogers, 1983

A behavior change theory with a community focus

Page 65: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Diffusion of Innovations

The progressive adoption by members of a community or society of an idea or practice over time.

Page 66: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Categories of Adopters

Innovators (<3%) Independent, risk-takers, eager to try new

ideas Not necessarily the most respected

members of the community Seek info on their own, rely on their own

judgment in making decisions about adoption

Try out new ideas and provide the first tests of the utility of the innovation

Page 67: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Categories of Adopters

Early Adopters (14%) Respected members of the community Opinion leaders Powerful influence on other potential

adopters Trendy … like to be up on what is good and

new Seen as opinion leaders

Page 68: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Categories of Adopters

Early Majority (34%)

Greatly influenced by mass media and opinion leaders

By virtue of their numbers, they begin to form a new norm

Lots of contact with peers, but don’t hold leadership positions.

Page 69: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Categories of Adopters

Late Majority (34%) Skeptical of change

Tend to wait until an innovation is established as a norm before adopting

Motivation is greatly influenced by peers

Don’t like risk and uncertainty

Page 70: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Categories of Adopters

Laggards (16%) Very traditional and conservative

Tend to have less education and lower SES

Socially and geographically mobile

Narrow and restricted communication networks

Suspicious of innovations and adverse to risk

Page 71: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Adoption Curve

Page 72: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Determinants of Diffusion’s Speed and Extent

Is the innovation better than what it will replace?

Does the innovation fit with the intended audience?

Is the innovation easy to use?

Can the innovation be tried out before adopting?

Are the results of the innovation observable and easily measured?

Page 73: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

A few more pieces

Predisposing, Reinforcing, and Enabling Factors

Barriers to change PRECEDE/PROCEED behavioral diagnosis

phase

Page 74: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Predisposing Factors

Provide the rationale or motivation for a person or group to act KAB (knowledge, attitudes, beliefs) Personal preferences Existing skills Self-efficacy beliefs

Individual level theories Intrapersonal are most appropriate for

addressing these factors.

Page 75: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Reinforcing Factors

Factors that provide reinforcement and reward for actions and encourage repetition of the action Social support Peer influence Significant others (family, spouse, partner) Employers, teachers, health providers,

community leaders, decision-makers

Page 76: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Reinforcing Factors Continued Interpersonal level theories are most

appropriate in addressing these factors

Interpersonal level theories suggest communication channels (e.g. significant others or social networks) and methods (e.g. incentives or social supports).

Page 77: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Enabling Factors

Factors that provide the means or make the action possible.

Availability of programs or services or skills training

Accessibility of programs or services or skills training

Page 78: THEORY. What is theory?  “… a set of interrelated concepts, definitions, and propositions that presents a systematic view of events or situations by.

Activity

Pick a theory (Health Belief Model, Theory of Planned Behavior, Transtheoretical Model, Social Cognitive Theory OR Diffusion of Innovation Theory)

Map out the constructs of the theory Where do these constructs fit into the Ecological

Model? Give a brief (at least one sentence) explanation

of each construct Provide examples for each construct that relates

to your topic List as many predisposing, reinforcing, and

enabling factors as you can think of for the topic. Keep this model for the next class.


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