Theories and Models Frequently Used in Health Promotion

As you are planning or describing your program, referring to individual, interpersonal, orcommunity-level theories that relate to health behavior change is sometimes useful. Forexample, these theories might be used in the “Causal Assumptions/ Theory of Change” columnin your logic model or to help you identify potential points of intervention.

Theory/Model Summary Key ConceptsIndividual

Health belief model For people to adopt recommended physicalactivity behaviors, their perceived threat ofdisease (and its severity) and benefits ofaction must outweigh their perceivedbarriers to action.

Perceived susceptibilityPerceived severityPerceived benefits ofactionPerceived barriers toactionCues to actionSelf-efficacy

Stages of change(transtheoreticalmodel)

In adopting healthy behaviors (e.g., regularphysical activity) or eliminating unhealthyones (e.g., watching television), peopleprogress through five levels related to theirreadiness to change—pre-contemplation,contemplation, preparation, action, andmaintenance. At each stage, differentintervention strategies will help peopleprogress to the next stage.

Pre-contemplationContemplationPreparationActionMaintenance

Relapse prevention Persons who are beginning regular physicalactivity programs might be aided byinterventions that help them anticipatebarriers or factors that can contribute torelapse.

Skills trainingCognitive reframingLifestyle rebalancing

Information processingparadigm

The impact of persuasive communication,which can be part of a social marketingcampaign to increase physical activity, ismediated by three phases of messageprocessing—attention to the message,comprehension of the content, andacceptance of the content.

Exposure; AttentionLiking/interest;Comprehension; Skillacquisition; YieldingMemory storageInformation search andRetrieval; Decision;Behavior; Reinforcement;Post-behaviorconsolidation.

Theories and Models Frequently Used in Health PromotionTheory/Model Summary Key ConceptsInterpersonal Level

Social learning/ socialcognitive theory

Health behavioral change is the result ofreciprocal relationships among theenvironment, personal factors, andattributes of the behavior itself. Self-efficacyis one of the most important characteristicsthat determine behavioral change.

Self-efficacyReciprocal determinismBehavioral capabilityOutcome expectationsObservational learning

Theory ofreasoned action

For behaviors that are within a person’scontrol, behavioral intentions predict actualbehavior. Intentions are determined by twofactors—attitude toward the behavior andbeliefs regarding others people’s support ofthe behavior.

Attitude toward thebehavior• Outcome expectations• Value of outcomeexpectationsSubjective norms• Beliefs of others• Desire to comply withothers

Theory of plannedbehavior

People’s perceived control over theopportunities, resources, and skills neededto perform a behavior affect behavioralintentions, as do the two factors in thetheory of reasoned action.

Attitude toward thebehavior• Outcome expectations• Value of outcomeexpectationsSubjective norms• Beliefs of others• Desire to comply withothersPerceived behavioralcontrol

Social Support Often incorporated into health promotioninterventions, social support can beinstrumental, informational, emotional, orappraising (providing feedback andreinforcement of new behavior)

Instrumental supportInformational supportEmotional supportAppraisal support

Individual Level

Theories and Models Frequently Used in Health PromotionTheory/Model Summary Key ConceptsCommunity Level

Communityorganization model

Public health workers help communitiesidentify health and social problems, andthey plan and implement strategies toaddress these problems. Active communityparticipation is essential.

Social planningLocality developmentSocial action

Ecological approaches Effective interventions must influencemultiple levels because health is shaped bymany environmental subsystems, includingfamily, community, workplace, beliefs andtraditions, economics, and the physical andsocial environments.

Multiple levels ofinfluence• Intrapersonal• Interpersonal• Institutional• Community• Public policy

Organizational changetheory

Certain processes and strategies mightincrease the chances that healthy policiesand programs will be adopted andmaintained in formal organizations.

Definition of problem(awareness stage)Initiation of action(adoption stage)Implementation of changeInstitutionalization ofchange

Diffusion of innovationstheory

People, organizations, or societies adoptnew ideas, products, or behaviors atdifferent rates, and the rate of adoption isaffected by some predictable factors.

Relative advantageCompatibilityComplexityTrialabilityObservability

Sources:1. Alcalay R, Bell RA. Promoting Nutrition and Physical Activity Through Social Marketing: Current Practices and

Recommendations. Davis, CA: Center for Advanced Studies in Nutrition and Social Marketing, University ofCalifornia, Davis; 2000.

2. National Institutes of Health. Theory at a Glance: A Guide for Health Promotion Practice. Bethesda, MD:National Institutes of Health, National Cancer Institute; 1995.

3. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General.Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention,National Center for Chronic Disease Prevention and Health Promotion.

This table adapted from:US Department of Health and Human Services. Physical Activity Evaluation Handbook. Atlanta, GA: US Departmentof Health and Human Services, Centers for Disease Control and Prevention; 2002, Appendix 3, pg. 43.(http://www.cdc.gov/nccdphp/dnpa/physical/handbook/pdf/handbook.pdf)