Theories and Models Frequently Used in Health Promotion

Based on Five Levels of Influence for Health Related Behaviors and Conditions

As you are planning or describing your program, referring to individual, interpersonal, or community-level (McLeroy and colleagues, 1988) theories that relate to health behavior change is sometimes useful. For example, these theories might be used in the “Causal Assumptions/ Theory of Change” column in your logic model or to help you identify potential points of intervention.

Key Concept
Health Belief Model (HBM)
For people to adopt recommended physical activity behaviors, their perceived threat of disease (and its severity) and benefits of action must outweigh their perceived barriers to action.
·      Perceived susceptibility
·      Perceived severity
·      Perceived benefits of action
·      Perceived barriers to action
·      Cues to action
·      Self-efficacy
Stages of change
In adopting healthy behaviors (e.g., regular physical activity) or eliminating unhealthy ones (e.g., watching television), people progress through five levels related to their readiness to change—pre contemplation, contemplation,  preparation, action, and maintenance. At each stage, different intervention strategies will help people progress to the next stage.
·      Pre-contemplation
·      Contemplation
·      Preparation
·      Action
·      Maintenance
Relapse prevention model (RP)/ Marlatt’ s Cognitive-Behavioral Model
Marlatt and Gordon’s (1985) RP model is based on social-cognitive psychology and incorporates both a conceptual model of relapse and a set of cognitive and behavioral strategies to prevent or limit relapse episodes.
Persons who are beginning regular physical activity programs might be aided by interventions that help them anticipate barriers or factors that can contribute to relapse.
·      Skills training
·      Cognitive reframing
·      Lifestyle rebalancing
Model/ Lefrancois Theory
The impact of persuasive communication,
which can be part of a social marketing
campaign to increase physical activity, is
mediated by three phases of message
processing—attention to the message,
comprehension of the content, and
acceptance of the content.
Exposure; Attention
Comprehension; Skill
acquisition; Yielding
Memory storage
Information search and
Retrieval; Decision;
Behavior; Reinforcement;
The Precaution Adoption Process Model (PAPM)
The PAPM attempts to explain how a person comes to decisions to take action and how he or she translates that decision into action. Adoption of a new precaution or cessation of a risky behavior requires deliberate steps unlikely to occur outside of conscious awareness. The PAPM applies to these types of actions, not to the gradual development of habitual patterns of behavior, such as exercise and diet, in which health considerations may play little role (though it would apply to the initiation of a new exercise program or a new diet). Nor does the PAPM explain the commencement of risky behaviors—such as a teenager accepting her first cigarette–which seem to be better explained in terms of a “willingness” to act rather than in terms of any plan to act (Gibbons, Gerard, Blanton, & Russell, 1998).
·         Unaware of issue
·         Unengaged of issue
·         Undecided about acting
·         Decided not to act
·         Decided to act
·         Acting
·         Maintenance
Interpersonal Level
Social learning/ social
cognitive theory
Health behavioral change is the result of
reciprocal relationships among the
environment, personal factors, and
attributes of the behavior itself. Self-efficacy
is one of the most important characteristics
that determine behavioral change.
·         Self-efficacy
·         Reciprocal determinism
·         Behavioral capability
·         Outcome expectations
·         Observational learning
Theory of
Reasoned Action (TRA)
For behaviors that are within a person’s
control, behavioral intentions predict actual behavior. Intentions are determined by two factors—attitude toward the behavior and beliefs regarding others people’s support of the behavior.
Attitude toward the
• Outcome expectations
• Value of outcome
Subjective norms
• Beliefs of others
• Desire to comply with
Theory of Planned
Behavior (TPB)
People’s perceived control over the
opportunities, resources, and skills needed
to perform a behavior affect behavioral
intentions, as do the two factors in the
theory of reasoned action.
Attitude toward the
• Outcome expectations
• Value of outcome
Subjective norms
• Beliefs of others
• Desire to comply with
Perceived behavioral
Social Support
Often incorporated into health promotion
interventions, social support can be
instrumental, informational, emotional, or
appraising (providing feedback and
reinforcement of new behavior)
·   Instrumental support
·   Informational support
·   Emotional support
·   Appraisal support
Community Level
organization model
Public health workers help communities
identify health and social problems, and
they plan and implement strategies to
address these problems. Active community
participation is essential.
·   Social planning
·   Locality development
·   Social action
Ecological approaches
Effective interventions must influence
multiple levels because health is shaped by
many environmental subsystems, including
family, community, workplace, beliefs and
traditions, economics, and the physical and
social environments.
Multiple levels of
• Intrapersonal
• Interpersonal
• Institutional
• Community
• Public policy
Organizational change
Certain processes and strategies might
increase the chances that healthy policies
and programs will be adopted and
maintained in formal organizations.
Definition of problem
(awareness stage)
Initiation of action
(adoption stage)
Implementation of change
Institutionalization of
Diffusion of innovations
People, organizations, or societies adopt
new ideas, products, or behaviors at
different rates, and the rate of adoption is
affected by some predictable factors.
·         Relative advantage
·         Compatibility
·         Complexity
·         Trialability
·         Observability

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