Program Planning: Models and Theories

Why Theories and Models?

• Builds clarity in understanding targeted health behavior and environmental context.

• Directs program planning - why, what and how?

• Directs evaluation as integral part

Explanatory Theory = Theory of the Problem (Health Belief Model, the Theory of Planned Behavior, Precaution Adoption Process Model)

Change Theory = Theory of Action (Ex: Community Organization, Diffusion of Innovations)

Planning Models

Social Marketing Approach

Key Concepts of Social Marketing

• Consumer orientation not expert driven• Concentrates on a defined target group• Must understand what drives current

behavior and what “levers” can be used to drive and maintain new behavior

4 “Ps” of Social Marketing

• Product• Price• Place (distribution)• Promotion (communication)

PRECEDE-PROCEED (Green and Kreuter)

• Systematic planning process• Empowers individuals with

– understanding– motivation– skills– active engagement in community affairs

9 phases

• 1-5 are diagnostic• 6-9 are implementation and evaluation

What is a Theory?

• Set of concepts, definitions, and propositions

• Systematic view of events or situations• Allows explanation of events or

situations

Applying Theories to Health Promotion

• Different theories work in different situations

• Combinations of theories are often most effective

A Good Fit Theory

• Is logical• Is consistent with observations• Is similar to those used in previous

successful interventions for a similar situation

Two Main Options

• Change people• Change the environment

• The most powerful approaches do both

3 Key Concepts at the Individual & Intrapersonal Level

1. Behavior is mediated by cognitions; that is, what people know and think affects how they act.

2. Knowledge is necessary for, but not sufficient to produce, most behavior changes.

3. Perceptions, motivations, skills, and the social environment are key influences on behavior.

Theory Focus Key concepts

Stages of Change Model

Individuals' readiness to change or attempt to change toward healthy behaviors

Precontemplation Contemplation Decision/determination Action Maintenance

Health Belief Model

Persons' perception of the threat of a health problem and the appraisal of recommended behavior(s) for preventing or managing the problem

Perceived susceptibility Perceived severity Perceived benefits of action Perceived barriers to action Cues to action Self-efficacy

The Theory of Planned Behavior /Theory of Reasoned Action

Behavioral intention is key, intention is driven by attitude and beliefs about what others who are important think

Behavioral Intention Attitude Subjective Norm Perceived Behavioral Control

Individual Level

Interpersonal Level

Theory Focus Key Concepts

Social Cognitive Theory

Behavior is explained via a 3-way, dynamic reciprocal theory in which personal factors, environmental influences and behavior continually interact

Behavioral capability Reciprocal determinism Expectations Self-efficacy Observational learning Reinforcement

Community Level

Theory Focus Key ConceptsCommunityOrganizationTheories

Emphasizes activeparticipation anddevelopment of communitiesthat can better evaluate andsolve health and socialproblems

EmpowermentCommunity competenceParticipation and relevanceIssue selectionCritical consciousness

Organiza-tionalChangeTheory

Concerns processes andstrategies for increasing thechances that healthy policiesand programs will be adoptedand maintained in formalorganizations

Problem definition(awareness stage)Initiation of action(adoption stage)Implementation of changeInstitutionalization of change

Diffusion ofInnovations

Addresses how new ideas,products, and socialpractices spread within asociety or from one society toanother

Relative advantageCompatibilityComplexityTrialabilityObservability