Chapter 4 Theoretical Foundations

8/12/2019 Chapter 4 Theoretical Foundations

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1. Define and explain the difference among theory, concept, construct, variable and

model.2. Explain the importance of theory to the health education discipline.3. Distinguish between models of implementation and change process theories4. Distinguish between planning models and the theories and models focusing on

behavior change.5. Identify the planning models and their components used in health / health

promotion an briefly explain each:a. PROCEDE-PROCEED

b. Model for Health Education Planning (MHEP)c. Comprehensive Health Education Planning and Resource Development (MHEPRD)d. Generic Health and Fitness Delivery System (GHFDS)e. Generalized Model for Program Planning (GMPP)6. Identify the theories and models focusing on behavior (change process theories)

and their components used in health / promotion and briefly explain each:a. . Health belief model

b. Transtheoretical model or stages of changec. Theory of planned theoryd. Social cognitive theoryc. Theory of diffusion


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Definitions: Glanz, Lewis and Rimer

It is a set of interrelated concepts, definitions andpropositions that presents a systematic view of events orsituations by specifying relations among variables inorder to explain event and predict the events of thesituations.

Mckenzie and Smelter It is a systematic arrangement of fundamental principles

that provide a basis for explaining certain happenings oflife.

Health Education It is a general explanation of why people act or do not

act to maintain and / or promote the health ofthemselves, their families, organizations andcommunities.


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CONCEPT it is the primary elements of

theories. CONSTRUCT - when a concept has been

developed, created or adopted for use with aspecific theory

VARIABLE - the operational form of aconstruct

MODEL - it is a subclass of a theory

- It provides health educators with a framework onwhich to create plans for programs.

Example: safety belt use


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- It helps guide the practice of health educators.

- It can help during the various stages of planning,implementing, and evaluating program.

- It can provide answers to program developersquestions regarding why people arent alreadyengaging in a desirable behavior of interest, how togo about changing their behaviors, and what factorsto look for when evaluating a programs focus.

- Provides direction and justification for programactivities and serves as a basis for processes that areto be incorporated into health promotion program.


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models of implementation change process theories

- This is also called as planningmodels which are used inplanning, implementing, andevaluating health education /promotion programs

-Focus on behavior change- These help explain, through theirconstructs, how change processtheories help explain, throughtheir constructs, how change takesplace.

Ex: non exerciser to exercise


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1. PRECEDE PROCEED PRECEDE stands for Predisposing,

Reinforcing, and Enabling Constructs inEducational / Environmental Diagnosis andEvaluation.

PROCEED stands for Policy, Regulatory, andOrganizational Constructs in Educational andEnvironmental Development


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PRECEDE PROCEED model Phase 5 Phase 4 Phase 3 Phase 2 Phase 1 Administrative Educational Behavioral and Epidemiological Social Diagnosis

and Policy and organizational Environmental DiagnosisDiagnosis Diagnosis Diagnosis

Predisposin

g FactorsHealthPromotion

HealthEducation

HealthEducation

PolicyRegula

tionOrganization

Reinforci

ngFactors

Enabling

factor

Behavior

andlifestyle

Environ

ment

healthQualityof life

Phase 8 impact evaluation Phase9 outcomeevaluation

Phase 6 implementation

Phase7 process evaluation


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It was first developed in 1966 by Mico andhas been periodically updated since. It hasbeen comprised of six phases: initiate, needsassessment, goal setting, planning and

programming, implementation, andevaluation. Within each phase, the modelfocuses on the three dimensions of content(subject matter), method (steps andtechniques), and process (interactions).


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Phase Content Dimension Method Dimension Process Dimension6. Evaluation Understand evaluation;

know problem and target

population

Clarify measures; collect

and analyze data; provide

feedback, redefine

problem

Come to agreement;

communicate; reduce

threat results

5. Implementation Know plan; subject, and

content and problem

solving; writing skills

Initiate activity; problem

solve; report

Communicate with and

help others; resolve

conflict

4. Planning programming Understand planning

techniques, system

analysis, and political

process

Develop an

implementation plan;

design management

systems; negotiatecommitments; create

agreements

Understand and commit

clarify roles;

communicate; negotiate

3. Goal setting Role of goals; nature of

policy; manage by

objectives; understand

theory of change

Establish criteria for and

set goals and objectives;

link to policy

development; determine

strategies forimplementation

Set agreement;

understand process and

roles

2. Needs assessment Identify standards,

criteria, and needed data

Review criteria; collect

and analyze data;

describe problem

Select starting point; open

communication with

appropriate people

1. Initiate Gain knowledge of the

problem and target

population

Gain entry to the

community; organize

those concerned

Reduce threat of the

unknown; build trust


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The CHEM like the MHEP, has six majorcomponents. However, these components arereferred to as steps and use different labels;involve people, set goals, define problems,

design plans, conduct activities, and evaluateresults.


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Step Description1. Involve people Identifying the target population and those needed

to carry out the program; determining the roles of

those involved; establishing the necessary

relationships among the people

2. Set goals Creating the ultimate goals related to healthstatus, personal action, health education practices,

and health education resources

3. Define problems Conducting a needs assessment; determining the

gaps between what is and what ought to be;

deciding what problem to tackle

4. Design plans Identifying the most appropriate approach for

reaching the goals; setting operational objectives;

defining timetables, activities, and resources;

piloting the plans; developing evaluation

procedures; getting approval for the plans;

obtaining commitments for resources

5. Conduct activities Obtaining the resources to implement; creating

policies and procedures for implementation;

carrying out the implementation

6. Evaluate results Determining the overall worth of the program by

comparing the results with the program objectives

and goals in the context of the activities andresources used


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The developers of this model have indicted that itcan be distinguished from others because itseparates process from end results, and because ofthe continuous evaluation, which tests and validates

program assumptions throughout the planningprocess.

Each of the five major components of the model -- health education plans, demonstration programs,

operational programs, research programs, andinformation and statistics - - represents an endresult of the planning process.


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This model was not developed specifically forhealth education/promotion programs; however,it can easily be adapted to them.

This goal-oriented planning model iscompromised of five steps - - needs assessment,goal setting, planning, program implantation,and evaluation. Each of the steps has aneducation and a service component. The

education component focuses on a cognitiveexperience, while the service component has amore psychomotor emphasis.


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Steps Education component Service component

Needs assessment

Input / feedback

Goal setting

Input/feedback

Planning

Input/feedback

Program implementation

Input/feedback

Evaluation

Educational needs

Learning goals and objectives

Learning intervention

Of learning intervention

Educational assessments

Behavioral needs

Behavioral goals and objectives

Behavioral intervention

Of behavioral intervention

Behavioral Assessments


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Each of the five models previously presented revolvesaround the six primary tasks incorporated in theGeneralized Model for Program Development such as:

1. Assessing the needs of the largest population2. Identifying the problem (s)3. Developing appropriate goals and objectives4. Creating an intervention that considers the peculiarities of

the setting5. Implementing the intervention6. Evaluating the results

Example: A health educator was hired to develop healthpromotion programs in a corporate setting.


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II. Theories and Models Focusing on Health(Change Process Theories)

As with planning models, there are a number of theories and modelsthat health educators can use to design appropriate health educationinterventions to help those in the target populations with behavior change.And, as with planning models, each of these theories and models worksbetter in some situations than in others depending on which level ofinfluence the health education program is being planned.

The concept of level of influence is included in the ecologicalperspective. This perspective includes five levels of influence on health-related behaviors and conditions:

1. Intrapersonal, or individual, factors 2. Interpersonal factors 3. Institutional, or organizational, factors 4. Community factors 5. Public policy factors


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Focused on factors within individuals suchas knowledge, attitudes, beliefs, self-concept, and mental history, pastexperiences, motivation, skills, and behavior.

The three theories that are useful inchanging these factors are the health belief

model, the transtheoretical model or stagesof change, and the theory of plannedbehavior.


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It addresses a persons perceptions of the threat of ahealth problem and the accompanying appraisal of arecommended behavior for preventing or managingthe problem.

It was developed in the 1950s by a group ofpsychologists to help explain why people would orwould not use health services.

Example: Why a person may or may not doself-screening for cancer.


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The transtheoretical model revolves aroundan individuals readiness to change orattempt to change toward healthy behaviors.

Example: chain smoker


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Individuals intention to perform a givenbehavior is a function of their attitude towardperforming the behavior, their beliefs aboutwhat relevant others think they should do,

and their perception of the ease of difficultyof performing the behavior.

Example: of the use of spit tobacco


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The category of interpersonal theories iscomprised of theories that include factorsrelated to individuals experience andperceptions of their environments in

combination with their personalcharacteristics.

Example: The social cognitive theory (SCT)

describes learning as a reciprocal interactionamong an individuals environment, cognitiveprocesses, and behavior.


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This group of theories includes three categories of factorsfrom the ecological perspective institutional, community,

and public policy.

Institutional factors include such things as rules,regulations, and policies of an organization that can impacthealth behavior.

Community factors include social networks and norms,while public policy includes legislation that can impacthealth behavior.

Example: The diffusion theory provides an explanation for

the diffusion of innovations in populations. In healtheducation/promotion, innovations come in the form of newideas, techniques, behaviors, and programs. When peoplebecome consumersof an innovation, they are referred toas adopters.


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Chapter 4 Theoretical Foundations