Why Theory Matters

Jackie Green

“There is nothing so practical as a good theory.”(Kurt Lewin)

Concerns

Seen by some as• Reductionist• Incompatible with holism and

empowerment• Inconsistent with respect for

human agency and voluntarism

Theory practice gap

Attributed to a narrow view of theory – linked to natural sciences and

positivism and attempts to offer universal explanations (Buchanan, 1994)

But ………

• A broader view of theory can and should:– Enhance understanding of complex

situations– Consider the influence of contextual

factors– Include the experience of practitioners

and communities

Evidence based practice

• Empirical evidence necessary but not enough.

• Need to extract THEORETICAL PRINCIPLES to avoid drowning in a mass of information

Definitions• Theories – offer explanations of how or

why something happens by identifying key variables and establishing the relationship between them– Concepts are the main elements of theories– Constructs operationalise concepts for use

in building theory• Models provide a looser, possibly

untested, framework to help understand reality and the relationship between concepts. They may draw on one or more theories.

Two broad types of theory

• Explanatory theorytheory of the problem – identifies key variables which need to

be addressed

• Change theorytheory of the solution – identifies the best means of changing

key variables

Theory can ……

• Ensure that all relevant variable are addressed and key elements of a programme are in place

• Take account of contextual factorsIt therefore avoids

• Type III error – an intervention failing to achieve successful results when it was so poorly designed that it could not possibly have had the desired effect (Basch and Gold, 1986: 300-1)

Like an expert chef, a theoretically grounded health education professional does not blindly follow a cookbook recipe, but constantly recreates it anew, depending on the circumstances. Without a theory, she or he has only the skills of a cafeteria line worker. (National Cancer Institute, 1997)

Ecological approach – levels of influence

• Intra-personal• Interpersonal• Institutional or organisational• Community• Public policy

(National Cancer Institute, 2005)

Examples of relevant theory

• Intrapersonal

• Interpersonal• Community

Health Belief ModelStages of ChangeTheory of Planned BehaviourHealth Action Model

Social Cognitive Theory

Community organisation e.g. Locality (Community) DevelopmentSocial Planning, Social Action

Diffusion of innovationsCommunication Theory

(based on National Cancer Institute, 2005)

The challenge ……• Not an absence of theory

but

• Which theory to select from the plethora availableor rather

• Which combination of theories to cope with the complexity of health issues

• How to select theory

Which theory• Does it include all relevant variables?• Does it not contain redundant variables?• Does it logically make sense to use it in

a particular situation?• Has it been used by others for similar

purposes?• Are there published studies supporting

its use for similar purposes?• Is it consistent with the values integral

to the work?(Tones and Green (2004)

belief motivation

normative

selfpersonality

behavioural intention

HEALTH ACTION

ROUTINE

relapse confirmation

EnvironmentPhysicalSocio-economicSocio-cultural

SkillsPsycho-motorSocial interactionSelf-regulatory

Knowledge

The Health Action Model HAM

Community organisation

• Community capacity• Social capital• Participation• Control and Empowerment• Critical consciousness

– Awareness– Motivation

Diffusion of Innovations• The characteristics of the innovation

– relative advantage – compatibility - with values, previous

experience and current needs– complexity – trialability – observability

• Communication channels• Time• The social system

Analysing the determinants of health issues

Understanding what needs to be changed

Programme planning and development

Outcomes: short, medium and long term

Selection of process and outcome indicators

THEORY

Evaluation•Contextual factors•Community insights•Practitioner insights

Identifying what needs to be done

Predicting likely effects

Establishing how to assess effects

SYSTEMATIC REVIEWS

References

• Basch, C.E. and Gold, R.S. (1986) ‘Type V errors in hypothesis testing’, Health Education Research, 1(4): 299-305

• Buchanan (1994) ‘Reflections on the relationship between theory and practice’, Health Education Research, 9(3): 273-283

• Green, J. (2000) ‘The role of theory in evidence-based health promotion practice’, Health Education Research, 15(2): 125-129

• National Cancer Institute (2005) Theory at a Glance: a Guide for Health Promotion Practice (2nd edition) (Website: http://www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf-5aa48ee1da4d/TAAG3.pdf)

• Nutbeam, D. and Harris, E. (2004) Theory in a Nutshell. Sydney: McGraw-Hill

• Tones, K. and Green, J. (2004) Health Promotion Planning and Strategies. London: Sage