Module 5 Applying Precede Proceed Model Paper Precede-Proceed and Intervention Mapping provide direction to plan, implement, and evaluate effective health

Module 5 Applying Precede Proceed Model Paper Precede-Proceed and Intervention Mapping provide direction to plan, implement, and evaluate effective health programs and interventions. These models use the theories and their constructs/levels to enable successful planning and to develop interventions that address defined health issues for specific target populations. Unlike the theories/models you have examined previously, these models do not attempt to explain or predict behavior. Rather, they allow the planner to systematically create programs utilizing those theoretical constructs to create successful outcomes. These models also provide guidance for the application of theories/models and the development of effective evaluation methods within interventions. Trim size: 7in x 9.25in
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PART FIVE
Copyright © 2015. John Wiley & Sons, Incorporated. All rights reserved.
USING THEORY IN RESEARCH AND PRACTICE
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CHAPTER 18
INTRODUCTION TO USING THEORY IN RESEARCH
AND PRACTICE
The Editors
Copyright © 2015. John Wiley & Sons, Incorporated. All rights reserved.
One of the greatest challenges for public health professionals is to learn to analyze the ?t of a theory or model
for issues and populations of interest. A working knowledge of a handful of theories, preferably from different
levels of intervention (e.g., individuals and communities),
and the ways in which they have been applied is a ?rst
step. Mastering the challenges of using theories appropriately and effectively is the logical next step. Effective
practice depends on marshaling the most appropriate
theory (or theories) and practice strategies for a given
situation. Theory-based research and evaluation further
require designs, measures, and procedures appropriate to
the health problem, context, and unique population at
hand, as well as the development and implementation of
promising or proven interventions.
No one theory or model will be right in all cases.
Depending on the unit of practice and type of health
behavior or issue, different theoretical frameworks will be
appropriate, practical, and useful. Often more than one
theory is needed to adequately address an issue. For comprehensive health behavior change programs, this is almost
always true. It is also evident in the use and description of
applied theories found in the professional literature.
The preceding sections of this book make clear that
theories often overlap, and that some ?t easily within
broader models. Generally, theories can be used most
effectively when they are integrated into a comprehensive
planning framework. Such a system assigns a central role
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior : Theory, research, and practice. Retrieved from http://ebookcentral.proquest.com
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to research as input; it determines the situation and needs of the population to be served,
the resources available, and the progress and effectiveness of the program at various stages.
Planning is a continuous process in which new information is constantly gathered to build or
improve the program.
The chapters in Part Five give speci?c examples of how theories can be combined for
greater impact. Chapter Nineteen, by L. Kay Bartholomew and colleagues, describes two welldeveloped planning models, PRECEDE-PROCEED and Intervention Mapping, that can be
used to integrate and apply diverse theoretical frameworks. Both models take comprehensive
approaches that begin with assessing the problem and population and continue to evaluation,
based on a theoretically informed logic model.
In Chapter Twenty, Kevin Volpp and his coauthors present the rationale for and the key
constructs of applying behavioral economics to health improvement programs. Behavioral
economics has roots in classical economics and expected utility theory, blended with a
grounding in theories and evidence from psychology and sociology. The authors illustrate
the broad applicability of behavioral economics constructs and provide examples of speci?c
applications to interventions to facilitate weight loss and improve medication adherence.
In Chapter Twenty-One, J. Douglas Storey and colleagues describe the purpose, key
components, and methods of social marketing. They illustrate the application of social
marketing in a family health program in Egypt and an ambitious social marketing program
in Uganda that addresses the multiple problems of HIV/AIDS, malaria, family planning, and
maternal and child health.
This chapter provides highlights from each of the remaining chapters in this section,
discusses emerging developments and challenges, and comments on the state of the art
in the use of theory in health behavior research and practice. Using theory thoughtfully
and appropriately is not simple but it can be rewarding. This discussion aims to provoke
thought and debate and stimulate further reading, rather than to provide de?nitive answers or
prescriptions for the ?eld.
Theory-Based Planning Models
In Chapter Nineteen, Bartholomew, Markham, Mullen, and Ferna?ndez, describe two models
for systematic development of theory- and evidence-based health promotion programs: the
PRECEDE-PROCEED Model and Intervention Mapping. They explicitly illustrate the ways
that behavior change theories can be applied and incorporated into a systematic planning
process and note the challenges of applying the models. As with some of the theories discussed
in earlier chapters, using these planning models can be a demanding and laborious process for
practitioners and community groups. But when mastered, it can lead to the development of
effective, appropriate health behavior change programs.
A key premise of this chapter is that while health behavior theories are critical tools,
they do not substitute for adequate planning and research. However, theories do help us
to interpret problem situations and plan feasible, promising interventions and appropriate
program evaluations. Because we can use theories to articulate the assumptions behind
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior : Theory, research, and practice. Retrieved from http://ebookcentral.proquest.com
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BEHAVIORAL ECONOMICS
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Copyright © 2015. John Wiley & Sons, Incorporated. All rights reserved.
intervention strategies, theories can be helpful in pinpointing intermediate steps that should
be assessed in evaluations.
The PRECEDE-PROCEED Model has as its raison d’e?tre the systematic application of
theory and previous research to assessment of local needs, priorities, circumstances, and
resources (Green et al., 1994). Phase 3 of this model focuses on examining factors that
shape behavioral actions and environmental factors. Theories help to guide examination of
predisposing, enabling, and reinforcing factors for particular behaviors. For example, constructs
from the Health Belief Model might help researchers to understand why some women do not
get mammograms (see Chapter Five). PRECEDE-PROCEED also can be used in conjunction
with the Transtheoretical Model of change to design stage-appropriate health messages (see
Chapter Seven). The concepts of priority, changeability, and community preferences should be
considered along with analytical and empirical ?ndings about health behavior determinants.
For example, health experts concerned with effecting distribution of safe drinking water must
understand how people in the recipient communities think about water sources and what
beliefs might be amenable to change. These ideas are also consistent with concepts presented
in earlier chapters on community engagement and implementation and dissemination.
Bartholomew and colleagues also describe Intervention Mapping (IM), a framework for
developing theory- and evidence-based health behavior or education programs, and illustrate
how IM has been applied. Intervention Mapping (Bartholomew, Parcel, Kok, Gottlieb, &
Fernandez, 2011) is composed of ?ve steps that are complementary to the planning phases
of the PRECEDE-PROCEED Model. Intervention Mapping can be helpful in guiding program
planners toward explicit speci?cations for using both theory and empirical ?ndings to develop
effective health behavior interventions.
Behavioral Economics
Behavioral economics has its foundations in classical economics and expected utility theory,
blended with a grounding in theories and evidence from psychology and sociology. Behavioral
economics has received growing attention in recent years, with applications in several ?elds in
which anticipated costs and bene?ts play a central role: labor markets, wage policies, savings
and retirement plans and policies, and organizational behavior (Camerer, Loewenstein, &
Rabin, 2004; Diamond & Vartianen, 2007). Its application to health behavior and health care
utilization is emerging rapidly, as described in Chapter Twenty.
Behavioral economics aims to increase the explanatory power of economics by grounding
that approach in psychological and social foundations. It is not a single theory per se, but
uses insights from cognitive psychology, sociology, and decision analysis (Camerer et al.,
2004). Behavioral economics recognizes that people make decision errors in weighing the costs
and bene?ts of their actions, and that message framing can in?uence how people react to
persuasive communications. Key implications from behavioral economics for health behavior
change suggest that incentives can improve health behaviors, but also, importantly, that the
way incentives are delivered can matter more than the amount of incentives. This idea, which
is also consistent with applied behavioral analysis and Social Cognitive Theory (Chapter Nine),
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior : Theory, research, and practice. Retrieved from http://ebookcentral.proquest.com
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has been used in health behavior intervention research by the chapter authors and others with
substantial success.
In Chapter Twenty, Volpp, Loewenstein, and Asch report on successful interventions that
used incentives and feedback to improve weight loss success and medication adherence. These
authors also noted an important limitation: that once incentives were no longer provided,
behavior changes were not maintained. This has been a constant in most studies of incentives,
which have been used in many programs over the years. Unless behavior change is internally
motivated by individuals and not merely a response to a reinforcement, once the incentive
has been applied, the desired behavior stops. Behavioral economics does not delve speci?cally
into the arena of habitual behaviors and maintenance, though this is a future direction for
researchers in this ?eld. An interesting prospect would be to blend behavioral economics with
central tenets of Self-Determination Theory, which posits that maintenance of behaviors over
time requires that patients internalize values and skills for change (Ryan & Deci, 2000).
Social Marketing
Copyright © 2015. John Wiley & Sons, Incorporated. All rights reserved.
Social marketing is a process that promotes desired voluntary behaviors among members
of a target market by offering attractive bene?ts and/or reducing barriers associated with
healthful choices. It involves the adaptation of commercial marketing technologies to promote
socially desirable goals. In Chapter Twenty-One, Storey, Hess, and Saf?tz take a fresh look
at social marketing. They emphasize how social marketing can be applied within a strategic
health communication framework and link key theories of health communication and health
behavior to the effective practice of social marketing.
When using social marketing, success is most likely when marketers accurately determine
the perceptions, needs, and wants of target markets and satisfy them through the design,
communication, pricing, and delivery of appropriate, competitive, and visible offerings. The
process is consumer-driven, not only expert-driven. This orientation is consistent with
principles of community organization, and its product development approach parallels the
innovation development process of diffusion theory. At the same time, it shares an economic
perspective with behavioral economics, a ?eld of inquiry that relates individual behaviors to
economic variables (Bickel & Vuchinich, 2000). Another parallel between social marketing and
behavioral economics is that each is adapted from a more mature and extensive ?eld: social
marketing uses some principles from commercial marketing and behavioral economics builds
on classic economic theory.
Like the PRECEDE-PROCEED Model and Intervention Mapping, social marketing provides
a framework to identify what drives and maintains behavior, and what factors might drive
and maintain behavior change. It also requires identi?cation of potential intermediaries,
channels of distribution and communication, and actual and potential competitors. As the
chapter authors indicate, theories of health behavior can help to guide the analytical process
in social marketing and aid in the formulation of intervention strategies and materials. The
authors explicitly illustrate four theories that contribute to social marketing approaches:
the Theory of Planned Behavior, the extended parallel processing model, Social Cognitive
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior : Theory, research, and practice. Retrieved from http://ebookcentral.proquest.com
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Theory
and
its observational
learning construct, and Diffusion of Innovations. Because of
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CROSS-CUTTING PROPOSITIONS ABOUT USING THEORY
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their focus on understanding consumers (or target audiences) from the consumers’ point of
view, social marketing models are robust for use in diverse and unique populations, including
disadvantaged groups and ethnic minorities, and in many countries. In fact, it is often thought
that social marketing programs tend to be inherently culturally sensitive because they follow
a consumer-oriented process. In social marketing it is always important to identify and ful?ll
demand—that is, to “start where the people are.”
Cross-Cutting Propositions About Using Theory
Here we offer some key cross-cutting propositions to readers to put the use of health behavior
theory in perspective. These ideas are germane to the review and discussion of the chapters in
this section and throughout this book.
1. Researchers and practitioners should not confuse using or applying theory with testing
theory or developing theory. They are fundamentally different activities even though
complementary.
2. Testing the ef?cacy or effectiveness of theory-based interventions does not constitute
testing a theory or theories per se.
Copyright © 2015. John Wiley & Sons, Incorporated. All rights reserved.
3. It is likely that the strongest interventions will be built from multiple theories. The most
replicable and transparent interventions will be built in a way that the contributions of
each theory can be understood.
4. When combining theories, it is important to clearly think through the unique contribution
of each different theory to the combined model. If this is not done carefully or well, the
“new” combined approach may be redundant, overlapping, and hard to interpret in the
context of established theories.
5. Rigorous tests of theory-based interventions, including measurements and analyses of
mediators and moderators, are the building blocks of the evidence base in health behavior change.
6. Theory use, testing, and development will be enhanced by the use of shared instruments
and reporting. The more researchers and practitioners can build on past efforts, the more
they are likely to advance the public’s health. We recommend employing adaptations of
the protocol concept used in clinical research so that the measures used with particular
theories and the ways in which theory is turned into interventions are transparent and
accessible. The opportunity to offer online materials to supplement journal publications
makes this increasingly feasible.
7. Theory, research, and practice are parts of a continuum for understanding the determinants
of behaviors, testing strategies for change, and disseminating effective interventions (see
Chapters Sixteen and Nineteen).
8. There is as much to learn from failure as there is to learn from success. Researchers and
practitioners who develop and test theory-based interventions should publish their ?ndings
when they are negative and when they are positive.
Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior : Theory, research, and practice. Retrieved from http://ebookcentral.proquest.com
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9. There is no substitute for knowing the audience. This applies to the conduct of fundamental
research to understand determinants of health behavior as much as it applies to developing
health promotion programs for speci?c individuals, groups, and communities. Participatory
research and program design improve the odds of success.
The authors of the remaining three chapters in Part Five describe tools, strategies, models,
and issues that are critical to consider when applying theories. This section of Health Behavior:
Theory, Research, and Practice tackles the complexity of health behavior and health promotion
at its multiple levels. A basic theme is that if intervention strategies are based on a carefully
researched understanding of the determinants of behavior and environments, and if systematic
approaches to tailoring, targeting, implementation, and evaluation are used, the chances are
good that programs will be effective. And when they are not effective, then there should be
good information about why they did not work. Understanding past failure is critical to future
success.
Moving Forward
Copyright © 2015. John Wiley & Sons, Incorporated. All rights reserved.
After one becomes familiar with some contemporary theories of health behavior, the challenge
is to use them within a comprehensive planning process. Researchers and practitioners can
increase the odds of success by examining health and behavior at multiple levels, as articulated
in ecological models (Chapter Three).
At its simplest, an ecological perspective emphasizes two main options: change people
and/or change the environment. The most powerful approaches will use both of these options
together (Smedley & Syme, 2000). The activities most directly tied to changing people are
derived from individual-level theories like the Health Belief Model, Transtheoretical Model
of change, and Integrated Behavioral Model. In contrast, activities aimed at changing the
environment draw on community-level theories. In between are Social Cognitive Theory,
theories of social support and social networks, and interpersonal communication models.
Each of these focuses on reciprocal relations among persons or between individuals and their
environments.
Theoretical frameworks are guides in the pursuit of successful change efforts, maximizing
researchers’ and practitioners’ ?exibility and helping them to apply abstract concepts of theory
in ways that are most useful in diverse wo…
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