Download H671 – Advanced Theories of Health Behavior

H671 – Advanced Theories of
Health Behavior
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Introductions
Review syllabus and requirements
– Including weekly writing assignments
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How to think about theory – Darcie
– Class activity and discussion
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Break
Advanced thinking about theory – Flay
– Discussion
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The TTI – Flay
– Discussion
WHY LEARN THEORY?
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In order to have an impact on health behavior, it is necessary
to understand it.
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In the current research and program environment, it is
increasingly important to demonstrate systematic
connections between:
– an assessment of a health problem (how you define the
problem, including applicable theory);
– what you say you are going to do about it (program
components); and
– how you know whether or not your program had an impact
(evaluation).
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Because theory is a tool for explaining behavior, it is a key
part of making such connections.
Theory & Practice
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Traditionally a duality
Dewey: “experimental
knowing” as the ground
between theory and
practice
Bidirectional Continuum
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Fundamental Research
Intervention Research
Surveillance Research
Application and Program
Delivery
Theory
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A systematic view of phenomena created to explain and
predict them
Theory must provide a logical explanation for a
phenomenon that takes all known information into
account
– Example: Newtonian physics
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A theory must have these qualities:
– Generality, Testability, Abstraction
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“A set of interrelated constructs (concepts), definitions,
and propositions that present a systematic view of
phenomena by specifying relations among variables,
with the purpose of explaining and predicting the
phenomena.”
– Kerlinger, 1986
Components of Theories
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Concepts
– Major components of a theory
– Building blocks
– May or may not have meaning outside the context of the theory
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Constructs
– A concept that has been developed or adopted for use in a
particular theory
– A construct can only be understood in the context of its parent
theory
• Example: Self-Efficacy
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Variables
– The empirical counterparts of constructs
– Operational form of a construct
– They specify how a construct is to be measured in a specific
situation
• Example: Creating a questionnaire to measure depression so you
can assign a score to an individual
Specifying Relations: How do
variables affect or relate to each other?
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Correlative
– Depression and Cancer
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Causative
– Smoking and Heart Disease
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Coincident
– Being left-handed and developing Diabetes Type I
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Mediating
– A process that intervenes between input and output in a system
– Example: Social Support mediates between stress & disease
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Moderating
– A variable that affects the direction or strength of the relation
between an independent and dependent variable
– Example: Lifestyle factors moderate the effects of race on
hypertension
Types of Theory
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Explanatory Theories
–
–
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Describe problems
Identify sources of problems
Search for modifiable factors
Examples
• Health Belief Model
• Theory of Planned Behavior
Types of Theory (Cont.)
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Change Theories
–
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Of behavior change
Intervention design
Evaluation strategies
Provide explicit assumptions for why a program
will work
– Help determine why a program didn’t work
– Examples
• Community Organization
• Diffusion of Innovations
ROOTS OF CURRENT
HEALTH BEHAVIOR THEORY
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Theories about something are explanatory statements or
models.
The term theory, as it is commonly used, derives its
meaning from a context of Western philosophy and science.
There are many other explanatory traditions as well.
Primary fields from which most current health behavior
theory come – psychology and social psychology.
And…Important contributions from ecology, sociology,
anthropology, organizational and community theory,
communications theory, and others.
BASIC ASSUMPTIONS IN THE
WESTERN TRADITION OF THEORY
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Order and regularity – that the universe is ordered and
regular, which has practical applications for technology, etc.
Predictability – if there is order and regularity, the rules or
“laws” can be learned, and used to predict.
Primacy of empirical data – the positivist epistemology
associated with the Western tradition holds that what we
know comes from our senses -- observable, tangible
evidence
Progress and perfectability – that there is an inexorable
movement towards more knowledge, better understanding,
higher complexity etc.
COGNITIVE PSYCHOLOGY
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Focus on the THINKING PROCESS.
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THINKING PROCESSES include perception, memory,
decision-making, interpretation, reasoning, judgment, etc.
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Some cognitive psychologists (e.g. Piaget) focus on the
development of the thinking process.
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See the influence of cognitive psychology in many of the
individual-level theories (e.g., Health Belief Model) that are
discussed in the course.
BEHAVIORIST PSYCHOLOGY
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ASSUMPTION: Behavior is learned through a process of stimulus
and response. “Thinking” not a major part of this process.
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Early focus on classical conditioning (Pavlov’s dog), then on operant
conditioning (Skinner) -- the conditioning of behavior by positive and
negative reinforcements. Idea of shaping behavior, behavior
modification.
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Behavior modification still used in smoking cessation, addiction
treatment and other programs.
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The basic assumptions about learning behavior through positive and
negative reinforcements appear in a number of health behavior
theories.
HUMANISTIC PSYCHOLOGY
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Focus on individual capacity, on human capability of choice.
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ASSUMPTION: That human beings desire to grow and
attain their full potential – role of psychology is to help.
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Before attaining higher level needs, humans have to satisfy
basic to “mid-level” needs, from basic physiological to
emotional to social (Maslow).
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Humanistic psychology influenced the public health
emphasis on quality of life, and the lifestyle concept.
SOCIAL PSYCHOLOGY
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Most of psychology focuses on the individual experience;
social psychology focuses on the interaction between
individuals and the group – groups, relationships, social
units.
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This may include: group dynamics, authority and legitimacy,
emotion and its expression, aggression, self-identity,
motivation, gender roles, norms, attitudes, group prejudices.
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Social psychology has had a considerable influence on
such health behavior theories as Social Cognitive Theory,
Theory of Planned Behavior, Social Network Theory, and
others.
SOCIOLOGY
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Sociology includes the study of society and its phenomena
– social groups, social hierarchies, social structures, the
nature of social interaction and organization, the interaction
between social and economic systems.
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There is overlap between sociology, psychology and
anthropology in explaining behavior.
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Influence on health behavior theory: concepts of class and
hierarchy, group norms and conformity, role of social
capital, social organization and its impact on behavior.
CULTURAL ANTHROPOLOGY
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Focus on the role of culture in human behavior, the ways in
which life-patterns are organized, together with systems of
knowledge and belief, language and symbol.
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This may include: cultural beliefs, attitudes, social-cultural
roles, gender, language, symbolic expression, social
authority and legitimacy, health knowledge systems, healing
practices, healers, etc.
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Influence on health behavior theory: holistic (ecological)
approaches, cultural influence on treatment and care,
values and meanings as connected to behavior, cultural
constructions of disease and illness.
ECOLOGY AND BIOLOGICAL SYSTEMS
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The study of how living organisms function within
interdependent systems – human ecology refers
to the same idea applied to human systems.
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This may include: relationships between the life
patterns of organisms and their environment;
ecological niches, symbiotic and other
relationships.
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Influence on health behavior theory: ecological
approach, focus on multiple determinants of
health, role of the environment in behavior.
Meta Information
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No one theory is adequate
Every theory and model has a specific goal
– What does it try to explain?
• Is it about how people learn?
• Is it about how people change?
• Is it about how people relate to others?
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Every theory/model is somehow connected to what came
before
– Evolution of understanding
– Increasing complexity and sophistication
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Every theory/model has a better/best fit:
– For particular problems
– For particular populations
– For particular interventions
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Every theory/model was developed in a cultural and
social milieu that may be different from present day
Reasons for Thinking Theoretically
about Health Promotion
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# 1 - Infuses Ethics and Social Justice into
Public Health Practice
# 2 - Represents A Moral Duty and A
Professional Responsibility
# 3 - Guides the Profession
# 4 - Prevents Ideological Take-Over, or
Hegemony
# 5 - Guides and Perfects Practice
# 6 - Builds Scientific Knowledge
# 7 - Provides Roadmaps for Research
Reason # 1:
Ethics and social justice
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The Tuskegee Study
– Breech of ethical principles in conducting research.
– One of the reasons for ethical mis-conduct:
• According to James Jones (author of the
book Bad Blood) – medicine, at the time,
was a profession “almost wholly composed
of people uninterested in theorizing”
(Jones, 1993, p. 96).
Reason # 1 cont.
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Tuskegee happened because…
– The medical (and public health) profession trained
physicians to become
• Healing technicians
• Health methodologists
• Health strategists
– Not trained to
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Reflect
Inquire
Question the status quo
OR: not trained to think theoretically
Reason # 2:Moral duty and
Professional responsibility
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Professions have defined tasks and values.
Professional tasks and values = professional
responsibilities
Most professions  CODE OF ETHICS and
PROFESSIONAL COMPETENCIES
Reason # 2 cont.
Our professional responsibilities include:
Develop
our professional tools
Become more effective and efficient
Reflect continually on our practice
Question our methods
Reform our views, when needed
Build narratives that provide meaning for
people’s health promotion efforts
Witness / Listen to our clients’ narratives
Reason # 2 cont.
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Theorizing: responsibility embedded in 6 of the 7
areas of professional responsibility for health
educators, defined by NCHEC (National
Commission for Health Education Credentialing).
Examples:
– “Identify factors that influence health behaviors”
(Area I – sub-competency C)
– “Identify factors that foster or hinder the process of
health education” (Area I – sub-competency E)
Reason # 3:
Guides the Profession
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Few scholars are thinking theoretically about the
direction health promotion/public health is
taking.
Those who have thought theoretically, have
contributed:
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New theories
New models and perspectives
New approaches
Helpful critiques
Reason # 3 cont.
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Few scholars engage in theoretical thinking
about public health because:
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It is disquieting
Can be disturbing
Can “rattle the status quo cage”
Yet: THIS is what theory does…
Reason # 4: Prevent ideological
take-over, or hegemony
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Ideology = the integrated assertions, theories
and aims that form the collection of plans
societies have for governing themselves.
Hegemony = happens when one social group’s
ideology dominates another group and becomes
the predominant influence over this group (OR:
an ideology take-over).
Reason # 4 cont.
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If public health professionals do not build and
shape public health’s ideology, professionals
outside public health will.
Consider the influence of other fields of
knowledge on public health, historically.
Public health cannot exist without an ideology (or
set of theories).
Someone has to build these theories and
assertions.
If not public health professionals, who?
Reason # 5: Guides and perfects
practice
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Practice = set of activities used to promote
health and prevent illness.
“Practice makes perfect”  “Theory makes
perfect” (Willinsky, 1998, p.245).
Prevention interventions: more effective when
based on theory
Many theories suggest strategies for changing
specific factors/variables/elements.
Practitioners may not have to re-invent the
wheel, when using these theories.
Reason # 6:
Builds scientific knowledge
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The body of knowledge in a given field needs
two types of research:
1. Descriptive
2. Analytical
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Public Health: too much descriptive research?
Not enough analytical?
“Chaos in the Brickyard” letter by Bernard K.
Forscher (Science, 1963)
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Too many scattered bricks (data)
No buildings (bricks connected in a planned
manner)
Reason # 7:
Provide roadmaps for research
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Most fields: asking for more theory-based
research
– Provides data that can be generalized more broadly
(applied to a larger number of
contexts/contingencies).
– Facilitates conducting and implementing research
projects.
– Provides blueprint for selecting which variables to
measure.
– Provides parameters for analyzing (and interpreting)
what was measured.
– Avoids: Re-inventing the wheel, going around in circles