1. 1.4 Health promotion
theoretical perspectives
Health Behaviour theories
By
Dr Iftikhar Uddin

2. • Ecological Models
• Community theories
• Diffusion of innovation
• Community organization theory
• Organizational change theory
• Interpersonal
• Social learning theory
• Social cognitive theory
• Individual
• Trans theoretical model / stages of change model
• Health belief model
• Consumer information processing model

3. Theories Focusing on Health Behaviour change
at Interpersonal level
Interpersonal theories.
• Comprised of theories that “include factors related to individua”
experience and perception of their environments In combination with
their personal characteristics”.
• Social cognitive theory/social learning theory..

4. Social Cognitive Theory
• Stemmed from the social learning theory (SLT), which has a rich
historical background dating back to the late 1800s.
• Albert Bandura first began publishing his work on SLT in the early
1960s.
• In 1986, Bandura officially launched the SCT with his book Social
Foundations of Thought and Action: A Social Cognitive Theory.

5. Social Cognitive Theory
Purpose of Theory:
• To understand and predict individual and group behavior.
• To identify methods in which behavior can be modified or changed.
• Frequently used in interventions aimed at personality development,
Behavior pathology and health promotion.

6. Social Cognitive Theory.
• Tenet 1: Response consequences (such as rewards or punishments)
influence the likelihood that a person will perform a particular
behavior again in a given situation.
• Tenet 2: Humans can learn by observing others (vicarious learning), in
addition to learning by participating in an act personally.
• Tenet 3: Individuals are most likely to model behavior observed by
others they identify with.
• The degree of similarity to one’s self.
• The degree of emotional attachment felt toward an individual.

7. Social Cognitive Theory.
Bandura defines human behavior as a triadic, dynamic and reciprocal
interaction of personal factors, behavior and the environment.
• Change results. Flow from learning through interaction among:
• Person (e.g., cognitive, effective, biological)
• Behavior (e.g., self. Regulation)
• Environment (e.g., economics, SES, social networks)
• An individual’s behavior is uniquely determined by each of these
three factors.
Person shapes environment and environment shapes person.

9. Key Concepts of SCT.
Decision making rarely conducted in vacuum.
People make decisions based on:
 Reciprocal Determinism
 Behaviour Capability
 Expectations
 Self Efficacy
 Observational Learning
 Reinforcement

10. Usefulness of Social Cognitive Theory in
Public Health
Used to study a wide range of health problems:
• Medical therapy compliance, alcohol abuse, immunization.
• The greatest contribution of CST is its aid in understanding how
children are socialized to accept the standards and values of their
society (Johnson et al 1997)
Limitations:
• Complex and difficult to operationalize.
• Many applications of the CST focus on one or two constructs, such as
self efficacy, while ignoring the others.

12. Theories focusing on Health Behavior Change
at Community Level.
Community Level Theories.
 Diffusion of Innovation.
 Community Organization.
 Theory of Reasoned Action.

13. Diffusion of Innovation.
Diffusionism was the point of view in anthropology that explained
social change in a given society as a result of the introduction of
innovations from another society.
(Rogers, 1995)

14. Diffusion of Innovation
• Analyzes as well as help explain, the adaptation of a new innovation.
• The purpose is to provide individuals from any discipline interested in
the diffusion of an innovation with a conceptual paradigm for
understanding the process of diffusion and social change.

15. Diffusion of Innovation
Diffusion.
• The process by which an innovation is communicated through certain
channels over time among the members of a social system.
Innovation.
• An idea, practice, or object that is perceived as new by an individual
or other unit of adaptation.

16. Diffusion of Innovation
Diffusion is the process by which an innovation is communicated
through certain channels over time among the members of a social
system.
Four main elements of the theory are the
1. Innovation.
2. Communication channels
3. Time
4. Social system.

17. Considerations for Change Agent
1. The characteristics of the innovation or change itself.
2. The characteristics of the target population (the adopter categories)
3. The stages of adaptation.
4. Each of these three categories should be analyzed and planned for,
when introducing an innovation or change

18. Characteristics of an Innovation
• Relative Advantage.
The degree to which an innovation is perceived as better than
the idea it supersedes.
• Compatibility.
The degree to which an innovation is perceived as being
consistent with existing values, past experiences and need of
Potential adopters.
• Complexity.
The degree to which an innovation is perceived as difficult to
understand and use.

19. Characteristics of an Innovation
• Trialability:
The degree to which an innovation may be experimented with
on a limited basis
• Observability:
The degree to which the results of innovation are visible to
others.

20. Characteristics of an Innovation
Innovations that are perceived by individuals as having greater relative
advantages, compatibility, trialability, observability and less
complexity will be adopted more rapidly than other innovations.
(Rogers, 1995)

21. Diffusion of Innovations: Adoption Curve

24. Adopter categories
• Innovators;
Venturesome. Cosmopolite, risk-taking, Information seeking,
with a higher financial status
• Early adopters;
Greatest degree of opinion Leadership, respected by other
members of social group. Strategies with a motivational
emphasis may be most effective at getting them involved in the
diffusion process.
• Early majority;
Deliberate, adopt new ideas just before the average member of
a system.

25. Adopter categories
• Late Majority;
Skeptical, adopt new ideas just after the average member of a
system. The pressure of peers is necessary to motivate
adaptation. Intervention strategies that help overcome barriers
are needed to get them to take up the innovation.
• Laggards;
Traditional, last in the social system to adopt in innovation, pays
little attention to the opinions of others.

26. Stages of Adaptation rate of Diffusion
• The new idea or innovation typically moves slowly as it is first
introduced.
• Then, as the adopter increase, the diffusion of the new idea moves at
a faster rate.
• The diffusion phenomena initially follows an S-shaped curve.
• Then, after the possible new adopters naturally decreases, so does
the diffusion curve.
• The diffusion is determined then by the social group, and each social
group of adopters can be designated in the curve normal curve for
populations.

28. Community Organization Theory
• Community organization is the process by which community groups
are helped to identify common problems or goals, mobilize resources,
develop and implement strategies for reaching their goals.
• It is also consistent with Social Learning Theory and can be
successfully used along with SLT-based strategies.

29. Community Organization Theory
• Locality development (also called Community development)
uses a broad cross section of people in the community to identify
and solve their own problems. It stresses consensus
development, capacity building and a strong task orientation;
outside practitioners help to coordinate and enable the
community to successfully address its concerns.

30. • Social planning.
Uses task goals and addresses substantive problem solving, with
expert practitioners providing technical assistance to benefit
community consumers.
• Social action
aims to increase the problem solving ability of the community
and to achieve concrete changes to redress social injustice that is
identified by a disadvantage or oppressed group.

33. Conclusions
• No single theory dominates health education and promotion, Nor
should it. The health problems, behaviors, populations, cultures, and
contexts of public health are broad and varied.
• In addition, the importance of subtypes of problems change over
time because of new technology and successful public health
activities.
• Some theories focus on individuals as the unit of change, while others
focus on change in the organizations or cultures.

34. Conclusions
• Because of these different frames of reference, theories that were
very important to public health education a generation ago may be of
limited use today.
• Theories often overlap, and that some seem as if they can fit within
broader models.
• More than one theory is needed to adequately address an issue for
comprehensive health promotion programs. This is most always true.

35. Conclusions
• One of the greatest challenges to public health professionals is to
learn to analyze the “fit” of a theory or model for issues one is
working with.
• A working knowledge of a handful of theories and how they have
been applied will go a long way to improve one’s skill in this area

39. Ecological perspective: 5 levels of influence
1. Intrapersonal or individual factors
2. Interpersonal factors.
3. Institutional or organizational factors
4. Community factors.
5. Public policy factors,
(MACLAURY, 1988)

40. Ecological perspective: 5 levels of influence
Intrapersonal Factors
Individual characteristics that
influence behavior, such as
knowledge, attitude, beliefs and
personality traits.

41. Ecological perspective: 5 levels of influence
.
Interpersonal Factors
Interpersonal processes and
primary groups, including family.
Friends, peers that provide social
identity, support and role definition

42. Ecological perspective: 5 levels of influence
Institutional Factors
Rules, regulations, policies, and
informal structure which may
constrain or promote
recommended behaviors

43. Ecological perspective: 5 levels of influence
Community Factor
Social networks and norms or
standards which exist as formal or
informal among individuals, groups,
and organizations

44. Ecological perspective: 5 levels of influence
Public Policy
local, state, federal policies and
laws that regulate or support
healthy actions and practices for
disease prevention, early detection,
control, and management.