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Introduction
In this section, we will discuss the differences
between theories and models, identify examples of
these theories and models at multiple levels and
apply these to public health issues.
Four broad theoretical traditions
Social ecology
Health promotion
Interpretive studies
Critical perspectives
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Theory vs Model
Theory
• Set of interrelated concepts,
constructs, and propositions
that predict behaviors
• Tend to encompass a broad
domain
• More formal
• Multiple theories may be
used to explain a
behavior/set of behaviors at
different levels
Model
• A heuristic device for
organizing components of a
domain to show
relationships between parts
and the outcome
• Applied to more narrowly
defined domains or
behaviors
• Less formal
• Make tentative claims about
causality
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Theoretical Traditions in Public Health
• Based upon the traditional public health model (host-agent
environment)
• Expanded to include social and cultural factors as key contributors to
health issues
• Social Ecology of Health Model
Social ecology
• Seeks to identify determinants and pathways of influence for
• health-related behaviors
• Focus on individual-level behavior change
• Key construct is self-efficacy
• Health Belief Model, Theory of Planned Behavior, Transtheoretical
Model
Health promotion
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Theoretical Traditions in Public Health
• Focus on subjective, perceptual, and cognitive dimensions of illness
• Meanings are not correct/incorrect and can change based upon
cognitive/social/cultural factors influencing the individual
• Qualitative approach often using illness narratives
• Theories from anthropology, sociology, psychology
Interpretive studies
• Challenge the dominant paradigms of public health practice and
seek alternative approaches to improve health
• Two approaches: political-economic and constructivist
• Argue that ecological models accept the social status quo and do
not challenge unequal distribution of resources
Critical perspectives
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Key Concepts of Theories and Models
Knowledge and attitudes
• Perceptions, attributions, attitudes, knowledge
• Cognitive factors are easy to study and typically straightforward
Health behavior
• Development of reliable and valid measures of specific health behaviors or prediction
of behaviors
• Often conceptualized according to different stages of behavior
Culture
• Explores differences across not only health states but explanations for health/illness
behaviors and perceptions
Social environment
• Social stress, social support, social networks, social capital
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Intrapersonal-Level Models
Cognitive models that focus on knowledge, attitudes, and
perceptions
Health Belief Model
• Decisions to take action are
based upon four factors:
perceived susceptibility,
perceived severity,
perceived benefits,
perceived barriers
Theory of Planned Behavior
• Intentional behavior is
determined by three
factors: attitude toward
the behavior, subjective
social norms, perceived
behavioral control
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Intrapersonal-Level Models
Transtheoretical Model
• Stage model of behavior
change
• People move through
stages of decision-making
from precontemplation
to adoption of the health
behavior change
Self-Regulatory Models
• Refers to the way in
which people monitor
their behavior and
continually make changes
to “regulate” their
actions to achieve goals
• Attempts to explain the
factors that are important
in this process
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Interpersonal-Level Models
Models and frameworks for understanding how social
context influences health
Social Support Theory
• Seeks to explain the
process of assistance
provided through
human relationships
Social Cognitive Theory
• Describes how social
relationships
influence cognitions
and behavior in a
reciprocal interaction
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Organizational-Level Models
Aids in understanding how complex public health
agencies work and is useful in trying to plan programs
involving these entities
Diffusion of Innovation Theory
New behaviors tend to be adopted in predictable stages that
have predictable patterns
Utilizes defined “types of adopters” to describe these
patterns
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Multi-Level Models
Address distal, intermediate, and proximate factors
Critical for understanding all types of health problems
and for analysis of public health issues
Biopsychosocial Model
Designed to explain the interplay of biological and social
factors in disease etiology
Includes “layers” from genetic to global systems level
While similar to the social ecology model, places greater
emphasis on the biological basis of disease