The document outlines various theories and models in health education (HE) aiming to enhance understanding and intervention strategies for health behaviors. Key theories discussed include the Health Belief Model, Theory of Reasoned Action, Theory of Planned Behavior, and Social Cognitive Theory, each explaining distinct aspects of health behavior determinants and change processes. It provides insights into how these theoretical frameworks serve as tools for effective health education planning and implementation.

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Module-3
THEORIES & MODELS IN HEALTH
EDUCATIONS

2. OBJECTIVEs
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At the end of this lecture students will be able to:
 Discuss the role of the theories/models in HE
 Describe the most common theories used in HE

3. What is theory?
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Theory is
“A set of interrelated concepts, definitions, and
proposition.
 present a systematic view of phenomena
 by specifying relations among variables with the purpose
of explaining and predicting the phenomenon”
 Theories explain why, what, how and when a particular
behavior occurs.

4. What is Models?
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Model is
“Generalized, hypothetical description used to
analyze or explain something’’.
 Is diagrammatic representation of a phenomena
 It provides plan foe investigating and/or addressing
phenomena.

5. Why theories/models?
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 Provides a road map for studying problems, developing
appropriate interventions, and evaluating their successes.
 Help to explain the dynamics of health behaviors.
 Help planners identify the most suitable target audiences,
methods for fostering change, and outcomes for evaluation.
 Guides the search for reasons why people do or do not
engage in certain health behaviors;

6. Classification…
Theories/Models in HE/HP
Planning theories/models
E.g. PRECEDE-PROCEED model
Behavior change Theories/Models
Intra-personal
theory / models
HBM, TRA,
TPB, TTM
Inter-personal
theory/ models
SCT
Community
theory/models
eg. TDI
Continuum theory
Eg.HBM, TPB, TRA
Stage theory
Eg. TTM

7. 1. Individual Health Behavior Model
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 Focus on individual characteristics that influence
behavior, such as knowledge, attitudes, beliefs, and
personality traits
 Health Belief Model (HBM)
 Theory of Reasoned Action (TRA)
 Theory of Planned Behavior (TPB)
 Trans-theoretical Model (TTM)- Stages of Change

8. 2.Interpersonal health behavior theories
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 Focus on interpersonal processes including relationship with family,
friends, and peers.
Social Cognitive Theory(SCT)
3. Community level Models
 Community-level models are frameworks for understanding how social systems
function and change, and how communities and organizations can be activated
Diffusion of Innovation (DoI)

9. HEALTH BELIEF MODEL
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10. 1. The health belief model (HBM)
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 The HBM has been developed by a group of psychologists in the
1950s to explain why people would or would not use health
services
 The model is used in explaining and predicting preventive health
behavior, as well as sick-role and illness behavior.
 It emphasizes the intellectual dimension of health
behavior.

11. HBM
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Focus:
 Individuals’ perceptions of the threat posed
by a health problem, the benefits of avoiding the threat, and
factors influencing the decision to act.
 Six main constructs influence people’s decisions about
whether to take action to prevent, screen for, and control
illness

12. constructs of the HBM
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 Perceived Susceptibility- refers to beliefs about the likelihood of
getting a disease or condition .
 Perceived severity- Feelings about the seriousness of
contracting an illness.
 Perceived benefit-the belief that changing one's behavior will
reduce the threat
 Perceived barriers-a perception of the obstacles to changing
one's behavior eg. Cost, side effect, culture…
 Self efficacy-the belief that one has the ability to change one's
behavior
 Cues to Action - may be internal or external.

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•Demographic variables
•Socio-psychological
variables (personality, peer
pressure etc)
•Structural variables (e.g.
knowledge about the
disease.
(OUT COME EXPECTATION)
•Perceived benefits of preventive
action
Minus
•Perceived barriers to preventive
action
•Perceived susceptibility
to Disease "X“
+
•Perceived seriousness
(Severity) of Disease "X"
Perceived threat
of Disease "X"
Likelihood of taking
recommended
preventive health
action
Cues to action
•Mass media campaigns
•Advice from others
•Reminder postcard from health workers
•Illness of family member or friend
HEALTH BELIEF MODEL
Individual perception Modifying Factors Likelihood of action

14. Exercise( 5 minutes)
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 If HBM model was used to shape a public program for Breast
cancer screening. What beliefs would it be necessary for
women to adopt so as to minimize the risk of developing Breast
cancer?

15. CONSTRUCT
Perceived Susceptibility
 Chances of getting breast cancer are high.
(on a 5 point scale,ranging from "strongly disagree" to "strongly agree")
Perceived Severity
 My marriage would be endangered if I had breast cancer.
(on a 5 point scale,ranging from "strongly disagree" to "strongly agree")
Perceived Benefits
 Getting a mammogram in our hospital has brought me peace of mind.
A mammogram is a routine part of my check up-exam.
(on a 5 point scale,ranging from "strongly disagree" to "strongly agree")
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16. constructs
Perceived Barriers
 Getting a mammogram is too embarrassing.
(on a 5 point scale,ranging from "strongly disagree" to "strongly agree")
Cues to Action
 Hearing about breast cancer in the news makes me think about getting
a mammogram.
(on a 5 point scale,ranging from "strongly disagree" to "strongly agree")
Self-Efficacy
 How sure are you that you know how to arrange an appointment for a
mammogram?
(on a 5 point scale,ranging from "unsure" to "very sure")
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17. 2. Theory of Reasoned Action
(Fishbein & Ajzen, 1970’s)
…TPB is the extension of TRA…

18. Introduction
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 TRA was introduced by Fishbein in 1967
 Modified & Refined over time (eg. Ajzen & Fishbein,
1980)
- concerned with the prediction and understanding
of human behavior
 It was designed to explain all human behavior that is
under volitional control.

19. Assumption:-
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 The theory rests on the assumptions that
humans are:
- rational,
- have control over their behavior, and
- seek out, utilize, and process all available
information about pending decisions before they
take actions.
therefore, Ajzen and Fishbein refer to their
approach as "a theory of reasoned action"

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INTENTION
Subjective
norms
Attitude
Behavioral belief
&
Outcome Evaluation
Normative beliefs of
referents
&
Motivation to comply
The theory of reasoned action.
BEHAVIOR

21. TRA…
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 Intentions are most immediate influence or
determinant of behaviors
If one has intend to perform a behavior then it is
likely that he/she will do so, if not intend then it is
unlikely to be performed.
 Performing a behavior is a function of intention.

22. TRA…
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 Intention :- function of two basic determinants:
 one personal and the other social
 Personal factor = attitude toward the behavior
 The social factor = subjective norm (SN)
SN is the person's perception of the social pressures put on
that person to perform or not perform the behavior in question.

23. TRA…
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Determinants of Attitude toward an Act
-Behavioral beliefs = The person’s beliefs that the behavior leads
to certain outcomes and
e.g physical exercise in reducing body weight
- Evaluation of outcome = his or her evaluations of those
outcomes
Therefore, A person’s Attitude is a function of their behavioral
beliefs, and Evaluation of outcome

24. TRA…
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Determinants of Subjective Norms
1. Normative beliefs
2. Motivation to comply
1. Normative beliefs = belief about what a specific
referent person thinks one should or should not do
regarding the behavior
Referent = specific individual or group who may influence
one’s behavior

25. TRA…
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 For each referent, we have a normative belief, what
we think that referent would want us to do
2. For each referent, we have a specific level of
motivation to comply with their wishes for us
Therefore, A person’s subjective norm is a function of their
normative beliefs for salient referents, and motivation to comply
with these different referents

26. TRA…
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27. Limitations
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 Not appropriate for predicting or explaining behavior in
situations where people had little power over events
around, i.e if there is non volitional control
 It is almost entirely rational and does not provide explicitly
for emotional fear arousal elements such as perceived
susceptibility to illness

28. Extensions (TPB)
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 To improve the predictive power ofTRA, Ajzen(1985) added a
third construct (Perceived behavioral control) to the original
theory to account for the performance of behaviors which are not
completely under the subject's control.
3.Theory of
Planned Behavior

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30. TPB…
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Perceived behavior control:
 is a perceived ease or difficulty in performing a behavior
 It covers non volitional factors which interfere with ones
attempt to perform a behavior.
 Made up of control beliefs and perceived power of a
control
Therefore, A person’s Perceived behavioral control is a function of
their Controlbeliefs, and Perceived power .

31. 4. Trans-theoretical Model (T TM)
(Prochaska & Diclemente, 1979)
…changeis a process with stages not just an event…

32. Introduction
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• Evidence suggest that behavior change occurs in stages or
steps
• Movement through these stages is not linear
• But, rather cyclical involving pattern of adoption, maintenance,
relapse & re-adoption over time .
 The model’s basic premise is that behavior change is a
process, not an event

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Stages of change
1. Precontemplation
2. Contemplation
3. Preparation/Decision
4. Action
5. Maintenance

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35. STAGES OF BEHAVIOR CHANGE
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1)Precontemplation(“ignorance is bliss”) or
enjoyment
 Person does not thinking about changing behavior
 No intention to change
 Un aware of their problem but their problems are recognized by their family
2) Contemplation(“sitting on the fence”)
 Thinking about changing behavior in the near future
 People are aware that a problem exist and
-are seriously considering taking some action to address the problem
-but, they have no commitment to undertake action
 weighing pros and cons of change

36. 3) Preparation (testing the waters)
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 Making a plan to change behavior
 Person decided to act
 Prepares to under take the desired change
Pros > cons
• Requires :
-gathering information
-finding out how to achieve the change
-ascertaining skills necessary
-deciding when change should take place`

37. 4) Action (“go for it”)
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• Implementing the plan to change behavior
• Individuals actually modify their behavior, experiences, or
environment in order to overcome their problems or to meet
their goals

38. 5)Maintenance (“steady as she goes”)
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 Continuation of behavior change
 People work to prevent relapse & consolidate, secure the
gains attained in the action stage
 Characteristics :
-Stabilization of the new behavior
-Avoidance of relapse

39. 5. Social Cognitive Theory
• Human behavior is the product of the dynamic interplay of
personal, behavioral, and environmental influences
• Give due attention to the human minds, and external
environment.
• S C T emphasizes reciprocal determinism in the interaction
between people and their environments

40. S C T… .

41. main constructs of S C T
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1. Reciprocal Determinism: Behavior changes result from
interaction between person and environment; change is bi-
directional.
2. Observational Learning: Beliefs based on observing others like
self and/or visible physical results.
3. Reinforcement: Responses to a person’s behavior that increase
or decrease the chances of recurrence.

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6. DIFFUSION
OF
INNOVATIONSTHEORY
(DOI)

43. Diffusion of innovation theory
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 process by which innovation is communicated through certain
channels over time among the members of a social system
 The four main elements of the definition are:
I. Innovation
II. Communication channels
III.Time
IV. Social system

44. I. Innovation
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idea, practice, or object that is perceived to be new by an
individual or other unit of adoption
- The Characteristicswhich determine an
innovation’s rate of adoption are:
1) Relative advantage
2) Compatibility
3) Complexity
4) Trialability and
5) Observability

45. Characteristics of …

46. II) communication channels
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-It is the means by which messages get from one individual to
another.
Mass media
Interpersonal

47. III. TIME
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- the two time factors are:
(a) innovation-decision process
(b) innovativeness

48. a) The Innovation - Decision Process
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 /The Adoption Process / - the process an individual
passes from first knowledge of an innovation to confirmation
of his decision.
 Five stages through which innovation passes:

49. 5 stages of Innovation-Decision Process…
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1. Awareness/knowledge-exposure to existence of the innovation
2. Interest/persuasion-the individual becomes interested in the new
idea
-seeks additional information about it
3. Evaluation/decision-individual mentally applies the innovation to his
present and anticipated future situation
-and then decides whether or not to try it
-commitment to its adoption

50. 5 stages…
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4. Trial/implementation-the individual makes full use of the innovation
5. Adoption/confirmation-the individual decides to continue the full
use of the innovation

51. b) ADOPTER CATEGORIES based on their
innovativeness
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 Diffusion process - occurs within society, as a group process;
 Adoption process-pertains to an individual.
Adopter Categories according their innovativeness:
1. innovators
- active information seekers of new ideas
- are the first 2.5% of the individuals in a system to adopt an
innovation

52. 2. Early adopters
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 very interested in the innovation but not the first to sign up
 the next 13.5% of the individuals in a system to adopt an innovation
Characteristics:
- integrated part of the local social system,
- greatest degree of opinion leadership in most systems,
- serve as role model for other members or society,
- respected by peers, and
- successful

53. 3. Early majority
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 is the next 34% of the individuals in a system to adopt an
innovation.
 need external motivation to get involved
- interact frequently with peers
- seldom hold positions of opinion leadership
- deliberate before adopting a new idea

54. 4. Late majority
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 is the next 34% of the individuals in a system to adopt an
innovation.
 are skeptics and will not adopt an innovation until most people in
the social system have done so
- pressure from peers,
- economic necessity,
- cautious

55. 5. Laggards
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 are the last 16% of the individuals in a system to adopt an
innovation.
 last to become involved by a mentoring program or through
constant exposure and have limited communication networks
- possess no opinion leadership
- isolates
- point of reference in the past
- suspicious of innovations

56. IV. SOCIAL SYSTEM
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- a set of interrelated units that are engaged in joint problem
solving to accomplish a common goal.
-Norms-established behavior patterns of the
members of the social system
-Opinion leadership -who have relatively frequent
informal influence over the behavior of others

57. Summary
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 Everyone is not ready to change behavior
 Behavioral change occurs in a cyclical process that
involves both progress and periodic relapse.
 People are thought to progress through these 5 stages
at varying rates.
 Even with successful behavior change, people are likely
to move back & forth along the continuum a number of
times before attaining the goal of maintenance

58. Summary …
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 Tailoring interventions (designing health programs ) to match a
person’s readiness or stage of change is essential.
eg - Consciousness raising
(Precontemplation )
- Self re-evaluation
( Contemplation)
- Providing skills
(Action )
- Reinforcement,Supporting environment
(Action, Maintenance ) ,etc.