Applying Theory to Practice and Research

The Theory of Reasoned Action, Health Belief Model, Theory of Planned Behavior, and Trans-theoretical Stages of Change model all enhance disease prevention and health promotion practices. They are also used in planning programs to describe and understand health behaviors and support experts to identify, develop, and implement interventions. The theories, their strengths and limitations are described in this paper.

Theory of Reasoned Action

The theory of reasoned action (TRA) proposes that the intention of people to engage in specific behaviors determine their health behaviors. The intention is the possibility that a person will behave in a specific way in a specific situation (Doane, Kelley, & Pearson, 2015). For instance, an individual with thoughts about quitting drinkinh has intentions to stop but the person may or may not comply with the intent. When applying TRA, the expert considers the attitudes of the person or population towards the behavior and the subjective norms that influence groups and people and that could affect the considered attitudes. In predicting whether an individual would or would not behave in a specific way, the theory explores the attitudes regarding the intended behavior and the norms that an individual perceives from the surrounding people regarding whether or not it would be a positive thing to do (Doane et al., 2015). Based on this theory, attitudes and norms influence the intention while the intention motivates behavior. The focus on attitudes and norms enables the theory to offer a model that can identify and measure the underlying reasons for an individual’s intent to or not to act in a specific way. Understanding the underlying reasons allows health experts to design accurate interventions to influence the person towards positive behavior.

One of the strengths of the model is that it offers a simple basis for locating where and how to target behavior change. The emphasis on understanding the underlying reasons allows experts to design an effective intervention. Additionally, the theory also uses social norms, a construct that other theories fail to provide (Doane et al., 2015). TRA is, however, insufficient as a sole model for predicting behavior because of the limited volitional control (Doane et al., 2015). Besides, TRA suggests that its constructs mediate the effects of external factors such as past behaviors on behavior and intention. Several studies have, however, demonstrated that past behavior has a residual effect on the target behavior (Doane et al., 2015). These studies found perceived behavioral control and intention to have a strong relationship with past behavior than with imminent behavior. The suggestion here is that past behavior can affect a person’s intentions even though intentions affect future behavior.

Health Belief Model (HBM)

HBM suggests that people engage in health-related behaviors such as exercising if they think that they will avoid a negative health issues such as a heart attack; are positive that they will avoid an adverse health problem by engaging in the recommended behavior (exercising often can prevent a heart attack), and believe that they can engage in the recommended health behavior successfully (can confidently and comfortably exercise) (Glanz & Bishop, 2010). HBM is used to motivate an individual to engage in positive health behavior using prime motivation involving the desire to avoid an adverse health outcome. For instance, since a heart attack is an adverse health outcome, the model uses the desire to avoid a heart attack to motivate an individual with high blood pressure to exercise regularly. Avoiding an adverse health outcome is the main element of this theory. The model can be applied effectively in designing health education approaches (Glanz & Bishop, 2010). The model has six concepts. Perceived susceptibility that defines the target at risk and the risk level, personalize risk through considering the behavior and trains the person and increases the perceived susceptibility if it is too low. Perceived severity specifies and describes outcomes of the condition and risk. Perceived benefits define the, required actions, clarify the expected positive outcomes, and describes a proof of effectiveness. Perceived barriers identify and decrease hindrances through assistance, incentives, and reassurances. Cues to action offer how-to information, support awareness, and offers reminders while self-efficacy offers training, direction, and positive reinforcement (Glanz & Bishop, 2010).

The application of simple constructs related to health is one of the main strengths of HBM because this simplifies testing, application, and implementation of the model. The model also offers a strong foundation for the examination of cognitive determinants of different behaviors through its focus on prerequisite variables for health behavior (Orji, Vassileva, & Mandryk, 2012). Many interventions for different behaviors have used the model. The main limitation of the HBM is its lack of a clear explanation regarding the association between various variables and the absence of rules to combine the variables (Orji et al., 2012). Another limitation is the model’s ability to predict in which even though the main variables such as barriers, benefits, severity, and susceptibility can significantly predict health-related behaviors, they have an insignificant effect (Orji et al., 2012). The model does not consider other vital variables that affect health behavior such as environmental or economic variables, which means it is incomplete.

Theory of Planned Behavior

Based on the theory of planned behavior, all or some of the four main variables including perceived behavioral control, subjective norm, attitude, and intention influence behavior. The theory is applied to determine psychological determinants of specific behavior, such as exercise to develop exercise programs. People engage in physical activity if they positively evaluate the activity. The intention of the person to exercise increases if the physical activity programs offer positive experiences since these experiences influence exercise behavior positively. It is, therefore, possible to enhance positive behavioral beliefs and their assessment by giving people enjoyable experiences and the increase the frequency, duration, and intensity of the activity gradually. Another vital variable that influences the intention to engage in a specific behavior is perceived behavioral control. If people perceive exercise to be a difficult activity, their intention to exercise reduces. The theory intervenes in these circumstances by helping people to address different obstacles such as inability feelings, obligations, or time to increase their perceptions of control regarding engaging in physical activity.

The theory of planned behavior is an evidence-based model that uses studies as the basis for raising questions to evaluate its variables in specific groups (Miller, 2017). The use of studies allows experts to identify the specific beliefs for specific people, which is vital since beliefs vary by activity and people. Another strength of the model is that the theory offers useful data that can be used to predict health behaviors and to plan and implement disease prevention and health promotion programs in different groups including older adults, the youth, pregnant women, minorities, and patients with different ailments. The theory, nevertheless, does not consider variables such as demographics, personality, previous physical activity behavior, mood and habit directly. Studies, for example, have found gender, age, and personality variations regarding the number of people engaging in exercises (Miller, 2017). Another limitation of the theory is the ambiguity about the way to describe perceived behavioral control since this leads to measurement issues (Miller, 2017). Besides, the theory relies on time since long term intervals between intention and activity reduces the possibility of the behavior occurring. Long time intervals may compel people to change their intention because of new information, which decreases the predictive validity of previously assessed behaviors before the emergence of the changes.

Trans-theoretical Stages of Change

The trans-theoretical/stages of change model focuses on several important insights that help in understanding and supporting the behavior change process. Based on the model, changing behavior occurs through a process that starts with the dissemination of information through support groups or classes (Glanz & Bishop, 2010). The implication of this is that every person attempting to change behavior reacts similarly to new guidance and information. A person can be assisted to realize the existence of an issue and see the need to change behavior. If the person does not change, it is because of his lack of willpower and motivation. Besides, the behavior change process occurs over a period and goes through the stages of change in which each change relates to the readiness of the person to change, which differs over time (Glanz & Bishop, 2010). Program developers can enhance the effectiveness of the programs by matching interventions to the applicable stage. Changing the behavior or any movement toward change like a move from a single stage to another define success. The model also emphasizes the regularity of relapse in which, for example, an alcoholic must attempt quitting several times before finally being successful (Glanz & Bishop, 2010). Relapse is a chance to learn how to sustain change in the future.

The main strength of the stages of change model is the possibility of tailoring its concepts to fit a person’s readiness to start changing behavior, which makes it possible to apply for individually based programs at the population level (Nigg et al., 2011). In turn, this would target and change unwanted behaviors effectively since different people will be at various readiness levels. Besides, the model is clear and can be used by a researcher or practitioner (Nigg et al., 2011). The model can also combine public health and clinical health intervention to maximize its success in changing health behavior. The model, however, does not consider the social setting in which change occurs since it does not have established criteria regarding the way to identify an individual’s stage of change. It lacks a clear sense of the time required for each stage (Nigg et al., 2011). Additionally, the model classifies behavior change into six different stages instead of being considered to be a continuous process (Nigg et al., 2011). It is important to classify people along a behavior change continuum by integrating specific psychological variable.

The best model to be used in developing a public health campaign is the Health Belief Model because the model offers a useful basis for examining health behaviors. Its components independently predict health behavior in which high perceived benefits, low barriers, and high perceived threat to behavior increase the possibility of engaging in the suggested behavior (Orji et al., 2012). Besides, the model also differs from other frameworks since it does not have strict guidelines regarding the way the various variables combine in predicting behavior. It suggests that each variable contributes to predicting behavior (Orji et al., 2012). The model has also been used widely to predict different behaviors with health implications.

References

Doane, A. N., Kelley, M. L., & Pearson, M. R. (2015). Reducing cyberbullying: A theory of reasoned action-based video prevention program for college students.  Aggressive Behavior ,  42 (2), 136– 146. https://doi.org/10.1002/ab.21610 

Glanz, K., & Bishop, D. B. (2010). The Role of Behavioral Science Theory in Development and Implementation of Public Health Interventions.  Annual Review of Public Health ,  31 (1), 399–418. https://doi.org/10.1146/annurev.publhealth.012809.103604 

Miller, Z. D. (2017). The Enduring Use of the Theory of Planned Behavior.  Human Dimensions of Wildlife ,  22 (6), 583–590. https://doi.org/10.1080/10871209.2017.1347967 

Nigg, C. R., Geller, K. S., Motl, R. W., Horwath, C. C., Wertin, K. K., & Dishman, R. K. (2011). A research agenda to examine the efficacy and relevance of the Transtheoretical Model for physical activity behavior.  Psychology of Sport and Exercise ,  12 (1), 7–12. https://doi.org/10.1016/j.psychsport.2010.04.004

Orji, R., Vassileva, J., & Mandryk, R. (2012). Towards an Effective Health Interventions Design: An Extension of the Health Belief Model.  Online Journal of Public Health Informatics ,  4 (3). https://doi.org/10.5210/ojphi.v4i3.4321