Pro*Doc Communication and Health
Theories of Health Behaviour
Date: 27 and 28 May 2010
Location: University of Lugano
Instructor:
Karen Glanz, PhD, MPH
kglanz@upenn.edu
(1.0 ECTS)
Objectives
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To increase students’ breadth and depth of knowledge about the application of social science-based theories to problems in health behavior and health communication
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To encourage participants to extend their knowledge of and experience with the conceptual, methodological, and statistical underpinnings of health behavior theories.
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To stimulate discussion and challenge students to expand their command of theories and their application, based on current literature and research in progress
Overview
This seminar is designed to offer both a broad perspective and analytical approach to the use, development, and evaluation of health behavior theory. It is recognized that all health behaviors occur within a multilevel context, thus this seminar will pay attention to the individual-level of analysis and will also recognize the role of social, institutional, and political factors. The course will not include a comprehensive review or evaluation of current theories, some of which students have become familiar with in previous courses and seminars.
Background Reading – general sources:
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Glanz, Rimer & Viswanath. Health Behavior & Health Education: Theory, Research and Practice (4th ed.). Jossey-Bass, Inc., 2008
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Theory at a Glance monograph (Glanz & Rimer). 2005 edition -- NIH Publ. 05-3896. http://www.cancer.gov/cancerinformation/theory-at-a-glance
Session Foci, Preparatory Readings and Assignments
Session I. Current Use of Health Behavior Theories
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What theories are being used – for descriptive/explanatory research; for intervention research?
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As reported in the literature, how are theories being used? Are they: a) testing theory, b) applying theory, c) informed by theory? Or something else?
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Describe trends/change over time
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Comment on whether the trends are responsive to major public health problems, and to calls for research and action in health behavior and social determinants areas
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Do often-used theories meet the criteria of “theory”?
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How fully developed and tested are widely used theories?
Readings:
Glanz, Rimer & Viswanath book – Chapters 1 and 2
Assignment:
Review one theory from the Glanz, Rimer & Viswanath book or Glanz & Rimer monograph, and come prepared to discuss whether it meets the "minimum criteria for a theory." At a minimum, review the book chapter on the theory. Supplement this reading with other articles as you have time.
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If your family name/surname begins with A through
Precaution Adoption Process Model (Chapter 6 in Glanz, Rimer & Viswanath)
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If your family name/surname begins with D through F
Health Belief Model (Chapter 3 in Glanz, Rimer & Viswanath)
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If your family name/surname begins with G through Z:
Diffusion of Innovations (Chapter 14 in Glanz, Rimer & Viswanath)
QUESTIONS TO GUIDE THE DISCUSSION:
Evaluate the various criteria on a continuum, rather than just yes/no
Begin with Kerlinger's (1986) definition of a theory (see book Chapter 2)
Evaluate the generality (to various health behaviors & various populations)
Assess the testability - in parts, and as an integrated theory
To what extent is this a "theory of the problem" (explanatory), "theory of action"?
Identify key concepts/constructs of the theory, and indicate how well these have been defined as variables with corresponding measures
How fully developed is the theory? How widely has it been tested/applied?
If you have time -
a) go back to some of the "classics" such as Lewin's work, Kuhn, or Babbie or Kerlinger's books - to examine the theory in context of their work, OR
b) discuss the paradigm that best fits the theory
Session II. Application of Theories to Health Behavior Change Interventions
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Describe examples of how theories at various levels have been applied to develop (and evaluate) interventions
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Analyze how faithful the interventions are/were to the theory/ies (partially? completely? If not completely, why and could they be made more faithful?)
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Are the theory-based interventions research tested (empirically)? Does research support the theory or not? Why/why not?
Readings:
Glanz, Rimer & Viswanath book – Chapters 3 to 6, Chapter 8
Assignment:
Read the above chapters and papers, and come prepared to discuss:
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To what extent has the TTM been supported in intervention research? Consider different types of health behaviors. Suggest research approaches to further test the TTM as a foundation for health behavior change interventions.
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Give one or 2 examples of behavioral issues for which the TTM does not fit well, using available data if possible. Provide analytic explanation of why the TTM does not fit well with that issue, and suggest alternative theories/theory that seem to fit better
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Some reviews and critiques show limited support for the TTM as a basis for health behavior change interventions. In light of this, why do you think the TTM is so widely used and popular?
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Consider the idea of “stage theories” – and examine the PAPM and TTM using Weinstein et al.’s propositions (see Chapter 6 of Glanz et al. book). Could the PAPM be considered a blend of the Health Belief Model and the Transtheoretical Model? Why or why not?
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Supplement the assigned readings with additional articles as time permits
Session III. Measuring Theoretical Constructs and Theory-Testing Analytical Approaches
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How are the key constructs measured?
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What is known about the characteristics of the measures?
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What are strengths/limitations of the available measures, and what needs do you identify?
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What analytic approaches have been used in explanatory/descriptive research using each theory? (Comment on research design as relevant)
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Has theory been analyzed in an integrated manner or as a collection of constructs/variables?
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Describe whether analyses have examined theoretical constructs as mediators/moderators, and with what results?
Readings:
Glanz, Rimer & Viswanath book – Chapters 21 and 22
Cherpitel C, Bond J, Ye Y, et al. Multi-level analysis of causal attribution of injury to alcohol and modifying
effects: Data from two international emergency room projects. Drug Alcohol Depend 82: 258-268, 2006.
Gee GC, Takeuchi DT. Traffic stress, vehicular burden and well-being: A multilevel analysis. Social Science and Medicine 59: 405-414, 2004.
Assignment:
Using the assigned readings, including citations from those chapters/articles, identify: 1) one good example of a study that uses a well-designed, systematic approach to measuring theoretically-derived constructs; and 2) one good example of a study that analyzes theoretical constructs in an integrated manner. One of the examples should be an intervention study. Come prepared to describe the examples you found and develop a summary handout (with chart/figure; no more than 1 page) to share with the group.