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I could not do my job without talking about theory. (Health promotion practitioner)
There is nothing so practical as a good theory (Kurt Lewin).
Like an expert chef, a theoretically grounded health education professional does not blindly follow a
cookbook recipe, but constantly creates it anew, depending on the circumstances. Without a theory, she or
he has only the skills of a cafeteria line worker. (US National Cancer Institute, 1997)
Planning is an unnatural process. It is far more fun just to do something. The really good thing about not
planning is that failure comes as a complete surprise rather than being preceded by prolonged periods of
worry and depression. (John Harvey Jones)
CONTENTS
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The Shaping the Future Collaboration is hosted and led by the Royal Society for Public Health, in
partnership with the Faculty of Public Health, the Institute of Health Promotion and Education and
the UK Public Health Register. However, it should be noted that these organisations have not yet
individually endorsed this briefing.
This version takes account of comments made at a Shaping the Future workshop in October 2008.
This is a living document which we would like to develop further. The important of
theory needs continuous discussion. Please send comments to Nelly Araujo at the
Royal Society for Public Health, NAraujo@rsph.org.uk.
Programmes and interventions that are based on sound theory are more likely to help your
organisation meet its key targets, for example reducing obesity, smoking and other addictive
behaviours, and to ensure that health promotion is cost-effective.
The capacity to select relevant health promotion theories or models, and apply them in
practice, is a key competence for public health. It is included in national competence
frameworks, for example the Public Health Skills and Career Framework and the standards of
the UK Public Health Register.
People outside of health promotion can sometimes be sceptical about the added value of
theory and want to move straight to action! This briefing emphasises that theory is an
important form of evidence for planning health improvement interventions.
This document is a short introduction and cannot explain all the major theories. For more
information, please consult a health promotion specialist or academic department, the sources
of information at the end, or ask the Institute of Health Promotion and Education
(www.ihpe.org.uk) or the Shaping the Future Collaboration (NAraujo@rsph.org.uk) who will
seek a colleague to discuss the issues with you.
US National Cancer Institute (2005). Theory at a Glance: A Guide for Health Promotion Practice
(second edition). U.S. Department of Health and Human Services, National Institutes of Health.
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www.cancer.gov/theory/pdf
Theories can help to explain situations or predict the ways in which change takes place in
individuals, communities, organisations and societies. The application of theory allows a
systematic assessment of the problem, its causes and possible solutions to be undertaken.
Without theory, interventions might easily:
Address wrong or inappropriate variables or issues (i.e. miss the target completely)
Tackle only a proportion of the combination of variables required to have the desired
effect (i.e. hit only a few of the total number of possible targets)2
Models provide a looser, often untested, framework to help understand reality and the
relationship between concepts. They may draw on one or more theories.
4. Which theory?
A key decision is which theories or models fit a health problem, such as promoting exercise or
healthy eating. If you are grappling with this issue, you may want to seek help from a health
promotion specialist or academic department, or consult one of the sources of information at
the end of this briefing. These questions may be helpful:3
Green, J. (2000) The role of theory in evidence-based health promotion practice, Health Education
Tones, K. and Green, J (2004). Health Promotion Planning and Strategies. London: Sage
For example, if you are planning or commissioning a programme to reduce obesity and
promote healthy eating, here are some of the theories you might find valuable:
The stages of change model would assess the readiness of the community to change
Learning theory, diffusion of innovations theory and communication theory would inform
behavioural interventions to help people to make healthy food choices
Community development theory would help in enabling the community to address
barriers to having a healthy diet (for example through setting up a food co-operative)
Policy theory would help with how to influence political processes (e.g. getting the
council to set aside land for allotments).
Explanatory theory
Explanatory theory describes the reasons why a problem exists, e.g. why young people take
up smoking. It will help to ensure that all relevant factors are identified, such as the
personal, environmental, social and behavioural determinants of the problem.
Examples of explanatory theories that explain behaviour change in individuals include:
This section is adapted from: Wills, J. and Earle, S. (2007), Theoretical perspectives on promoting public
health. IN: Earle, S., Lloyd, C.E., Sidell, M., Spurr, S. Theory and research in promoting public health. Sage
publications in association with the Open University.
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5.2
Communities
Because health is influenced by so many factors, and in part determined by external
conditions (social, economic and environmental), many projects and programmes focus on
change at the community or system level. Health promotion has a strong emphasis on
community development and engagement.5 Community development itself draws on several
important theories concerned with the building of groups, inter-sectoral collaboration and
organisational change.
To understand a community, we need to know about the motivation and capacity to respond
of families, social networks, local organisations etc.
Health promotion works by
strengthening this capacity, by being an empowering influence.
5.3
Change theory
Change theory guides the development of interventions and assists evaluation. Examples of
change theories include community organisation and diffusion of innovations.
The diffusion of innovations theory (developed initially by Rogers and Shoemaker in the
1970s as communication of innovations theory) helps to explain the spread and adoption of
new ideas within a community:
Innovators and early adopters are few in number and may be from higher socioeconomic groups
Then the early majority, for whom the utility of the change must be clear
See the leaflet Specialised health promotion: You cant be the best without it! from the Shaping the Future
Collaboration.
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Then the late majority, who tend to gain information from those around them
Then the laggards, who tend to be more isolated and thus traditional in behaviour