Key Health Promotion Theories

Why This Matters

Health promotion theories aren't just academic abstractions—they're the practical blueprints that guide every public health intervention you'll encounter on exams and in the field. When a health department designs a smoking cessation campaign or a hospital implements a diabetes prevention program, they're drawing on these theoretical frameworks to predict what will work and why. You're being tested on your ability to recognize which theory fits which scenario, understand the mechanisms each theory proposes for behavior change, and critically evaluate when one approach might work better than another.

These theories fall into distinct categories based on their level of analysis (individual vs. community), their core mechanism (cognitive processing, social influence, environmental factors), and their approach to change (stage-based vs. continuous). Don't just memorize the names and components—know what problem each theory was designed to solve and when you'd recommend it over alternatives. That's the difference between recall and application, and application is what earns you points on FRQs.

---

Individual Cognition Theories

These theories focus on how people think about health risks and behaviors. They assume that changing beliefs, perceptions, and attitudes will lead to behavior change—a cognitive-first approach.

Health Belief Model

• Perceived susceptibility and severity—individuals must believe they're at risk for a health problem and that the problem is serious enough to warrant action
• Perceived benefits vs. barriers—behavior change happens when people see the advantages of action outweighing the costs or obstacles
• Cues to action—external triggers (symptoms, media campaigns, advice from others) prompt individuals to move from intention to behavior

Theory of Planned Behavior

• Behavioral intention—the most immediate predictor of whether someone will actually perform a health behavior
• Three determinants of intention—attitudes toward the behavior, subjective norms (what do important others think?), and perceived behavioral control
• Perceived behavioral control—functions similarly to self-efficacy; people must believe they can perform the behavior, not just that they should

Precaution Adoption Process Model

• Seven distinct stages—moves from unaware of the issue through deciding to act (or not) to taking and maintaining action
• Stage-specific barriers—different interventions needed depending on whether someone is unaware, unengaged, or actively deciding
• Personal relevance—emphasizes that people must see themselves as personally at risk, not just acknowledge a general hazard

---

Stage-Based Change Theories

These models reject the idea that behavior change is a single event. Instead, they treat change as a process with distinct phases requiring different intervention strategies.

Transtheoretical Model (Stages of Change)

• Five core stages—precontemplation (not thinking about change), contemplation (considering it), preparation (getting ready), action (doing it), and maintenance (sustaining it)
• Stage-matched interventions—consciousness-raising works for precontemplators; action plans work for those in preparation; relapse prevention works for maintenance
• Non-linear progression—individuals cycle through stages, often relapsing and re-entering; this is normal, not failure

---

Social and Environmental Influence Theories

These theories recognize that individual cognition isn't enough—people exist within social networks and environments that shape their choices. Context matters.

Social Cognitive Theory

• Reciprocal determinism—behavior, personal factors (cognition, emotions), and environment continuously influence each other in a dynamic system
• Self-efficacy—the cornerstone concept; belief in one's capability to execute a behavior is often more predictive than actual skill level
• Observational learning—people learn behaviors by watching others, especially role models who are rewarded for those behaviors

Social Ecological Model

• Five levels of influence—individual, interpersonal, organizational, community, and policy; effective interventions address multiple levels simultaneously
• Environmental determinism—recognizes that individual motivation means little if environments don't support healthy choices (food deserts, unsafe neighborhoods)
• Cross-sector collaboration—health outcomes require partnerships across education, housing, transportation, and other sectors

Diffusion of Innovations Theory

• Adopter categories—innovators, early adopters, early majority, late majority, and laggards adopt new practices at different rates and for different reasons
• Innovation attributes—adoption speed depends on perceived relative advantage, compatibility, complexity, trialability, and observability
• Opinion leaders and change agents—early adopters with social influence can accelerate or block diffusion throughout a community

---

Community-Level Theories

These approaches shift the unit of analysis from individuals to communities, emphasizing collective action, empowerment, and systemic change.

Community Organization and Community Building

• Community-driven priorities—residents identify their own health concerns rather than having outside experts impose agendas
• Capacity building—focuses on developing leadership skills, organizational infrastructure, and resource networks within communities
• Sustainability through ownership—initiatives led by community members are more likely to persist than externally imposed programs

Empowerment Theory

• Power redistribution—aims to shift control over resources and decision-making to marginalized individuals and communities
• Critical consciousness—encourages people to analyze the social, political, and economic forces affecting their health (why are conditions this way?)
• Health equity focus—explicitly addresses disparities by building skills, confidence, and collective efficacy among underserved populations

---

Strategic Communication Theories

These theories apply principles from marketing and communication science to promote health behaviors at scale.

Social Marketing Theory

• Four Ps framework—product (the behavior), price (costs of adopting it), place (where/when to perform it), and promotion (how to communicate about it)
• Audience segmentation—divides populations into subgroups with similar characteristics to tailor messages and channels
• Exchange theory foundation—assumes people adopt behaviors when they perceive the benefits outweigh the costs; marketing's job is to enhance perceived value

---

Quick Reference Table

---

Self-Check Questions

1. Which two theories both use a stage-based approach to behavior change, and what distinguishes when you'd apply each one?

2. A public health department wants to increase HPV vaccination rates among adolescents. Parents' attitudes, peer norms, and teens' confidence in navigating healthcare all matter. Which theory would best guide intervention design, and why?

3. Compare and contrast Social Cognitive Theory and Social Ecological Model: What level of influence does each primarily address, and how might you use them together in a comprehensive intervention?

4. An FRQ describes a community with high diabetes rates, limited access to healthy food, and residents who feel excluded from local health planning. Which theory would you recommend, and what specific constructs from that theory would you apply?

5. Why might a social marketing campaign fail if designers only considered the Health Belief Model? What additional factors would social marketing theory prompt them to address?