HEALTH BEHAVIOR HEALTH EDUCATION

Glanz.ffirs 7/2/08 11:22 AM Page iii HEALTH BEHAVIOR AND HEALTH EDUCATION Theory, Research, and Practice 4TH EDITION KAREN GLANZ BARBARA K. RIME...
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HEALTH BEHAVIOR AND

HEALTH EDUCATION Theory, Research, and Practice 4TH EDITION

KAREN GLANZ BARBARA K. RIMER K. VISWANATH Editors Foreword by C. Tracy Orleans

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HEALTH BEHAVIOR AND

HEALTH EDUCATION

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HEALTH BEHAVIOR AND

HEALTH EDUCATION Theory, Research, and Practice 4TH EDITION

KAREN GLANZ BARBARA K. RIMER K. VISWANATH Editors Foreword by C. Tracy Orleans

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Copyright © 2008 by John Wiley & Sons, Inc. All rights reserved. Published by Jossey-Bass A Wiley Imprint 989 Market Street, San Francisco, CA 94103-1741—www.josseybass.com No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on the Web at www.copyright.com. Requests to the publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, 201-748-6011, fax 201-748-6008, or online at www. wiley.com/go/permissions. Readers should be aware that Internet Web sites offered as citations and/or sources for further information may have changed or disappeared between the time this was written and when it is read. Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifi cally disclaim any implied warranties of merchantability or fi tness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profi t or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Jossey-Bass books and products are available through most bookstores. To contact Jossey-Bass directly call our Customer Care Department within the U.S. at 800-956-7739, outside the U.S. at 317-572-3986, or fax 317-572-4002. Jossey-Bass also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Library of Congress Cataloging-in-Publication Data Health behavior and health education : theory, research, and practice / Karen Glanz, Barbara K. Rimer, and K. Viswanath, editors. — 4th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-7879-9614-7 (cloth) 1. Health behavior. 2. Health education. 3. Health promotion. I. Glanz, Karen. II. Rimer, Barbara K. III. Viswanath, K. (Kasisomayajula) [DNLM: 1. Health Behavior. 2. Health Education. W 85 H43415 2008] RA776.9.H434 2008 613—dc22 2008021038 Printed in the United States of America FOURTH EDITION

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CONTENTS Foreword C. Tracy Orleans Tables and Figures Preface The Editors The Contributors

PART ONE: HEALTH EDUCATION AND HEALTH BEHAVIOR: THE FOUNDATIONS ONE: THE SCOPE OF HEALTH BEHAVIOR AND HEALTH EDUCATION The Editors Key Points The Changing Context of Health Behavior Health Education and Health Behavior in Context Settings and Audiences for Health Education Progress in Health Promotion and Health Behavior Research Summary TWO: THEORY, RESEARCH, AND PRACTICE IN HEALTH BEHAVIOR AND HEALTH EDUCATION The Editors Key Points Theory, Research, and Practice: Interrelations What Is Theory? Paradigms for Theory and Research in Health Promotion and Education Trends in Use of Health Behavior Theories and Models Selection of Theories for This Book Fitting a Theory or Theories to Research and Practice Limitations of This Book Summary

xiii xvii xxi xxvii xxxi

1

3 3 6 9 12 16 18

23 23 24 26 29 31 33 35 37 38

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PART TWO: MODELS OF INDIVIDUAL HEALTH BEHAVIOR

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THREE: THE HEALTH BELIEF MODEL Victoria L. Champion and Celette Sugg Skinner Key Points Origins of the Model Description of HBM and Key Constructs Evidence for the Model’s Performance Measurement of HBM Constructs Applications of the HBM to Mammography and AIDS-Related Behaviors Comparison of HBM to Other Theories Challenges in Future HBM Research Summary FOUR: THEORY OF REASONED ACTION, THEORY OF PLANNED BEHAVIOR, AND THE INTEGRATED BEHAVIORAL MODEL Daniel E. Montaño and Danuta Kasprzyk Key Points Origins and Historical Development Theory of Reasoned Action and Theory of Planned Behavior An Integrated Behavioral Model Elicitation Application of IBM to HIV Prevention in Zimbabwe Summary FIVE: THE TRANSTHEORETICAL MODEL AND STAGES OF CHANGE James O. Prochaska, Colleen A. Redding, and Kerry E. Evers Key Points Core Constructs Applications of the Transtheoretical Model Multiple-Behavior Change Programs Limitations of the Model Future Research Summary

45 45 46 46 50 51 53 60 61 62

67 67 68 70 77 82 82 92

97 97 98 108 114 116 116 117

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SIX: THE PRECAUTION ADOPTION PROCESS MODEL 123 Neil D. Weinstein, Peter M. Sandman, and Susan J. Blalock Key Points 123 How Stage Theories Address Explaining and Changing Behavior 124 The Precaution Adoption Process Model 126 Using the PAPM to Develop and Evaluate Behavior Change Interventions 131 How Stage Theories Can Be Tested 134 An Example Using Matched and Mismatched Treatments 134 Review of Research Using the PAPM 140 Criteria for Applying Stage-Based Interventions 143 Future Directions 145 Summary 145 SEVEN: PERSPECTIVES ON HEALTH BEHAVIOR THEORIES THAT FOCUS ON INDIVIDUALS Noel T. Brewer and Barbara K. Rimer Key Points Why Theory Is Needed How to Decide Which Theory to Use A Closer Look at Individual-Level Theories Commonalities and Differences Across the Theories New Constructs and Theories Summary

PART THREE: MODELS OF INTERPERSONAL HEALTH BEHAVIOR EIGHT: HOW INDIVIDUALS, ENVIRONMENTS, AND HEALTH BEHAVIORS INTERACT: SOCIAL COGNITIVE THEORY Alfred L. McAlister, Cheryl L. Perry, and Guy S. Parcel Key Points Concepts of SCT Applications to Health Promotion Case Studies New Applications Limitations in Research on New SCT Applications Summary

149 149 150 151 152 157 160 162

167

169 169 170 175 178 182 184 185

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NINE: SOCIAL NETWORKS AND SOCIAL SUPPORT Catherine A. Heaney and Barbara A. Israel Key Points Definitions and Terminology Background of the Concepts Relationship of Social Networks and Social Support to Health Empirical Evidence on the Influence of Social Relationships Translating Theory and Research into Practice Social Network and Social Support Interventions Health Education and Health Behavior Applications Future Directions for Research and Practice Summary

189

TEN: STRESS, COPING, AND HEALTH BEHAVIOR Karen Glanz and Marc D. Schwartz Key Points Historical Concepts of Health, Stress, and Coping The Transactional Model of Stress and Coping: Overview, Key Constructs, and Empirical Support Theoretical Extensions Applications to Specific Health Behavior Research Areas Research Gaps and Future Directions Summary

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ELEVEN: KEY INTERPERSONAL FUNCTIONS AND HEALTH OUTCOMES: LESSONS FROM THEORY AND RESEARCH ON CLINICIAN-PATIENT COMMUNICATION Richard L. Street Jr. and Ronald M. Epstein Key Points Communication Between Health Care Providers and Patients: Historical Perspective Pathways Between Clinician-Patient Communication and Health Outcomes Key Functions of Clinician-Patient Communication Moderators of Communication-Outcome Relationships Clinician-Patient Communication: Application in Health Education and Health Behavior Directions for Future Research Summary

189 189 192 193 195 197 199 203 206 207

211 212 213 220 226 229 230

237 237 239 239 245 255 261 263

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TWELVE: PERSPECTIVES ON MODELS OF INTERPERSONAL HEALTH BEHAVIOR K. Viswanath Key Points Some Defining Characteristics of Interpersonal Interaction Theories and Models at the Interpersonal Level Summary and Future Directions

PART FOUR: COMMUNITY AND GROUP MODELS OF HEALTH BEHAVIOR CHANGE

ix 271 271 272 273 279

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Karen Glanz

THIRTEEN: IMPROVING HEALTH THROUGH COMMUNITY ORGANIZATION AND COMMUNITY BUILDING Meredith Minkler, Nina Wallerstein, and Nance Wilson Key Points Historical Perspective The Concept of Community Models of Community Organization Concepts in Community Organization and Community-Building Practice Community Capacity and Social Capital Issue Selection, Participation, and Relevance Measurement and Evaluation Issues Application of Community Organization and Community Building Community Organizing and Community Building with Youth: Challenges and Considerations The Challenge of Community Organization Approaches Summary FOURTEEN: DIFFUSION OF INNOVATIONS Brian Oldenburg and Karen Glanz Key Points Development of the Field and Related Research Traditions Key Concepts Important Factors in the Diffusion Process The Role of Settings and Organizations in Diffusion of Health Behavior Innovations The Practice of Dissemination and Diffusion of Health Behavior Interventions

287 287 288 290 291 293 295 296 298 300 307 308 309

313 313 314 317 319 321 322

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Applications Limitations of the Model and Challenges for the Future Summary

FIFTEEN: MOBILIZING ORGANIZATIONS FOR HEALTH PROMOTION: THEORIES OF ORGANIZATIONAL CHANGE Frances Dunn Butterfoss, Michelle C. Kegler, and Vincent T. Francisco Key Points Introduction to Theories of Organizational Change Change Within Organizations Organizational Development Theory Change Across Organizations Applications of Organizational Theory to Health Promotion Future Research to Inform Organizational Change Theories Summary SIXTEEN: COMMUNICATION THEORY AND HEALTH BEHAVIOR CHANGE: THE MEDIA STUDIES FRAMEWORK John R. Finnegan Jr. and K. Viswanath Key Points Organization of Communication Studies Message Production and Media Effects Major Models and Hypotheses at the Individual Level Theories at the Macro Level Planned Use of Media Future Directions Summary SEVENTEEN: PERSPECTIVES ON GROUP, ORGANIZATION, AND COMMUNITY INTERVENTIONS Michelle C. Kegler and Karen Glanz Key Points New Concepts and Strategies for Macro-Level Change Multiple Levels of Influence and Action Models for Change Approaches to Defining Needs, Problems, and Aims The Influence of Technology on Macro-Level Theory and Practice Similarities Between Models Research Issues Summary

323 328 330

335 335 336 338 341 345 350 355 357

363 363 364 365 367 371 379 382 384

389 389 390 391 392 395 396 397 399 400

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PART FIVE: USING THEORY IN RESEARCH AND PRACTICE EIGHTEEN: USING THE PRECEDE-PROCEED MODEL TO APPLY HEALTH BEHAVIOR THEORIES Andrea Carson Gielen, Eileen M. McDonald, Tiffany L. Gary, and Lee R. Bone Key Points Overview of the PRECEDE-PROCEED Model Issues to Consider in Using PRECEDE-PROCEED Case Study: The SAFE Home Project Case Study: Project Sugar 1 Summary

xi 405

407

408 408 417 418 424 429

NINETEEN: SOCIAL MARKETING J. Douglas Storey, Gary B. Saffitz, and Jose G. Rimón Key Points Definition of Social Marketing Basic Principles of Social Marketing The Role of Social Marketing Within a Strategic Communication Framework The Role of Theory and Research in Social Marketing International and Domestic (U.S.) Social Marketing Experiences Summary

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TWENTY: ECOLOGICAL MODELS OF HEALTH BEHAVIOR James F. Sallis, Neville Owen, and Edwin B. Fisher Key Points Background, History, and Principles of Ecological Models Application of Ecological Models to Health Behavior Critical Examination of Ecological Models of Health Behavior Summary

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TWENTY-ONE: EVALUATION OF THEORY-BASED INTERVENTIONS Russell E. Glasgow and Laura A. Linnan Key Points Benefits and Challenges of Evaluating Theory-Based Interventions Types of Evaluation Phases of Research

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465 466 470 479 482

487 487 487 489 490

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Types of Validity Intervention Contexts and Intermediate Outcomes Evaluation Models The RE-AIM Framework Evaluation Methods and Analytical Strategies for Theory-Based Interventions Cost Issues Examples of Evaluating Theory-Based Interventions Challenges to Conducting and Evaluating Theory-Based Health Behavior Research in Applied Settings Summary

TWENTY-TWO: PERSPECTIVES ON USING THEORY: PAST, PRESENT, AND FUTURE Karen Glanz and Barbara K. Rimer Key Points Cross-Cutting Propositions About Using Theory The PRECEDE-PROCEED Planning Model Social Marketing Ecological Models Evaluation of Theory-Based Health Behavior Interventions Moving Forward Name Index Subject Index

492 493 495 496 498 499 499 503 505

509 509 510 512 513 514 515 516 519 533

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FOREWORD C. Tracy Orleans, Ph.D.

Health behavior change is our greatest hope for reducing the burden of preventable disease and death around the world. Tobacco use, sedentary lifestyle, unhealthy diet, and alcohol use together account for almost one million deaths each year in the United States alone. Smoking prevalence in the United States has dropped by half since the first Surgeon General’s Report on Smoking and Health was published in 1964, but tobacco use still causes over 400,000 premature deaths each year. The World Health Organization has warned that the worldwide spread of the tobacco epidemic could claim one billion lives by the end of this century. The rising prevalence of childhood obesity could place the United States at risk of raising the first generation of children to live sicker and die younger than their parents, and the spreading epidemic of obesity among children and adults threatens staggering global health and economic tolls. The four leading behavioral risks factors and a great many others (for example, nonadherence to prescribed medical screening and prevention and disease management practices, risky sexual practices, drug use, family and gun violence, worksite and motor vehicle injuries) take disproportionate tolls in low-income and disadvantaged racial and ethnic populations, as well as in low-resource communities across the world. Addressing these behavioral risks and disparities, and the behaviors related to global health threats, such as flu pandemics, water shortages, increasingly harmful sun exposure, and the need to protect the health of the planet itself, will be critical to world health in the twenty-first century. In the past two decades since the publication of the first edition of Health Education and Health Behavior: Theory, Research, and Practice in 1990, there has been extraordinary growth in our knowledge about interventions needed to change health behaviors at both individual and population levels. This progress can be measured in the proliferation of science-based recommendations issued by authoritative evidence review panels, including the U.S. Clinical Preventive Services Task Force, the Centers for Disease Prevention and Control Task Force on Community Preventive Services, and the international Cochrane Collaboration. Today, there are evidence-based clinical practice guidelines for most major behavioral health risks, including tobacco use, unhealthy diet, sedentary lifestyle, risky drinking, and diabetes management. And there are parallel research-based guidelines for the health care system changes and policies needed to assure their delivery and use. New community practice guidelines offer additional evidence-based recommendations for a wide array of population-level school-, worksite-, and community-based programs and public policies to improve vaccination rates and physical activity levels for children and adults, improve diabetes self-management, reduce harmful sun exposure, reduce secondhand

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smoke exposure, prevent youth tobacco use and help adult smokers quit, reduce workplace and motor vehicle injuries, and curb drunk driving and family and gun violence. Another success of the past two decades of theory-based research can be seen in the evolution of theories and models themselves—a move away from a major focus only on individual behavior change and toward broader multi-level behavior and social change models. By the late 1980s, the limited reach and staying power of even our most effective individual health behavior interventions, based on theories emphasizing intrapersonal and interpersonal determinants of health behaviors, made it clear that an exclusive reliance on individually oriented interventions would be inadequate to achieve our pressing population health and health care goals. These failures led to a fundamental “paradigm shift” in our understanding of what the targets of effective interventions needed to be, not just individuals but the broader contexts in which they live and work. This shift fueled the rise of ecological models of health promotion that have guided the development of powerful interventions in public health and health care arenas. Related shifts in the models and strategies of public health and clinical health promotion opened the way for even broader population models that link health plans and community public health organizations, communities, clinicians, and public health practitioners. Examples are the Chronic Care Model promulgated by the Institute of Medicine and the similar framework promoted by the World Health Organization. And these frameworks energized efforts to refine and apply models and theories to translate effective clinical and public health interventions into practice and policy, including the diffusion of innovations model, community and organizational change theories, and social marketing and communications theories. Tremendous parallel gains in what we have learned about the paradigms, processes, methods, and limitations of public health promotion and health care quality improvement over the past two decades illustrate the fundamental premise of this and previous editions of Health Behavior and Health Education—that a dynamic exchange between theory, research, and practice is critical to effective health education and promotion. Just as previous editions of Health Behavior and Health Education have provided essential stewardship for many of the advances described here, this fourth edition will help us navigate the new frontiers and challenges that lie ahead. As this volume makes clear, using theory to craft and evaluate health behavior change interventions results in more powerful interventions and more robust theories. Like the previous editions, it presents in one place authoritative and highly readable summaries and critiques of the major theories and models of health education at multiple levels (individual, interpersonal, organizational, community, public policy) and in a wide variety of settings and populations. Thorough analyses of their strengths and weaknesses and helpful summaries of how their major constructs have been measured and operationalized—illustrated with clear practical applications and case studies—are features of the book designed to be helpful for researchers, practitioners, and program planners at all levels of experience, from those new to the field to its most seasoned leaders. The rigor and accessibility of these reviews reflect the extraordinary knowledge and vision of the editors and authors, who include many of the most

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respected and accomplished leaders in the field of health education and health behavior; together, they bring exceptional skill and experience in planning, implementing, and evaluating theory-based interventions for a diverse range of problems, settings, and populations. In addition to describing important developments in theory and practice since the previous edition, this volume gives special attention to cultural and health disparities, global applications, and advances in health communications and e-health. It also prepares us for the urgent need to identify, extract, and replicate the critical “active” ingredients of effective interventions through theory-driven reviews and syntheses of past trials and studies, as well as formative early assessments of promising innovations and rigorous theory-based studies of “natural experiments.” Theory is the essential “divining rod” in new efforts to learn rapidly about “what works” by evaluating grassroots efforts in schools and communities across the country and the world to implement programs, policies, and environmental changes to curb the rise in childhood obesity. For example, logic models that reflect lay conceptions of how programs can work are helping the Robert Wood Johnson Foundation to identify early on the more and less promising strategies being tried for obesity prevention. The strategies that align best with theory are often the most promising. This type of practical application of theory makes clear that, in the broadest sense, health education and health behavior encompass the processes of policy development, which are so critical to understanding and overcoming policy resistance to dissemination of the growing number of evidence-based interventions. In short, readers will find that the fourth edition of Health Education and Health Behavior retains and builds on all of the features that have established it as the preeminent text and indispensable reference for our field—the first book we reach for to help us think about the foundations on which to design an intervention or research plan, inform a systematic evidence review, write or review an article or grant application, plan a course or presentation, and consult with other practitioners or researchers both within and outside our own disciplines. As the editors state in Chapter Two, “the gift of theory” is that it provides the essential conceptual underpinnings for well-crafted research, effective practice, and healthy public policy. The gift of this volume is that it provides essential guidance for our efforts to realize the full potential of theory, as we build on our remarkable past progress in navigating the new frontiers and challenges that lie ahead. February 2008

C. Tracy Orleans Distinguished Fellow and Senior Scientist Robert Wood Johnson Foundation Princeton, New Jersey

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In memory of my brother, David Glanz, who contributed so much and so well to his family, in his scholarship and to the lives of older adults. —K. G.

To my husband, Bernard Glassman, my parents, Joan and Irving, and my sisters, Liz and Sara, with gratitude for their unflagging support. —B.K.R.

To my parents, whose life of hard work and sacrifice allowed their children to succeed in their endeavors. —K. V.

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TABLES AND FIGURES TABLES Table 2.1

Definitions of Theory

27

Table 2.2

Trends in the Most Commonly Used Health Behavior Theories and Models

32

Table 3.1

Key Concepts and Definitions of the Health Belief Model

48

Table 3.2

Cronbach’s Alpha of Champion’s HBM Scales Translated into Four Cultures

52

Learning Objectives Used to Change Mammography Perceptions and Practices Among Urban Minority Women

55

Table 4.1

TRA, TPB, and IBM Constructs and Definitions

74

Table 4.2

Table of Elicitation Questions

83

Table 4.3

Strength of Association of Behavioral, Normative, and Efficacy Beliefs with Intention to Use Condoms with Steady Partners

86

Table 5.1

Transtheoretical Model Constructs

98

Table 5.2

Processes of Change That Mediate Progression Between the Stages of Change

105

Examples of Factors Likely to Determine Progress Between Stages

129

Precaution Adoption Process Model: Stage Classification Algorithm

136

Progressed One or More Stage Toward Purchasing a Radon Test (percentage)

137

Table 6.4

Radon Test Orders (percentage)

137

Table 8.1

Social Cognitive Theory Concepts

171

Table 8.2

Methods for Increasing Self-Efficacy

177

Table 9.1

Characteristics and Functions of Social Networks

191

Table 9.2

Typology of Social Network Interventions

200

Table 10.1

Transactional Model of Stress and Coping

214

Table 11.1

Representative Models of Patient-Centered Communication Functions

241

Table 3.3

Table 6.1 Table 6.2 Table 6.3

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Table 11.2

Representative Measures and Coding Systems of Patient-Centered Communication Functions

246

Key Concepts in Community Organization and Community Building

294

Table 13.2

Examples of YES! Group Social Action Projects

306

Table 14.1

Key Concepts and Stages of Diffusion

317

Table 14.2

Characteristics of Innovations That Affect Diffusion

319

Table 15.1

Organizational Change: Stage Theory

340

Table 15.2

Summary of Organizational Change Concepts

342

Table 15.3

Constructs of the Community Coalition Action Theory

349

Table 16.1

Selected Communication Theories and Levels of Analysis

368

Table 16.2

Knowledge Gap Concepts, Definitions, Applications

372

Table 16.3

Agenda-Setting Concepts, Definitions, Applications

376

Table 18.1

PRECEDE-PROCEED Model as an Organizing Framework for Application of Theory and Principles

413

Table 18.2

Main Results of Project Sugar 1 Interventions

428

Table 19.1

Comparisons Between Social Marketing, Commercial Marketing, and Health Education

437

Applications of Major Theories and Research in Social Marketing

449

Table 20.1

Historical and Contemporary Ecological Models

468

Table 21.1

Model of Phases of Research (Greenwald and Cullen, 1985)

491

Table 21.2

RE-AIM Dimensions and Questions in Evaluating Health Education and Health Behavior Programs

496

Common Challenges Encountered in Evaluating Health Behavior Interventions

504

Table 13.1

Table 19.2

Table 21.3

FIGURES Figure 3.1

Key Concepts and Definitions of the Health Belief Model

49

Figure 4.1

Theory of Reasoned Action and Theory of Planned Behavior

70

Figure 4.2

Integrated Behavior Model

77

Figure 5.1

Point Prevalence Abstinence Rates Over Time for Smokers Recruited by Reactive Versus Proactive Strategies and Treated with TTM-Tailored Home-Based Expert System Interventions

113

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Tables and Figures

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Figure 6.1

Stages of the Precaution Adoption Process Model

127

Figure 6.2

Two Examples of the Stages of the Precaution Adoption Process Model: Home Radon Testing and Taking Calcium to Prevent Osteoporosis

127

AIDS Community Demonstration Projects: Exposure and Behavior Change in Carrying Condoms

182

Conceptual Model for the Relationship of Social Networks and Social Support to Health

194

Figure 10.1

Transactional Model of Stress and Coping

216

Figure 11.1

Direct and Indirect Pathways from Communication to Health Outcomes

240

Examples of Potential Moderators of Clinician-Patient Communications

256

Community Organization and Community-Building Typology

293

Figure 13.2

Conceptual Risk Model

302

Figure 13.3

YES! Intervention Model

303

Figure 15.1

Community Coalition Action Theory (CCAT)

348

Figure 18.1

PRECEDE-PROCEED Planning Model

410

Figure 18.2

Application of PRECEDE-PROCEED to Injury Prevention

419

Figure 18.3

Safe Home Case Study Design and Results

423

Figure 18.4

Application of PRECEDE-PROCEED to Diabetes Care and Self-Management Interventions

425

Figure 19.1

The Blue Circle (Indonesia)

446

Figure 19.2

Communication for Healthy Living (Egypt)

455

Figure 19.3

Red Ribbon Question Mark Campaign (Baltimore, Md.)

460

Figure 20.1

Ecological Model of Four Domains of Active Living

472

Figure 20.2

Illustrative Model of Relationships among Organizational Factors and Supports for Diabetes Self-Management

477

Figure 21.1

BEAUTY Conceptual Model

489

Figure 21.2

Hypothetical Worksite Intervention Participation Flow Diagram

494

Figure 8.1 Figure 9.1

Figure 11.2 Figure 13.1

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PREFACE The Editors

Programs to influence health behavior, including health promotion and education programs and interventions, are most likely to benefit participants and communities when the program or intervention is guided by a theory of health behavior. Theories of health behavior identify the targets for change and the methods for accomplishing these changes. Theories also inform the evaluation of change efforts by helping to identify the outcomes to be measured, as well as the timing and methods of study to be used. Such theory-driven health promotion and education efforts stand in contrast to programs based primarily on precedent, tradition, intuition, or general principles. Theory-driven health behavior change interventions and programs require an understanding of the components of health behavior theory, as well as the operational or practical forms of the theory. The first edition of Health Behavior and Health Education: Theory, Research, and Practice, published in 1990, was the first text to provide an in-depth analysis of a variety of theories of health behavior relevant to health education in a single volume. It brought together dominant health behavior theories, research based on those theories, and examples of health education practice derived from theory that had been tested through evaluation and research. The second (1996) and third (2002) editions of Health Behavior and Health Education updated and improved on the earlier volume. People around the world are using this book, and it has been translated into multiple languages, including recent Japanese and Korean editions. It has been over five years since the release of the third edition; the fourth edition of Health Behavior and Health Education once again updates and improves on the preceding edition. Its main purpose is the same: to advance the science and practice of health behavior and health education through the informed application of theories of health behavior. Likewise, this book serves as the definitive text for students, practitioners, and scientists in these areas and education in three ways: by (1) analyzing the key components of theories of health behavior that are relevant to health education, (2) evaluating current applications of these theories in selected health promotion programs and interventions, and (3) identifying important future directions for research and practice in health promotion and health education. The fourth edition responds to new developments in health behavior theory and the application of theory in new settings, to new populations, and in new ways. This edition includes (1) an enhanced focus on the application of theories in diverse populations and settings, (2) an expanded section on using theory, including its translation for program planning, and (3) chapters on additional theories of health behavior.

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More global applications from both developing and developed countries are included. As new communication and information technologies have opened up an unprecedented range of strategies for health behavior change, this edition integrates coverage of e-health into health communications examples throughout the book. Issues of culture and health disparities are also integrated into many chapters, rather than covered as a separate chapter. These issues are of broad and growing importance across many theories and models.

AUDIENCE Health Behavior and Health Education speaks to graduate students, practitioners, and scientists who spend part or all of their time in the broad arenas of health behavior change, health promotion, and health education; the text will help them both understand the theories and apply them in practical settings. Practitioners, as well as students, will find this text a major reference for the development and evaluation of theory-driven health promotion and education programs and interventions. Researchers should emerge with a recognition of areas in which empirical support is deficient and theory testing is required, thus helping to set the research agenda for health behavior and health education. This book is intended to assist all professionals who value the need to influence health behavior positively. Their fields include health promotion and education, medicine, nursing, health psychology, behavioral medicine, health communications, nutrition and dietetics, dentistry, pharmacy, social work, exercise science, clinical psychology, and occupational and physical therapy.

OVERVIEW OF THE BOOK The authors of this text bring to their chapters an understanding of both theory and its application in a variety of settings that characterize the diverse practice of public health education—for example, worksites, hospitals, ambulatory care settings, schools, and communities. The chapters, written expressly for the fourth edition of this book, address theories and models of health behavior at the level of the individual, dyad, group, organization, and community. This book is organized into five parts. Part One defines key terms and concepts. The next three parts reflect important units of health behavior and education practice: the individual, the interpersonal or group level, and the community or aggregate level. Each of these parts has several chapters, and ends with a perspectives chapter that synthesizes the preceding chapters. Part Two focuses on theories of individual health behavior, and its chapters focus on variables within individuals that influence their health behavior and response to health promotion and education interventions. Four bodies of theory are reviewed in separate chapters: the Health Belief Model, the Transtheoretical Model, the Theory of Reasoned Action/Theory of Planned Behavior/Integrated Behavioral Model, and the Precaution Adoption Process Model.

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Part Three examines interpersonal theories, which emphasize elements in the interpersonal environment that affect individuals’ health behavior. Three chapters focus on Social Cognitive Theory: social support and social networks, clinical-patient and interpersonal communication, and stress and coping. Part Four covers models for the community or aggregate level of change and includes chapters on community organization, diffusion of innovations, organizational change, and media communications. Part Five explores “Using Theory,” which presents the key components and applications of overarching planning and process models, and a discussion of the application of theory in culturally unique and other unique populations. It includes chapters on the PRECEDE-PROCEED Model of health promotion planning, social marketing, ecological models, and evaluation of theory-based interventions. The major emphasis of Health Behavior and Health Education is on the analysis and application of health behavior theories to health promotion and education practice. Each core chapter in Parts Two, Three, and Four begins with a discussion of the background of the theory or model and a presentation of the theory, reviews empirical support for it, and concludes with one or two applications. Synthesis chapters review related theories and summarize their potential application to the development of health education interventions. Strengths, weaknesses, areas for future development and research, and promising strategies are highlighted. Chapter authors are established researchers and practitioners who draw on their experience in state-of-the-art research to critically analyze and apply the theories to health education. This text makes otherwise lofty theories accessible and practical, and advances health education in the process. No single book can be truly comprehensive and still be concise and readable. Decisions about which theories to include were made with both an appreciation of the evolution of the study of health behavior and a vision of its future (see Chapter Two). We purposely chose to emphasize theories and conceptual frameworks that encompass a range from the individual to the societal level. We acknowledge that there is substantial variability in the extent to which various theories and models have been codified, tested, and supported by empirical evidence. Of necessity, some promising emerging theories were not included. The first three editions of Health Behavior and Health Education grew out of the editors’ own experiences, frustrations, and needs, as well as their desire to synthesize the diverse literatures and to draw clearly the linkages between theory, research, and practice in health behavior and education. We have sought to show how theory, research, and practice interrelate and to make each accessible and practical. In this edition we have attempted to respond to changes in the science and practice of public health and health promotion, and to update the coverage of these areas in a rapidly evolving field. Substantial efforts have been taken to present findings from health behavior change interventions, based on the theories that are described, and to illustrate the adaptations needed to successfully reach diverse and unique populations. Health Behavior and Health Education has now been established as a widely used text and reference book. We hope the fourth edition will continue to be relevant and

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useful, and to stimulate readers’ interest in theory-based health behavior and health education. We aspire to provide readers with the information and skills to ask critical questions, think conceptually, and stretch their thinking beyond using formulaic strategies to improve health.

ACKNOWLEDGMENTS We owe deep gratitude to all the authors whose work is represented in this book. They worked diligently with us to produce an integrated volume, and we greatly appreciate their willingness to tailor their contributions to realize the vision of the book. Their collective depth of knowledge and experience across the broad range of theories and topics far exceeds the expertise that the editors can claim. We pay special tribute to Dr. Everett Rogers, a luminary in our broad field, whose work in the area of diffusion of innovations has taught and inspired us, and whose body of work cuts across several chapters in this book. Along with many colleagues, we were saddened by Ev’s death in the fall of 2005 and know his work will continue to be influential in using theory to improve research and practice. We also wish to acknowledge authors who contributed to the first three editions of this text. Although some of them did not write chapters for this edition, their intellectual contributions form an important foundation for the present volume. We especially appreciate the contributions of Frances Marcus Lewis, an editor for the first three editions. And we welcome K. “Vish” Viswanath, an internationally recognized health communication scholar, to the editorial team. The staff at Jossey-Bass Publishers provided valuable support to us for development, production, and marketing from the time that the first edition was released through completion of this edition. Our editors at Jossey-Bass—Andy Pasternack and Seth Schwartz—provided encouragement and assistance throughout. Kate Harris provided exceptional technical editing support for this edition. The editors are indebted to their colleagues and students who, over the years, have taught them the importance of both health behavior theories and their cogent and precise representation. They have challenged us to stretch, adapt, and continue to learn through our years of work at the University of Michigan, University of North Carolina at Chapel Hill, Emory University, Harvard University, the University of Minnesota, Ohio State University, The Johns Hopkins University, Temple University, Fox Chase Cancer Center, Duke University, the University of Hawai’i, and the National Cancer Institute (NCI). The updated review of theory use for this edition was completed by doctoral students at Emory University—Julia Painter, Michelle Hynes, Christina Borba, and Darren Mays. We particularly want to acknowledge Kelly Blake and Jenny Lewis for their editorial and substantive contributions. Completion of this manuscript would not have been possible without the dedicated assistance of Kristen Burgess, Johanna Hinman, Jenifer Brents, Kat Peters, Terri Whitehead, Mae Beale, Suzanne Bodeen, Dave Potenziani, Elizabeth Eichel, Lisa Lowery, Shoba Ramanadhan, and Josephine Crisistomo.

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Karen Glanz would like to acknowledge partial funding support from the Georgia Cancer Coalition for technical editing and production of this volume. We also wish to express our thanks to our colleagues, staffs, friends, and families, whose patience, good humor, and encouragement sustained us through our work on this book. Karen Glanz Atlanta, Georgia Barbara K. Rimer Chapel Hill, North Carolina K. Viswanath Boston, Massachusetts

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THE EDITORS Karen Glanz is a professor and a Georgia Cancer Coalition Distinguished Research Scholar in the Rollins School of Public Health at Emory University, where she holds appointments in the Departments of Behavioral Sciences and Health Education and Epidemiology. She is also the founding director of the Emory Prevention Research Center. Prior to coming to Emory, Karen Glanz was professor and director of the Social and Behavioral Sciences Program at the Cancer Research Center of Hawai’i at the University of Hawai’i from 1993 to 2004. From 1979 to 1993, she was a professor in the Department of Health Education at Temple University in Philadelphia. She received her M.P.H. (1977) and Ph.D. (1979) degrees in health behavior and health education from the University of Michigan. Glanz’s research and academic interests have been in the area of health behavior change program development and evaluation, community nutrition environments, cancer prevention and control, ethnic differences in health behavior, and risk communication. She is currently principal investigator on five federally funded research grants that test health behavior change interventions for skin cancer prevention, colorectal cancer risk counseling, and chronic disease prevention; and on several grants that focus on translation and dissemination of effective interventions and measurement tools. Glanz’s scholarly contributions consist of more than 270 journal articles and book chapters, and she serves on the editorial boards of several journals. She was recognized in 2006 as a Highly Cited Author by ISIHighlyCited.com, in the top 0.5 percent of authors in her field over a twenty-year period. Glanz has been recognized with several national awards and was the 2007 recipient of the Elizabeth Fries Health Education Award from the James and Sarah Fries Foundation. She was honored by the Public Health Education and Health Promotion Section of the American Public Health Association (APHA) with the Early Career Award (1984), the Mayhew Derryberry Award for outstanding contributions to theory and research in health education (1992; with Barbara Rimer and Frances Lewis), and the Mohan Singh Award for contributions to humor in health education (1996). Her recent health education programs in skin cancer and underage drinking prevention have received national awards for innovation and program excellence. Glanz serves on numerous advisory boards and committees for scientific and health organizations in the United States and abroad, including the Task Force on Community Preventive Services at the Centers for Disease Control and Prevention. 䊏 䊏 䊏

Barbara K. Rimer is dean and Alumni Distinguished Professor of Health Behavior and Health Education in the School of Public Health at the University of North Carolina at Chapel Hill. Rimer received an M.P.H. (1973) from the University of Michigan, with joint majors in health education and medical care organization, and

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a Dr.P.H. (1981) in health education from The Johns Hopkins School of Hygiene and Public Health. Previously, she served as deputy director for Population Sciences at UNC Lineberger Comprehensive Cancer Center at UNC-Chapel Hill (2003–2005), as director of the Division of Cancer Control and Population Sciences at the National Cancer Institute (part of the National Institutes of Health), from 1997–2002, as Professor of Community and Family Medicine at Duke University (1991–1997), and as director of behavioral research and a full member at the Fox Chase Cancer Center in Philadelphia (1987–1991). Rimer has conducted research in a number of areas, including informed decision making, long-term maintenance of behavior changes (such as diet, cancer screening, and tobacco use), interventions to increase adherence to cancer prevention and early detection, dissemination of evidence-based interventions, and use of new technologies for information, support, and behavior change. Rimer is the author of over 280 publications and serves on several journal editorial boards. She is the recipient of numerous awards and honors, including the Healthtrac Foundation Award for Health Education (2004), the Secretary’s Award for Distinguished Service from the U.S. Department of Health and Human Services (2000), the Director’s Award from the National Institutes of Health (2000), and the American Cancer Society Distinguished Service Award (2000). Rimer was the first woman and behavioral scientist to lead the National Cancer Institute’s National Cancer Advisory Board—a presidential appointment. She currently is vice chair for the Task Force on Community Preventive Services at the Centers for Disease Control and Prevention. 䊏 䊏 䊏

K. “Vish” Viswanath is an associate professor in the Department of Society, Human Development and Health at the Harvard School of Public Health (HSPH) and associate professor of population sciences at Harvard’s Dana-Farber Cancer Institute (DFCI). He is also the director of the Dana-Farber Harvard Cancer Center’s Health Communication Core and chair of the steering committee of the Health Communication Concentration of HSPH. Before coming to Harvard, Viswanath was the acting associate director of the Behavioral Research Program, Division of Cancer Control and Population Sciences, at the National Cancer Institute. He was also a senior scientist in the Health Communication and Informatics Research Branch. He came to the National Cancer Institute from Ohio State University where he was a tenured faculty member in the School of Journalism and Communication. He also held an adjunct appointment in the School of Public Health and was a Center Scholar with Ohio State’s Center for Health Outcomes, Policy, and Evaluation Studies. Viswanath received his doctoral degree in mass communication from the University of Minnesota (1990). Viswanath’s research interest is studying how macro-social factors influence health communication, particularly strategic communication campaigns. His scholarly work focuses on health communication and social change in both national and international contexts, with a particular focus on communication inequities and health disparities and sociology of health journalism. He has been involved with planned social change projects in India and the United States. His current research examines

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