By Dr. Ebun Ebunlomo
Associate Professor, Public Health, American Military University
Note: This article is the second article in a two-part series.
Part 1 of this article involved a discussion of five common individual-level theories of health promotion and what motivates people to live healthy lifestyles. This article discusses the transtheoretical model/stages of change, the precaution adoption process model and the social cognitive theory.
Start a public health degree at American Military University.
The Transtheoretical Model/Stages of Change
This model describes the five Stages of Change that an individual goes through to alter a problematic health behavior or to adopt a positive one. The stages are:
These five Stages of Change are a progression from not having any intention of exercising in the next six months to adopting and maintaining daily exercise for more than six months.
Precontemplation: An individual does not have any intention of changing a problematic health behavior or is unaware that the behavior is problematic. In other words, the individual is not ready to change.
Contemplation: An individual is now aware that a health behavior is problematic and has started thinking about the pros and cons of continuing the problematic behavior or changing. At this stage, the individual is getting ready to change.
Preparation: An individual is planning to take action within the next few months and may have already set some plans in motion toward changing the problematic behavior. At this stage, the individual is set to change.
Action: An individual has made specific behavioral changes, either stopping a problematic health behavior or adopting a new positive health behavior.
Maintenance: An individual has maintained the newly adopted positive health behavior for at least six months. Based on this theory, effective strategies would include:
- Increasing an individual’s awareness of the benefits of exercising
- Motivating him or her to set gradual goals and to problem-solve to address any barriers such as “I can’t run outside in the summer because it is too hot.”
- Creating a coping strategy to prevent relapses.
The Precaution Adoption Process Model
This model describes an individual’s journey from lack of awareness about preventing a disease to action and maintenance of a preventive health behavior. Similar to the Stages of Change, this individual journey to a desired behavior runs from increasing awareness about the problematic health behavior to the decision to act in a preventive way and maintain the newly adopted behavior despite any barriers that might emerge.
The Social Cognitive Theory
The Social Cognitive Theory (SCT) covers personal and environmental factors and how they influence one another to bring about health behavior change. SCT includes some concepts from individual-level theories such as confidence in one’s ability to take action (i.e. self-efficacy from the Health Belief Model above) while emphasizing the essence of the socio-ecological model.
One SCT idea we are most familiar with is the “carrot vs. stick” technique used as an incentive or disincentive for a desired health behavior. Another is the observational notion. We see this when community role models or respected individuals promote a behavior that prompts others to adopt a similar behavior. For instance, former first lady Michelle Obama’s initiatives to combat childhood obesity by exercising with children and showing them that exercising can be fun.
These are some common theories that professionals use to design interventions and programs for promoting health and preventing disease. Because one of the characteristics of a useful theory is its consistency with everyday observations, we should be able to recognize these concepts in our daily activities. So I encourage you to test some of these theories as you go about your daily routine, and see which of them apply to you.
About the Author
Dr. Ebun Ebunlomo, MPH, MCHES, is a trained scholar in health promotion and health education, with over 10 years of experience developing, implementing and evaluating public health programs in clinical, community and work-site settings. She previously was an evaluation fellow at the Centers for Disease Control and Prevention in Atlanta. She received her Ph.D. in Health Promotion and Behavioral Sciences, with minors in Epidemiology and Leadership/Management from the University of Texas School of Public Health.