Download - Why Theory Matters
Concerns
Seen by some as• Reductionist• Incompatible with holism and
empowerment• Inconsistent with respect for
human agency and voluntarism
Theory practice gap
Attributed to a narrow view of theory – linked to natural sciences and
positivism and attempts to offer universal explanations (Buchanan, 1994)
But ………
• A broader view of theory can and should:– Enhance understanding of complex
situations– Consider the influence of contextual
factors– Include the experience of practitioners
and communities
Evidence based practice
• Empirical evidence necessary but not enough.
• Need to extract THEORETICAL PRINCIPLES to avoid drowning in a mass of information
Definitions• Theories – offer explanations of how or
why something happens by identifying key variables and establishing the relationship between them– Concepts are the main elements of theories– Constructs operationalise concepts for use
in building theory• Models provide a looser, possibly
untested, framework to help understand reality and the relationship between concepts. They may draw on one or more theories.
Two broad types of theory
• Explanatory theorytheory of the problem – identifies key variables which need to
be addressed
• Change theorytheory of the solution – identifies the best means of changing
key variables
Theory can ……
• Ensure that all relevant variable are addressed and key elements of a programme are in place
• Take account of contextual factorsIt therefore avoids
• Type III error – an intervention failing to achieve successful results when it was so poorly designed that it could not possibly have had the desired effect (Basch and Gold, 1986: 300-1)
Like an expert chef, a theoretically grounded health education professional does not blindly follow a cookbook recipe, but constantly recreates it anew, depending on the circumstances. Without a theory, she or he has only the skills of a cafeteria line worker. (National Cancer Institute, 1997)
Ecological approach – levels of influence
• Intra-personal• Interpersonal• Institutional or organisational• Community• Public policy
(National Cancer Institute, 2005)
Examples of relevant theory
• Intrapersonal
• Interpersonal• Community
Health Belief ModelStages of ChangeTheory of Planned BehaviourHealth Action Model
Social Cognitive Theory
Community organisation e.g. Locality (Community) DevelopmentSocial Planning, Social Action
Diffusion of innovationsCommunication Theory
(based on National Cancer Institute, 2005)
The challenge ……• Not an absence of theory
but
• Which theory to select from the plethora availableor rather
• Which combination of theories to cope with the complexity of health issues
• How to select theory
Which theory• Does it include all relevant variables?• Does it not contain redundant variables?• Does it logically make sense to use it in
a particular situation?• Has it been used by others for similar
purposes?• Are there published studies supporting
its use for similar purposes?• Is it consistent with the values integral
to the work?(Tones and Green (2004)
belief motivation
normative
selfpersonality
behavioural intention
HEALTH ACTION
ROUTINE
relapse confirmation
EnvironmentPhysicalSocio-economicSocio-cultural
SkillsPsycho-motorSocial interactionSelf-regulatory
Knowledge
The Health Action Model HAM
Community organisation
• Community capacity• Social capital• Participation• Control and Empowerment• Critical consciousness
– Awareness– Motivation
Diffusion of Innovations• The characteristics of the innovation
– relative advantage – compatibility - with values, previous
experience and current needs– complexity – trialability – observability
• Communication channels• Time• The social system
Analysing the determinants of health issues
Understanding what needs to be changed
Programme planning and development
Outcomes: short, medium and long term
Selection of process and outcome indicators
THEORY
Evaluation•Contextual factors•Community insights•Practitioner insights
Identifying what needs to be done
Predicting likely effects
Establishing how to assess effects
SYSTEMATIC REVIEWS
References
• Basch, C.E. and Gold, R.S. (1986) ‘Type V errors in hypothesis testing’, Health Education Research, 1(4): 299-305
• Buchanan (1994) ‘Reflections on the relationship between theory and practice’, Health Education Research, 9(3): 273-283
• Green, J. (2000) ‘The role of theory in evidence-based health promotion practice’, Health Education Research, 15(2): 125-129
• National Cancer Institute (2005) Theory at a Glance: a Guide for Health Promotion Practice (2nd edition) (Website: http://www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf-5aa48ee1da4d/TAAG3.pdf)
• Nutbeam, D. and Harris, E. (2004) Theory in a Nutshell. Sydney: McGraw-Hill
• Tones, K. and Green, J. (2004) Health Promotion Planning and Strategies. London: Sage