3.4 Selecting Theory and Matching Constructs
Key Takeaways
- Theory selection should follow the determinant described by assessment data.
- Common constructs include self-efficacy, perceived barriers, cues to action, norms, reinforcement, and readiness.
- Ecological thinking reminds planners to address interpersonal, organizational, community, and policy influences.
- A theory-based plan still needs local adaptation, resources, and evaluation measures.
Matching the reason for behavior with the design of the intervention
Health behavior theory is useful in planning because it makes the planner explain the pathway from a problem to a change strategy. A theory is not chosen because it is familiar or popular. It is chosen because its constructs match the determinants found in assessment. On CHES items, the theory clue is often embedded in the stem: confidence, perceived risk, barriers, norms, readiness, reinforcement, role modeling, access, or policy support.
The Health Belief Model is often useful when the stem emphasizes perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, or self-efficacy. If adults are not getting flu vaccines because they believe they are not at risk and worry about side effects, the planner may address perceived susceptibility, benefits, and barriers. The strategy might include a trusted clinician message, myth correction, reminder prompts, and easy access.
Social Cognitive Theory is useful when the stem describes reciprocal interaction between personal factors, behavior, and environment. Key constructs include observational learning, reinforcement, outcome expectations, behavioral capability, and self-efficacy. If teens need to practice refusal skills and see peers model those skills, a social cognitive approach fits better than a one-way lecture.
The Transtheoretical Model focuses on stages of change, such as precontemplation, contemplation, preparation, action, and maintenance. It is helpful when the stem says participants differ in readiness or need stage-matched support. A person not considering physical activity may need consciousness raising and relevance. A person already walking three days a week may need relapse prevention and social support.
The Theory of Planned Behavior emphasizes attitudes, subjective norms, perceived behavioral control, and intention. It may fit scenarios where behavior is influenced by what people believe others expect and whether they feel able to perform the behavior. For example, a college sexual health program may address perceived peer approval, confidence discussing testing, and intention to schedule testing.
Diffusion of Innovations is helpful for planning adoption of a new practice, policy, or technology across a group or organization. Constructs include relative advantage, compatibility, complexity, trialability, observability, and adopter categories. A hospital wellness program introducing a new referral workflow might plan pilot testing, visible early wins, champion users, and simplified procedures.
The Social Ecological Model is a planning lens rather than a single behavior-change recipe. It reminds CHES professionals to consider individual, interpersonal, organizational, community, and policy levels. If low physical activity is driven by unsafe sidewalks, lack of workplace flexibility, family caregiving demands, and limited knowledge, a multilevel plan is stronger than an individual lesson alone.
Theory should not replace cultural humility or stakeholder input. A construct may be valid, but the expression of that construct can vary by community. Perceived barriers may involve cost, immigration concerns, stigma, disability access, past discrimination, language, or clinic hours. Planning should involve people who understand those conditions and can review whether strategies are respectful and realistic.
For exam purposes, avoid overcomplicating the theory decision. First identify the determinant. Then ask what construct names that determinant. Then choose the strategy that modifies the construct. If the problem is low confidence, look for skills practice, feedback, and mastery experiences. If the problem is social norms, look for peer influence or credible norm correction. If the problem is policy access, look beyond education to organizational or environmental change.
| Stem clue | Likely construct or lens | Strategy direction |
|---|---|---|
| "I do not think I am at risk" | Perceived susceptibility | Risk communication with relevance |
| "I cannot do this correctly" | Self-efficacy | Practice, feedback, modeling |
| "My friends would disapprove" | Subjective norms | Peer norms and supportive messages |
| "The clinic process is too hard" | Perceived barrier | Navigation or workflow redesign |
| "Sites are adopting at different rates" | Diffusion | Champions, trialability, visibility |
Assessment shows that adults skip blood pressure checks because they do not believe hypertension can affect them. Which construct is most directly involved?
A school program uses peer modeling, guided practice, and feedback to build refusal skills. Which theory is most clearly reflected?
A CHES professional is planning different messages for employees who are not considering exercise, those preparing to start, and those already active. Which model is the best fit?