Social and Behavioral Theories

10. Summary

Theory, research, and practice are part of a continuum for understanding the determinants of behaviors, testing strategies for change, and disseminating effective interventions. Rigorous tests of theory-based interventions, including measurement and analyses of mediator and moderators, are the building blocks of the evidence base in health behavior change.

Recent reviews of research on health behavior change have shown that interventions based on theory or theoretical constructs are more effective than those not using theory. However, the mechanisms that explain the larger effects have not been studied.

The most-often used theories of health behavior are Social Cognitive Theory, The Transtheoretical Model/Stages of Change, the Health Belief Model, and the Theory of Planned Behavior. The most-often mentioned theoretical model that has not been fully applied in research and practice is the Social Ecological Model. This promising model needs to better articulated, applied and evaluated.

Other widely used theoretical models and planning frameworks:

Theory of Reasoned Action/Theory of Planned Behavior

The Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB) focus on theoretical constructs concerned with individual motivational factors as determinants of the likelihood of performing a specific behavior. TRA and TPB both assume the best predictor of a behavior is behavioral intention, which in turn is determined by attitude towards the behavior and social normative perceptions regarding it. TPB is an extension of the TRA and includes an additional construct, perceived control over performance of the behavior. The TRA and TPB focus on the constructs of attitude, subjective norm, and perceived control, and explain a large proportion of the variance in behavioral intention, and predict a number of different behaviors, including health behaviors.


The main purpose of the PRECEDE-PROCEED Model is to provide a structure for applying theories and concepts systematically for planning and evaluating health behavior change programs. PRECEDE-PROCEED is an example of a logic model in that it links the causal assessment and the intervention planning and evaluation into one overarching planning framework. We will use the terms “model” and “framework” interchangeably in reference to PRECEDE-PROCEED. The PRECEDE framework was developed in the 1970s by Green and colleagues. The acronym stands for Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation. PRECEDE is based on the premise that, just as medical diagnosis precedes a treatment plan, so should educational diagnosis precede an intervention plan. In 1991, PROCEED (Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development) was added to the framework to recognize the importance of environmental factors as determinants of health and health behaviors.

Social support and social networks

Several key terms have been used in studies of the health-enhancing components of social relationships. The term social network refers to the web of social relationships that surround individuals. The provision of social support is one of the important functions of social relationships. Thus, the term social network refers to linkages between people that may or may not provide social support and that may serve functions other than providing support.
Social networks give rise to various social functions: social influence, social control, social undermining, social comparison, companionship, and social support. Social support can be defined as the functional content of relationships that can be categorized into four broad types of supportive behaviors or acts: Emotional support involves the provision of empathy, love, trust, and caring. Instrumental support involves the provision of tangible aid and services that directly assist a person in need. Informational support is the provision of advice, suggestions, and information that a person can use to address problems. Appraisal support involves the provision of information that is useful for self-evaluation purposes, in other words, constructive feedback and affirmation.

Stress and coping theories

The Transactional Model of Stress and Coping is a framework for evaluating processes of coping with stressful events. Stressful experiences are construed as person–environment transactions in which the impact of an external stressor, or demand, is mediated by the person's appraisal of the stressor and the psychological, social, and cultural resources at his or her disposal. When faced with a stressor, a person evaluates potential threats/harms (primary appraisal), as well as his/her ability to alter the situation and manage negative emotional reactions (secondary appraisal). Actual coping efforts, aimed at problem management and emotional regulation, give rise to outcomes of the coping process (for example, psychological well-being, functional status, adherence, and so on). Recent extensions of coping theory suggest that positive psychological states should also be taken into account.

Diffusion of innovations

Diffusion is the process by which an innovation is communicated through certain channels over time among members of a social system, and dissemination involves planned, systematic efforts to maximize the reach and adoption of new programs, strategies, or policies. Diffusion is also the outcome of dissemination efforts. A key premise of the Diffusion of Innovations model is that some innovations diffuse quickly and widely (like the Internet), while others are weakly or never adopted, and others are adopted but subsequently abandoned. Also, innovations are adopted by different individuals and spread at different rates in subgroups of individuals. Three groups of variables have been used to explain these different outcomes: (1) characteristics of the innovation; (2) characteristics of adopters; and (3) features of the setting or environmental context.

Social marketing

Social marketing is the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designed to influence the voluntary behavior of target audiences in order to improve their personal welfare and that of their society. The use of a marketing perspective to influence behavior for individual and social good lies at the heart of all social marketing efforts. The focus on outcomes that improve personal and social welfare is the primary distinction between social and commercial marketing. Some of the basic principles that have made social marketing popular and effective as a health promotion strategy are: (1) focusing on behavioral outcomes, (2) prioritizing consumers’ rather than marketers’ benefits, (3) maintaining an ecological perspective, (4) developing a strategic “marketing mix” of communication elements according to the Four Ps (product, placement, promotion and price), and (5) using audience segmentation to identify meaningful differences among consumers that affect their responses to the product or service being offered.