Theories of Change in the Promotion of Health

This page is intended to support students and professionals in their engagement with a range of behaviour change theories. As you might imagine it has a bias towards physical activity research however much of the content is relevant for thinking about a range of health behaviours.

There are some key concepts introduced and a number of theories are listed along with a selection of further reading.

For the technically-minded lovers of detail out there, it's not all theories of change. I know! Towards the end there are links to intervention development resources that are the key to using the theories outlined below effectively.

An Overview of Behaviour Change Theories & Strategies

The reasons why people behaviour in certain ways are complex and multifaceted. The concept of a socio-ecological model, with it's origins in Lewin (1951), Barker (1968) and then most often traced back to the work of Uri Bronfenbrenner, is often used as a starting point to illustrate the various layers of influence that exist in relation to conscious and non-conscious decision making (for more on the determinants of behaviour see this additional resource page).

For an excellent review and summary of the development of health behaviour theories see Rhodes et al (2019) or review the articles at the bottom of this page that examine the use of theories in general.

Dahlgren and Whitehead's Rainbow (below) is also in common use for illustrating the interplay between the various levels of influence. Also see this 30 year review by Dahlgren and Whitehead.

The structure and categorisation below is based on that used in the Intervention Mapping Approach (Bartholomew et al, 2016) and while the theories are listed in one way on this page, an alternative presentation of the theories can be found in Kok et al (2016). The taxonomy put forwards by Kok et al shows how many of these theories overlap and have been put to use in more than one layer of the ecological model below.

Individual Theories

Theory of Planned Behaviour

Ajzen, I., & Fisbbein, M. (1974). Factors influencing intentions and the intention-behavior relation. Human Relations, 27(1), 1-15. [abstract]

Ajzen, I. (1991). The theory of planned behavior. Organizational behavior and human decision processes, 50(2), 179-211. [pdf]

Self-determination Theory

Deci, E. L., & Ryan, R. M. (2008). Self-determination theory: A macrotheory of human motivation, development, and health. Canadian Psychology/Psychologie canadienne, 49(3), 182. [pdf]

Teixeira, P. J., Carraça, E. V., Markland, D., Silva, M. N., & Ryan, R. M. (2012). Exercise, physical activity, and self-determination theory: a systematic review. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 78. https://doi.org/10.1186/1479-5868-9-78

Ntoumanis, N., Ng, J. Y., Prestwich, A., Quested, E., Hancox, J. E., Thøgersen-Ntoumani, C., ... & Williams, G. C. (2020). A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health. Health Psychology Review, 1-31. https://doi.org/10.1080/17437199.2020.1718529

http://www.selfdeterminationtheory.org/

Self-Efficacy

Ashford, S., Edmunds, J., & French, D. P. (2010). What is the best way to change self‐efficacy to promote lifestyle and recreational physical activity? A systematic review with meta‐analysis. British Journal of Health Psychology, 15(2), 265-288. [pdf]

Olander, E. K., Fletcher, H., Williams, S., Atkinson, L., Turner, A., & French, D. P. (2013). What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act, 10, 29.[pdf]

Prestwich, A., Kellar, I., Parker, R., MacRae, S., Learmonth, M., Sykes, B., ... & Castle, H. (2014). How can self-efficacy be increased? Meta-analysis of dietary interventions. Health Psychology Review, 8(3), 270-285. https://doi.org/10.1080/17437199.2013.813729

Social Cognitive Theory

Bandura, A. (1986). Social foundations of thought and action (pp. 5-107). Prentice Hall.: Englewood Cliffs, NJ.[google books]

Bandura, A. (1998). Health promotion from the perspective of social cognitive theory. Psychology and Health, 13(4), 623-649. [pdf]

Beauchamp, M. R., Crawford, K. L., & Jackson, B. (2018). Social cognitive theory and physical activity: Mechanisms of behavior change, critique, and legacy. Psychology of Sport and Exercise. https://doi.org/10.1016/j.psychsport.2018.11.009

Young, M. D., Plotnikoff, R. C., Collins, C. E., Callister, R., & Morgan, P. J. (2014). Social cognitive theory and physical activity: a systematic review and meta‐analysis. Obesity Reviews, 15(12), 983-995. https://doi.org/10.1111/obr.12225

Transtheoretical Model

Prochaska, J. O., Redding, C. A. & Evers, K.E. (2008). The Transtheoretical model and stages of change. In Health Behavior and Health Education: Theory, Research, and Practice by Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). John Wiley & Sons. [pdf]

Romain, A. J., Caudroit, J., Hokayem, M., & Bernard, P. (2018). Is there something beyond stages of change in the transtheoretical model? The state of art for physical activity. Canadian Journal of Behavioural Science, 50(1), 42-53. http://dx.doi.org/10.1037/cbs0000093

Romain et al. (2018) Matched or nonmatched interventions based on the transtheoretical model to promote physical activity. A meta-analysis of randomized controlled trials. Journal of Sport and Health Science, 7(1) https://doi.org/10.1016/j.jshs.2016.10.007

http://www.uri.edu/research/cprc/TTM/detailedoverview

Behavioral Economics (Nudge Theory) - (NB these theories sit broadly across both individual and environmental considerations)

Eyal, N. (2014). Nudging by shaming, shaming by nudging. International journal of health policy and management, 3(2), 53. https://dx.doi.org/10.15171%2Fijhpm.2014.68

Ledderer, L., Kjær, M., Madsen, E. K., Busch, J., & Fage-Butler, A. (2020). Nudging in public health lifestyle interventions: a systematic literature review and metasynthesis. Health Education & Behavior, 47(5), 749-764. https://doi.org/10.1177%2F1090198120931788

Li, M., & Chapman, G. B. (2013). Nudge to health: Harnessing decision research to promote health behavior. Social and Personality Psychology Compass, 7(3), 187-198.

Laiou, E. et al (2021) Review: Nudge interventions to promote healthy diets and physical activity. Food Policy 102, 102103 https://doi.org/10.1016/j.foodpol.2021.102103

Rayner, G., & Lang, T. (2011). Is nudge an effective public health strategy to tackle obesity? No. BMJ, 342.

Thorgeirsson, T., & Kawachi, I. (2013). Behavioral economics: merging psychology and economics for lifestyle interventions. American Journal of Preventive Medicine, 44(2), 185-189.

Roberto, C. A., & Kawachi, I. (Eds.). (2015). Behavioral economics and public health. Oxford University Press.

Marteau, T. M., Ogilvie, D., Roland, M., Suhrcke, M., & Kelly, M. P. (2011). Judging nudging: can nudging improve population health?. BMJ 342. [full text]

Matjasko, J. L., Cawley, J. H., Baker-Goering, M. M., & Yokum, D. V. (2016). Applying behavioral economics to public health policy: illustrative examples and promising directions. American Journal of Preventive Medicine, 50(5), S13-S19.

General Environment-Oriented Models

Systems Theory

Carey, G., & Crammond, B. (2015). Systems change for the social determinants of health. BMC Public Health, 15(1), 662.

Johnston, L. M., Matteson, C. L., & Finegood, D. T. (2014). Systems science and obesity policy: a novel framework for analyzing and rethinking population-level planning. American Journal of Public Health, 104(7), 1270-1278.

Naaldenberg, J., Vaandrager, L., Koelen, M., Wagemakers, A. M., Saan, H., & de Hoog, K. (2009). Elaborating on systems thinking in health promotion practice. Global Health Promotion, 16(1), 39-47.

Meadows, D. H. (2008). Thinking in systems: A primer. Chelsea Green Publishing.

Theories of Power

Minkler, M., & Wallerstein, N. & Wilson, N (2012). Improving health through community organizing and community building. In Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research, and practice. John Wiley & Sons. [5th Ed full text]

Ecological Models

Sallis, J. F., Owen, N., & Fisher, E. B. (2008). Ecological models of health behavior. In Health behavior and health education: Theory, research, and practice, 4, 465-485. by Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). John Wiley & Sons. [pdf]

Interpersonal-Level Theories

Heaney, C. and Israel, B. Social Networks and Social Support In Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research, and practice. John Wiley & Sons.

Organizational-Level Theories

Cummings, T. G., & Worley, C. G. (2009). Organization development and change. Cengage learning. [full text at http://otgo.tehran.ir/Portals/0/pdf/organization%20development%20and%20change.pdf]

Kok, G., Gurabardhi, Z., Gottlieb, N. H., & Zijlstra, F. R. (2015). Influencing organizations to promote health: Applying stakeholder theory. Health Education & Behavior, 42(1_suppl), 123S-132S.

Community-Level Theories

Butterfoss, F. D., & Kegler, M. C. (2009). The community coalition action theory. Emerging theories in health promotion practice and research, 2, 237-276. [google books]

Societal and Governmental Theories

Smith, K. E., & Katikireddi, S. V. (2013). A glossary of theories for understanding policymaking. J Epidemiol Community Health, 67(2), 198-202.

Breton, E., & De Leeuw, E. (2010). Theories of the policy process in health promotion research: a review. Health Promotion International, 26(1), 82-90.

Clavier, C., & de Leeuw, E. (Eds.). (2013). Health promotion and the policy process. OUP Oxford.

Further Reading

Buchan, D. S., Ollis, S., Thomas, N. E., & Baker, J. S. (2012). Physical activity behaviour: an overview of current and emergent theoretical practices. Journal of Obesity,

Davis, R., Campbell, R., Hildon, Z., Hobbs, L., & Michie, S. (2015). Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review. Health Psychology Review, 9(3), 323-344.

Kelly, M. P., & Barker, M. (2016). Why is changing health-related behaviour so difficult?. Public Health, 136, 109-116. https://doi.org/10.1016/j.puhe.2016.03.030

Lynch, E. A., Mudge, A., Knowles, S., Kitson, A. L., Hunter, S. C., & Harvey, G. (2018). “There is nothing so practical as a good theory”: a pragmatic guide for selecting theoretical approaches for implementation projects. BMC Health Services Research, 18(1), 857. https://doi.org/10.1186/s12913-018-3671-z

Michie, S. F., West, R., Campbell, R., Brown, J., & Gainforth, H. (2014). ABC of behaviour change theories. Silverback Publishing.

Nigg, C. R., & Geller, K. S. (2012). Theoretical Approaches to Physical Activity Intervention. In The Oxford Handbook of Exercise Psychology, 252.[google books]

Raingruber, B. (2014). Contemporary health promotion in nursing practice, Jones & Bartlett (Ch 3: Health promotion theories.)

Rebar, A. L., Dimmock, J. A., Jackson, B., Rhodes, R. E., Kates, A., Starling, J., & Vandelanotte, C. (2016). A systematic review of the effects of non-conscious regulatory processes in physical activity. Health Psychology Review, 10(4), 395-407. https://doi.org/10.1080/17437199.2016.1183505

Tones, K., Green, J., Cross, R. and Woodall, J. (2015). Health Promotion: Planning and Strategies (3rd Ed.). London: Sage.

Does the use of theory lead to better interventions?

Brand, R., & Cheval, B. (2019). Theories to explain exercise motivation and physical inactivity: Ways of expanding our current theoretical perspective. Frontiers in Psychology, 10, 1147. https://doi.org/10.3389/fpsyg.2019.01147

Cassidy, T. (2016). The role of theory, interpretation and critical thought within qualitative sport and exercise research. In Routledge handbook of qualitative research in sport and exercise (pp. 419-430). Routledge.

Davidoff, F., Dixon-Woods, M., Leviton, L., & Michie, S. (2015). Demystifying theory and its use in improvement. BMJ quality & safety, 24(3), 228-238. http://dx.doi.org/10.1136/bmjqs-2014-003627

Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual review of public health, 31, 399-418. http://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.012809.103604

Kwasnicka, D., Dombrowski, S. U., White, M., & Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychology Review, 10(3), 277-296.

McEwan, D., Beauchamp, M. R., Kouvousis, C., Ray, C. M., Wyrough, A., & Rhodes, R. E. (2019). Examining the active ingredients of physical activity interventions underpinned by theory versus no stated theory: a meta-analysis. Health Psychology Review, 13(1), 1-17. https://doi.org/10.1080/17437199.2018.1547120

Michie, S., West, R., Sheals, K., & Godinho, C. A. (2018). Evaluating the effectiveness of behavior change techniques in health-related behavior: a scoping review of methods used. Translational Behavioral Medicine, 8(2), 212-224.

Prestwich, A., Sniehotta, F. F., Whittington, C., Dombrowski, S. U., Rogers, L., & Michie, S. (2014). Does theory influence the effectiveness of health behavior interventions? Meta-analysis. Health Psychology, 33(5), 465-474.http://dx.doi.org/10.1037/a0032853

Prestwich, A., Webb, T. L., & Conner, M. (2015). Using theory to develop and test interventions to promote changes in health behaviour: evidence, issues, and recommendations. Current Opinion in Psychology, 5, 1-5.

Taylor, N., Conner, M., & Lawton, R. (2012). The impact of theory on the effectiveness of worksite physical activity interventions: a meta-analysis and meta-regression. Health Psychology Review, 6(1), 33-73.

Hagger, M. S., & Weed, M. (2019). DEBATE: Do interventions based on behavioral theory work in the real world?. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 36. https://doi.org/10.1186/s12966-019-0795-4

West, R., Godinho, C. A., Bohlen, L. C., Carey, R. N., Hastings, J., Lefevre, C. E., & Michie, S. (2019). Development of a formal system for representing behaviour-change theories. Nature Human Behaviour, 3(5), 526-536. https://doi.org/10.1038/s41562-019-0561-2

Varpio, L., Paradis, E., Uijtdehaage, S., & Young, M. (2020). The distinctions between theory, theoretical framework, and conceptual framework. Academic Medicine, 95(7), 989-994. https://doi.org/10.1097/acm.0000000000003075

Willmott, T. and Rundle-Thiele, S. (2021) Are we speaking the same language? Call for action to improve theory application and reporting in behaviour change research. BMC Public Health 21, 479. https://doi.org/10.1186/s12889-021-10541-1