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. It's designed to help consider the process of engaging with theories in general and then contains links to specific theories.

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

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 (often traced back to the work of Uri Bronfenbrenner) is often used 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).

Dahlgren and Whitehead's Rainbow (below) is commonly used to illustrate various levels of influence as are figures such as the one below which are more closely related to the work of Bronfenbrenner.

Recommended Reading

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2015). Health behavior: Theory, research, and practice. John Wiley & Sons. [5th Ed full text]

Kok, G., Gottlieb, N. H., Peters, G. J. Y., Mullen, P. D., Parcel, G. S., Ruiter, R. A., ... & Bartholomew, L. K. (2016). A taxonomy of behaviour change methods: an Intervention Mapping approach. Health psychology review, 10(3), 297-312.

Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., ... & Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46(1), 81-95.

Rhodes, R. E., McEwan, D., & Rebar, A. L. (2019). Theories of physical activity behaviour change: A history and synthesis of approaches. Psychology of Sport and Exercise. 42: 100-109 https://doi.org/10.1016/j.psychsport.2018.11.010

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]

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

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]

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

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

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.

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

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.)

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?

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.

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.

Useful Resources

Social and Behavioural Theories - An interactive learning resource

Appreciative Inquiry - a model that seeks to engage stakeholders in self-determined change

Related Pages on this website

Main Health Behaviour Change Page

Intervention Mapping

Supporting Behaviour Change