Unit 4 Introduction

Health Promotion Theories

and Models
Congratulations, you have reached the final unit and session of this Module. The
focus is on theories and models which are relevant to Health Promotion. You may
wonder why it is necessary to study theories when you are a practitioner in the field,
but as you are probably aware, much practice is informed by theory and can be
improved and developed through applying theories.
If you feel unsure of the difference between theories and models, you will have a
chance to study this uestion in the first part of this session. However, you may be
interested in the reasons for our introducing models and theories at this point of the
module.
Theories combine understandings gained from past practice and suggest what is
li!ely to happen in future situations. They also help us to organise comple"ity in our
practice. Models offer the possibility of creating order out of the chaos of practice and
can assist us as health promoters to design interventions based on the
commonalities observed in the e"periences of others.
In this #nit there is one $tudy $ession which will ta!e you about three hours.
$tudy $ession %& 'pplying Health Promotion Theories and Models to Practice
The intended outcomes are listed below, but in reality, the most important outcome
for you will be to be able to plan a health promoting intervention using the common
wisdom and guidance of theories and models developed in the field to date& this is
what the 'ssignment see!s to assess.
Learning outcomes of Unit 4
By the end of Unit 4, you should be able to:
'pply selected Models of Change to a Health Promotion problem.
(escribe a plan for programme evaluation.
There are also a number of academic s!ills which have been integrated into
the unit. They focus mainly on applying theoretical concepts and models to life
situations.
'n e"ample is provided so that you can practise this sort of academic writing
and loo! at the !ind of points which one could ma!e in such a discussion. (o
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not be afraid to use it at first as the basis for your answer. Then move away
from it and develop your own approach.
)hen you have completed the Module, we would be grateful if you would fill
in the evaluation form. You*ll find it at the end of the module& please send it to
us with your 'ssignment. Your positive and negative e"periences of studying
this Module through fle"ible learning will be helpful to us in trying to improve
the system and the support we give through the materials. 'lthough this may
not benefit you, it could help the ne"t group of students. )e loo! forward to
hearing from you+
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Unit 4 - Session 1
Applying Health Promotion
Theories and Models to
Practice
Introduction
This is the final session of the Health Promotion module, and although it may
loo! li!e the most theoretical section so far, it has been designed to give you a
chance to try out applying theoretical models to a real case study before you
have to do so in your 'ssignment.
The session starts off by clarifying the differences between theories and models
and then focuses on one particular category of model which is very relevant to
Health Promotion , Models of Change. ' selection of relevant e"amples are
presented in terms of addressing change in individuals, in the community,
through communication and in organisations. )e hope that you will find the
session challenging, and through it recognise the value of using models in
theories in your Health promotion wor!.

Contents
1 Learning outcomes for this session
2 Readings
- #nderstanding the terms theories and models
. Commonly used models in Health Promotion
/ 'pplying Health Promotion theory to practice
0 The value of theories and models
1 $ession summary
2 3eferences and further readings
Timing of this session
This session contains three tas!s and two readings. 'llow three hours for it, and
ta!e a brea! after section ..
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1 LEARNING U!C"E# $ !%I# #E##IN
Intended learnin& outco'es
4y the end of this session, you should be able to&
%ealth (ro'otion outco'es:
5utline the !ey components of the
Health 4elief Model, the $tages of
Change Model and the (iffusion of
Innovations Model.
6"plain how theories and models
can assist in Health Promotion
practice.
(escribe a plan for programme
evaluation.
Acade'ic outco'es:
'pply concepts to case studies.
'pply components of theories and
models to practice in the form of case
studies.
$ummarise a te"t.
) REA*ING#
The readings for this session are listed below. You will be directed to them in the
course of the session. There is also one website to consult in relation to section
-& http&77www.nci.nih.gov
In the Health Management I module, you will be introduced to the process of
programme planning. The end of 3eading %0 loo!s at the lin! between theory
and programme planning. You might find it useful to refer to this reading while
studying #nit . of Health Management I.

Readin& (ublication details
16 Nutbeam, D. & Harris, . !1"""#. Theory in a Nutshell: A Guide to
Health Promotion Theory. Rose$i%%e, &ustra%ia' (c)ra*+Hi%%.
1, -ou%son, N., )o%dstein, .. & Ntu%i, &. !1""/#. -ha0ter 6 of Promoting
Health in South Africa: An Action Manual. .andton' Heinemann.
+ UN*ER#!AN*ING !%E !ER"# THEORIES AN* MODELS
In order to get down to studying some selected theories and models relevant to
Health Promotion, we are first going to investigate what is commonly meant by
a theory or a model and how they are both used to assist Health Promotion
practice. The first reading 83eading %09 e"plores these terms. 's you read, try
to answer the uestion in Tas! %.
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READING 16: :utbeam, (. ; Harris, 6. 8%<<<9. Theory in a Nutshell: A Guide to
Health Promotion Theory. 3oseville, 'ustralia& Mc=raw>Hill& %?>%2.
$EE*BAC,
There are many different definitions and uses of these two terms. 5ften they are
used as interchangeable terms. 4oth aim to offer a hypothesis or an e"planation
as to how something wor!s, or to describe and illustrate the principles
underlying an issue or a sub@ect. They do however have distinct characteristics
which are useful to consider when reading about particular Health Promotion
models and theories, li!e the Health 4elief Model or the (iffusion of Innovation
Theory.
In attempting to differentiate between the two terms, 6arp and 6nnett note that
a model is often used to mean the visual representation of the elements of a
theory. It is often informed by more than one theory, and allows the inclusion of
processes and characteristics not grounded in formal theory but in empirical
findings or derived from practising professionals 86arp ; 6nnett, %<<%& %0.9.
' theory is thus seen as a broader concept, something that interprets or
represents reality from a discipline>specific perspective. 6arp and 6nnett 8%<<%9
suggest that theories are Ausually concerned with very general and global
classes of behaviour and do not deal directly, as conceptual models do, with
specific types of behaviour in specific conte"tsB 86arp ; 6nnett, %<<%&%009.
Theories are the roots of the ideas and concepts that form the basis of models.
's you might recall from your reading on the history of Health Promotion in
earlier $tudy $essions, Health Promotion is a relatively young sub@ect and
draws on a number of disciplines for its theory. These include&
Teaching and learning theory e.g. $ocial Cearning theory assists in the
development of Health 6ducation campaigns.
Communication theory e.g. $ocial Mar!eting Theory is used in some areas
of Health Promotion.
$ociological theory, which assists in understanding issues related to gender,
ethnicity, social divisions and social change.
Psychological theory which assists in understanding individual constructs
li!e self esteem, self efficacy, locus of control and the different stages of the
life cycle. These ideas are valuable in understanding the attitudes and needs
of clients.
Theories of organisational change which assist in e"plaining the
development and implementation of public policy.
You might have noticed that in 3eading %0, :utbeam and Harris note that unli!e
the physical sciences, many of the theories in Health Promotion have not been
rigorously tested and thus might be Amore accurately referred to as theoretical
framewor!s or modelsB 8%<<%& %%9. =iven that Health Promotion is a social
science 8as opposed to a physical science9 this is to be e"pected.
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!as- 1 . Read about theory in the %ealth (ro'otion conte/t
)hat do you understand by the terms theory and modelD Eot down your own
interpretation, and then add to your e"planations from the 3eading.
It is li!ely that in your own wor! and reading you will find that different authors,
learners and health professionals will use these two terms in a variety of
different ways. $ome people might also even use the term approaches > a term
that 6wles and $imnett used in %<2/ when they mapped out the various ways
one could approach Health 6ducation practice. Their five approaches ranged
from AMedicalB interventions where patients were encouraged to see! early
detection and treatment of diseases to a A$ocietal ChangeB approach which
focused on ta!ing action to change the physical and social environment.
)hilst it would be important in your Health Promotion wor! to be able to
communicate clearly about the different theories and models > we would li!e to
suggest that it is not necessary to be overly particular about the e"act difference
between the two terms. More important is to be able to use and apply the
different theories and models in practice.
If you would li!e more information on theories and models in Health Promotion
Faren =lanG has produced a useful monograph entitled Theory at a Glance: a
Guide for Health Promotion Practice. 8$ee bo" below9.
4 C""NL0 U#E* "*EL# IN %EAL!% (R"!IN
In the field, one freuently hears other people tal!ing about different Health
Promotion models. $ometimes you might not recognise the name of a model ,
this should not alarm you as there are many models out there+
's :utbeam and Harris suggest, Ano single theory dominates health promotion
practice, and nor could it, given the range of health problems and their
determinants, the diversity of populations and settings, and differences in
available resources and s!ills among practitionersB 8%<<<&%/9.
's a Health Promotion practitioner, you will find that models are useful in that
they can really help you ma!e your wor! more effective. In the field of Health
Promotion, you are li!ely to come across three different groups or clusters of
models&
Planning models& These are often used by organisations to plan an intervention
or a programme. This forms part of #nit . of the Health Management I Module.
Models of Health 6ducation and Health Promotion 8which we have discussed in
#nit H, $tudy $ession %9. Models of change& $uch models focus on change at
an individual, organisational and community level. )e will concentrate on the
third cluster.
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It can be accessed off the :ational Cancer Institute website at http&77www.nci.nih.gov7
You will need to go to Acancer informationB then to Ainformation for the public and
mediaB then to ApublicB and then to ApublicationsB. You will need to search for
publications using the title of ATheory at a glanceB.
411 "odels of Chan&e
Cet us now consider the third cluster , Models of Change, and introduce you to
some e"amples that underpin Health Promotion practice in this area. The
following table outlines the areas in which health promoters wor! and lists some
of the common theories or models that can be applied to HP problems or
dilemmas in each area. Clustering the theories in this way enables you to select
a model according to the area of Health Promotion wor! in which you are
involved.
Area of 2or- Co''on dile''as or
3roble's that the theories or
'odels can hel3 2ith
!heories or "odels
Individual How can we motivate individuals
to changeD
How do individuals learnD
)hy do individuals relapse or
not complyD
Health 4elief model.
$tages of Change7model.
$ocial Cearning Theory.
Theory of 3easoned 'ction.
Community )hy do some people adopt new
ideas readily whilst others are
more conservativeD
(iffusion of Innovation Theory
or (iffusion of Ideas Model.
Community MobiliGation.
Communication How do we mar!et or design
effective communicationD
$ocial Mar!eting.
Communication>4ehaviour
Change Model.
5rganisational
Change
)hy do some organisations
resist changeD
Theories of 5rganisational
Change.
' Model of Inter>sectoral
'ction.
8The above table has been adapted from Table % in :utbeam and Harris, %<<<& <9.
41111 #elected 'odels
In the ne"t section, we loo! in more detail at selected models. Preview reading
%1 and ta!e a loo! at the guiding uestions in Tas! H.
$EE*BAC,
Here are short summaries of the theories or models clustered according to the
areas of wor!. )e have included feedbac! on organisations too.
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REA*ING 17& Coulson, :., =oldstein, $. ; :tuli, '. 8%<<29. Chapter 0 of Promoting
Health in South Africa: An Action Manual. $andton& Heinemann& /H>1H.
TASK 2 Clarify your understanding of three Change Models
's you read, focus on the Health Belief Model HBM!" the Stages of Change Model
and the #iffusion of Ideas Model.
$ummarise the main points that are made about these models focusing in turn on
the first three areas of wor! $ indi%idual" community and communication.
Individual
's you will see, the first set of models focus on the level of individual health
behaviour and behaviour change. The Health 4elief Model and $tages of
Change model fall into this category. They are directed at the intra>personal
8within an individual9 or the inter>personal 8between individuals9 levels.
The models consider things li!e people*s !nowledge, beliefs and attitudes about
health. They also focus on the barriers and benefits that individuals perceive to
improving their health as well as the factors that influence behaviour change 8or
that influence an individual*s intention to act9 both at an individual level and in
interaction with the environment. They ta!e account of self>efficacy or the belief
in one*s ability to ta!e action as well as the actual process of behavioural
change. In relation to behavioural change, Prochas!a and (iClemente 8%<<H9
in their $tages of Change model suggest that there are five different stages of
behavioural change& pre>contemplation, contemplation, preparation, action and
maintenance.
Community
The second set of models includes the (iffusion of Innovation Theory or
(iffusion of Ideas Model and the Community MobiliGation model. These models
focus on change in communities and communal action for health. The models in
this set are directed at understanding and improving the health of populations
and achieving change in social and environmental conditions affecting health
rather than focusing on the health of individuals. The diffusion of innovation
model developed by 6verett 3ogers, which loo!s at how the adoption of new
ideas and practices occurs through communities, is an e"ample of this category
of model.
4y identifying the variables that will determine how an innovation is ta!en up by
different members of a community, models assist health promoters to plan how
to introduce a new idea or practice into the community.
:utbeam and Harris 8%<<<9 also place models which describe the process of
community participation and community action in this category. Their view is
that these models serve to assist health promoters to understand how they
could support and strengthen the capacity of individuals to act collectively to
solve problems.
Communication
The third category loo!s at models and theories that guide the use of
communication strategies. The communication can be directed at an individual
level or at a mass communication level.
$ocial Mar!eting falls into this category. $ocial Mar!eting is the application of
commercial mar!eting techniues li!e mar!et analysis, to the health and welfare
conte"t. Mar!et analysis see!s to predict the appropriate balance between the
value of the product, the price, the promotion strategy and its accessibility to the
mar!et. It also aims to evaluate its success.
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4y borrowing these mar!eting principles, $ocial Mar!eting tries to sell ideas and
products which are socially beneficial to the public. The $ocial Mar!eting of
condoms 8at an affordable price to local communities9 is a good e"ample of how
this theory has been applied to Health Promotion in $outh 'frica.
:utbeam and Harris 8%<<<9 mention another communication model& Mc=uire*s
Communication>4ehaviour Change Model which loo!s at what the different
components of an educational campaign are that should be considered in its
development. Important considerations in developing a campaign are, for
e"ample, understanding the particular needs and opinions of the target
audience, selecting an appropriate person or organisation to deliver the
message to the target audience, deciding on the content and form of the
message and the best medium to convey the message as well as identifying the
desired outcomes of the campaign.
Organisations
The fourth area of wor! focuses on the level of organisational change. Theories
of 5rganisational Change assist health promoters to understand how change
occurs within organisations and to plan for this. Ior e"ample if a health
promoter is attempting to influence the policies or activities of an organisation
so that it becomes more health supportive, s7he would do well to draw on
5rganisational and Management Theory. This would enable her7him to analyse
the organisational setting and to plan an intervention that ac!nowledges the
different stages of change that the organisation is li!ely to go through.
$imilarly, if a health promoter was trying to facilitate a process whereby a
number of organisations collaborate with one another to promote the health of a
community, for e"ample, in trying to improve living conditions or develop
recreational facilities, s7he would do well to draw on other*s e"periences of
wor!ing inter>sectorally. :utbeam and Harris suggest that these models
Aprovide useful guidance on the different steps reuired to introduce and sustain
a program in different organisational settingsB 8:utbeam ; Harris, %<<<& 0/9.
The success of such programmes, it is hoped, will bring about systematic and
lasting change within or between organisations.
There is one other area of theory relevant to Health Promotion > that of public
policy. )ell> !nown theorists in this area of Health Promotion include :ancy
Milio, de Ceeuw and 6rio Jiglio. This is a category that we are not going to focus
on in this $tudy $ession. However, if you would li!e to find out more about
public policy, Chapter 2, pp 2<>%?% of Coulson et al 8%<<29 provides a basic
introduction to the development and implementation of health public policy. )e
have not provided this chapter.
Iinally, it is important to remember that the use of a theory or a model alone will
not guarantee the success of an intervention. Theories and models can,
however, assist in increasing the rigour of the intervention design and enhance
the chances of success.
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4 A((L0ING %EAL!% (R"!IN !%ER0 ! (RAC!ICE
The following section contains an opportunity to test your ability to apply Health
Promotion models to practice. )e have developed a sample or model answer
for one of the scenarios listed below, so that you are able to get guidance on the
tas!. If you would li!e to get feedbac! on your own wor!, you can send your
response to this tas! to the $chool of Public Health Programme and your
supervisor for this Module will return it with feedbac!.
Scenario 1 A smoking cessation service
You are a health wor!er in a district clinic. You have decided to develop a
smo!ing cessation service for smo!ers who have not yet thought of giving up,
and for those who want to give up.
)hat programme8s9 will you offerD How will you publicise the new serviceD How
will you evaluate the serviceD
Scenario 2 Nutrition education in schoos
You want to introduce better nutrition education into all schools in your district,
possibly followed by a more general Health Promoting $chools pro@ect. How will
you do thisD )ho do you thin! the !ey sta!eholders would beD )hat would you
do with the schools and the communities themselvesD How will you evaluate
the pro@ectD
Scenario ! Im"roving a communit# recreationa $aciit#
Cocal residents in an urban neighbourhood have nowhere for their children to
play safely. The local par! is run down& the boundary fence is bro!en, it suffers
from dog fouling and there are no rubbish bins, the children*s swings are bro!en
and homeless people use the par! to sleep in. You are part of a local wor!ing
group that has been set up to address the problem. )hat would you doD How
would you evaluate whether you have made a differenceD

Scenario % Im"roving h#gienic "ractice at a $ood sta
The stallholders at a local food mar!et at the ta"i ran! are criticised by residents
for their unhygienic practices, the way they attract flies to the area and the way
they leave rubbish behind their stalls at the end of each day. There have been
some instances of serious illnesses caused by poor food handling. You are a
member of the district health service and have been as!ed to represent the
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!A#, + 5 A33ly -ey co'3onents of %( theories and 'odels to 3ractice
Choose one of three scenarios below. $!etch out a HP intervention that
incorporates ideas from the models of behaviour change in individuals,
organisations and communities. You don*t need to provide precise details of the
intervention but concentrate on which theory could help you and in what way it
could be of use to you.
)rite down how you would evaluate your proposed intervention.
service on a tas! team that has been formed to solve the problem. )hat do you
thin! the team should doD How should they evaluate their wor! at the endD
8This e"ercise has been adapted from the wor! of (r 3achael (i"ey, Health
6ducation (epartment, Ceeds Metropolitan #niversity, #nited Fingdom9.
)e have developed a response to $cenario %. 3emember that there are always
a number of ways in which you can tac!le a tas! li!e this& this is the way we
have approached it.
$EE*BAC,
A33lyin& %ealth (ro'otion "odels to a #'o-in& Cessation (ro&ra''e
5ne way of addressing this need would be to use the $tages of Change Model
and design one clinic smo!ing cessation programme for both the groups.
However, as the model suggests, you would need to organise interventions in a
seuential way so as to incorporate each of the five stages i.e. starting with pre>
contemplation. In this way you would tailor your interventions to fit people*s
particular needs in relation to thin!ing about 8or not thin!ing about9 giving up
smo!ing.
(ublicity
Ior those that have not thought about giving up smo!ing, you could advertise a
clinic support group for smo!ers who are trying to uit the habit. You could
encourage those attending the clinic to come to an introductory meeting. In the
introductory meeting, the principles underlying the smo!ing cessation
programme could be introduced. Issues li!e the benefits and limitations of
smo!ing could be discussed, why people smo!e and their e"periences of
smo!ing could also be e"plored.
Innovative pamphlets giving basic information about the effects of smo!ing for
particular target groups could also be developed. Ior e"ample, with a group of
pregnant mothers, you could discuss the effects of smo!ing on the health of
babiesK for teenagers, an information pac! could be designed which could have
contemporary or trendy role>models tal!ing about how AundesirableB it is to !iss
a smo!er+ These interventions could be used to encourage smo!ers to consider
the implications of their habit and advice could be given about the opportunities
available at the clinic, if they should thin! of giving up smo!ing.
(ro&ra''e de6elo3'ent
Ior those smo!ers who are already wanting to give up smo!ing, they could @oin
the smo!ing cessation support group. The support group could run in such a
way that it provided particular support to individuals throughout the stages of the
change cycle. The facilitator 8and possibly the other members9 would help other
participants to move on to the ne"t stage, or to support one another in times of
relapse.
It would be important to run the smo!ing cessation group at a convenient time
and place for participants. This would ensure that the practicalities of attending
a support group would not discourage participants from initially attending
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meetings, or maintaining their involvement. It might initially be important to
encourage and follow up with participants who have e"pressed an interest in
attending the group, ma!ing sure that their first e"perience of the group is
encouraging and inspiring+
It would also be important that the group is facilitated by someone empathetic to
the issue or habit. $uch a person should be a good role>model for the
community and 8ideally9 an inspirational change agent as well+ 'lthough a nice
idea, an e">smo!er would not necessarily always be the most appropriate
facilitator , given that many e">smo!ers often become the most unsympathetic
and intolerant non>smo!ers once they have uit the habit+ The group facilitator
would also need to possess s!ills to handle group dynamics, counsel individual
clients and be able to give input to the group about life s!ills issues e.g. self>
esteem, assertiveness and informed decision>ma!ing where appropriate.
The (iffusion of Ideas Model could also aid one in identifying how a ne& idea
li!e stopping smo!ing could be adopted and supported within the group and in
the broader community. The introduction of a new practice is more li!ely to be
successful if it is compatible with the prevailing ideas and values of those whom
one is trying to target. If the relative advantage of using the new practice over
the old is made clear, or if the innovation is sufficiently fle"ible and simple, it
would not reuire any unnecessary e"pense. Those contemplating the adoption
of an innovation would also be encouraged to do so if they are able to observe
the results in those who have already adopted the new practice e.g. They could
be e">smo!ers who feel strong and confident about not smo!ing or women
smo!ers who have not put on weight after uitting smo!ing. Thus, the strategies
suggested by the clinic to smo!ers who are trying to uit, should be considered
in the light of these characteristics, so that they do not promote unrealistic
innovation strategies.
The Health 4elief Model could also assist the health wor!er and his7her team to
gain insight into some of the !ey factors that influence smo!ing behaviour. Ior
e"ample, the model could guide the health team to e"plore with smo!ers
whether they feel that they are at increased ris! of getting lung cancer by
smo!ing, or whether smo!ing had or would have serious conseuences on their
health. Here they would be e"ploring the 'ercei%ed threat.
They could also e"plore whether they believed that a ris! reduction option such
as uitting smo!ing, would in fact minimise their susceptibility to ill>health, and
whether the benefits of adopting the option would outweigh the costs or the
barriers to giving up smo!ing.
The model would also assist one to determine the level of self>efficacy of the
potential clients. 6fficacy means the e"tent to which they believe in their own
competence to ta!e the recommended action i.e. the actions reuired to stop
smo!ing and to !ic! the habit on an ongoing basis. 'n understanding of such
beliefs would assist the team to design strategies which ta!e account of their
client*s perceptions of the issue, and wor! with their real concerns and
e"pectations.
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The 4'$:6I Model 8a model based on '@Gen and Iishbein*s theory of
3easoned 'ction and Planned 4ehaviour9 would also alert one to e"plore what
enabling factors e"isted within the client*s environment to support a change in
their behaviour. Ior e"ample, to what e"tent do the clients* peer group or social
circle influence their behaviour and would they be supportive if the client were to
change their behaviour. In other words, would it be possible to give up smo!ing
if there was considerable pressure to be part of a group which considered
smo!ing desirableD In addition, this approach encourages one to consider
whether the client has sufficient time to commit to wor!ing on changing their
behaviour e.g. do they have time to attend a support groupD
E6aluation strate&y
In terms of evaluation, the health wor!er might want to consider evaluating the
smo!ing cessation pro@ect by e"ploring some of the following issues&
)hat encouraged the smo!ers to @oin the programmeD
)hat encouraged them to maintain their participation in the programmeD
)hat hindered people from @oining the programme, or what caused clients to
leave the programmeD
How successful was the programme in getting clients to stop smo!ing both
in the short>term and after a couple of months , and even in the medium to
long term e.g. a year or two laterD
)hat impact did the educational pamphlets have on smo!ers and non>
smo!ers visiting the clinicD
How else could the clinic have responded to this issueD
)hat was the cost of the programme i.e. how much time, staff and finances
did the programme cost the clinicD
$ome of the ways of conducting the evaluation could be&
Interviewing a sample of longer>term clients of the support group and as!ing
them to describe their e"periences of being part of the group e.g. what
helped them stay part of the group, how they have benefited personally from
the $mo!ing Cessation Programme, what were some of the difficulties they
e"perienced in trying to give up smo!ing and what would they li!e to have
changed in the programme.
Interviewing clients who had @ust started the programme. Here one could as!
them to discuss their e"pectations of the group and the programme and why
they have decided to @oin the programme.
Interviewing a random sample of patients or clients as they leave the clinic
and as!ing them whether they pic!ed up an information pamphlet about
smo!ing, or saw the poster advertising the smo!ing cessation group. If they
did, one might as! them what the !ey messages were for them in the
pamphlet or poster. The opportunity could also be used to as! these patients
and visitors to the clinic what they thin! the clinic should do about smo!ing
and for their ideas on the issue.
3unning a focus group with clinic staff members and as!ing them what their
involvement had been in the programme, how they thought it had impacted
on their wor! 8both negatively and positively9 and how they thought it could
be improved.
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3eviewing the records of the $mo!ing Cessation $upport =roup and
determining the success rate. Ior e"ample, one could calculate the
proportion of people who had participated in the programme and had been
able to stop smo!ing versus those that had not been able to stop smo!ing.
5ne could calculate how many people were still on the programme and were
attempting to give up the habit as well as how many people had left the
programme or had left for periods and then returned.
's suggested earlier, a sample of the group*s clients could be followed up
individually for interviews, during which one could also determine whether
those that had given up the habit were still not smo!ing and why those that
had left the programme had left. 5ne could also as! them what could have
prevented them from leaving the programme. It would also be interesting to
review how long, on average, it too! for people to stop smo!ing, so as to
give one an indication of how long the cycle described in the $tages of
Change Model too!. This would help the clinic in its future planning. The
annual cost of the programme could also be calculated if good
administrative records were developed from the beginning of the
programme.
Try out the other scenarios using this answer as a model. It will be good
practice for your 'ssignment

7 !%E 8ALUE $ !%ERIE# AN* "*EL#
Theories and models are important in Health Promotion for a number of
different reasons. Ta!e a loo! at 3eading %0. These two diagrams illustrate the
range of purposes which models and theories might serve.
)e will discuss the value of models and theories below.
Iirstly, theories and models help to organise comple"ity.
AHealth promotion theories and models can help to bind together our
observations and ideas, and ma!e sense of themB 8:utbeam ; Harris, %<<<&
%%9.
In some ways models offer a possible way of creating order out of the chaos of
practice. They organise and synthesise a variety of disparate variables li!e
causes and effects into a coherent form which allows the practitioner to then
uic!ly grasp the !ey points. In this way models can also allow the practitioner
to ta!e a step bac! 8metaphorically9 and observe how all the different variables
wor! together. This helps to see the &hole more clearly.
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READING 16: :utbeam, (. ; Harris, 6. 8%<<<9. Theory in a Nutshell: A Guide to
Health Promotion Theory. 3oseville, 'ustralia& Mc=raw>Hill, Iigure % on page %H and
Iigure H on page %1.
Models and theories can also assist in the design of an intervention.
ATheories L inform decisions on the timing and seuencing of our interventions
in order to achieve ma"imum effectsB 8:utbeam ; Harris, %<<<& %-9.
Theories and models can also guide or assist you as you embar! on developing
an intervention or a programme. They help you to consider what other people
might have learnt in the past about targeting a change in behaviour within an
organisation or a community.
More specifically, theories or models can help us to&
#nderstand the causes of the problem or the issue.
Pinpoint what you need to !now or do to design an intervention.
$hape programme strategies to reach the targeted individuals or
organisations.
Identify what needs to be monitored in the implementation process.
Identify what outcomes ought to have been achieved at the end of the
intervention.
9 #E##IN #U""AR0
In this session, you have been introduced to a number of theories and models
and as!ed to apply them to several real scenarios. You were also offered the
opportunity to clarify what theories and models are and their value for Health
Promotion interventions. You were also provided with an e"ample of applying
them to a scenario.
You are as!ed to do @ust this in your 'ssignment, so ta!e advantage of the
practice run offered to you in Tas! -& you may send it to your Module Tutor at
the $chool of Public Health to ma!e sure you are on trac!.
This is the final session of the Health Promotion I module& by now, you should
be wor!ing on your 'ssignment and preparing to submit your (raft 'ssignment.
)e hope that the Module has been interesting and that it has given you some
deeper insights into the different perspectives embodied in Health Promotion
and its approaches.
: RE$ERENCE# AN* $UR!%ER REA*ING#
If you would li!e to read more about some of the issues discussed above,
Coulson et al*s Promoting Health in South Africa: An Action Manual has a useful
discussion of community development presented in a simple but clear way in
Chapter %%. In addition, Chapter %? of the te"t discusses media and Health
Promotion in greater detail and Chapter 2 focuses on health policy.
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Iran 4aum*s boo! The Ne& Pu(lic Health: An Australian Pers'ecti%e 8%<<29 is
also an e"cellent boo! for further reading on these and other issues related to
Health Promotion.
4aum, I. 8%<<29. The Ne& Pu(lic Health: An Australian Pers'ecti%e. Melbourne&
5"ford #niversity Press.
(i"ey, 3. 8%<<<9. (iscussion with :. $chaay. Health 6ducation (epartment,
Ceeds Metropolitan #niversity, #nited Fingdom.
6arp, E.'. ; 6nnett, $.T. 8%<<%9. Conceptual models for health education
research and practice. Health )ducation *esearch" 08H9& %0->%1%.
6wles, C. ; $imnet, I. 8%<<<9. Promoting Health: A Practical Guide" Iourth
6dition. Condon& 4ailliere Tindall.
=lanG, F. Theory at a Glance: a Guide for Health Promotion Practice. See
http&77www.nci.nih.gov
:utbeam, (. ; Harris, 6. 8%<<<9. Theory in a nutshell: a Guide to Health
Promotion Theory. 3oseville, 'ustralia& Mc=raw>Hill.
Prochas!a, E. 5. ; (iClemente, C. C. 8%<<H9. $tages of change in the
modification of problem behaviors. In M. Hersen, 3. M. 6isler, ; 3 M. Miller
86ds.9, Progress in Beha%ior Modification" H2. $ycamore, IC& $ycamore& %2.>
H%2.
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E6aluation co''ents on the Health Promotion I "odule
MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM
Please ta+e a little time to gi%e us some feed(ac+ on your e,'erience of this
module. Than+s %ery much.
)hat were some of the strong points of the Health Promotion I moduleD Thin!
about content, what you learnt, what was covered.
)hat were some of the areas that could be improved in the moduleD
)hat were some of the things which made the materials helpfulD
)hat suggestions would you ma!e to improve the materialsD
If you were to be honest, what percentage of the Tas!s did you do in a $tudy
$essionD
Please say how you found the Tas!s in terms of challenge, interest and clarity.
(id you feel sufficiently prepared when you started the 'ssignmentD
Can you pinpoint any specific areas of a unit or session which you found
difficult. Pages numbers would be helpful.
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