Theories in Health Behavior for Children
Childhood obesity has escalated in the last several decades, with approximately one out of every three children meeting the criteria for being overweight or obese (Ogden, Carroll, Kit, & Flegal, 2012). Despite the deleterious effects of childhood obesity, there has been little progress in combating the epidemic (Dietz & Economos, 2015). Yet the physiological consequences of being overweight or obese are well documented (Ferrannini, 1995), and the associations between childhood obesity and school performance are substantial. Children who are overweight or obese have more school-related problems than their non-overweight peers (Carey, Singh, Brown, & Wilkinson, 2015). Obese children are absent more often (Carey et al., 2015), show lower school engagement (Carey et al., 2015), and perform poorly on standardized achievement tests (Roberts, Freed, & McCarthy, 2010). Childhood obesity also is associated with a greater risk for depression, anxiety, lower self-esteem, emotional problems, and body dissatisfaction (Russell-Mayhew, McVey, Bardick, & Ireland, 2012).
But obesity is hardly the only student health problem education professionals must confront. Other behaviors affecting children’s physical health have been extensively studied as well given their link to children’s school performance. Physical activity, screen time, nutrition, substance use, and risky sexual behavior are the most targeted behaviors in health-based interventions (Bradley & Greene, 2013). Although the authors recognize that student psychosocial health is paramount in a comprehensive discussion regarding student health, the scope of the interventions regarding student mental health are too vast to include within this chapter. Thus, the aim here is to focus on the health-promoting interventions that target physical activity, screen time, inadequate nutrition, substance use, and risky sexual behavior. All can weaken the educational foundation students need, and researchers have consistently documented the relationship between each of these health behaviors and school performance.
A large number of studies have been published based on interventions designed to promote better health behaviors among students. Each of the interventions included in the chapter was selected based on whether there were clearly identifiable theoretical components within the intervention. This chapter will review five key theories that provide the intellectual underpinning for the majority of health-based interventions targeting children and adolescents. It will also provide practical applications from these theories for professionals working with schoolage youth within a case study at the end of the chapter. It is critical to elucidate these theories as theory-driven practice helps researchers hypothesize outcomes, interpret results, and use evidence to refine methods and increase the effectiveness of health-promoting interventions that can help students succeed.
Social Cognitive Theory
Review of Theory
Social Cognitive Theory (SCT) is one of the most successful theories used to explain health behavior in children. Bandura (1986) posited that individuals and their environments interact with one another and affect one another through a process called reciprocal determinism. In his model of triadic reciprocity, one’s personal experiences, environment, and general behavior interact to influence health and physical activity behaviors.
SCT consists of four major constructs: self-efficacy, outcome expectations, goals, and socio-structural factors (Bandura, 2004). Self-efficacy is thought to have a direct effect on behavior and indirect effects on other components such as facilitators, physical expectations, social expectations and goals (Bandura, 2004). If a child does not feel that success is possible in performing a task such as volleyball, the child is less likely to attempt that task. Therefore, finding a way for the task to seem achievable increases the likelihood that the participant will engage in that task. Outcome expectations, another construct within SCT, represent an individual’s judgement of the probable results of engaging or not engaging in a particular behavior. If, for instance, the child thinks that engaging in the behavior will help in gaining popularity (social expectations), the child may be more likely to try out for or join the volleyball team. SCT assumes that people will behave in ways that lead to outcomes they value while avoiding behaviors that lead to undesired outcomes. Goals, a third construct of SCT, have a direct effect on behavior and range from distant and general to proximal and specific. Reaching those goals depends on the individual’s self-monitoring, goal setting, and self-reward. Making the team may be a goal for the volleyball player mentioned above; therefore, the player’s actions may include practicing more outside of official practices and playing volleyball with friends during recess. The final construct of SCT,
socio-cultural factors, entails the barriers to and facilitators of a behavior that affect the goal indirectly. Specifically, if this is applied to the child who desires to make the volleyball team, she is likely to practice more, find an off-season league to play in, and surround herself with others who play volleyball because they will support her goal.