So, what is theory? Theory has been variably defined. For our purposes, we draw upon Kerlinger’s definition of theory in his classic textbook, Foundations of Behavioral Research (1986), as it is comprehensive and useful. Kerlinger defines theory as

a set of interrelated constructs, definitions, and propositions that present a systematic view of phenomena by specifying relations among variables, with the purpose

of explaining or predicting phenomena. (p. 9).

In this definition, theory refers to a systematic way of understanding events, behaviors, and/or situations. It reflects a set of interrelated concepts, definitions, and propositions that explain or predict events and situations by specifying relationships among variables. Thus, the purpose of theory is to provide a roadmap or pathway among constructs, definitions, and propositions as well as their relationships to promote an understanding of the phenomenon of interest and to enable prediction of outcomes (DePoy & Gitlin, 2015). Simply put, the purpose of theory is to explain and predict events.

Theories differ with regard to scope and levels of abstraction and specificity and are often categorized into one of three levels, although there is not necessarily consensus on this nor which theories should be included in each of the levels. At the broadest level there are “grand theories,” which function at a very high level of abstraction. This level of theory focuses mostly on social structure and social processes such as how financial strain affects psychosocial well-being.

Grand theories typically lack operational definitions or clarity as to the relationships among their propositions and constructs and are used to understand or encompass an entire field. Examples include critical theory or structuralism or Orem’s self-care deficit theory (Bengtson, Burgess, & Parrott, 1997; Dowd, 1988; Taylor, Geden, Isaramalai, & Wongvatunyu, 2000).

In contrast, “midrange” theories can be derived from a grand theory and are less abstract. Midrange theories are composed of operationally defined propositions and constructs that are testable. This level of theory is the most useful for behavioral intervention research, and some of the most commonly used are described in Table 4.1.

Finally, “micro” level theories can be specific to particular populations, fields, or phenomena and have the narrowest scope and level of abstraction. Also referred to as “practice- or situation-specific” theories, they are useful in clinical situations or the study of small-scale structures. They typically focus on the individual level and/ or social interactions, with symbolic interactionism, social phenomenology, and exchange theory as prime examples.

Regardless of level, a well-developed theory is one which yields testable hypotheses and has some empirical evidence to support its value. Although theories may be rooted in distinct philosophical traditions and categorized variably, that is not our concern here. Our approach is practical. For the purposes of this chapter, we use the terms “theory,” “conceptual frameworks,” and “models” interchangeably and view each as working tools for advancing behavioral interventions. We also do not differentiate between levels of theories (macro, mid, or micro). Our message

TABLE 4.1 Examples of Select Theories Commonly Used in Behavioral Intervention Research


Brief Explanation of Model

1. Health Belief Model (HBM) (Rosenstock, 1974)

People will be motivated to avoid a health threat if they believe they are at risk ("perceived susceptibility") for the disease/condition and if they deem it serious ("perceived severity"). These two necessary conditions—perceived susceptibility and perceived severity—converge to describe "perceived threat," the central construct of HBM. Perceived threat is also influenced by "cues to action," which are environmental stimuli such as advertisement campaigns and relatives who have the disease; cues to action extend this individual-level theory into an ecological perspective. An individual's decision to engage in health behaviors is further influenced by the counterbalance between "perceived barriers" and "perceived benefits." The HBM comprises all of these factors, moderated by demographic characteristics.

In 1988, Rosenstock and colleagues added to the model an additional construct—"self-efficacy"—to capture individual perceptions of confidence to perform a behavior.

2. Health Action Process Approach (HAPA) (Schwarzer, 2008)

HAPA theorizes that intention to change is the most potent predictor of whether an individual will actually change his or her undesirable behavior to a more desirable one. Within this framework, HAPA proposes two stages of motivation:

(1) "preintentional motivation" and (2) "postintentional volition." Preintentional processes (e.g., outcome expectancies, risk perception, action self-efficacy) result in the emergence of intention, whereas postintentional processes (e.g., maintenance self-efficacy, planning) result in the actual behavior being enacted.

3. Theory of Reasoned Action (TRA) (Ajzen & Fishbein, 1980)

An individual will engage in a health behavior if he or she has the intention to do so. Intention is composed of two main elements: "attitudes" and "subjective norms." Attitudes are operationalized as the belief that one's behavior will result in positive health outcomes ("behavioral beliefs") and is also dependent on the degree to which one values these positive health outcomes ("evaluation"). Subjective norms are operationalized as the appraisal of whether others will approve or disapprove of one's behavior ("normative beliefs") and whether or not the individual is affected by these normative beliefs ("motivation to comply").

4. Theory of Planned Behavior (TPB) (Ajzen & Madden, 1986)

TPB is incremental to TRA with the addition of the construct "perceived behavioral control." Perceived behavioral control is conceptualized as the degree to which an individual perceives a specific behavior as either easy or difficult to enact.

5. Life-Span Theory of Control (Heckhausen & Schulz, 1995) and Motivational Theory of Life-Span Development (Heckhausen et al., 2010)

Life-Span Theory of Control suggests that threats to, or actual losses in the ability to, control important outcomes may activate individuals to use strategies to buffer threats and losses. To the extent that control-oriented behavioral and cognitive strategies are used that are directed toward attaining valued goals, threats to, or actual losses of, control may be minimized and positive affect enhanced.

is simple: Interventions must be built upon theoretical and/or conceptual foundations. Theory/conceptual frameworks structure each phase of design, evaluation, and implementation of an intervention; as such, different theories/frameworks may be drawn upon and utilized depending upon phase, specific research questions being addressed, and the focus or objectives of a behavioral intervention.

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