Praxis Health Education (5551)

A theory is a set of interrelated concepts that explains or predicts behavior. A model draws on one or more theories to address a particular problem or setting, and a construct is a concept defined for use within a specific theory. Health educators use theory to identify why people behave as they do, to decide which factors instruction should target, and to select what an evaluation should measure. Theories are commonly grouped by the level at which they operate: individual, interpersonal and community.

The Health Belief Model holds that people take a health action when they believe they are personally at risk of a serious condition, that a specific action will reduce the threat, and that the benefits of acting outweigh the costs. It was developed to explain why people failed to use free screening and prevention services, and it fits one-time or preventive actions such as vaccination, screening and seat belt use.

Susceptibility and severity together form perceived threat. Modifying variables such as age, knowledge and culture shape each perception. Protection Motivation Theory applies similar reasoning to fear-based messages: a person weighs a threat appraisal (severity and vulnerability) against a coping appraisal (response efficacy, self-efficacy and response costs). Fear appeals are effective only when paired with a clear, achievable protective action; fear without efficacy tends to produce denial or avoidance.

The Transtheoretical Model, or Stages of Change, treats behavior change as a process that unfolds over time, not a single event. People progress through stages, frequently relapse to an earlier stage and recycle, and benefit most from strategies matched to their current stage.

The model also names ten processes of change. Experiential processes, such as consciousness raising, dramatic relief and self-reevaluation, are most useful in the early stages. Behavioral processes, such as stimulus control, counterconditioning, reinforcement management and helping relationships, support the later stages. Decisional balance is the weighing of pros and cons: cons dominate in precontemplation, and the perceived pros must rise before a person moves toward action. Self-efficacy increases as people advance.

The Theory of Reasoned Action states that the most immediate predictor of a behavior is behavioral intention, which is shaped by attitude and subjective norm. The Theory of Planned Behavior adds a third determinant, perceived behavioral control, which influences both intention and behavior.

Locus of control describes where a person places responsibility for outcomes. An internal locus holds that health results mainly from personal actions; an external locus attributes health to chance, fate or powerful others such as physicians. An internal health locus of control is generally associated with more preventive behavior, and skills-based instruction is designed to strengthen it.

Social Cognitive Theory explains behavior as the product of continuous interaction among personal factors, environmental influences and the behavior itself. A change in one element affects the other two. The theory underlies most skills-based health curricula because it emphasizes learning through observation, guided practice and feedback.

Self-efficacy grows from four sources: mastery experiences (successful practice, the strongest source), vicarious experience (seeing similar peers succeed), verbal persuasion (credible encouragement) and the interpretation of physical and emotional states. A refusal-skills role-play with peer models and teacher feedback draws on all four.

The social norms approach rests on the finding that students commonly overestimate how many peers use alcohol, tobacco or other drugs and underestimate how many practice healthy behaviors. Because perceived norms influence behavior, campaigns publicize accurate local data (for example, that most students in the school do not vape) to correct the misperception and reduce pressure to conform to a false norm.

The Social Ecological Model places individual behavior within several interacting levels of influence. Its central claim is that change is most likely, and most durable, when interventions address multiple levels at once instead of relying on individual knowledge alone.

Diffusion of Innovations theory describes how a new idea, product or practice spreads through a social system over time. Adoption follows a bell-shaped curve across five adopter categories. Spread is faster when the innovation offers relative advantage, compatibility with existing values, low complexity, trialability and observable results. Early adopters are typically respected opinion leaders, so recruiting them speeds acceptance of a new curriculum or policy.

PRECEDE-PROCEED is a planning model, not a theory of behavior. Planning begins with the desired outcome and works backward. The PRECEDE phases are assessments: social, epidemiological, educational and ecological, and administrative and policy. The PROCEED phases cover implementation followed by process, impact and outcome evaluation. The educational and ecological assessment sorts the causes of a behavior into three groups of factors.