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Why Theory Matters

Jackie Green. Why Theory Matters. “There is nothing so practical as a good theory.” (Kurt Lewin). Concerns. Seen by some as Reductionist Incompatible with holism and empowerment Inconsistent with respect for human agency and voluntarism. Theory practice gap.

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Why Theory Matters

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  1. Jackie Green Why Theory Matters “There is nothing so practical as a good theory.” (Kurt Lewin)

  2. Concerns Seen by some as • Reductionist • Incompatible with holism and empowerment • Inconsistent with respect for human agency and voluntarism

  3. Theory practice gap Attributed to a narrow view of theory – linked to natural sciences and positivism and attempts to offer universal explanations (Buchanan, 1994)

  4. But ……… • A broader view of theory can and should: • Enhance understanding of complex situations • Consider the influence of contextual factors • Include the experience of practitioners and communities

  5. Evidence based practice • Empirical evidence necessary but not enough. • Need to extract THEORETICAL PRINCIPLES to avoid drowning in a mass of information

  6. Definitions • Theories – offer explanations of how or why something happens by identifying key variables and establishing the relationship between them • Concepts are the main elements of theories • Constructs operationalise concepts for use in building theory • Models provide a looser, possibly untested, framework to help understand reality and the relationship between concepts. They may draw on one or more theories.

  7. Two broad types of theory • Explanatory theory theory of the problem – identifies key variables which need to be addressed • Change theory theory of the solution – identifies the best means of changing key variables

  8. Theory can …… • Ensure that all relevant variable are addressed and key elements of a programme are in place • Take account of contextual factors It therefore avoids • Type III error – an intervention failing to achieve successful results when it was so poorly designed that it could not possibly have had the desired effect (Basch and Gold, 1986: 300-1)

  9. Like an expert chef, a theoretically grounded health education professional does not blindly follow a cookbook recipe, but constantly recreates it anew, depending on the circumstances. Without a theory, she or he has only the skills of a cafeteria line worker. (National Cancer Institute, 1997)

  10. Ecological approach – levels of influence • Intra-personal • Interpersonal • Institutional or organisational • Community • Public policy (National Cancer Institute, 2005)

  11. Examples of relevant theory Health Belief Model Stages of Change Theory of Planned Behaviour Health Action Model • Intrapersonal • Interpersonal • Community Social Cognitive Theory Community organisation e.g. Locality (Community) Development Social Planning, Social Action Diffusion of innovations Communication Theory (based on National Cancer Institute, 2005)

  12. The challenge …… • Not an absence of theory but • Which theory to select from the plethora available or rather • Which combination of theories to cope with the complexity of health issues • How to select theory

  13. Which theory • Does it include all relevant variables? • Does it not contain redundant variables? • Does it logically make sense to use it in a particular situation? • Has it been used by others for similar purposes? • Are there published studies supporting its use for similar purposes? • Is it consistent with the values integral to the work? (Tones and Green (2004)

  14. behavioural intention self personality belief motivation normative The Health Action Model HAM ROUTINE Environment Physical Socio-economic Socio-cultural HEALTH ACTION Skills Psycho-motor Social interaction Self-regulatory relapse confirmation Knowledge

  15. Community organisation • Community capacity • Social capital • Participation • Control and Empowerment • Critical consciousness • Awareness • Motivation

  16. Diffusion of Innovations • The characteristics of the innovation • relative advantage • compatibility - with values, previous experience and current needs • complexity • trialability • observability • Communication channels • Time • The social system

  17. Analysing the determinants of health issues Understanding what needs to be changed THEORY Identifying what needs to be done Programme planning and development SYSTEMATIC REVIEWS Outcomes: short, medium and long term Predicting likely effects Establishing how to assess effects Selection of process and outcome indicators • Contextual factors • Community insights • Practitioner insights Evaluation

  18. References • Basch, C.E. and Gold, R.S. (1986) ‘Type V errors in hypothesis testing’, Health Education Research, 1(4): 299-305 • Buchanan (1994) ‘Reflections on the relationship between theory and practice’, Health Education Research, 9(3): 273-283 • Green, J. (2000) ‘The role of theory in evidence-based health promotion practice’, Health Education Research, 15(2): 125-129 • National Cancer Institute (2005) Theory at a Glance: a Guide for Health Promotion Practice (2nd edition) (Website: http://www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf-5aa48ee1da4d/TAAG3.pdf) • Nutbeam, D. and Harris, E. (2004) Theory in a Nutshell. Sydney: McGraw-Hill • Tones, K. and Green, J. (2004) Health Promotion Planning and Strategies. London: Sage

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