Factors to Consider When Selecting a Theory or Model for Health Promotion or Disease Prevention
When selecting a theory or model to guide health promotion or disease prevention programs, you must consider: the specific health problem being addressed, the population(s) being served, the provider's knowledge and skills, and the contexts within which the program is being implemented. Client theoretical preferences are not a primary consideration in evidence-based theory selection.
Core Selection Criteria
The Specific Health Problem Being Addressed
The health problem itself should directly inform theory selection. 1 The American Heart Association guidelines emphasize that theory selection must be grounded in whether there is a theoretical basis for expecting that specific objectives and strategies will be effective for the particular health issue at hand. 1 The logic model and theoretical framework must link directly to the mechanisms expected to precede changes in disease rates for that specific condition.
Population(s) Being Served
Theory selection must account for the target population's characteristics and context. 1 Communities should select theories that "make the greatest sense to them," and listening to community input about feasibility and likelihood of success is critical to the planning process. 1 The ecological approach recognizes that interventions must address individuals within their nested systems (families, communities, organizations), requiring theory selection that accounts for these multiple levels. 1
Provider's Knowledge, Skills, and Ability
The implementer's familiarity with theories and ability to apply them is a crucial practical consideration. 1 Research shows that many guideline developers and implementers may not be aware of relevant theories or understand how to use theory when interpreting determinants or tailoring interventions. 1 Studies reveal that only 83.3% of implementation efforts provided any rationale for theory selection, and many rationales lacked specificity. 1 Further research has established the need to determine whether implementers are familiar with theories and how education or discipline affects theory use. 1
Contexts Within Which the Program is Being Implemented
Implementation context is dynamic and demands individual tailoring of strategies. 1 Assessment of influencing factors through determinant frameworks is crucial for the specific context, as each level of context requires adapted implementation strategies. 1 The socioecological model explicitly recognizes that environmental and policy system changes must be linked with personal behavioral changes within the implementation context. 1
Evidence-Based Selection Process
Theoretical and Empirical Grounding
Theory selection requires asking two fundamental questions: 1
- Is there a theoretical basis for expecting this combination of objectives and strategies to be effective?
- Have these objectives and strategies been shown effective in other populations?
Integration of Multiple Theoretical Perspectives
Effective theory selection often integrates complementary frameworks. 1 Green and Kreuter's framework identifies three key determinants common across theories: factors that predispose (educate and motivate), enable, or reinforce behavior change. 1 Any intervention combination should ensure educational efforts are accompanied by strategies that reinforce and enable behavior change.
Validation and Prior Use
Theories should be selected based on prior validation and successful application. 1 Studies commonly justified theory selection by noting the theory had been "validated and used in multiple health care settings" or had been "previously used by others." 1
Common Pitfalls to Avoid
Many implementation efforts cite theory but fail to explicitly link identified context-specific determinants with particular theoretical constructs. 1 This represents a critical gap—rationales for theory selection often lack specificity and fail to show how theoretical constructs predict or explain context-specific conditions. 1
Suboptimal use of implementation frameworks can result in wasted resources, inappropriate implementation strategies, and wrong conclusions. 1 Only 22.5% of implementation studies adequately used theories, and mixed results are often attributed to limited or absent theoretical underpinning. 1
Avoid selecting theory without systematic assessment of determinants. 1 Assessment of influencing factors through determinant frameworks must precede theory selection, with results used to select suitable theories and adapt strategies for the specific context. 1
What NOT to Prioritize
Client theoretical preferences are not mentioned as a selection criterion in the evidence base. The focus is on evidence-based selection grounded in the health problem, population characteristics, implementation context, and empirical support—not on subjective client preferences for particular theoretical approaches.