PREFACE

Programs to influence health behavior, including health promotion and education programs and interventions, generally are more likely to benefit participants and communities when guided by a theory or theories of health behavior. Theories of health behavior can help program planners consider the sources of influence on particular health behaviors and identify the targets for behavior change and methods for accomplishing these changes. Theories also can inform the evaluation of change efforts by helping planners, evaluators, and others to specify the outcomes to be measured and the timing and methods of study. Although the evidence is not unequivocal, when they are developed and implemented thoughtfully and systematically, theory-driven health promotion and education efforts stand in contrast to programs based primarily on precedent, tradition, intuition, or general principles.

Theory-driven health behavior change interventions and programs require an understanding of the components of health behavior theories and operational or practical forms of the theories. The first edition of this book, published in 1990, was the first text to provide an in-depth analysis of various theories of health behavior relevant to health education in a single volume. It brought together dominant health behavior theories, research based on those theories, and examples of health education practice derived from theory that had been tested through evaluation and research. The second (1996), third (2002), fourth (2008), and fifth (2015) editions of this book updated and improved upon the earlier volumes. People around the world are using this book. It has been translated into multiple languages, including, most recently, Japanese, Korean, and Chinese editions.

We are confident that the sixth edition of Health Behavior: Theory, Research, and Practice improves upon on the preceding edition, as each earlier edition has done. The main purpose of the book is the same: to advance the science of understanding health behavior and the practice of health behavior change through the informed application of theories of health behavior. Likewise, this book serves as the definitive text for students, practitioners, and scientists in these areas and education in three ways: by analyzing the key components of health behavior theories, by describing current applications of these theories in selected public health and health promotion programs and interventions, and by identifying important future directions for research and practice in health behavior change.

The sixth edition responds to new developments in health behavior theories and the application of theories in new settings, to new populations, and in new ways. This edition includes an enhanced focus on the application of theories for diverse populations and settings, and there are more chapters written by diverse authors. There is a corresponding integration of issues related to race and ethnicity in multiple chapters and a new chapter (Chapter 14) focused on theories of race and racism. Authors recognize the complexity of race/ethnicity; these are not mere variables. Rather, they are the lenses through which people experience the world. Issues of culture and health inequities are also integrated into many chapters. These issues are of broad and growing importance across many theories and models. We believe that these additions strengthen the book and increase its value for use in settings around the world. The world is more global than ever before, and professionals working on behavior change often will work in multiple countries. We have a heightened commitment to addressing health risks and threats in low- and middle-income countries (LMICs). Thus, more global applications from both developing and developed countries are included.

As new information and communication technologies have opened up an unprecedented range of strategies for health behavior change, this edition integrates expanded coverage of social media and digital health behavior interventions examples throughout the book.

Audiences

This book is written for graduate students, practitioners, and scientists who spend part or all of their time in the broad arenas of health behavior change, public health, health promotion, and health education; the text will assist them both to understand the theories and to apply them in practical settings. Practitioners, as well as students, should find this text a major reference for the development and evaluation of theory-driven health behavior change programs and interventions. Researchers should emerge with a recognition of areas where empirical support is deficient or inconclusive, helping set the research agenda for health behavior going forward.

This book is intended to assist all professionals who value the need to influence health behavior positively. Their fields include health promotion and education, health communication, medicine, nursing, public health, health psychology, behavioral medicine, health communications, nutrition and dietetics, dentistry, pharmacy, social work, exercise science, clinical psychology, and occupational and physical therapy.

Overview of the Book

The chapters, written expressly for this sixth edition, address theories and models of health behavior at the level of the individual, interpersonal, group, organization, and community and approaches that are integrated across multiple levels.

The book is organized into five parts. Part One defines key terms and concepts and introduces ecological models. The next three parts reflect important units of health behavior and education practice: the individual, the interpersonal or group level, and the community or aggregate level. Each of these parts begins with an introductory chapter to orient readers to the next chapters and their interrelationships, and has several chapters. Part Two covers theories of individual health behavior, and its chapters focus on variables within individuals that influence their health behavior and response to health promotion and education interventions. Three bodies of theory are reviewed in separate chapters: Health Belief Model; Theory of Reasoned Action/Theory of Planned Behavior/Integrated Behavioral Model and the Reasoned Action Approach, and The Transtheoretical Model. Part Three examines interpersonal theories, which emphasize elements in the interpersonal environment that affect individuals' health behavior. Four chapters examine Social Cognitive Theory: social support, social networks; and stress and coping. Part Four covers models for the community or aggregate level of change and includes chapters on race, health, and health equity; community engagement; implementation, dissemination, and diffusion of innovations; and media communications. Part Five explores "Using Theory," which presents the key components and applications of overarching planning and process models and integrated models and approaches to health behavior change. It includes chapters on theory-based planning models, behavioral economics, social marketing, and social media (new for this edition).

The major emphasis of this book is on the analysis and application of health behavior theories to public health and health promotion practice. The section introductory chapters in Parts Two, Three, Four and Five introduce the theories in their sections; summarize their potential application to the development of health behavior change interventions; and highlight strengths, weaknesses, gaps and areas for future development and research, and promising strategies. Each core chapter in Parts Two, Three, and Four begins with a discussion of the background of the theory or model and a presentation of the theory; reviews empirical support for it; and concludes with one or two applications.

Chapter authors are established, highly regarded researchers, and practitioners who draw on their experiences in state-of-the-art research to critically analyze and apply the theories to health behavior and education. This text makes otherwise lofty theories accessible and practical, and advances both research and practice in the process.

No single book can be truly comprehensive and still be concise and readable. Decisions about which theories to include were made with both an appreciation of the evolution of the study of health behavior and a vision of its future (see Chapter 2). We emphasize theories and conceptual frameworks that encompass a range from the individual to the societal level. We acknowledge that there is substantial variability in the extent to which various theories and models have been codified, tested, and supported by empirical evidence. Of necessity, some promising emerging theories were not included.

The first five editions of this book grew out of the editors' own experiences, frustrations, and needs as well as their desire to synthesize many literatures and to draw clearly the linkages between theory, research, and practice in health behavior and education. We have sought to show how theory, research, and practice interrelate and to make each accessible and practical. In this sixth edition, we have attempted to respond to changes in the science and practice of public health and health promotion and to update the coverage of these areas in a rapidly evolving field. Substantial efforts have been taken to present findings from health behavior change interventions based on the theories that are described and to illustrate the adaptations needed to successfully reach diverse and unique populations. Through the preceding five editions, Health Behavior: Theory, Research and...