Models & Theories of Health Promotion in
Multicultural Populations
Dr. Jim Frankish
Senior Scholar, Michael Smith Foundation for Health Research
Partners in Community Heath
Research-Training Program
Current & Recent Projects
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Research Training Program in Community Partnership Research
BC Homelessness & Health Research Network Project
Evaluation of Homeless Individuals & Families Information System
Service Utilization for Homeless Persons with Mental Illness
Social Construction of Homelessness - Whose Fault? What Solutions?
Measurement of Health Literacy
Health Promotion in Primary Care Project
"Health 101" Course
Report Card on Impacts of 2010 Games on Health & Quality of Life
Measuring Community Capacity & Measures of Community Health
Evaluation of the "Cooking Fun for Families" Program
Health Regions and Non-Medical Determinants of Health
Adolescents’ Concept of Depression and Help-Seeking
Ethics Guidelines for Community-Based Research
National Health Literacy Survey
Evaluation of National Literacy and Health Program
QUEST - Georgia Basins Future Project
Mid-Life Health Interventions for Healthy Aging
Current Student Projects
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Primary health care reform and disadvantaged
populations
Health education in women with Aids in Latin
America
Mental health promotion and early psychosis
Multicultural nutritional health literacy
Criteria for health resource allocations to
"special interest" groups
Pediatric HIV education
Adolescent depression
Early child development and health
IV drug use and street kids
Living well with chronic illness
Poverty and nutrition in inner-city schools
Child injury prevention in low-income parents
Social capital and health in resource
communities
Poverty and nutrition - cultural variations
Source Publication
• 2007. Frankish J, Lovato C, Poureslami, I.
Models, Theories and Principles of Health
Promotion in Multicultural Populations in
R. Huff & M. Kline, Editors, Promoting
Health in Multicultural Populations, Second
Edition, Sage.
• "By telling us about the what, how, when, and why,
theories can inform programs in health
education....The what tells us the elements we
should consider as the targets for the
intervention....The why tells us about the processes
by which changes occur in the target variables.
The when tells us about the timing and sequencing
of our interventions in order to achieve maximum
effects. The how tells us the methods or ways we
should focus our interventions; it includes the
specific means of inducing changes in the
explanatory variables (Glanz, Lewis & Rimer,
1990).
Basic Approach
• Rationale for Using a Theoretical Framework
• Distinguishing Theories, Models and
Frameworks
• Values and Theories
Links Between Theory & Applied
Models of Health & Illness
theory
Positivism
Biomedical Model
Post-positivism
Biopsychosocial Model
Population Health
Human Ecology
Disease Ecology
Ecosystem Health
Introduction to Theory
– Positivism:
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The “scientific method”
Quantitative – data driven
Top down
Scientific reductionism
Quest for causes and universal laws
– Post-positivism or Humanism
• Holistic, interdependencies complexity of systems and
interactions between systems
• Qualitative, constructivist
• Quest is for understanding
More comparisons of positivism/
humanism or post-positivist
POSITIVISM:
Considers aggregate data, large-scale
projects
Preserves status quo
Top down
Minimizes importance of dynamic
determinants
POST-POSITIVISM/humanism:
• Recognizes importance of individual
experience
• Gives rise to individual level studies
• Doesn’t strip context
• Considers issues of participation,
equity, community, justice
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Theories built up by reproducing
studies, facts and truth
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EXAMPLES:
AIDS/HIV in New York spread along
commuter lines
Spatial patterning of diseases
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“Sonnets no matter how eloquent do not
stop viruses, do not help us look ahead”
Emphasizes individuality and
subjectivity
Theories are built up through learning
EXAMPLES:
Anthropological and ethnographic studies:
men living with HIV, women living
with MS
A Lexicon for Health Promotion
• Concepts: the 'idea' of community capacity
• Constructs: the operational definition or characteristics of
community capacity
• Theories/Models: Hypothesized relations between important
constructs
• Measures/Indicators: Data on important constructs
• Strategies: Means of acting to change important relations
between constructs in the model or theory
• Standards: definitions of success for each aspect of community
capacity
Theory/Model
Originators
Level of Change
Basic Concept
Health Belief Model
Godfrey Hochbaum, Stephen Kegels,
Irwin Rosenstock
1952
Individual
Predicts health-related behaviour in terms of
certain patterns of beliefs. The model is used to
explain and predict preventative health behaviour,
sick role and illness behaviour.
Transtheoretical Model
(Stages of Change)
James Prochaska, Carol DiClemente
1979
Individual
Processes of change that need to occur to produce
a change in behaviour.
Social Cognitive Theory
Albert Bandura
1986
Interpersonal
Behaviour as a product of reciprocal interaction of
personal factors, behaviour and the environment.
Looks at role of cognitions in pathway.
Theory of Planned Behaviour/Reasoned
Action
Icek Ajzen, Martin Fishbein, 1967-1970
Interpersonal
Relationship between an individual’s attitudes and
behaviour. Predicts motivational influences on
behaviour.
Diffusion of Innovations, Communication
Theory, Organizational Change
Various researchers
Community
Looks at process of social and organizational
change. How behaviours are adopted at
community, organizational and social levels.
(Source: Adapted from materials from University of South Florida, Community & Family Health, 1999)
Ecological Models
Ecological Psychology, Kurt Lewin,
Environmental
Looks at behaviour in relation to the environment
1936
(interpersonal, organizational and community
Social Ecological Approach, Rudolph
levels)
Four Prevalent Models for
Health Education
• Social Learning Theory (Reference
Group-Based Social Influence Theory)
• Health Belief Model
• Theory of Reasoned Action/Theory of Planned
Behavior
• Transtheoretical (Stages of Change) Model
More Ecological Models
• Precede-Proceed
• Social Ecology
• PEN-3 Model
• Community Participation
Additional Models
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Aids Risk Reduction Model
Coping Theory
Cognitive-Behavioral Theory
Communication Theory
Diffusion of Innovation
Expectancy-Value Theory
Information-Motivation Model
Learned Helplessness Theory
Precaution Adoption Model
Social Marketing Theory
Social Support Theory
Contact Information
• Dr. Jim Frankish, Senior Scholar, Michael Smith Foundation
Institute of Health Promotion Research
Rm 425, Library Processing Centre
2206 East Mall Vancouver BC V6T 1Z3
604-822-9205, 822-9210, frankish@interchange.ubc.ca
Personal Website: jimfrankish.com
BC Homelessness & Health Research – Network
bchhrn.ihpr.ubc.ca
BC Homelessness Virtual Library - www.hvl.ihpr.ubc.ca
Partners in Community Health Research www.pchr.net