How to Use

General Strategy & Special Circumstances

Do Your Own Analysis

1. Map the causes of your health behavior in a logical sequence.
2. Ask your stakeholders whether this “common sense” map aligns with their front-line experience, and adjust your map accordingly.
3. Search the scientific literature (e.g., via the NIH database PubMed or the NIH Behavioral and Social Science e-source) for studies that used a theory to explain or address your health problem.
4. Decide whether TheoryPicker, your map, and the literature all point to the same theory. If they do, it’s probably a good choice. Seek guidance from a behavioral scientist, perhaps at a local university.
5. If you have access to an expert in social or behavioral science who has designed successful health behavior change interventions, follow the expert’s guidance in theory selection. Real world settings have nuances, and applying theory requires judgment calls. An experienced consultant will be aware of these subtleties and realistic about what to expect at various stages of the project.

One Theory or Parts of Several?

There are trade-offs between:

• the number of behavioral influences targeted by an intervention, and the available resources for addressing each influence
• the number of variables measured in an evaluation of a program and a respondent’s willingness to complete a survey.

In practice, these tradeoffs often mean choosing between:

• taking all of the key variables from one theory into account, or…
• selecting a few variables from each of several theories

Expert opinion is divided on this issue.

Each theory included in this tool specifies a coherent pathway to behavior change. The two best reasons for keeping the theoretical pathways intact as you plan and evaluate your program are:

• If your intervention worked, a coherent theory can help you understand how it worked, and that will help to guard its effectiveness when it is adapted for different circumstances or updated in the future.
• If your intervention did not work, you might be able to figure out where the process broke down if you measured all the key constructs along a hypothesized causal chain.

So some experts suggest addressing and measuring all the major elements of one theory well, and adding a few promising constructs from other theories only if time allows.¹³ Other experts who have designed successful behavior change programs advise using an alternative approach -- moving directly from a behavior change objective to major plausible determinants from a variety of theories.^4,5,6

In Case of a Tie…

TheoryPicker will give more than one theory the same numeric rank if your answers resulted in a tie. You could combine the theories, but be aware that if you limit the number of constructs you address you can focus your intervention and save resources. Don’t break the tie just by picking the theory that seems easiest to use – you might miss opportunities and waste time and resources in the long run.

I picked a theory – now what?

Picking a theory narrowed the universe of potential psychosocial mechanisms of behavior change to a short list. You still need to identify intervention strategies and tactics for bringing the behavior change about. For ideas about how to put theories into practice, look for case examples in the literature on your health problem. You can also consult articles,¹⁷ books,^4, and online resources that organize potential behavior change strategies and tactics by ecological system level, behavior change objective, and/or theoretical construct.

After you have selected a general theory-based strategy, there may be additional, more narrowly focused theories that can provide tactical direction.¹² For example:

• The Theory of Planned Behavior highlights attitudes. Changing attitudes involves persuasive arguments, and several theories deal directly with persuasion.⁷
• Social Cognitive Theory emphasizes observational or vicarious learning to build self-efficacy. Narrative approaches (e.g., photonovellas, comic books, and soap operas) can be used to model complex behaviors and build self-efficacy in audience members. There are theories specifically about narratives.^8,9

Measuring Theory Components

Theories are made up of “constructs” (e.g., hypothetical factors such as stress, knowledge, social support and intentions). There are links to the sets of constructs that make up each of the 6 theories that are ranked by the TheoryPicker on the Theory List screen.

For examples of ways to measure the constructs from any of the theories, go to the GEM system maintained by the National Cancer Institute at NIH, or Health Communication Outcomes published by Public Health Ontario.

Search online for other sites that offer sample measures for particular theories (e.g., for the Transtheoretical Model).