Applying Psychological Theories to Promote Healthy Lifestyles

Church-based health promotion (CBHP) interventions can reach broad populations and have great potential for reducing health disparities. From a socioecological perspective, churches and other religious organizations can influence members' behaviors at multiple levels of change. Formative research is essential to determine appropriate strategies and messages for diverse groups and denominations. A collaborative partnership approach utilizing principles of community-based participatory research, and involving churches in program design and delivery, is essential for recruitment, participation, and sustainability. For African Americans, health interventions that incorporate spiritual and cultural contextualization have been effective. Evidence indicates that CBHP programs have produced significant impacts on a variety of health behaviors. Key elements of CBHP are described with illustrations from the authors' research projects.

Theory-based health behavior change programs are thought to be more effective than those that do not use theory. No previous reviews have assessed the extent to which theory is used (that is, operationalized and tested) in empirical research. The purpose of this study was to describe theory use in recent health behavior literature and to assess the proportion of research that uses theory along a continuum from: informed by theory to applying, testing, or building theory. A sample of empirical research articles (n = 193) published in ten leading public health, medicine, and psychology journals from 2000 to 2005 was coded to determine whether and how theory was used. Of health behavior articles in the sample, 35.7% mentioned theory. The most-often-used theories were The Transtheoretical Model, Social Cognitive Theory, and Health Belief Model. Most theory use (68.1%) involved research that was informed by theory; 18% applied theory; 3.6% tested theory; and 9.4% sought to build theory. About one third of published health behavior research uses theory and a small proportion of those studies rigorously apply theory. Patterns of theory use are similar to reports from the mid-1990s. Behavioral researchers should strive to use theory more thoroughly by applying, testing, and building theories in order to move the field forward.

The Health Belief Model (HBM) relates a socio-psychologic theory of decision making to individual health-related behaviors. We conducted a meta-analysis of the relationships between four HBM dimensions (Susceptibility, Severity, Benefits and Costs) and health behavior on 16 studies that measured all four of the dimensions, measured a behavioral dependent variable and included some measures of reliability, minimal criteria for establishing the validity of the dimensions. Mean effect sizes were computed for all the studies, subgroupings representing studies of screening, risk reduction and adherence to medical regimen, and prospective and retrospective study designs. Of 24 mean effect sizes, 22 were found to be positive and statistically significant. The actual variance accounted for ranged from 0.001 to 0.09. Homogeneity was rejected for 15 of the 22, however, suggesting that the same underlying construct was not measured. Retrospective studies were found to have significantly large effect sizes for benefits and costs and smaller effect sizes for severity when compared to prospective studies. The weak effect sizes and lack of homogeneity indicate that it is premature to draw conclusions about the predictive validity of the HBM as operationalized in these studies. Our finding of only 16 studies meeting minimal criteria for valid representation of the HBM dimensions indicates that future studies should focus more on such issues.