Scientists from the Department of Health and Human Services, after reviewing causes of death in the United States, concluded that about half of all deaths could be attributed to a limited number of largely preventable behaviors and exposures.1,2 These scientists estimated external (nongenetic) modifiable causes of mortality for the year 2000 and concluded that tobacco, poor diet and physical inactivity, alcohol consumption, microbial agents, toxic agents, motor vehicle related fatality, firearms, sexual behavior, and illicit drug use accounted for the most mortality. Their analysis led Mokdad et al. to argue for increased efforts toward prevention in our health care and public health systems.2
Responding to these disease threats, several agenda-setting documents have been produced to guide the reduction of disease risk through the modification of health behavior. Healthy People 2010 is perhaps the most critical document of this type and defines a set of comprehensive disease prevention and health-promotion objectives for the United States to be achieved by the year 2010.3 Healthy People 2010 was designed to realize two overarching goals including (a) increase quality and years of healthy life and (b) eliminate health disparities. Healthy People 2010 has selected a set of 10 “leading health indicators” that will be used to measure the health of the nation over the coming years and that reflect major health concerns facing the United States in the first 10 years of the twenty-first century. These leading indicators include physical activity, overweight and obesity, tobacco use, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care.
Health behavior research often occurs within two broad categories. First, investigators continuously work toward a better understanding of the factors that explain and predict behavior. A better understanding of these determinants will provide guidance for the development of interventions that have a reasonable chance of producing changes in behavior. Therefore, basic research on the determinants of health behavior will ultimately improve health promotion interventions. The second broad category involves the development of intervention strategies, usually targeting changes in behavior, with the goal of modifying health behavior as well as physiological risk factors and ultimately morbidity and mortality.
This chapter will describe several intervention approaches as well as frequently utilized theories in health behavior research. We will also provide guidance to resources that may help with the development and evaluation of effective theory-based interventions.
THEORIES OF BEHAVIOR CHANGE
Rationale for the use of theory
Theories are used in health behavior research in a number of ways. First, theory is used to identify variables that explain and predict behavior and as a result, guide studies conducted to provide empirical evidence on postulated determinants of behavior. Second, theories are used to guide the design of interventions. The selection of variables to target for intervention and the development of specific messages ...