MPH 601 Week 1 Health Education Theories and Models Example

Why Maria Skipped the Walking Group: Using the Health Belief Model, Social Cognitive Theory and the Stages of Change to Design Diabetes Prevention Education

[Student Name]

University of Phoenix

MPH/601: Public Health Promotion and Education

Week 1 Assignment

[Instructor Name]

[Date]

The county, its program, participants and their stories are composites written for a model paper; research findings come from the sources cited.

The county health department runs a 16-session diabetes prevention program for adults with prediabetes on the east side. Enrollment is strong, but many participants stop attending within a month. A community health worker described one: Maria, 54, whose doctor had warned her that her glucose readings were in the prediabetes range, joined the program, attended three sessions and then stopped coming. When the worker called, Maria said she did not have time, that the walking group met when she was at work and that she was not sure she could lose weight anyway. This paper uses health education theories to understand Maria's choices and redesign the program.

Why Theory Matters

A good theory offers a reasoned account of behavior and points to levers that might shift it. A review of theory use in public health found increasing evidence that interventions based on social and behavioral science theories are more effective than those lacking a theoretical base, and it described widely used theories, including the health belief model, the transtheoretical model, social cognitive theory and the ecological model, along with the challenges of applying them in large programs (Glanz & Bishop, 2010).

The Health Belief Model

In the health belief model, action against a health threat depends on how susceptible they believe they are, how severe they think the consequences would be, the benefits they expect from action and the barriers they perceive, prompted by cues to action. When researchers looked back over ten years of studies, barriers stood out: of all the model's dimensions, what people saw as obstacles predicted behavior most strongly, across many behaviors (Janz & Becker, 1984).

Maria Through the Health Belief Model

Maria's perceived susceptibility was moderate; her doctor's warning was a cue to action. She understood that diabetes is serious; her mother had lost a toe to it. She believed exercise would help. But her barriers were high: her work schedule clashed with the walking group, and she cared for grandchildren in the evenings. The model points to reducing barriers as the priority. Maria did not doubt the danger; she could not fit the program into her life.

Social Cognitive Theory

Social cognitive theory holds that behavior results from interactions among personal factors, behavior and environment. It places self-efficacy, a person's belief in their ability to act, at the center, working together with goals, outcome expectations and perceived environmental barriers and facilitators; self-efficacy affects whether people consider change, whether they persist and how they recover from setbacks, and comprehensive health promotion also requires changing social systems (Bandura, 2004).

Maria Through Social Cognitive Theory

Maria's self-efficacy for weight loss was low: she said she had tried diets before and failed. The program's first sessions focused on weight goals rather than small wins. She had few models of people like her succeeding, since the facilitator was a young nurse. Her environment offered few safe places to walk in the evening and a corner store stocked mostly with sugary drinks and chips near the register.

The Stages of Change

The transtheoretical model describes change as a progression through stages: precontemplation, contemplation, preparation, action and maintenance, with different strategies suited to each. It suggests that programs designed for people ready to act may lose those still deciding. Maria seemed to be in contemplation or early preparation: interested but not confident or ready for a full action plan.

What Other Participants Said

Maria was not alone. The community health worker called 20 participants who had stopped attending. Fourteen named scheduling conflicts with work or caregiving, nine said they doubted they could succeed, six said the sessions felt like lectures and five said they felt out of place because most participants were older or spoke only English. Several named more than one reason. The pattern pointed to barriers, confidence and fit rather than a lack of knowledge.

The Ecological Model

Individual-level theories miss part of the picture. An ecological perspective adds layers of influence: family, where Maria cooked for five people with different preferences; community, where parks and stores shaped options; and policy, where her employer offered no flexible hours. These layers explain why motivation alone did not produce change.

Comparing the Theories

The health belief model is simple and useful for identifying barriers but says little about how to build skills. Social cognitive theory explains how confidence and environment interact and offers strategies such as modeling and small goals. The stages of change help match programs to readiness but have been criticized for arbitrary stage boundaries. The ecological model broadens the view but is harder to translate into session content. Together, they cover beliefs, confidence, readiness and context.

Redesign One: Reduce Barriers

Following the health belief model, the program will offer sessions at two times, including Saturday mornings, provide child care during sessions and offer a phone option for sessions participants must miss.

Redesign Two: Build Self-Efficacy

Following social cognitive theory, early sessions will set small, achievable goals, such as a ten-minute walk after dinner or replacing one sugary drink a day, and celebrate them. Graduates from the same neighborhood, people with lives like Maria's, will co-lead sessions as peer models, since seeing someone similar succeed is one of the strongest sources of confidence.

Redesign Three: Meet People Where They Are

Following the stages of change, a two-session introductory track will help people still deciding explore their reasons for change before committing to the full program.

Redesign Four: Culture and Family

Because Maria cooks for her family, sessions will invite a family member, include recipes built on familiar dishes and discuss how to make changes without cooking separate meals. Sessions will be offered in Spanish as well as English.

Redesign Five: Change the Environment

Following the ecological model, the department will work with the park district on a lighted evening walking loop, with a corner store on healthier drink options and with employers on flexible time for participants.

A Word on Knowledge

The original program assumed that participants needed information: what prediabetes is, which foods raise blood sugar and how much activity helps. Most participants already knew much of this. Theory explains why knowledge alone rarely changes behavior, and the redesign shifts time from lectures to practice, problem-solving and support.

Measuring Constructs

The program will measure perceived barriers, self-efficacy and readiness with short validated questions at enrollment and at the fourth session to see whether the redesign changes them and whether they predict attendance.

Conclusion

Maria stopped attending not because she misunderstood the risk but because barriers were high, her confidence was low, she was not yet ready for full action and her environment worked against her. The health belief model, social cognitive theory, the stages of change and the ecological model each explain part of that story. Evidence that theory-based programs work better supports a redesign built on all four.

References

Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164. https://doi.org/10.1177/1090198104263660

Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual Review of Public Health, 31, 399-418. https://doi.org/10.1146/annurev.publhealth.012809.103604

Janz, N. K., & Becker, M. H. (1984). The health belief model: A decade later. Health Education Quarterly, 11(1), 1-47. https://doi.org/10.1177/109019818401100101