Theory

How does Theory Support Precision Research?

A goal of precision research is to promote health equity by learning what works best, for whom, in which contexts, why and how. Such research should be informed by theories that provide rationale for how interventions result in change and how and why systems and context moderate that change.

Theories guide our thinking and give meaning to what we observe. In research, theories are invaluable for making predictions and developing sound hypotheses. Theories provide a coherent framework and common language for intervention design and evaluation. Theories also influence how evidence is collected, analyzed, understood, and used. An underlying assumption of precision home visiting research is that service quality and outcomes for parents and children can be improved if intervention and model developers, implementers, and researchers ground their work in explicit theories. 

Many interventions within home visiting aim to promote or reduce specific behaviors. For these interventions, this means grounding intervention design and research in theories of behavior and behavior change.

What are Theories of Behavior & Behavior Change?

Theories of behavior are designed to explain the factors that determine behavior and the importance of those factors in predicting and explaining a given behavior. 

Theories of behavior change are process-oriented and seek to explain how behaviors can be changed and/or change over time and the important sources of influence to be targeted to alter the behavior. 

These two types of theories integrate relevant and moderators of behavior change. Theories of behavior change aim to support interventions in either changing existing, or encouraging the adoption of new behaviors. While having distinct purposes, theories of behavior and theories of behavior change are also highly complementary. Trying to change a behavior requires a thorough understanding of the factors that determine and influence the behavior.[1]

How HARC is Developing Resources for Theories of Behavior & Behavior Change

There are hundreds of theories relevant for precision research on home visiting services and implementation systems. HARC’s objective is to develop resources focused on theories to build capacity of researchers who wish to use them. To do this, the HARC research team:

1. Identified 159 unique theories of behavior and theories of behavior change through detailed review of literature, materials provided on the HomVEE website, and intervention researcher recommendations
2. Conducted independent reviews and internal consensus activities to determine inclusion of theories for consideration (view methods).
3. Surveyed over 55 intervention researchers to gather data on 34 theories of behavior related to familiarity, use, quality, and relevance for home visiting (view results).
4. Surveyed 85 intervention researchers to gather data on 48 theories of behavior change related to familiarity, use, quality, and relevance for home visiting (view results).
5. Identified 13 theories of behavior and 10 theories of behavior change that were familiar to the majority of intervention researchers and that they rated as both high quality and high relevance for home visiting (listed below).  

6. Surveyed representatives from 17 evidence-based and emerging home visiting models to assess the comprehensiveness of the theories to include in online resources (view results).
7. Created brief summaries for each of the 10 theories of behavior change that were judged by most researchers to be high quality and relevant for home visiting.

Theories & Frameworks Focused on Social and Structural Determinants

Theories of behavior and behavior change may be limited in explaining how social, community, and structural factors influence how interventions work to achieve outcomes, particularly for groups that have been economically and socially marginalized. Intervention design and research should also be grounded in theories and frameworks that seek to explain how public policies, institutional practices and cultural representations contribute to health disparities. Such theories may not include the explicit mechanisms for how an intervention is designed to achieve intended outcomes, but their use is critical in understanding how intervention impacts are moderated by contextual factors. Some examples include:[2]

• Critical Race Theory
• Family Stress Model
• Indigenist Stress Coping Model
• Indigenous Connectedness Framework
• Integrative Model for the Study of Developmental Competencies in Minority Children
• Intersectionality Framework
• Minority Stress Model
• Structural Determinants of Early Learning

[1] van der Linden, S. (2013). A response to Paul Dolan. In A. Oliver (Ed.), Behavioural Public Policy (pp. 209-215). Cambridge University Press: Cambridge, UK.

[2] Recommended by members of the HARC Diversity, Equity and Inclusion Resource Group.