Tag Archives: precaution adoption model

5 Theories for change

Change theories are an important part of public health efforts (whether they’re explicitly referred to or not). Because change theories have significant overlap with the field of instructional design, I thought I’d discuss some of them here and call out their larger applications.

The big picture

The five theories I’ll discuss can be boiled down to three basic concepts:

  1. Cognition and behavior go hand-in-hand: what people know and think affects their actions
  2. Most behavior changes require new knowledge, but knowledge alone won’t be sufficient to cause change (i.e, don’t forget the affective components of learning)
  3. An individual’s social environment has an important influence on his/her behavior

Change efforts have to be focused on three targets in order to succeed:

  • The individual learner
  • The learner’s  interpersonal relationships (friends, family, coworkers, etc)
  • The communities (or organizations) in which the learner finds himself or herself in

Theory 1. Health Behavior Theory

This theory examines the beliefs that  influence whether someone will take action to change his or her behavior.

Although this theory was developed to understand why so few people participate in public health programs (Glanz, Rimer, and Su, 2005), it’s applicable in a more general sense.  For example, you might ask what prevents a person from engaging in a desired behavior in any setting. As a start, you’d consider the person’s attitudes towards the consequences of engaging or not engaging in a particular behavior and the rewards in place to support a desired behavior (vs an undesired behavior). Ultimately, if you’re working with adult learners, they need to believe in the WIIFM factor, take part in developing their own individualized learning program, and transfer learning back to the environment where the behavior matters.

For more information, see these past posts on:

Theory 2. Stages of change theory

A person’s readiness for change (Jones & Edwards, 2002; Peterson, 2002)  is also an important factor in considering how to design an instructional program.

Learning programs may need to be specialized to account for different stages of change.

Theory 3. Theory of planned behavior

Like the stages of change theory, this theory acknowledges that a learner may not be ready for a desired behavior or performance. As shown in the illustration below,  a learner’s perception that he or she is likely to adopt a new behavior (behavioral intention) is influenced by his/her personal beliefs, social influences (how important the change is to family, friends, coworkers, etc), and his/her perceived control over outcomes.

Since a positive behavioral intention is need to effect change/performance, instructional strategies should be designed to encourage positive attitudes towards change, develop a positive social support system, and to demonstrate that changed behavior can result in positive outcomes and will be supported by the community/organization.

Theory 4. Precaution adoption model

In this model, the individual is not aware of improper or desired behavior.

The necessary instructional strategy, therefore, requires both informing the individual about the desired behavior and motivating him/her to view it positively. Once the individual decides to act, instructional strategies can be similar to those identified for theory 2. If the individual decides not to act, the instructor/trainer should consider what’s influencing the learner’s behavioral intentions and use design strategies that motivate change (e.g., as in theory 3).

Theory 5. Social cognitive theory

Social cognitive theory, like social learning theory, considers the important impact of social interactions on learning, but it also recognizes  that a sense of personal agency or autonomy is an important motivating factor.

Room for overlap

Hopefully, it’s apparent that these theories overlap and that none of these instructional strategies are prescriptive. Additionally, the order of instructional strategies isn’t necessarily linear.  As the name of this blog implies, I’m generally in favor of a context-dependent approach that takes the best of multiple applicable theories.

The theories I’ve discussed generally address individual and interpersonal influences and don’t address organizational/community change. However, organizational and community change (or lack thereof) also have important influences on individual and interpersonal change and implicate the instructional designer’s role as a:

  • Community leader and facilitator
  • Communicator and (to some extent, marketer) of learning programs and follow-through efforts
  • Liaison between learners and community/business leaders, with some potential to influence policies

For more information about theories of community change, the Glanz, Rimer, and Su article (2005) is worth checking out.


Glanz, K., Rimer, B.K., Su, S.M. (2005). Theory at a glance, a guide for public health practice. National Cancer Institute, US Dept of Health and Human Services, National Institutes of Health. Retrieved from http://www.cancer.gov/PDF/481f5d53-63df-41bc-bfaf-5aa48ee1da4d/TAAG3.pdf

Jones, H., et al. (2002).Changes in diabetes self-care behaviors make a difference in glycemic control: The Diabetes Stages of Change (DiSC) study. Diabetes Care, 26(3), 732-7.

Peterson, K.A. (2002). Readiness to change and clinical success in a diabetes educational program. Journal of the American Board of  Family Practice, 15, 266-71.