Models for Health Education – Theory of Reasoned Action

The Theory of Reasoned Action was developed in 1967 that looks at the expectations of the person who performs the behavior (Fishbein & Azjen, 1975).  The job of the person using this model is basing their outcomes on what the person or group expects will happen, not what they think should happen.  This points back to perceptions.  Even if I believe the outcome to a behavioral intervention will be positive, the person may have beliefs which has them thinking otherwise.  In public health we can assume anything about any group we are working with.

Here is a picture of what the process looks like: (By FIDIS [CC0], via Wikimedia Commons)


Many of the models I will be writing about have limited use for diverse populations.  I believe this is one of the exceptions.  The reason being, culture has a large influence on what a person does.  If the person has a cultural system that prevents them from performing the behavior, you will have to go back to the drawing board on what to do.  An example would be if you had a culture in your community that didn’t believe in the germ theory.   The germ theory says that viruses and bacteria cause disease.  So teaching this community to wash their hands to prevent germs from transferring to others is not going to work. The best thing to do is to find out what they do believe in the prevent illness and work with that.  A prime example of this working is in several countries around the world that work with indigenous populations who believe their healers will cure disease.  However, instead of attempting to make the community believe something different, doctors work with the healers to help the people.  They are still doing what they believe, but getting the help they need to fight the disease.  Traditional healing may or may not work, but modern medicine does.  Merging the two influences the outcome.

Before we use any model, we need to take the time to understand the culture we are working.  Once we do that, it’ll be easier to create a communications strategy that works.  I would add a step to the left on this chart called “cultural awareness”.  This means in order to start the process cultural awareness needs to take place before you understand the attitudes and behaviors of the person.  While everyone is unique, knowing a person’s culture first then their personal beliefs is key to using this model.