Assignment 1 - Please submit your replies here.

Part 1

For either of the case studies readings (Foy, Zoellner, or Shafer), please describe the following:

1. How did the authors use theory?  Where would you place it on a continuum of uses of theory we discussed?

The Theory of Planned Behavior (TPB) asserts that attitudes, perceived control, and subjective norms contribute to one’s intentions and behaviors. Zoellner et al. (2012) applied this theory in a qualitative study examining constructs related to the consumption of sugar-sweetened beverages (SSB). The authors conducted eight focus groups with 54 adult participants who exceeded recommendations for daily SSB consumption. Group moderators used a script grounded in theory to execute the groups.  Meaning units were coded to identify the major themes of the group discussions.  The themes were organized based on the TPB, assessing attitudes, subjective norms, perceived control and intentions for SSB and other beverage consumption. 

I would place this study at Phase II (exploratory trial) on a continuum of theory use. That is, the authors described components of a replicable intervention and protocol for comparing it to an alternative. Of note, the authors did not test an active intervention; rather, they used a qualitative approach to better understand behavior, rooted in TPB.

2. How did it relate to the uses of theory as described by Bartholemew and Mulen?

Bartholemew and Mulen proposed developing logic models that integrate constructs from multiple theories and from empirical evidence into a causal model.  This contrasts Zoellner et al.’s use of a single theory in their approach. The authors differentiate theories (cohesive explanations describing specific causal relationships between constructs) from models (heuristic representations of multiple constructs that may be relevant to a target behavior, and the possible relationships between constructs and that behavior).  In their view, intervention models should be developed with multiple theories in consideration, as well as predictors without theoretical models. They suggest moving beyond a narrow focus on awareness/knowledge to a broader array of constructs to inform interventions. Consistent with Bartholemew and Mulen’s description, Zoellner et al. utilized TPB in both the logic model of the problem and the logic model of changes in their approach.

3. In you view of the work, how much did they explanation of the data ‘fit’ the theoretical components?

The authors organized their results based on the components of the TPB.  That is, themes that emerged from the focus groups were organized under attitudes, subjective norms, perceived behavioral control, and intention for beverage consumption.  They used inductive and deductive qualitative coding to both extract and analyze the data obtained from the focus groups.  The explanation of these findings clearly ‘fit’ the theory, but it would be hard for it not to based on the fact that group moderators used semi-structured scripts based on the TPB to lead the groups, and organized the findings based on the theory’s components. 

Part 2

1. Select a behavior that is relevant to your area of interest. 1a.Which levels (individual, social, institutional, environmental) are most likely to have a significant role? 1b.Who would you engage to develop a formative project to understand more about this behavior?

Primary Care Physician (PCP) practices related to the identification, assessment, and treatment of behavioral health care are behaviors relevant to my area of interest (i.e., primary care-mental health care integration).  Individual and institutional factors both play significant roles in PCP practices.  Thus, I would engage both physicians and institutional stakeholders to develop a project. 

For students who are not applying theory currently to an active project:

2. Using examples from the theories and frameworks presented in class create a table to organize concepts related to this behavior. Make sure to specify which theory they relate to, the types of measures you might use to capture these behavioral concepts, and which strategies you would use to measure them.

I am working on developing an evaluation of a quality improvement (QI) project that is currently in its formative stages.  In this project, physician “champions” for behavioral health-primary care integration are developing a QI program at the Palo Alto Medical Foundation (PAMF) called the Adolescent Behavioral Health (ABH) project. In this project, Pediatrics and Family Medicine PCPs will be trained in identification of adolescents (ages 12-18) with behavioral health problems.  In addition, smart sets in Epic will be implemented to facilitate the identification of these problems based on general behavioral health categories (e.g., anxiety, depression, substance abuse).  Later, a resource navigator will provide assistance to PCPs in the behavioral health referral process.  This navigator will be available to all PCPs with adolescent patients in need of behavioral health care.  Finally, a care manager will be placed in 1-2 clinics to provide more hands-on management of behavioral health problems in concert with PCPs and behavioral health specialists.  Because development of the QI project is in its nascent stages, our plans for evaluation are in progress.  For purposes of this assignment, I will use the Theory of Planned Behavior to organize concepts related to changing physician behavior in regards to identifying, assessing, and treating behavioral health problems in adolescents.