Let’s Talk Theory

May 15, 2014 (old blog)

Why do so many people dislike theory? In most undergraduate classes, theory is taught on powerpoint with little context – no wonder why it’s dry. It has only been within the last two years that I’ve taken a genuine interest in understanding theories of behaviour change, and I’ve got to say that it’s particularly interesting when you can see it in action. I’ve also come to realize that rarely can theory be disentangled from research application in the discipline of behaviour change.

Last week I talked about the importance of theoretically driven interventions and how it is good to remain open-minded to theories and models that might not match your personal ideologies, particularly for pilot projects. As promised, this week I will tell you about RIPPLE’s theoretical underpinnings, which include the Health Belief Model (HBM), Theory of Planned Behaviour (TPB), and Motivational Interviewing (MI)… why these three?


A recent addition to this model includes the ‘cue to action’…  what is this? A cue to action is any trigger that may activate behaviour change when certain other beliefs are held. For example, you know that the yearly dentist appointment is beneficial to your health and that poor dental hygiene may be associated with some serious risks, but you haven’t booked your yearly appointment yet. Oh, but wait – you just received that reminder postcard in the mail and you are on the phone to book your appointment! That reminder postcard represents a cue to action. As you can imagine, cues to action can be unpredictable and variable (can be as short-lived as a sneeze or as long-lasting as the conscious processing of an ad), thus they remain understudied.
It is hypothesized that RIPPLE will act as a cue to action which may facilitate behaviour change if parents hold certain beliefs about their children’s health (e.g., they perceive suboptimal lifestyle behaviours to be detrimental to their child’s health, they feel confident they can improve their child’s lifestyle behaviours, etc.).

As mentioned before, parents will be randomly assigned to either the injunctive ordescriptive category – one comparing parents’ feedback to national recommendations and the other to normative data from the population. The latter component which pertains to normative data and how parents perceive their child’s behaviour in comparison has been informed by the TPB.

Motivational interviewing has gained increasing popularity over recent years, as many clinicians and researchers have come to the consensus that if patients or families are not ready to make changes, their motivation and readiness to change must be addressed before healthy behaviour change is. The dominant theme behind MI is to activate motivation and readiness to change, and clinicians can use a number of approaches to achieve this, such as taking a non-judgmental, neutral position and listening reflectively.

For those of you familiar with any of these theories, you will know that we are using bits and pieces from each. Although at times this eclecticism makes me uneasy, I know that findings from this pilot project will determine the strength of each contributing construct, which will allow us to accurately inform a future randomized controlled trial with increased confidence.


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