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VIEWPOINT

Is One Theory Better than Another in Nutrition Education?


A Viewpoint: More Is Better

C H E RY L A C H T E R B E R G , P H D; 1 C A R L A M I L L E R , P H D, RD 2
1
The Schreyer Honors College,The Pennsylvania State University, University Park, Pennsylvania;
2
Department of Nutritional Sciences,The Pennsylvania State University, University Park, Pennsylvania

variables (or vice versa).Therefore, theory specifies the vari-


ABSTRACT ables that affect the target behavior, the relations among
those variables, how to intervene to promote behavior
Health behavior theories describe the relations among vari-
change, and provides predictability for expected outcomes.
ables influencing a behavior and specify targets for facilitat-
ing behavior change. Nutrition education does not have a One of the reasons for theory in any field (or general sub-
dominant theory specific to the discipline. Instead, constructs ject matter) is to assist professionals in that field to organize
from multiple theories have been borrowed, primarily from information along certain principles. The theory of evolu-
the social sciences, and have been applied to describe or pre- tion is powerful precisely because it cuts across the many dif-
dict nutrition-related behaviors. However, current theories ferent domains of biology, pulling them all together in a way
do not fully predict behavior or behavior change. A more that no other ideas, theories, or systems of thought had
effective approach may be to integrate distinct constructs before. In effect, evolution unified our understanding of the
from competing theories into one or more polytheoretical way things are (ie, explanation) and the ways things may be
models that can be empirically tested and refined into a in the future (ie, prediction). When fields or, more specifi-
more comprehensive, tailored theory or set of theories spe- cally, disciplines (specialties within a field) (J. Sobel, personal
cific to food and nutrition behavior changes. In our view,
communication, April 2003) are relatively young in terms of
more than one will be needed to address the complex array
of people, issues, and contexts that we routinely address in their developmental trajectory, it makes sense to hold, and
nutrition education and behavioral interventions. even promote, several competing theories. It would be a dis-
service to the discipline to discard any theories prematurely
KEY WORDS: theory, health promotion, behavior change, (although theories should be rejected if they do not hold up
nutrition education empirically). In short, to answer the question originally
posed, more is better. But life is more complex than that.
( J Nutr Educ Behav. 2004;36:40-42.)
Once a theory is well established and in place, history shows
that it is difficult to overthrow that theory unless there are
new problems it cannot answer or there is new thinking that
This viewpoint was written to address the question, Is does a better job of explaining the target behavior. Kuhn
one theory better than another in nutrition education? described the change phenomenon as a paradigm shift.3
Although we offer our viewpoint, different viewpoints exist Hoffman, in a recent article, specifies the qualities or
in the field. Numerous theories have been used to describe characteristics a theory must have to be accepted.4 These
or predict health behaviors and to design and evaluate include simplicity (ie, esthetic appeal), storytelling ability or
behavior change programs.1 Theories of health behavior pro- symmetry, portability, and productivity. Looked at from this
pose that mediating variables predict behavior and interven- perspective, it becomes clear why some models or theories
tions promote change in the mediating variables.2 Individu- in nutrition education have hung on and why others have
als who experience greater change in the target behavior never taken hold. Food and dietary behavior is complex; as
should also experience particular changes in the mediating humans, we would like to simplify our understanding of it.
The classic knowledge-attitude-behavior model offers sim-
plicity, however inadequate it may be, and it may be for that
esthetic appeal alone that it has lingered in our literature for
Address for correspondence: Cheryl Achterberg, PhD,The Schreyer Honors College, several decades. The second characteristic of telling a good
The Pennsylvania State University, 10 Schreyer Honors College, University Park, PA
16802;Tel: (814) 865-2631; Fax: (814) 863-8688; E-mail: agy@psu.edu. story may be best illustrated in our field by the Transtheo-
2004 SOCIETY FOR NUTRITION EDUCATION retical Model.1,5 Its sense-making and relatively easy-to-

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Journal of Nutrition Education and Behavior Volume 36 Number 1 January February 2004 41

recall sequence (A to B to C to D, etc) may help to explain theoretical models fully predict behavior or behavior
its rapid and widespread adoption by practitioners. change 6 ; perhaps they never will. However, eliminating
Hoffmans third characteristic of portability refers to the redundant constructs and combining distinct constructs into
ease by which others (beside the originating author) can use more comprehensive polytheoretical models* hold some
or apply the theory.6 Many of the theories in nutrition edu- promise for improvement in nutrition education and behav-
cation are considered too complex to learn or apply in var- ioral interventions. This may be the next most reasonable
ious practitioner settings (eg, a brief office encounter with a step for investigators to pursue. Of course, the value of this
client). Even other researchers seem reluctant to adopt other more comprehensive theoretical approach can be judged
researchers models if they are complex. On a related note, only on its ability to explain and better predict the target
Hoffman also points out the role of productivity (ie, the best behavior and promote change in the mediating variables fol-
theories should stimulate experiment).4 Only a few (eg, lowing intervention. We would assume that multiple poly-
Transtheoretical Model, Social Cognitive Theory) of our theoretical models would be needed because it is unlikely
theories appear, as yet, to have done so. Of course, we would that any one theory will work alone. Undoubtedly, research
interpret the concept experiment broadly to include inter- in nutrition behavior and behavior change might make bet-
ventions, comparisons, or any other systematic approach to ter progress if investigators joined together as a community to
building knowledge. apply, test, and evaluate promising theories.
Finally, Hoffman suggests that the acceptance of theories Furthermore, we need to determine the usefulness of the-
depends as much on the psychology of human beings as on ory in predicting specific behaviors for specific subgroups
the content of the theories.4 We would not presuppose an and the circumstances under which the theory is useful.
understanding of the psychology underlying our discipline, Some interventions are more effective for some people (eg,
but we are willing to hazard a guess that nutrition educators, those recently diagnosed with a chronic disease).7 Other
as a group, do not mirror the mentality of grazing animals. theories have successfully predicted a specific class of behav-
Rather, we tend to be characterized by individual interests ior (eg, milk consumption).2 Similarly, the same behavior in
and a variety of agendas.We ask different questions, use dif- different situations (eg, eating an apple for a snack at home
ferent tools, adopt different philosophical approaches, and versus at work) is subject to different influences. A single
rarely consult others (to our collective loss) in the process theory may successfully predict behavior under specific cir-
all of which mitigates against a single theory. cumstances for those highly motivated to change but have
Food- and nutrition-related behavior, education, and little predictive power when the circumstances are altered.
intervention (or what some people call behavioral nutrition We have only begun to tease apart these relationships, but it
education) are still too young to have developed a domi- is not unreasonable to suppose that nutrition education and
nant theory. Nutrition education and intervention began, as intervention may continue to use a set of theories, with dif-
all disciplines do, without any theory specific to the disci- ferent (but specific) theories used to address different (but
pline. However, theories, or parts of theories, have been specific) problems.
lifted and employed from related disciplines in the social To return to the central question: Is one theory better
sciences.Although no specific timetable can be given to pre- than another in nutrition education? We assert that no one
dict when any given theory in nutrition education will theory is better for all people under all conditions.The util-
dominate or, later, when such a theory will be overthrown, ity of a polytheoretical model(s)* that incorporates constructs
we feel safe in saying that we are not there yet. So we must from many disciplines proven to explain or predict nutrition-
encourage further development and exploration of theory, related behaviors awaits development.Then we can begin to
generate new ideas, continue testing a variety of theories, determine if a particular set of theories is sufficiently robust
and work toward those that can unify our various settings, to predict specific behaviors for some people under certain
audiences, and target behaviors of interest.A combination of conditions and, if so, the implications of those findings. Even-
qualitative and quantitative approaches may be most effective tually, this set of polytheoretical models (actually, theories in
in this enterprise. Given the range of ages, ethnicities, nutri- themselves) might evolve into a supertheory specific to food
tion issues, and other contextual variables that are routine in and nutrition behavior changes. The discipline is severely
our work, nutrition education and intervention may be a lacking such theories at present. Indeed, it is hard to imagine
discipline that continues to use several theories, but research any at this point in our development. Clearly, more powerful
should indicate which specific theory (or theories) should be concepts and understandings will have to be built.We do not
used to resolve any given problem. know what we do not know. At present, we can only assert,
At present, many of the frequently used theories in nutri- suggest, or guess. However, we are optimistic; the future holds
tion education and intervention include similar constructs promise for a more comprehensive and effective theoretical
(eg, outcome expectancies in Social Cognitive Theory, per- approach. Is one theory better than another in nutrition edu-
ceived benefits in the Health Belief Model, and the pros of cation? Well, yes and no; some are better than others, but
performing a behavior in the Transtheoretical Model are none are good enough. Not yet. Perhaps one day the answer
overlapping constructs).2,5 However, none of our current will be markedly different.
42 Achterberg and Miller/VIEWPOINT: THEORIES FOR NUTRITION EDUCATION

ENDNOTE 2. Baranowski T, Cullen KW, Baranowski J. Psychosocial correlates of dietary


intake: advancing dietary intervention. Annu Rev Nutr. 1999;19:17-40.
*We use the word model only because the term poly- 3. Kuhn TS. The Structure of Scientific Revolutions. 3rd ed. Chicago, Ill:The
theoretical theory sounds awkward; we actually mean to University of Chicago Press; 1996.
infer theory composed of multiple smaller theories or con- 4. Hoffman R.Why buy that theory? American Scientist. 2003;91:9-11.
structs thereof. 5. Elder JP, Ayala GX, Harris S. Theories and intervention approaches
to health-behavior change in primary care. Am J Prev Med. 1999;17:
275-284.
REFERENCES 6. Baranowski B, Lin LS,Wetter DW, Resnicow K, Hearn MD.Theory as
mediating variables: why arent community interventions working as
1. Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Educa- desired? Ann Epidemiol. 1997;Suppl 7:S89-S95.
tion:Theory, Research and Practice. 3rd ed. San Francisco, Calif: Jossey-Bass 7. Peyrot M. Behavior change in diabetes education. Diabetes Educator.
Publishers; 2002. 1999;25(suppl):62-73.

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