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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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some are better than others.Although no specific timetable can be given to pre.”4 We would not presuppose an and the circumstances under which the theory is useful. do not mirror the mentality of grazing animals. So we must from many disciplines proven to explain or predict nutrition- encourage further development and exploration of theory. and the “pros” of cation? Well. have been specific) problems. Finally. related behaviors awaits development.5 However. change 6 . when such a theory will be overthrown. the implications of those findings. many of the frequently used theories in nutri. and target behaviors of interest. intervention (or what some people call “behavioral nutrition We have only begun to tease apart these relationships. theories.Then we can begin to generate new ideas. per. Nutrition education and intervention began. understanding of the psychology underlying our discipline. Of course.A combination of conditions and. At present. and little predictive power when the circumstances are altered. determine if a particular set of theories is sufficiently robust and work toward those that can unify our various settings. eliminating Hoffman’s 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.and nutrition-related behavior. promise for improvement in nutrition education and behav- cation are considered too complex to learn or apply in var.We ask different questions. but research any at this point in our development. The discipline is severely our work. we would that any one theory will work alone. but performing a behavior in the Transtheoretical Model are none are good enough. theories in in this enterprise. etc) may help to explain theoretical models fully predict behavior or behavior its rapid and widespread adoption by practitioners. Some interventions are more effective for some people (eg.6 Many of the theories in nutrition edu. Social Cognitive Theory) of our theoretical models would be needed because it is unlikely theories appear. the value of this client). lowing intervention. without any theory specific to the disci. Not yet. We would assume that multiple poly- Transtheoretical Model. in nutrition behavior and behavior change might make bet- ventions. the future holds tion education and intervention include similar constructs promise for a more comprehensive and effective theoretical (eg. On a related note. it is hard to imagine discipline that continues to use several theories. none of our current will be markedly different. Even other researchers seem reluctant to adopt other more comprehensive theoretical approach can be judged researchers’ models if they are complex. a brief office encounter with a step for investigators to pursue. Undoubtedly. later. approach. to predict specific behaviors for some people under certain audiences. nutri. test. the best behavior and promote change in the mediating variables fol- theories should stimulate experiment). yes and no. eating an apple for a snack at home ferent tools. outcome expectancies in Social Cognitive Theory. themselves) might evolve into a “supertheory” specific to food tion issues. Even- qualitative and quantitative approaches may be most effective tually. education.7 Other as a group.2 Similarly. Clearly. 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. ity of a polytheoretical model(s)* that incorporates constructs we feel safe in saying that we are not there yet.4 Only a few (eg. 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. perhaps they never will. However. we are optimistic. research interpret the concept “experiment” broadly to include inter. those recently diagnosed with a chronic disease). “lifted” and employed from related disciplines in the social To return to the central question: Is one theory better sciences. but we are willing to hazard a guess that nutrition educators. this set of polytheoretical models (actually.2. comparisons. suggest. theories have successfully predicted a specific class of behav- Rather. This may be the next most reasonable ious practitioner settings (eg. to have done so.We do not used to resolve any given problem. Hoffman suggests that the acceptance of theories Furthermore.The util- dominate or. apply. or parts of theories. ioral interventions. use dif. ferent (but specific) theories used to address different (but pline. cumstances for those highly motivated to change but have Food. the same behavior in and a variety of agendas. Indeed. but it education”) are still too young to have developed a domi. if so. we tend to be characterized by individual interests ior (eg. or guess. However. is not unreasonable to suppose that nutrition education and nant theory. Perhaps one day the answer overlapping constructs). Of course. and other contextual variables that are routine in and nutrition behavior changes. ethnicities. . know what we do not know. and versus at work) is subject to different influences. Is one theory better than another in nutrition edu- ceived benefits in the Health Belief Model. as intervention may continue to use a set of theories. nutrition education and intervention may be a lacking such theories at present. Given the range of ages. different situations (eg. However. milk consumption). At present. and evaluate promising theories.Journal of Nutrition Education and Behavior Volume 36 Number 1 January • February 2004 41 recall sequence (A to B to C to D. only on its ability to explain and better predict the target Hoffman also points out the role of productivity (ie. with dif- all disciplines do. more powerful should indicate which specific theory (or theories) should be concepts and understandings will have to be built. as yet. we can only assert. adopt different philosophical approaches. 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. continue testing a variety of theories. or any other systematic approach to ter progress if investigators joined together as a community to building knowledge.

The Structure of Scientific Revolutions.Why buy that theory? American Scientist. contact Jackie at 800-235-6690. 5. Rimer BK. Hoffman R. 2002. 1999. Paper ballots will be available. Resnicow K. Harris S.Suppl 7:S89-S95.org Voting will occur during February. 4. Lin LS. Baranowski T. Kuhn TS. Ill:The theoretical theory” sounds awkward. Elder JP. 1997. If you have concerns or questions. Can’t get on-line? Members without e-mail will be notified by mail. REFERENCES 6. Diabetes Educator. 2003.42 Achterberg and Miller/VIEWPOINT: THEORIES FOR NUTRITION EDUCATION ENDNOTE 2. *We use the word “model” only because the term “poly. SNE Elections 2004 Will Be On-Line! For the first time.91:9-11. tion:Theory. we actually mean to University of Chicago Press. Baranowski J. Behavior change in diabetes education. Health Behavior and Health Educa.17: 275-284.Wetter DW. Look for more information about voting procedures • via email • on SNEEZE • in JNEB • at www.25(suppl):62-73. eds. Hearn MD. Annu Rev Nutr. Publishers. The procedure promises to be easy for members while saving SNE lots of money. Cullen KW.19:17-40. Peyrot M. Glanz K. structs thereof. Calif: Jossey-Bass 7. . infer theory composed of multiple smaller theories or con. San Francisco. Ayala GX. Research and Practice. Theories and intervention approaches to health-behavior change in primary care. 1999. Chicago.sne. Am J Prev Med. 3rd ed.Theory as mediating variables: why aren’t community interventions working as 1. SNE members will be able to vote on-line in the 2004 elections. 3. Baranowski B. desired? Ann Epidemiol. Psychosocial correlates of dietary intake: advancing dietary intervention. 3rd ed. 1999. Lewis FM. 1996.