Theories, Models, and Methods of Health Promotion in Rural Settings

  • John P. Elder
  • Guadalupe X. Ayala
  • Marion F. Zabinski
  • Judith J. Prochaska
  • Christine A. Gehrman


Health promotion interventions are evaluated on both the amount of individual behavior change achieved and the extent to which broader generalizations can be made to other behavior change efforts. This is largely a function of whether the interventions and evaluation methods employed are theory-driven (Elder, Geller, Hovell, & Mayer, 1994). Yet many theories and models current in the field have limited applicability to rural populations since the underlying theories are generally predicated on more urban notions of individual autonomy and purpose, with potentially less relevance for populations in smaller and more traditional communities. In addition, many theories imply detailed, thorough individual measurement, making them less practical for people not accustomed to such instrumentation or with limited literacy, or for programs with no resources for such measurement.


Problem Behavior Health Promotion Plan Behavior Rural Setting Health Behavior Change 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Academy for Educational Development. (1995). A tool box for building health communication capacity. Washington DC: Author.Google Scholar
  2. Ackerman, N. J. (1984). A theory of family systems. New York: Gardner Press.Google Scholar
  3. Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl&J. Beckmann (Eds.), Action-control: From cognition to behavior (pp. 11–39 ). Heidelberg: Springer.Google Scholar
  4. Ajzen, I. (1987). Attitudes, traits, and actions: Dispositional prediction of behavior in personality and social psychology. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 20; pp. 163 ). San Diego: Academic Press.Google Scholar
  5. Ajzen, I.,&Madden, T. (1986). Prediction of goal-directed behavior: Attitudes, intentions, and perceived behavioral control. Journal of Experimental Social Psychology, 22, 453–474.Google Scholar
  6. Bandura, A. (1969). Principles of behavioral modification. New York: Holt, Rinehart&Wintston.Google Scholar
  7. Bandura, A. (1974). Behavior theory and the models of man. American Psychologist, 29, 859–869.CrossRefGoogle Scholar
  8. Bandura, A. (1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  9. Bandura, A. (1986). Social foundations of thought and action. A social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  10. Barnett, P.,&Balak, D. W. (1986). Unplanned pregnancy in young women: Managing treatment. Social Casework, 67 (8), 484–489.Google Scholar
  11. Bateson, G., Jackson, D., Haley, J.,&Weakland, J. (1956). Toward a theory of schizophrenia. Behavioral Science, 1, 251–264.Google Scholar
  12. Bessey, J. L.,&Borduin, C. M. (1986). Application of behavioral principles within family systems therapy: A conceptual framework for the treatment of alcoholism. Deviant Behavior; 7 (4), 357–369.Google Scholar
  13. Bingham, C. R.,&Crockett, L. J. (1996). Longitudinal adjustment patterns of boys and girls experiencing early, middle, and late sexual intercourse. Developmental Psychology, 32, 647–658.Google Scholar
  14. Blue, C. L. (1995). The predictive capacity of the theory of reasoned action and the theory of planned behavior in exercise research: an integrated literature review. Research in Nursing and Health, 18, 105–121.PubMedCrossRefGoogle Scholar
  15. Bowen, M. (1966). The use of family theory in clinical practice. Comprehensive Psychiatry, 7, 345–374.PubMedCrossRefGoogle Scholar
  16. Bowen, M. (1991). Alcoholism as viewed through family systems. Family Dynamics of Addiction Quarterly, 1 (1), 94–102.Google Scholar
  17. Breslow, L. (1996). Social ecological strategies for promoting health lifestyles. American Journal of Health Promotion, 10 (4), 253–257.PubMedCrossRefGoogle Scholar
  18. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and designCambridge, MA: Harvard University Press.Google Scholar
  19. Bunch, R. (1982). Two ears of corn: A guide to peoplecentered agricultural improvement. Oklahoma City: World Neighbors.Google Scholar
  20. Campbell, M. K., Symons, M., Demark-Wahnefried, W., Polhamus, B., Bernhardt, J. M., McClelland, J. W.,&Washington, C. (1998). Stages of change and psychosocial correlates of fruit and vegetable consumption among rural African-American church members. American Journal of Health Promotion, 12, 185–191.Google Scholar
  21. Chang-Yit, L., Lippert, M.,&Thielges, I. (1992). Model for rural collaboration for AIDS education: A case study. Family&Community Health, 15 (3), 62–69Google Scholar
  22. Clarke, L. L.,&Miller, M. K. (1990). The character and prospects of rural community health and medical care. In A. E. Luloff& L. E. Swanson (Eds.), American rural communities (pp. 74–105 ). Boulder, CO: Westview Press.Google Scholar
  23. Combrinck-Graham, L. (1990). Developments in family systems theory and research. Journal of the American Academy of Child&Adolescent Psychiatry, 29 (4), 501–512.CrossRefGoogle Scholar
  24. DeBarr, K. A., Ritzel, D. O., Wright, W. R.,&Kittleson, M. J. (1998). Friends and family: Implications for youth tractor safety. Journal of Safety Research, 29, 87–95.Google Scholar
  25. Denham, A., Quinn, S. C.,&Gamble, D. (1998). Com- munity organizing for health promotion in the ru- ral south: An exploration of community compe- tence. Family&Community Health, 21 (1), 1–21.Google Scholar
  26. Denton, W. (1990). A family systems analysis of DSM-III-R. Journal of Marital and Family Therapy, 16 (2), 113–125.CrossRefGoogle Scholar
  27. DiClemente, C. C.,&Prochaska, J. O. (1982). Self-change and therapy change of smoking behavior: A comparison of processes of change in cessation and maintenance. Addictive Behaviors, 7, 133–142.Google Scholar
  28. DiClemente, C. C., Prochaska, J. O., Fairhurst, S. K., Velicer, W. F., Velasquez, M. M.,&Rossi, J. S. (1991). The process of smoking cessation: An analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295–304.Google Scholar
  29. Dijkstra, A., De Vries, H., Roijackers, J.,&van Breukelen, G. (1998). Tailoring information to enhance quitting in smokers with low motivation to quit: three basic efficacy questions. Health Psychology, 17, 513–519.Google Scholar
  30. Dishman, R. K. (1991). Increasing and maintaining exercise and physical activity. Behavior Therapy, 22, 345–378.CrossRefGoogle Scholar
  31. Donovan, J. E., Jessor, R.,&Costa, F. M. (1991). Adolescent health behavior and conventionality-unconventionality: An extension of problem-behavior theory. Health Psychology, 10, 52–61.Google Scholar
  32. Dulany, D. E. (1968). Awareness, rules, and propositional control: A confrontation with S-R behavior theory. In T. R. Dixon&D. L. Horton (Eds.), Ver-bal behavior and general behavior theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  33. Elder, J., Geller, G., Hovell, M.,&Mayer, J. (1994). Motivating health behavior. New York: Delmar.Google Scholar
  34. Fishbein, M. (1967). Readings in attitude theory and measurement. New York: Wiley.Google Scholar
  35. Fishbein, M. (1993). Introduction. In D. J. Terry, C.Gallois,&M. McCamish (Eds.), The theory of reasoned action: Its application to AIDS preventive behaviour. Oxford, England: Pergamon Press.Google Scholar
  36. Fishbein, M.,. and.Ajzen, I. (1975). Belief attitude, intention and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.Google Scholar
  37. Fuguitt, G. V. (1995). Population change in non-metropolitan America. In E. N. Castle (Ed.), The changing American countryside: Rural people and places (pp. 77–100 ). Lawrence: University of Kansas Press.Google Scholar
  38. Galston, W. A.,&Baehler, K. J. (1995). Rural development in the United States: Connecting theory, practice, and possibilities. Washington, DC: Island Press.Google Scholar
  39. Godin, G.,&Kok, G. (1996). The theory of planned behavior: A review of its applications to health-related behaviors. American Journal of Health Promotion, 11, 87–98.Google Scholar
  40. Gottlieb, N. H., Galavotti, C., McCuan, R. A.,&McAlister, A. L. (1990). Specification of a social-cognitive model predicting smoking cessation in a Mexican-American population: A prospective study. Cognitive Therapy and Research, 14, 529–542.Google Scholar
  41. Graeff, J., Elder, J.,&Booth, E. (1993). Communications for health behavior change: A developing country perspective. San Francisco: Jossey-Bass.Google Scholar
  42. Green, L. W., Richard, L.,&Potvin, L. (1996). Ecological foundations of health promotion. American Journal of Health Promotion, 10 (4), 270–281.Google Scholar
  43. Greene, G. W.,&Rossi, S. R. (1998). Stages of change for reducing dietary fat intake over 18 months. Journal of the American Dietetic Association, 98, 529–534.Google Scholar
  44. Guerin, P. J.,&Chabot, D. R. (1997). Development of family systems theory. In P. L. Wachtel&S. B. Messer (Eds.), Theories of psychotherapy (pp. 181225 ). Washington, DC: American Psychological Association.Google Scholar
  45. Haley, J. (1976). Problem-solving therapy. San Francisco: Jossey-Bass.Google Scholar
  46. Hart, J. F. (1995). “Rural” and “farm” no longer mean the same. In E. N. Castle (Ed.), The changing American countryside: Rural people and places (pp. 63–76 ). Lawrence: University of Kansas Press.Google Scholar
  47. Herzog, T. A., Abrams, D. B., Emmons, K. M., Linnan, L. A.,&Shaddel, W. G. (1999). Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model. Health Psychology, 18 (4), 369–375.Google Scholar
  48. Janis, I. L.,&Mann, L. (1968). A conflict-theory approach to attitude change and decision making. In A. Greenwald, T. Brook,&T. Ostrom (Eds.), Psy-chological foundations of attitudes (pp. 327–360 ). New York: Academic Press.Google Scholar
  49. Janis, I. L.,&Mann, L. (1977). Decision making: A psychological analysis of conflict, choice, and commitment. New York: The Free Press.Google Scholar
  50. Jessor, R. (1987). Problem-behavior theory, psychological development, and adolescent problem drinking. British Journal of Addiction, 82, 331–342.PubMedCrossRefGoogle Scholar
  51. Jessor, R. (1991). Risk behavior in adolescence: A psychosocial framework for understanding and action. Journal of Adolescent Health, 12, 597–605.Google Scholar
  52. Jessor, R.,&Jessor, S. L. (1973). A social psychology of marijuana use: Longitudinal studies of high school and college youth. Journal of Personality and Social Psychology, 26, 1–15.Google Scholar
  53. Jessor, R., Donovan, J. E.,&Costa, F. M. (1991). Beyond adolescence. New York: Cambridge University Press.Google Scholar
  54. Joanning, H., Quinn, W., Thomas, F.,&Mullen, R. (1992). Treating adolescent drug abuse: A comparison of family systems therapy, group therapy, and family drug education. Journal of Marital&Family Therapy, 18 (4), 345–356.Google Scholar
  55. Kanfer, F. H. (1975). Self-management methods. In F. H. Kanfer&A. R Goldstein (Eds.), Helping people change (pp. 309–316 ). New York: Pergamon.Google Scholar
  56. Kristal, A. R., Goldenhar, L., Muldoon, J.,&Morton, R. F. (1997). Evaluation of a supermarket intervention to increase consumption of fruits and vegetables. American Journal of Health Promotion, 11, 422–425.Google Scholar
  57. Lee, B. C., Jenkins, L. S.,&Westaby, J. D. (1997). Factors influencing exposure of children to major hazards on family farms. Journal of Rural Health, 13, 206–215.Google Scholar
  58. Luloff, A. E.,&Swanson, L. E. (1990). Introduction. In A. E. Luloff&L. E. Swanson (Eds.), American rural communities (pp. 1–18 ). Boulder, CO: Westview Press.Google Scholar
  59. Mah, Z.,&Bryant, H. E. (1997). The role of past mammography and future intentions in screening mammography usage. Cancer Detection and Prevention, 21, 213–220.PubMedGoogle Scholar
  60. Marcus, B. H., Bock, B. C., Pinto, B. M., Forsyth, L. H., Roberts, M. B.,&Traficante, R. M. (1998). Efficacy of an individualized, motivationally-tailored physical activity intervention. Annals of Behavioral Medicine, 20, 174–180.Google Scholar
  61. Martin, G. L.,&Newman, I. M. (1990). Women as motivators in the use of safety belts. Health Values, 14, 37–47.Google Scholar
  62. McGuire, W. J. (1989). Theoretical foundations of campaigns. In R. E. Rice&C. K. Atkin (Eds.), Public communication campaigns ( 2nd ed.; pp. 43–65 ). Newbury Park, CA: Sage Publications.Google Scholar
  63. Miller, L. K. (1980). Principles of everyday behavior analysis. Monterey, CA: Brooks/Cole.Google Scholar
  64. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.Google Scholar
  65. Minuchin, S., Lee, W.,&Simon, G. M. (1996). Mastering family therapy: Journeys of growth and transformation. New York: Wiley.Google Scholar
  66. Moore, S., Barling, N.,&Hood, B. (1998). Predicting testicular and breast self-examination behaviour: A test of the theory of reasoned action. Behaviour Change, 15, 41–49.Google Scholar
  67. Moos, R. H. (1979). Social ecological perspectives on health. In G. C. Stone, F. Cohen,&N. E. Alder (Eds.), Health psychology-a handbook: Theories, applications, and challenges of a psychological approach to the health care system (pp. 523–547 ). San Francisco: Jossey-Bass.Google Scholar
  68. Plested, B., Smitham, D. M., Jumper-Thurman, P. Oetting, E. R.,&Edwards, R. W. (1999). Readiness for drug use prevention in rural minority communities. Substance Use and Misuse, 34 (4&5), 521–544.PubMedCrossRefGoogle Scholar
  69. Potvin, L., Gauvin, L.,&Nguyen, N. M. (1997). Prevalence of stages of change for physical activity in rural, suburban, and inner-city communities. Journal of Community Health, 22, 1–13.Google Scholar
  70. Prochaska, J. O. (1979). Systems of psychotherapy: A transtheoretical analysis. Homewood, IL: Dorsey Press.Google Scholar
  71. Prochaska, J. O.,&DiClemente, C. C. (1983). Stages and processes of self-change in smoking: Towards an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395.Google Scholar
  72. Prochaska, J. O., Velicer, W. F., Guadagnoli, E„ Rossi, J. S.,&DiClemente, C. C. (1991). Patterns of change: Dynamic typology applied to smoking cessation. Multivariate Behavioral Research, 26, 83–107.Google Scholar
  73. Prochaska, J. O.,&DiClemente, C. C. (1998). Towards a comprehensive, transtheoretical model of change: Stages of change and addictive behaviors. In W. R. Miller&N. Heather (Eds.), Treating addictive behaviors ( 2nd ed.; pp. 3–24 ). New York: Plenum Press.Google Scholar
  74. Prochaska, J. 0., DiClemente, C. C., Velicer, W. F.,&Rossi, J. S. (1993). Standardized, individualized, interactive and personalized self-help programs for smoking cessation. Health Psychology, 12, 399–405.Google Scholar
  75. Prochaska, J. O., Redding, C. A., Harlow, L. L., Rossi, J. S.,&Velicer, W. F. (1994). The transtheoretical model of change and HIV prevention: A review. Health Education Quarterly, 21, 471–486.Google Scholar
  76. Rakowski, W., Ehrich, B., Goldstein, M. G., Rimer, B. K., Pearlman, D. N., Clark, M. A., Velicer, W. F.,&Woolverton, H. III. (1998). Increasing mammography among women aged 40–74 by use of a stage-matched, tailored intervention. Preventive Medicine, 27 (5, Pt. 1), 748–756.Google Scholar
  77. Richard, L., Potvin, L., Kishchuk, N., Prlic, H.,&Green, L. W. (1996). Assessment of the integration of the ecological approach in health promotion programs. American Journal of Health Promotion, 10 (4), 318–328.Google Scholar
  78. Ricketts, T.C. III, Johnson-Webb, K. D.,&Randolph, R. K. (1999). Populations and places in rural America. In T. C. Ricketts (Ed.), Rural health in the United States (pp. 7–24 ). New York: Oxford University Press.Google Scholar
  79. Robin, A. L., Bedway, M., Siegel, P. T.,&Gilroy, M. (1996). Therapy for adolescent anorexia nervosa: Addressing cognitions, feelings, and the family’s role. In E. D. Hibbs&P. S. Jensen (Eds), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (pp. 239–259 ). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  80. Rochín, R. I.,&Marroquin, E. (1997). Rural Latino resources: A national guide. East Lansing, MI: Julian Samora Research Institute.Google Scholar
  81. Rohrbaugh, M., Shoham, V., Spungen, C.,&Steinglass, P. (1995). Family systems therapy in practice: A systemic couples therapy for problem drinking. In B. M. Bongar,&L. E. Beutler (Eds), Comprehensive textbook of psychotherapy: Theory and practice (Vol. 1; pp. 228–253 ). New York: Oxford University Press.Google Scholar
  82. Rothman, J. (1968). Three models of social work practice. In National Conference on Social Welfare (Ed.), Social work practice: Proceedings. New York: Columbia University Press.Google Scholar
  83. Roy, R. (1986). A problem-centered family systems approaching treating chronic pain. In A. D. Holzman&D. C. Turk (Eds.), Pain management: A handbook of psychological treatment approaches. Pergamon general psychology series (Vol. 136; pp. 113–130 ). New York: Pergamon Press.Google Scholar
  84. Salamon, S. (1995). The rural people of the Midwest. In E. N. Castle (Ed.), The changing American countryside: Rural people and places (pp. 352–368 ). Lawrence: University of Kansas Press.Google Scholar
  85. Sallis, J. F., Hovell, M., Hofstetter, C. R.,&Barrington, E. (1992). Explanation of vigorous physical activity during two years using social learning variables. Social Science Medicine, 34 (1), 25–32.Google Scholar
  86. Schorling, J. B., Roach, J., Siegel, M., Baturka, N., Hunt, D. E., Guterbock, T. M.,&Stewart, H. L. (1997). A trial of church-based smoking cessation interventions for rural African Americans. Preventive Medicine, 26, 92–101.Google Scholar
  87. Schulman, M.D., Evensen, C.T., Runyan, C.W., Cohen, L.R.,&Dunn, K.A. (1997). Farm work is dangerous for teens: Agricultural hazards and injuries among North Carolina teens. The Journal of Rural Health, 13 (4), 295–305.Google Scholar
  88. Shoham, V., Rohrbaugh, M. J, Stickle, T. R.,&Jacob, T. (1998). Demand-withdraw couple interaction moderates retention in cognitive-behavioral versus family-systems treatments for alcoholism. Journal of Family Psychology, 12 (4), 557–577.Google Scholar
  89. Skinner, B. E (1953). Science and human behavior. New York: Macmillan.Google Scholar
  90. Stokols, D. (1996). Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion, 10(4), 282298.Google Scholar
  91. Sullivan, H. S. (1953). Interpersonal theory of psychiatry. New York: W.W. Norton.Google Scholar
  92. U.S. Census Bureau. (1990). Statistical abstract of the United States. Washington, DC: Government Printing Office.Google Scholar
  93. U.S. Department of Health and Human Services. (1989). Making health communication programs work: A planner’s guide. (NIH publication no. 89–1493 ). Washington, DC: U.S. Government Printing Office.Google Scholar
  94. Velicer, W. F., DiClemente, C. C., Prochaska, J. O.,&Brandenburg, N. (1985). A decisional balance measure for predicting smoking cessation. Journal of Personality and Social Psychology, 48, 1279–1289.Google Scholar
  95. Velicer, W. F., DiClementi, C. C., Rossi, J. S.,&Prochaska, J. O. (1990). Relapse situations and self-efficacy: An integrative model. Addictive Behaviors, 15, 271–283.Google Scholar
  96. Wallack, L.,&Dorfman, L. (1996). Media advocacy: A strategy for advancing policy and promoting health. Health Education Quarterly, 23 (3), 293–317.PubMedCrossRefGoogle Scholar
  97. Wallack, L. (1990). Two approaches to health promotion in the mass media. World Health Forum, 11 (2), 143–154.PubMedGoogle Scholar
  98. Witte, K., Peterson, T. R., Vallabhan, S.,&Stephenson, M. T. (1993). Preventing tractor-related injuries and deaths in rural populations: Using a persuasive health message framework in formative evaluation research. International Quarterly of Community Health Education, 13 (3), 219–251.Google Scholar
  99. Wysocki, T., Harris, M. A., Greco, P., Harvey, L. M., McDonell, K. D., Caroline, L. E., Bubb, J.,&White, N. H. (1997). Social validity of support group and behavior therapy interventions for families of adolescents with insulin-dependent diabetes mellitus. Journal of Pediatric Psychology, 22 (5), 635–649.Google Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • John P. Elder
    • 1
  • Guadalupe X. Ayala
    • 1
  • Marion F. Zabinski
    • 1
  • Judith J. Prochaska
    • 1
  • Christine A. Gehrman
    • 1
  1. 1.Graduate School of Public Health and SDSU-UCSD Joint Doctoral Program in Clinical PsychologySan Diego State UniversitySan DiegoUSA

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