• Open Access

Theoretical foundations of health education and health promotion



By Manoj Sharma and John Albert Romas . Published by Jones and Barlett Publishers , 2008 . Paperback 263 pages plus index . ISBN 9780763749484 RRP US$69.95

Reviewed by Louise Rowling

University of Sydney, New South Wales

This book, with a particular focus on theories and models of health education and health promotion is an introductory text for undergraduate students. Its purpose is as a resource for the certificate examination of core competencies for entry level practitioners for the United States Commission for Health Education Credentialing. The parameters for the text are explicitly within the US traditions of health promotion. For example, the authors state that “In health education and health promotion, we are primarily interested in predicting and explaining changes in behaviours or environments” (p 28). This positioning of the text has significant implications for European, Australian and New Zealand readers, in particular the complete omission in the text of conceptualising a socio-economic determinants approach to health promotion.

As to be expected of a text for undergraduate students, the same clear pattern is used to cover the content of each chapter. Key concepts and learning objectives are provided at the beginning followed by jargon free descriptions of the focus theory, and finally practical applications and learning tools (such as Glossaries and Review Questions).

Initially a number of planning models are elaborated such as PRECEDE-PROCEED, then followed by theories and models that focus on behaviour change – health belief model, transtheoretical model, theories of reasoned action and planned behaviour. Theoretical perspectives of stress and coping are also considered as they are seen by the authors to be an integral part of behaviour change. Their inclusion is unusual and perhaps for the purposes of this text an over-emphasised element on behaviour change. Additionally social cognitive theory, theoretical and practical applications for social marketing, diffusion of innovations and Freire's model of adult education are elaborated.

What many readers will miss from these chapters is the inclusion of a greater focus on the social and environmental aspects of health and their theoretical underpinnings. While consideration of the environment is included in social cognitive theory there is little attention to it in other chapters. In discussing the limitations of diffusion of innovations theory, its linearity is highlighted as a problem and attention to systematic context and norms is recommended. But this is not elaborated and the beginning practitioner models offer no explanations of this. There are no chapters that include work on community mobilisation, theories of organisational change, models of intersectoral action and a consideration of public policy. Similarly concepts such as community development and community empowerment are defined in an initial chapter but never elaborated elsewhere in the book.

In reviewing the Index notable omissions in content become apparent, such as inequalities, population health and social context. This is an indication of the limitations of this text in that the theories and models included focus almost exclusively on behaviour change for individuals, without balancing that content with attention to the wider social determinants of health.

I would not recommend this book as a sole reference on theories and models. Additionally, as a text that is supposedly introducing students to a field in Australia, it is an incomplete representation of health promotion theories and models. However, a review of its content critiquing its representation of health promotion would form a excellent assignment for those in training in Australia.