DPH 801 Module 5 Choosing a Theory for a Population Example

Choosing the Right Lens: Selecting and Justifying a Theory for Hypertension Control Among Black Men

Student Name

Doctor of Public Health Program, Aspen University

DPH 801: Health Determinants, Disparities, Behavior and Promotion

Instructor Name

Month Day, Year

Choosing the Right Lens: Selecting and Justifying a Theory for Hypertension Control Among Black Men

Knowing theories is not enough; a doctoral practitioner must choose among them and defend the choice for a specific population. This paper applies explicit selection criteria to choose a theoretical framework for improving blood pressure control among middle-aged Black men in a composite city, the group with the widest gap in controlled blood pressure and the lowest use of primary care.

The Population

In the composite city, Black men aged 35 to 64 have the highest rates of uncontrolled hypertension and the fewest primary care visits of any adult group. Many work hourly jobs with limited leave, and focus groups describe distrust of clinics and a sense that high blood pressure matters only when symptoms appear. They also describe barbershops and churches as places where they talk openly about health.

Selection Criteria

Five criteria guided selection: fit with the determinants identified earlier, evidence of effectiveness in similar populations, cultural relevance, availability of measurable constructs and usefulness for designing interventions. A review of theory in public health recommended matching theory to the level of influence and the behavior, and using multiple theories when problems span levels (Glanz & Bishop, 2010).

Candidates Compared

The table rates five candidates.

Why a Combined Framework

No single theory met all criteria. The ecological perspective best fits determinants that span individual, interpersonal, organizational, community and policy levels (McLeroy et al., 1988). Within it, social cognitive theory offers constructs for the individual and interpersonal levels, especially self-efficacy and observational learning (Bandura, 2004), and diffusion theory guides spread across barbershops and churches.

Evidence Supporting the Choice

The barbershop blood pressure trial, which reduced systolic pressure dramatically among Black men by combining trusted settings, peer encouragement and on-site treatment, reflects all three components: an institutional setting, interpersonal influence through barbers and structural access to care (Victor et al., 2018). Its success in a similar population supports the framework.

Cultural Relevance

The framework respects community strengths by working through institutions residents already trust and by using peers as models. It avoids framing the problem as individual failure, which focus group participants said they resented, and instead emphasizes collective protection of families and communities.

Community Input

The candidate framework was presented to a community advisory group of barbers, pastors and men living with hypertension. Members endorsed the barbershop and church focus, suggested adding workplace outreach at two large employers and asked that messages emphasize staying strong for family. Their input refined the framework's application. Two members also volunteered to serve as peer champions once the program launched.

The Final Framework

The final framework uses the ecological perspective as the organizing structure, social cognitive constructs to design individual and interpersonal components, and diffusion principles to plan spread. Each component will be linked to measurable constructs, such as self-efficacy for blood pressure control, perceived social support and site adoption.

Guiding Design and Evaluation

The framework will guide the intervention designed in the next module, with components at each ecological level. It will also guide evaluation: measuring constructs shows whether the intervention worked through its intended mechanisms, not only whether blood pressure changed. The same diagram will appear in grant applications, linking the framework to budget lines and measures.

Limitations of the Choice

Combining theories adds complexity and may make it harder to identify which component produced effects. Evidence from other cities may not transfer fully. The framework will be revisited after pilot data are collected.

Alternative Choices Considered

An alternative would have been to use only the health belief model with a clinic-based education program, which is simpler to evaluate. It was rejected because it would not address the structural and community factors driving the disparity, and because focus group members distrusted clinics as a primary setting.

Operationalizing Constructs

Each construct will be defined for the population: self-efficacy as confidence in taking medication daily, checking blood pressure at home and attending pharmacist visits; social support as help from family and peers with those tasks; adoption as sites hosting monthly stations. Clear definitions allow measurement and consistent program design.

Anticipating Critiques

Reviewers might argue that combined frameworks are too loose. The response is that each component has a specific role and linked measures, and that the ecological perspective provides structure rather than a list of unrelated theories.

Ethical Considerations in Theory Choice

Theory choice carries ethical weight. Frameworks that locate problems solely in individuals can reinforce stigma, while those that include structural factors direct attention to responsibility shared by institutions. The chosen framework aligns with the equity goals of the Doctor of Public Health program.

Linking to Determinants

The chosen framework maps onto the determinants analysis: the individual level addresses beliefs and confidence, the interpersonal level addresses family and peer influence, the organizational level addresses access through trusted institutions, the community level addresses norms and spread and the policy level addresses structural barriers such as cost and pharmacist practice rules.

Testing the Framework

Pilot data will test key assumptions: that men will use barbershop and church stations, that self-efficacy will rise and that sites will adopt the program. If assumptions fail, the framework and design will be revised.

Communicating the Framework

The framework will be explained to partners with a one-page diagram showing the five levels, the components at each and the constructs they target. A clear visual helps partners see how their roles fit and helps evaluators know what to measure.

Conclusion

Applying explicit criteria led to a combined framework for hypertension control among Black men in the composite city: the ecological perspective for structure, social cognitive theory for individual and interpersonal components and diffusion of innovations for spread. Supported by evidence, shaped by community input and linked to measurable constructs, it provides a defensible foundation for intervention design.

References

Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164. https://doi.org/10.1177/1090198104263660

Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual Review of Public Health, 31, 399-418. https://doi.org/10.1146/annurev.publhealth.012809.103604

McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377. https://doi.org/10.1177/109019818801500401

Victor, R. G., Lynch, K., Li, N., Blyler, C., Muhammad, E., Handler, J., Brettler, J., Rashid, M., Hsu, B., Foxx-Drew, D., Moy, N., Reid, A. E., & Elashoff, R. M. (2018). A cluster-randomized trial of blood-pressure reduction in Black barbershops. New England Journal of Medicine, 378(14), 1291-1301. https://doi.org/10.1056/NEJMoa1717250