Community coalition action theory and the behavioral ecological model: Complex, multi-level theories and implications for health promotion practice and research

Until recently, most of the theories used in health education and health promotion focused on psychosocial factors such as attitudes and social support and how they influence individual behavior change. Theories at higher levels of the social ecological framework were rare, and tended to outline relatively simple models of a process, for example, stages of organizational change. More recently, theories at higher levels of the social ecology (e.g., organizations, community) are more complex and outline inter-related constructs and propositions that specify relationships among variables that explain and/or predict how community change and population health outcomes are achieved. The Community Coalition Action Theory (CCAT) is one such example. Briefly, the CCAT outlines a series of practice-proven propositions that explain how coalitions create collaborative synergy to advance community change, strengthen community capacity, and improve health and social outcomes. The Behavioral Ecological Model (BEM) is a second theory developed to explain complex behavior among groups of people within larger social units. Drawing upon concepts from operant conditioning, the BEM explains how interlocked behaviors and macro-contingencies can help explain how systems of subgroups within the overall population can impact health. Both theories will be presented, along with examples of the types of research needed to further test the theories. Challenges associated with the theories, such as complexity, will also be discussed, along with the implications for health education and health promotion practice.