Theory for change: An integrative behavior change model for community-centered obesity interventions

Differences in community level factors across socioeconomic status are a significant contributor to health disparities. However, little in-depth attention is paid to how individual level experiences of identity formation, norms and behavior change processes may operate differently in constrained community environments, potentially reinforcing negative health behaviors. Perhaps more critical for public health ethics, few models of individual-level behavior change adequately explain the complexity whereby seemingly negative health behaviors may nevertheless serve to support positive community level factors (e.g., emotional connection, social ties, familial respect, informal support).

In this paper, we focus on patterns of unhealthy eating behaviors in disadvantaged communities. We present our analysis of standard theories of behavioral change, focusing critically on how sensitive they are to how community factors influence individual health norms to reinforce both negative and positive eating behaviors. We propose a new and integrative model based upon the authors' previous theoretical and empirical work. Lastly, following principles of community based participatory research, we explore how well our model coheres with the experiences of eating behaviors based on follow-up discussions with four fast food student workers from low income communities, and present model revisions stemming from this feedback.

Through this theoretical work we build a framework to better understand how individual psychological factors interact with environmental constraints for those living in disadvantaged communities, affecting eating behaviors; this theoretical framework will inform those interested in reducing health disparities at the community level, including public health and medical workers, policy makers, government leaders, activists and community members.