Theories and Models

💡Major health behaviour models

Theory/model	Main concept	FCPS recognition clue
Health Belief Model (HBM)	Behaviour depends on perceived susceptibility, severity, benefits, barriers, cues to action and self-efficacy	Patient acts because they believe they are at risk and treatment will help
Theory of Planned Behaviour (TPB)	Behaviour is predicted by intention, which depends on attitude, subjective norms and perceived behavioural control	Social pressure and perceived control influence intention
Theory of Reasoned Action (TRA)	Intention is influenced by attitude and subjective norms	Behaviour is largely intentional and under voluntary control
Social Cognitive Theory (SCT)	Behaviour, personal factors and environment influence each other	Observational learning, role models, self-efficacy and reinforcement
Transtheoretical Model (Stages of Change)	Behaviour change occurs through stages	Patient is not ready, considering change, preparing, acting or maintaining
Protection Motivation Theory (PMT)	Threat appraisal and coping appraisal influence protective behaviour	Perceived threat plus belief that a response will work
Health Action Process Approach (HAPA)	Separates motivation from translating intention into action	Patient intends to change but needs planning and coping strategies
Diffusion of Innovations	Explains how new ideas and practices spread through a population	Innovators, early adopters, early majority, late majority and laggards
PRECEDE–PROCEED Model	Framework for assessing needs, planning, implementing and evaluating health programmes	Predisposing, reinforcing and enabling factors; programme evaluation
COM-B Model	Behaviour requires capability, opportunity and motivation	Identify which of the three components is preventing the desired behaviour

💡Health Belief Model

HBM is one of the most commonly tested models.

Component	Meaning	Dental example
Perceived susceptibility	Belief about personal risk	“My frequent sugar intake puts me at risk of caries.”
Perceived severity	Belief about seriousness	“Untreated caries could cause pain and tooth loss.”
Perceived benefits	Belief that action will help	“Fluoride toothpaste will reduce my risk.”
Perceived barriers	Obstacles to taking action	“I cannot afford regular dental visits.”
Cues to action	Trigger that initiates behaviour	A dentist's advice, reminder or educational message
Self-efficacy	Confidence in one's ability to act	“I can brush twice daily and reduce sugary snacks.”

MCQ trap: A patient knows oral cancer is serious but does not attend screening because they believe they are unlikely to develop it. The key HBM construct is low perceived susceptibility.

Theory of Planned Behaviour vs Theory of Reasoned Action

Feature	TRA	TPB
Attitude	Included	Included
Subjective norms	Included	Included
Perceived behavioural control	Not a core component	Included
Best application	Voluntary behaviours	Behaviours where control or resources may be limited

Exam pearl: “I intend to quit smoking, but I don't think I can manage withdrawal or avoid triggers” points towards perceived behavioural control in TPB.

💡Transtheoretical Model — stages of change

Relapse can occur; change is not always linear.
Dental example: A smoker who is not considering quitting is in precontemplation; someone who has selected a quit date and is arranging support is in preparation.

Other behavioural theories that are easy to miss

These are worth adding to your revision list because they explain why patients adopt, maintain or fail to adopt health behaviours. Behavioural theories are also used in oral-health research and periodontal health interventions.

Theory	Main concept	Example / MCQ clue
Social Learning Theory — Bandura	People learn by observing and imitating others	A child copies a parent's toothbrushing
Self-efficacy theory — Bandura	Confidence in one's ability to perform an action	A patient believes they can quit smoking
Locus of Control — Rotter	Whether outcomes are attributed to internal or external control	“My oral health depends on my actions” vs “It is all fate”
Self-Determination Theory	Intrinsic vs extrinsic motivation; autonomy, competence and relatedness	Patient brushes because they personally value oral health, not just to avoid punishment
Self-Regulation Theory	People monitor and adjust behaviour using goals and feedback	Tracking plaque scores or brushing performance
Cognitive Dissonance Theory — Festinger	Conflict between beliefs and behaviour creates psychological discomfort	A smoker who knows smoking is harmful but continues may rationalize the behaviour
Attribution Theory	How people explain the causes of events influences future behaviour	A patient attributes caries to bad luck rather than frequent sugar intake
Health Locus of Control	Health control may be internal, attributed to powerful others, or chance	“Only my dentist can keep my teeth healthy”
Salutogenesis — Antonovsky	Focuses on factors that support health rather than only causes of disease	Resources, coping and sense of coherence help maintain wellbeing
Protection Motivation Theory	Threat appraisal + coping appraisal influence protective action	A patient uses protective measures because the threat is serious and the action seems effective
Precaution Adoption Process Model	Distinguishes being unaware, unengaged, deciding and acting	A person has never considered oral cancer screening, then gradually decides to attend
Self-Regulatory Model / Common-Sense Model of Illness	Illness beliefs influence coping and treatment behaviour	A patient believes bleeding gums are normal and therefore does not seek care

💡The three concepts frequently confused in MCQs

Concept	What it asks
Locus of control	Who or what controls the health outcome?
Self-efficacy	Am I capable of performing the behaviour?
Perceived behavioural control	How much control do I believe I have over performing the behaviour, including barriers?

They overlap, but they are not interchangeable.

💡Health education and learning theories

These overlap heavily with Community Medicine, health promotion, health education and preventive dentistry.

Theory / principle	Main concept	Typical exam clue
Classical conditioning — Pavlov	Association between two stimuli produces a learned response	A previously neutral stimulus triggers a response after repeated pairing
Operant conditioning — Skinner	Behaviour is shaped by consequences	Rewards, reinforcement and punishment
Observational learning — Bandura	Learning by watching a model	Children imitate parents or teachers
Cognitive learning theory	Learning involves mental processes, understanding and organization of information	Patient understands why fluoride prevents caries
Constructivism	Learners build new understanding from previous experience	Interactive, problem-based patient education
Experiential learning — Kolb	Learning through experience, reflection, conceptualization and experimentation	Demonstration followed by practice and feedback
Adult learning theory — Knowles (andragogy)	Adults learn best when relevant, practical and connected to their experience	A patient learns a skill that solves an immediate problem
Social learning / social cognitive theory	Learning through observation, modelling, reinforcement and self-efficacy	Demonstrating brushing to a group of children
Theory of Multiple Intelligences — Gardner	People may have different strengths in processing information	Using visual, verbal and hands-on teaching methods
Bloom's Taxonomy	Classifies cognitive learning objectives from simpler to more complex	Recall, understanding, application, analysis, evaluation and creation

Classical vs operant conditioning

Feature	Classical conditioning	Operant conditioning
Associated with	Ivan Pavlov	B. F. Skinner
Learning mechanism	Association between stimuli	Consequences of behaviour
Main focus	Stimulus-response association	Behaviour followed by reinforcement or punishment
Example	A patient associates a dental clinic's sounds with anxiety after a painful experience	A child receives praise for brushing correctly and repeats the behaviour

💡Reinforcement vs punishment

Term	Meaning	Example
Positive reinforcement	Add something desirable to increase behaviour	Praise a child for brushing
Negative reinforcement	Remove something unpleasant to increase behaviour	A reminder stops once the agreed behaviour is completed
Positive punishment	Add an unpleasant consequence to reduce behaviour	Adding an aversive consequence after an unwanted behaviour
Negative punishment	Remove something desirable to reduce behaviour	Removing a privilege after an unwanted behaviour

Important: In psychology, negative means removal, not necessarily something harmful. Reinforcement increases behaviour; punishment decreases it.

Bloom's Taxonomy — cognitive domain

Level	What the learner does	Dental example
Remember	Recalls facts	Names the causes of caries
Understand	Explains meaning	Explains the role of plaque
Apply	Uses knowledge	Demonstrates the correct brushing technique
Analyze	Breaks information into parts	Identifies why a patient has recurrent caries
Evaluate	Makes a justified judgment	Compares two preventive strategies
Create	Produces something new	Designs an oral-health education programme

The classic version is often taught as knowledge, comprehension, application, analysis, synthesis and evaluation. The revised version uses remember, understand, apply, analyze, evaluate and create.

💡Health promotion models and planning frameworks

These are particularly relevant to community-based prevention programmes, school dental health projects, tobacco cessation and population-level interventions.

💡A. PRECEDE–PROCEED Model

A major framework for planning and evaluating health-promotion programmes.

PRECEDE focuses on assessment and planning; PROCEED focuses on implementation and evaluation.

PRECEDE components

Factor	Meaning	Dental example
Predisposing	Knowledge, attitudes, beliefs and motivation	Parents do not know that frequent sugar intake causes caries
Reinforcing	Feedback and social consequences that support behaviour	Family and teachers encourage toothbrushing
Enabling	Resources, skills and access that make behaviour possible	Availability of toothbrushes, fluoride toothpaste and affordable dental services

The classic PRECEDE framework includes social assessment, epidemiological assessment, behavioural and environmental assessment, educational/ecological assessment, and administrative/policy assessment.

PROCEED and evaluation

Evaluation type	What is assessed?	Example
Process evaluation	Was the programme implemented as planned?	Number of schools visited
Impact evaluation	Did knowledge, behaviour or immediate risk factors change?	Improvement in brushing technique
Outcome evaluation	Did longer-term health outcomes improve?	Reduced caries prevalence

Exam clue: Predisposing, reinforcing and enabling factors point to PRECEDE. Process, impact and outcome evaluation are commonly tested alongside the PRECEDE–PROCEED framework.

💡Ottawa Charter for Health Promotion

The Ottawa Charter (1986) is a core health-promotion framework in Community Medicine.

Action area	Meaning	Dental example
Build healthy public policy	Policies that support health	Restrictions on tobacco advertising
Create supportive environments	Make healthy choices easier	Sugar-free choices available in schools
Strengthen community action	Communities participate in decisions	Community-led oral-health campaigns
Develop personal skills	Improve health knowledge and practical skills	Brushing and oral cancer awareness education
Reorient health services	Shift from treatment alone towards prevention	Preventive dental services and risk-based recall

Three basic strategies: Advocate, enable and mediate.

Health behaviour is shaped by multiple interacting levels, not just individual choice.

Level	Example
Individual	Knowledge, beliefs, skills
Interpersonal	Family, friends and peers
Organizational	School or workplace policies
Community	Local norms and access to dental clinics
Policy / societal	Tobacco taxation, fluoride policy and regulations

MCQ clue: A question asking you to address an oral-health problem through individual counselling, family support, school policies and legislation is pointing towards the Social Ecological Model.

💡Community Medicine models, theories and frameworks

These are not exclusively dental. They appear in public health, health services, epidemiology, community diagnosis and health planning.

💡Models of disease causation

Model	Main concept	Example / recognition clue
Epidemiological triad	Disease results from interaction between agent, host and environment	Caries: cariogenic biofilm, susceptible tooth/host and dietary/environmental factors
Web of causation	Multiple interrelated factors contribute to disease	Periodontitis involving smoking, diabetes, plaque, genetics and social factors
Wheel of causation	Host factors interact with a biological, physical and social environment; no single agent is necessarily central	Multifactorial chronic disease
Sufficient-component cause model (Rothman)	A disease occurs when a complete causal mechanism, or sufficient cause, is assembled from component causes	Several combinations of risk factors can lead to the same disease
Natural history of disease	Disease progresses through stages without intervention	Preclinical disease followed by clinical disease and possible outcomes
Iceberg phenomenon	Diagnosed clinical cases represent only part of the total burden	Many cases of early caries or hypertension remain undetected
Spectrum of disease	Disease ranges from subclinical infection to severe illness	Infection with varying degrees of symptoms
Multifactorial causation	Multiple risk factors jointly influence disease	Caries and periodontal disease

Epidemiological triad vs web of causation

Feature	Epidemiological triad	Web of causation
Structure	Agent–host–environment	Interconnected causal factors
Best suited to	Many infectious disease examples; also useful for broader disease analysis	Complex chronic diseases
Main idea	Interaction among three broad components	Multiple linked pathways can produce disease

Rothman's sufficient-component cause model

A sufficient cause is a complete causal mechanism that produces the outcome.
A component cause is one part of that mechanism.
A necessary cause is present in every sufficient causal mechanism for a particular outcome.
A component cause need not be necessary on its own.

Exam clue: A disease occurs only when a particular combination of factors is complete, but different combinations can produce the same disease.

💡Natural history of disease and levels of prevention

Stage	Description	Prevention
Primordial	Prevent emergence of risk factors	Healthy public policy, healthy school environments
Primary	Prevent disease before it occurs	Fluoride exposure, tobacco avoidance, immunization
Secondary	Detect disease early and treat promptly	Screening and early treatment of oral potentially malignant disorders
Tertiary	Reduce disability and restore function after established disease	Rehabilitation after oral cancer surgery
Quaternary	Avoid unnecessary or harmful medical intervention	Avoid unnecessary investigations and overtreatment

Important distinction: Primordial prevention prevents the development of risk factors; primary prevention prevents disease in an individual who may already have risk factors.

Epidemiological transition theory

Associated with Abdel Omran.

Describes changes in the leading causes of illness and death as populations and societies develop.
Broadly, infectious diseases and high mortality become less dominant, while chronic noncommunicable diseases account for a larger proportion of disease burden.
Modern populations may experience a double burden of communicable and noncommunicable diseases.

Dental application: A population may continue to experience infectious diseases and untreated oral disease while also seeing increasing diabetes, oral cancer and other chronic conditions.

Demographic transition model

Describes changes in birth and death rates as a population transitions through stages of development.

Stage	Birth rate	Death rate	Population pattern
I — High stationary	High	High	Slow growth
II — Early expanding	High	Falling	Rapid growth
III — Late expanding	Falling	Low	Growth slows
IV — Low stationary	Low	Low	Stable or slow growth
V — Declining (in some models)	Very low	Low or rising relative to births	Natural decrease

MCQ clue: Death rates fall before birth rates, producing rapid population growth in stage II.

Diffusion of Innovations — Everett Rogers

Explains how a new idea, technology or health practice spreads through a social system.

Adopter group	Approximate proportion	Characteristics
Innovators	2.5%	First to adopt; willing to take risks
Early adopters	13.5%	Respected opinion leaders
Early majority	34%	Adopt before the average person
Late majority	34%	Adopt after much of the community
Laggards	16%	Last to adopt; often cautious about change

Dental example: Introducing a new preventive protocol, fluoride programme or digital dental service.

Exam clue: The question asks who adopts an innovation first or how an innovation spreads across a community.

💡Health services and access models

Model / concept	Main idea	Example
Andersen Behavioral Model of Health Services Use	Healthcare use is influenced by predisposing, enabling and need factors	Dental attendance depends on age/beliefs, affordability/access and perceived or assessed need
Inverse Care Law — Julian Tudor Hart	Availability of good medical care tends to vary inversely with the need of the population served	Underserved communities may have fewer dental services despite greater disease burden
Levesque framework of access	Access depends on service accessibility and people's abilities to perceive, seek, reach, pay for and engage with care	A clinic exists but patients cannot afford transport or treatment
Donabedian model	Healthcare quality is assessed through structure, process and outcome	Dental clinic facilities, care delivered and resulting oral-health outcomes
Primary Health Care — Alma-Ata	Essential, accessible healthcare with community participation and intersectoral action	Community-based oral-health promotion and basic preventive services

Donabedian model — very testable

Component	Meaning	Dental example
Structure	Resources and setting	Trained dental staff, equipment, sterilization facilities
Process	What is done during care	Proper examination, prevention, treatment and counselling
Outcome	Result of care	Reduced caries, improved function and patient satisfaction

Memory aid: Structure = what you have; process = what you do; outcome = what happens.

💡Community diagnosis, health education and programme evaluation

Concept / framework	Main idea	Exam clue
KAP model	Knowledge, attitudes and practices are assessed to understand health behaviour	A questionnaire measures what people know, believe and do
Community diagnosis	Systematic assessment of a population's health problems, determinants and resources	Identifying the main oral-health needs of a district
Needs assessment	Identifies gaps between current and desired health status or services	Determining unmet dental treatment needs
SMART objectives	Specific, measurable, achievable, relevant and time-bound objectives	“Increase twice-daily brushing among schoolchildren by 20% within one year”
Logic model	Links inputs, activities, outputs and outcomes	Staff and supplies → school visits → children reached → improved brushing
RE-AIM framework	Evaluates Reach, Effectiveness, Adoption, Implementation and Maintenance	Assessing whether a community intervention works and can be sustained
PRECEDE–PROCEED	Links community assessment, intervention planning, implementation and evaluation	Planning a school oral-health programme

💡KAP vs HBM

Feature	KAP	HBM
Purpose	Describes knowledge, attitudes and practices	Explains beliefs influencing health behaviour
Typical use	Community surveys	Designing behavioural interventions
Example	Measuring the proportion who know fluoride prevents caries	Investigating why someone avoids fluoride despite knowing its benefits

Important: Knowledge alone does not guarantee behaviour change. Attitudes, social influences, access, motivation and self-efficacy can also matter.

💡Theories of communication and interpersonal behaviour

These are useful for questions about counselling, patient compliance, health education and behaviour change.

Theory / concept	Main idea	Example
Shannon–Weaver communication model	Sender, message, channel, receiver and noise	Background noise prevents a patient from hearing instructions
Transactional model of communication	Communication is a two-way, ongoing process with feedback	Dentist and patient clarify each other's understanding
Osgood–Schramm model	Communication involves reciprocal encoding, decoding and interpretation	Dentist and patient repeatedly exchange information
Maslow's hierarchy of needs	Physiological needs, safety, belonging, esteem and self-actualization	A patient struggling with basic needs may prioritize food and shelter over preventive dental visits
Theory of Social Capital	Social networks, trust and reciprocity influence collective action	A trusted community leader encourages families to attend screening
Empowerment theory	People gain knowledge, control and capacity to influence decisions affecting their health	Communities participate in designing oral-health programmes
Motivational interviewing	Collaborative counselling helps resolve ambivalence and strengthen the patient's own motivation	A smoker explores reasons for quitting without being lectured

Theory / model	Main concept	Recognition clue
Social determinants of health	Health is shaped by living conditions, income, education, work and access to services	Poverty and housing influence health outcomes
Fundamental Cause Theory	Socioeconomic resources influence multiple disease outcomes through flexible access to protective resources	Higher socioeconomic groups can use new preventive information and treatments more readily
Inverse Care Law	Good care may be least available where need is greatest	Areas with high dental disease have insufficient services
Biomedical model	Disease is primarily explained through biological or physiological abnormalities	Focus on diagnosing and treating pathology
Biopsychosocial model — Engel	Health and illness reflect biological, psychological and social interactions	Chronic pain influenced by pathology, anxiety and social circumstances
Salutogenesis	Focuses on resources and processes that support health	Coping, resilience and a sense of coherence
Social Ecological Model	Behaviour is influenced by individual, interpersonal, organizational, community and policy factors	Multilevel tobacco-control intervention
One Health	Human, animal and environmental health are interconnected	Zoonotic disease prevention and environmental health

Biomedical vs biopsychosocial model

Biomedical	Biopsychosocial
Emphasizes biological disease mechanisms	Includes biological, psychological and social influences
Focuses mainly on diagnosis and treatment	Also considers behaviour, emotions, family and environment
May not explain why patients behave differently with the same diagnosis	Helps explain differences in coping, adherence and outcomes