Developing methods for locating and synthesising theory for application in public health: a pilot study

Abstract

BackgroundDespite published work suggesting that public health interventions will probably be more effective when underpinned by relevant theory, this is often missing from their design and development. This absence might be because the theoretical published work is not easily accessible, because its sheer volume is overwhelming, or because the theories are not always clearly articulated. There is a need to develop ways of accessing and synthesising bodies of theory for use in public health. We use the area of health-related risk taking as an example and explore the feasibility of locating and synthesising sociological theories in this area. Sociological theories are underused in public health, but are necessary to help to shift the focus towards the social structures that affect behaviour, ensuring that responsibility for change is not placed solely on the individual. We aimed to search for sociological theories of health-related risk taking and to explore the feasibility of theory synthesis as an instrument for public health. MethodsWe hand searched the abstracts of all volumes of the journals Sociology of Health and Illness (volume 1, 1979, to May, 2012) and Social Science and Medicine (volume 1, 1982, to mid-June, 2012) and checked the references of selected papers for relevant publications. Papers were included if they were sociological, relevant to risk taking, and theoretical. After a method outlined by sociological theorist Jonathan Turner, we undertook a synthesis of four of the theories that were related in terms of their subject matter and theoretical perspective. The process of theory synthesis includes the following steps: (1) synthesis preparation, which involves clarifying theories, abstracting them to make them comparable, and extracting what is viewed as most plausible and useful to the question at hand; (2) synthesis, which is the systematic comparison of theories for points of convergence and divergence; and (3) synthesis refinement, which involves closer analysis of the theories with a view to the production of a more robust theory for practical application, including a clarification of causal processes. FindingsWe found 16 different theories that we grouped into seven broad categories according to their theoretical perspective: (1) theories that draw a link between culture and risk taking; (2) theories that conceptualise risk taking as social practice; (3) theories that regard risk taking as a response to dominant social forces; (4) situated rationality and social action theories that place risk taking within wider power relations; (5) the theory of habitus, which helps explain how patterns of risk taking persist over generations and according to social class; (6) theories that stress the positive functions of risk taking; and (7) theories that link serious risk taking with social exclusion. A synthesis of theories in this last category resulted in a new theoretical proposition: that serious and persistent risk taking occurs on the margins of mainstream society and might be related to powerlessness and a liminal social status. InterpretationA limitation of the study was that papers were not independently screened by two people and this shortcoming would need to be addressed in future studies. By suggesting that risk taking might have social causes and functions, the sociological theories form a valuable counterbalance to prevailing theoretical perspectives that focus on individual behaviour and, in so doing, have the potential to inform a broader range of public health interventions. Further work will explore the possibility of applying these methods on a larger scale and of incorporating the results of theory syntheses into logic models to provide a practical instrument for use in the design of complex public health interventions. FundingThe study was funded by DECIPHer, a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council (RES-590-28-0005), Medical Research Council, the Welsh Government, and the Wellcome Trust (WT087640MA), under the auspices of the UKCRC, is gratefully acknowledged.