Theory development in health promotion: are we there yet?

Theory development has not proceeded at a pace commensurate with the evolution of health promotion practice. At least three examples of this disparity are apparent: (1) theory is developed in an evidence-based paradigm rather than a practice-based paradigm, (2) a substantial majority of health behavior theories exist at the individual level, thereby neglecting contextual realities that shape behavior, and (3) "accessibility" levels of theory to practitioners may be quite low in comparison to the growing demands to prevent disease through expanding health promotion practices. The challenges of health promotion demand a great deal more attention to developing theories that reflect the reality of broad influences on health behavior. One critical question that must be answered involves setting limits regarding the realistic role of behavioral interventions in public health practice. The evolution of theory should be practice-based, largely ecological in nature, and the resulting theories should be easily accessible to practitioners.