A Challenge for Health Education: The Enactment Problem and a communication-Related Solution

Much scholarship has focused on explaining adolescents' risky health practices (e.g., drinking, drug use, unprotected sexual contact). The Health Belief Model and Fishbein's Theory of Reasoned Action attempt to explain adolescents' use of cost and benefit analysis to form intentions to behave. This article argues that intention-based actions (enactment) have not been effectively accounted for by current models. A challenge remains to translate health knowledge and healthy intentions into healthy behaviors. A useful beginning is to approach enactment as a communication problem. This article (a) reviews evidence of the limited success of health education to produce behavior changes; (b) explores explanations of why knowledge and behavioral intention may not lead to behavior change; (c) suggests how communication-based curricula help bridge the gap between knowledge, intention, and behavior, and (d) sets a research agenda that has implications for the practice of health education.