Sexually Transmitted Diseases  >  Program Guidelines  >  Community and Individual Behavior Change Interventions

Program Operations Guidelines for STD Prevention
Community and Individual Behavior Change Interventions

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Sections on this page:

• Health Belief Model
• Theory of Reasoned Action
• Social (Cognitive) Learning Theory
• Transtheoretical Model (stages of change)
• Diffusion of Innovation
• Empowerment Theory/Popular Education

Appendix BC-B

BEHAVIOR CHANGE MODELS

Health Belief Model

Premise—Health behavior is a function of specific health beliefs; all must be operating for a (risk reducing/health promoting) behavior to occur.

I. THREAT

* Perceived susceptibility
" I could get it."

* Perceived severity
"The consequences of getting it would be serious."

II. OUTCOME EXPECTATIONS

* Perceived benefits of performing a behavior
" If I use condoms/bleach, I can prevent HIV infection."

* Perceived barriers of performing the behavior
"Cleaning my works is a real drag."

* Belief that the benefits of performing a behavior outweigh the consequences of not performing it before behavior change will occur
"I'd rather use clean needles than get HIV."

III. SELF EFFICACY (later addition)

* Belief that one can perform a behavior, even under difficult circumstances
"I know I can do this."

Theory of Reasoned Action

Premise—In order for behavior change to occur, one must have an intention to change; intentions are influenced by two major factors.

I. ATTITUDES TOWARD THE BEHAVIOR

* Belief regarding performing behavior, based on positive or negative consequences (outcome expectations, decisional balance)
"If I asked my boyfriend to use a condom, he'd get really mad."

* Evaluation of the consequences to performing behavior
"It's important to me to prevent HIV."
"Using condoms isn't worth it if my boyfriend gets upset."

II. SUBJECTIVE NORMS ABOUT THE BEHAVIOR

* What significant others think about performing the behavior
"My friends think using condoms is a good thing."

* Motivation to perform behavior based on subjective norms
"Since my friends think I should use condoms, I guess I'll ask my boyfriend to use them."

* What attitudes and beliefs toward the behavior, along with the perception of what significant others think an individual should do, influence intentions toward behavior.
"I'm not too crazy about using condoms, but I'm crazy about Pat, and Pat really wants me to use them, so I guess I will."

Social (Cognitive) Learning Theory

Premise—Behaviors are dynamic, and influenced by both personal and environmental factors (reciprocal determinism); behaviors are learned through direct experience or by modeling others' behaviors through observation.

I. SELF EFFICACY

* A person's belief about his/her ability and confidence in performing a particular behavior, and belief that it can be done even under difficult circumstances.
"Even when we're really strung out and my partner tries to talk me out of cleaning my works, I can talk him right back into cleaning them."

II. OUTCOME EXPECTANCIES

* A person's belief about the positive or negative consequences of performing a particular behavior. It will be performed to the extent that it will lead to a positive outcome.
"I heard that cleaning my rig with bleach can kill HIV so I got some bleach and now I always clean my works."

* Practicing new behaviors through observation and modeling are important components of this theory, as well as providing support for provisional tries.

Transtheoretical Model (Stages of Change)

Premise—Behavior occurs in a series of stages, independent of specific theoretical factors. Movement through the stages varies from person to person and group to group. There are 5 stages of change, as well as various processes and levels of change.

Five Stages of Change

* Precontemplation—no intention to change behavior; not aware of risk, or believe behaviors don't place them at risk.
"I know I have a lot of sexual partners, but I don't need to use condoms because my partners aren't at risk for HIV."

* Contemplation—recognizes behavior puts them at risk and is thinking of changing, but not committed to making that change.
"I know that not using a condom puts me at risk for HIV, but sex isn't the same when I wear a condom."

* Preparation—person intends to change risky behavior sometime soon and is actively preparing.
"I just bought some condoms and am going to talk to my partner about using them the next time we have sex."

* Action—person has changed risky behavior recently, with change having occurred in a relatively recent time period (i.e., 6 months)
"My partner and I used a condom for the first time and it wasn't as bad as I thought."

* Maintenance—person has maintained behavior change for a long period of time (> 6 months), and has adapted to the change.
"Using condoms is no big deal anymore; my partner and I have our routine down and always use them when we have sex."

* Relapse is a normal process in one's attempt to change behaviors.

Diffusion of Innovation

Premise—Process through which any new idea is communicated to members of a group or population, and at what stages or intervals over time people respond to and accept those messages.

I. COMMUNICATION CHANNELS

* for dispersing the innovation or new message.
Word of mouth, telephone, Internet, newspaper, newsletters, "street sheets" (role-model stories)

II. OPINION LEADERS

* visible, respected people who can assist in disbursing the innovation or message.
(i.e., Magic Johnson's personal experiences with HIV and his education/testing campaign.)

III. TIME AND PROCESS REQUIRED

* for the innovation to reach community or group members

* people receive/accept messages at different time intervals

Innovators	Early Adopters	Early Majority	Late Majority	Laggards

IV. SOCIAL NETWORK TO LINK MEMBERS

* diffusion process aided by social networks
Peers, significant others, family, friends, dealers, bar owners

Empowerment Theory/Popular Education

Premise—A social action process that promotes participation of people, organizations, and communities in gaining control over their lives in their community and larger society.

Empowerment is not characterized as achieving power to dominate others, but as power to act with others to bring about change.

I. TARGETS FOR CHANGE

• individual level
• group (agency or organizational)
• structural (within a larger organizational or societal setting)

II. 3-STAGE METHOD FOR PARTICIPATORY EDUCATION

• listening (understanding the felt issues of the problem in the community)
• participatory dialogue (among all members in the group)
• action (envisioning positive change during the dialogue)
• * process-driven, rather than task oriented

III. 5-STEP QUESTIONING STRATEGY USED BY FACILITATOR

• describe what participants see and feel
• define the many levels of the problem as a group
• share similar experiences from their lives
• question why the problem exists
• develop action plans to address the problem
• * Role of Health Educator: facilitator, guide discussion from the personal, to social analysis and action level, through the use of codes (pictures, poems, stories, slides, role plays, etc.), and 5-step questioning strategy

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