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Theories of Change. Anthropology 393 – Cultural Construction of HIV/AIDS Josephine MacIntosh. Theories of Change. Popular theoretical models for HIV/STI risk reduction highlight importance of Motivating target audiences think & talk about own need for behaviour change

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theories of change

Theories of Change

Anthropology 393 – Cultural Construction of HIV/AIDS

Josephine MacIntosh

theories of change2
Theories of Change
  • Popular theoretical models for HIV/STI risk reduction highlight importance of
    • Motivating target audiences
      • think & talk about own need for behaviour change

(Peterson & Di Clemente, 2000)

  • Providing information, behavioural skills, removal of perceived barriers
    • integral to the maintenance of individual-level behaviour change
  • But… w/o personal motivation to integrate risk reduction strategies, little changes
individual level models
Individual-level Models
  • Health Belief Model
  • AIDS Risk Reduction Model
  • Social Cognitive Theory
  • Theory of Reasoned Action
  • Theory of Planned Behaviour
  • Information-Motivation-Behavioural Skills
  • Transtheoretical Model
social level models of change
Social-level Models of Change
  • Diffusion Theory
  • Leadership Models
  • Social Movement Theory
individual level models5
Individual-level Models
  • Health Belief Model
    • 1950’s U.S. Public health model designed by health psychologists in the 1950’s
  • Fundamental assumption
    • Conscious, rational decision-making processes determine health behaviours
  • Knowledge should lead to preventative if
    • Susceptible or vulnerable
    • Risk is severe (negative health outcomes),
    • Benefits of prevention outweigh the costs (both physical and social)
individual level models6
Individual-level Models
  • AIDS Risk Reduction Model
    • Stage model of behaviour change
    • Designed specifically for HIV intervention
        • Dolcini, Coats, Catania, Kegeles & Hauck, 1995
    • Prevention efforts must build upon one another
    • Complex behaviours are more likely to be enacted if the individual has first integrated lower level acts
      • Dolcini, Coats, Catania, Kegeles & Hauck, 1995
individual level models7
Individual-level Models
  • AIDS Risk Reduction Model
    • Effectiveness depends on ability to systematically utilize learned harm reduction techniques
      • Must labelthe behaviour as risky
      • Must make a commitment to reducing risk and increasing prevention efforts
        • Rational assessment of perceived cost and benefits
      • Must consistently enactbehavioural changes that reduce risk
    • May entail engaging in novel, complex activities
individual level models8
Individual-level Models
  • Social Cognitive Theory Bandura, 1994
    • Self-efficacy is the key to effecting positive changes in health behaviour
      • Best described as the sense of control over motivation and environment, and especially behaviour
    • Central
      • Information,
      • Development of self-regulatory and risk-reduction skills
      • Increased feelings of self-efficacy
      • Social supports that facilitate change
    • Impart the skills & self-beliefs that enable consistent engagement in the desired behaviours
individual level models9
Individual-level Models
  • Theory of Reasoned Action
        • Fishbein, Middlestack & Hitchcock, 1994
    • Most socially relevant behaviours are under volitional control
    • Should be predictable by intention
  • Goal is to strengthen behavioural intent
    • Should increase the enactment of preventative behaviours
individual level models10
Individual-level Models
  • Theory of Planned Behaviour
        • Fishbein, Middlestack & Hitchcock, 1994
    • Adds perceived behavioural control as a construct
    • Accounts for the influences of factors which undermine personal control (perception of ability to act on intentions)
      • sexual arousal
      • gender-based power differentials
      • alcohol and drug use
    • When personal control is perceived to be absolute, TPB reverts to TRA
individual level models11
Individual-level Models
  • Information-Motivation-Behavioural Skills Model (IMB) Fisher & Fisher, 1998
    • designed specifically to address HIV
      • integrates theory & research from HIV prevention & social psychology
    • maintains that information and motivation are independent constructs
    • when found in conjunction with well-defined behavioural skills sets
      • are causally related to the enactment of preventive behaviours
individual level models12
Individual-level Models
  • Information-Motivation-Behavioural Skills Model (IMB) Fisher & Fisher, 1998
    • Main assumption
      • If an individual is well informed, highly motivated and possesses the necessary behavioural skills
      • Then likely to initiate and maintain preventive behaviours
  • Addresses importance of changing attitudes, social norms and emotional responses that are contradictory to sexual & reproductive health
individual level models13
Individual-level Models
  • Transtheoretical Model Prochaska et al., 1994
    • stage model designed for HIV prevention (like the AARM)
      • approaches change as a non-linear process
    • six stages of change
      • Precontemplation
      • Contemplation
      • Preparation
      • Action
      • Maintenance
      • Termination
individual level models14
Individual-level Models
  • Transtheoretical Model Prochaska et al., 1994
    • Progress hinges on a decisional balance
    • Earlier stages rely on experiential processes
      • Consciousness raising
      • Awareness
      • Self re-evaluation
    • Later stages depend on behavioural processes
      • Reinforcement
      • Counter-conditioning
      • Helping relationships
individual level models15
Individual-level Models
  • Transtheoretical Model Prochaska et al., 1994
  • The two greatest challenges
    • Finding a means to motivate precontemplators to process the information necessary for change
    • Finding reinforcements that will promote perseverance among those in the later stages
summary
Summary
  • Individual-level theoretical models for HIV/STI risk reduction highlight the importance of
    • Accurate information
    • Motivation
    • Behavioural skills social norms which support safer behaviours
  • BUT… individual-level theories offer little insight into how to shift social norms to support safer behaviour
social level models of change17
Social-level Models of Change
  • Social models can shape the norms, values, & interests of at-risk social groups
    • Necessary adjuncts to any large-scale intervention
    • Norms and referents have a strong influence on individual intention to act
      • HIV highlights issues that are social
    • Individual-level risk-reduction enhanced by addressing group and subcultural norms
      • Capitalizing on existing community and interpersonal networks to improve public health delivery
      • Removing social barriers that hinder safer behaviours
social level models of change18
Social-Level Models of Change
  • Diffusion Theory
    • Anthropological and sociological model
    • Examines a culture or subculture to determine which innovations are most likely to be adopted
    • Also concerned with how innovation will be used differently within a culture or sub-culture other than the one in which it originated
      • Dearing, Meyer & Rogers, 1994
social level models of change19
Social-Level Models of Change
  • Leadership-Focused Models
    • Capitalize on influences of peers & esteemed referents
    • Enlist pre-existing group leaders to champion harm reduction innovations
    • Thru observation of social networks
      • identify local leaders
      • recruit and train
    • Use existing networks and principals to diffuse prevention messages
      • may be a useful means of jump-starting social movements
        • Friedman, Des Jarlais & Ward, 1994
social level models of change20
Social-level Models of Change
  • Social Movement Theory
      • Typically originate from the efforts of individuals & local leaders in response to a threat to the community
      • On occasion, inspired by outside intervention
      • Especially useful if a high degree of local participation is necessary if opposition is likely
    • Context = HIV prevention  may be resistance
      • small groups (partners resistant to condom use)
      • local leaders (needle sellers who resist needle exchange progs)
      • political or economic elites (those who control the distribution of experimental treatments)
effective hiv pregnancy prevention programming
Effective HIV & Pregnancy Prevention Programming
  • Focus on reducing one or more specific HRSB
  • Theory-based
  • Advocate avoiding sexual risk-taking
  • Provide accurate information
  • Attend to social pressures
  • Model sexual communication & negotiation skills
  • Use interactive teaching methods
  • Appropriately targeted: age, sexual & cultural exp
  • Adequate in length
  • Include and train teachers and peer leaders
    • Kirby, 2001