Individual level of Behavior Change
Communication:
Practical review of relevant theories
for outreach workers that do
interventions among IDUs
This review gives useful knowledge for an outreach worker to
implement efficient interventions and help IDUs to reduce
their risky behaviors
Presentation 3
Why it is important?
• Provides understanding of process of behavior change
• Gives knowledge of what to do and what not to do
• Discovers reasons why people change behavior and
why people may oppose changes
• Explains some things that are usually hidden for
observation but are important to take into account
Main theories to be considered:
Elaboration Likelihood Model (petty, Cacioppo)
Social Learning Theory (Bandura)
Protection Motivation Theory (Rogers, Lazarus, Leventhal, Boer, Seydel)
Social Cognitive Theory (Miller, Dollard, Bandura, Walters)
Social Support Theory (Barnes, Cassel, House, Berkman, Glanz)
Transactional Model of Stress and Coping (Lazarus, Cohen, Antonovsky, Kats)
Stages of Change Model Change (Prochaska, DiClemente)
The Health Belief Model (Becker, Radius, Rosenstock)
Theory of Planned Behavior/Reasoned actions (Ajzen, Fishbein)
What is about?
How does individual change his mind? (Elaboration Likelihood Model)
What is role of other people in individual’s behavior change? (Social
Learning Theory)
How does individual typically act in case of perceiving certain behavior
as risky and probably a one to change? (Protection Motivation Theory)
What is role of individual’s environment in forming behavior and its
change? (Social Cognitive Theory)
What is social support and how it contributes to behavior change?
(Social Support Theory)
How people ordinary cope with stressful events? (Transactional
Model of Stress and Coping)
What stages does individual make in a process of changing behavior?
(Stages of Change Model)
How individual’s beliefs about risk, actions to be taken and about own
capabilities affect behavior change? (Health Belief Model)
 What forms individual’s intention to undertake actions to
avoid/reduce risk? (Theory of Planned Behavior/Reasoned Action)
Theory: Elaboration Likelihood Model
Key findings for Behavior Change Communication:
• Attitudes are important – they guide decisions and other behaviors
• Persuasion is a primary source to form an attitude
• The key point is involvement (motivation and ability to
think about the advocated position and arguments)
• When people are motivated and able to think about the
content of the message, elaboration (for changes, actions and etc.)
is high
BCC related theories: individual level
Theory: Social Learning Theory
Key findings for Behavior Change Communication:
• People do change their behavior through learning from other
people. It takes general stages:
o Close contact – contact with people is basic condition
o Imitation of superiors – a person needs a model of perfection to
imitate
o Understanding of concepts – a person needs to understand
meanings behind imitated behavior or to find its own
o Role model behavior:
imitation + understanding of what is behind = role model behavior
BCC related theories: individual level
Theory: Social Learning Theory
Key assumptions for outreach worker who work with IDUs:
•It is important to be in a close trustful contact with client to talk
about behavior change
•Give a client right examples for imitation
•Help a client to understand why the other person (example)
does what he/she does and to find its own meaning to do
similarly
•Support a client in forming a convenient role behavior – explain
a client what to do, show a client how to do it (give an example),
help a client to find out why to do that
BCC related theories: individual level
Theory: Protection Motivation Theory
Core Assumptions and Statements
Recognizing health threat, people are expected to
react it somehow. While reacting, a person
demonstrates adaptive or maladaptive behavior.
Adaptive or maladaptive coping with a health threat
appears as a result of two appraisal processes: a
process of threat appraisal and a process of coping
appraisal. Adaptive behavior – intention to perform
adaptive responses based on protection motivation.
Maladaptive behavior – all those responses that place
an individual at health risk, they include behaviors
that lead to negative consequences and absence of
behaviors, which eventually may lead to negative
consequences.
BCC related theories: individual level
Theory: Protection Motivation Theory
The theory proposes that the intention to
protect oneself depends upon four factors:
•The perceived severity of a health threat
•The perceived probability of the occurrence or
vulnerability of a person to the particular threat
•The efficacy of the recommended preventive behavior
•The perceived level of confidence in one’s ability to
undertake the recommended preventive behavior
BCC related theories: individual level
Theory: Protection Motivation Theory
Key assumptions for outreach worker who work with IDUs:
•Give a client to understand thoroughly risks and danger of
present state of things first (contribute to client’s threat
appraisal)
•Convince a client in personal vulnerability for the risks and help
a client to understand why the particular health threat is very
likely for him to happen
•Explain clearly why the preventive measures you recommend
are proven to be efficient to help a client to avoid the health
threat
•Discuss with a client whether the recommended preventive
measures are easy for him to follow, consider obstacles and
develop a personal guide on how to form a preventive skill or
habit (remember social learning postulates: contact-example to
follow-understanding of acquired behavior-encourage new role
behavior)
BCC related theories: individual level
Theory: Social Cognitive Theory
Core Assumptions and Statements
Behavioral change depends on the factors:
environment, people and behavior. These three
factors are constantly influencing each other.
There are social and physical environments. Social
environment include family members, friends,
colleagues and other relevant people. Physical
environment:
water,
food,
temperature,
availability of drugs and etc. The environments
provide models for behavior.
BCC related theories: individual level
Theory: Social Cognitive Theory
Key findings for Behavior Change Communication:
•To make people changed, it is important to
understand their environments first
•To make people changed, it is necessary to shift
their environments or to change something in the
environments (to remove some factors or to
introduce new factors)
•Behavioral capability – a person to perform
behavior must know what the behavior is and have
the skills to perform it
BCC related theories: individual level
Theory: Social Cognitive Theory
Key assumptions for outreach worker who work
with IDUs:
•Assess your capabilities to change client’s
environment and use it
•Become a part of client’s environment
•Let a client to understand a behavior change
•Provide client with skills for behavior change
BCC related theories: individual level
Theory: Social Support Theory
Core Assumptions and Statements
Social support is associated with how networking helps people
cope with stressful events. Social support through networking
distinguishes between four types of support: Emotional
support, Instrumental support, Informational support, Appraisal
support. Emotional support is associated with empathy, love,
trust and caring. Instrumental support involves the provision of
tangible aid and services that directly assist a person in need.
Informational support involves the provision of advice,
suggestions and information that a person can use to address a
problem. Appraisal support involves the provision of
information that is useful for self-evaluation purposes:
constructive feedback, affirmation and social comparison.
BCC related theories: individual level
Theory: Social Support Theory
Key findings for Behavior Change Communication:
•Networking helps people to cope with stressful events (like behavior
change)
•Behavior change goes better if a person receives enough empathy, love,
trustful interpersonal contact and caring
•It is important to provide a person with relevant instruments and services
that will assist in a process of changes
•It is very important to provide a person with necessary and useful
information regarding behavior change and ensure that the information is
understood
•Constructive feedback, affirmations and social comparison are also very
important on the way of behavior change
BCC related theories: individual level
Theory: Social Support Theory
Key assumptions for outreach worker who work with
IDUs:
•Provide enough of clear information about threats and
why to change something
•Explain how to change, provide options and ready-to-use
solutions
•You may help people by gathering them together into
self-support groups
•Use supportive emotions for a person who is on stages of
change
•Provide feedback on a progress, and involve others to
prove achievements
BCC related theories: individual level
Theory: Transactional Model of Stress and Coping
Core Assumptions and Statements
The transactional Model of Stress and Coping
explains a process of how people cope with
stressful events. Experience of coping with
stress construes personal attitudes to various
threats in further.
Individual’s actions depend on how he/she
appraise a threat, but also it depend on social
and cultural factors.
BCC related theories: individual level
Theory: Transactional Model of Stress and Coping
Simple scheme of the Model:
(A THREAT APPEARS)
•Is it really so significant for me?
•Can I control it or cope with it easy and quickly?
•What should I do to make the threat less important to me, to take
control?
•I undertake my efforts!
•How can I see the threat differently and less significant?
•I believe it is less serious for me now! I believe I can make it!
•I feel better now! I’m proud for myself!
•Next time I will do similarly because it seems working…
•I neglect any further threat since I was successful to cope with the
threats
•Is it really so? It is really so! Is it really so? It is really so! Is it really
so? …
BCC related theories: individual level
Theory: Transactional Model of Stress and Coping
Key assumptions for outreach worker who work with IDUs:
•Show a threat (risky behavior) and its significance for a particular
person
•Follow the process of how your client assess the situation by asking
questions, listening and watching for signs of possible change
•Make it possible to discuss options to undertake and help a client to
choose a proper solution for further action
•Support client in his actions
•Make a client understand that a threat is still serious and it is important
to be aware
•Help a client to avoid a stereotype problem solving: different solutions
for different problems
•Encourage attention for threats (risks) and active search for proper
ways of coping with them
BCC related theories: individual level
Theory: Stages of Change Model
Core Assumptions and Statements
The idea is that behavior change does not happen in one step. People tend
to progress through different stages on their way to successful change. The
model is related to the assumption that a decision to change (to move to
the next stage of change) must come from inside of a person -- stable, long
term change cannot be externally imposed. In each of the stages, a person
has to do with a different set of issues and tasks that relate to changing
behavior. Thus, for each for each stage of change, actions and tools are
suggested.
BCC related theories: individual level
Theory: Stages of Change Model
• Precontemplation (Not yet
acknowledging that there is a
problem behavior that needs to
be changed)
• Contemplation (Acknowledging
that there is a problem but not
yet ready or sure of wanting to
make a change)
• Preparation/Determination
(Getting ready to change)
• Action/Willpower (Changing
behavior)
• Maintenance (Maintaining the
behavior change)
• Relapse (Returning to older
behaviors and abandoning the
new changes)
BCC related theories: individual level
Presentation 3
Theory: Stages of Change Model
Key assumptions for outreach worker who work with IDUs:
•It is important to recognize risky behavior, to
identify one to work with at once
•Identify a stage of change for the particular risky
behavior
•There are suggested actions for a certain stage of
stage – stick to them
•Usually client doesn’t change a behavior
immediately, it takes some time
•Some behaviors take more time and attempts than
others
BCC related theories: individual level
Theory: Health Belief Model
Core Assumptions and Statements
Health Belief Model is based on the understanding
that a person will take a health-related action (e.g.
use clean syringes or condoms), if that person:
 feels that a negative health condition can be
avoided
 has a positive expectation that by taking a
recommended action, he/she will avoid a negative
health condition
 believes that he/she can successfully take a
recommended health action
BCC related theories: individual level
Theory: Health Belief Model
Key assumptions for outreach worker who work with IDUs:
•Find out how a client assesses a risk, convince a client that
the risk is more that real for him personally
•Make a client understand that the risk is serious and will
pose negative consequences
•Provide how-to information, promote awareness, suggest
options to avoid/reduce a risk
•Help a client to realize and accept benefits of adopting of
suggested behavior that reduces risk
•Together with client consider and rearrange any serious
barriers that may obscure or discourage adoption of
promoted less risky behavior
•
BCC related theories: individual level
Theory of Planned Behavior/Reasoned Action
Core Assumptions and Statements
Person’s behavior is determined by his/her intention
to perform the behavior. Intention is the best
predictor of probability of a behavior –
representation of a person’s readiness to perform
given behavior. Intention is determined by:
• person’s attitude toward the specific behavior
• person’s beliefs about how he/she will look like in
other people’s view while practicing the specific
behavior
• person’s perception of own ability to perform given
behavior
BCC related theories: individual level
Theory of Planned Behavior/Reasoned Action
Key assumptions for outreach worker who work
with IDUs:
•Make sure that client’s attitudes toward the
promoted behavior is positive
•Let a client see that relevant others support him
in adopting the promoted behavior
•Improve client’s ability to manage and control
the adopted behavior under various
circumstances
BCC related theories: individual level