The Psychology of Behaviour
Change
•
•
•
•
•
Planned Behaviour Change
Applying Theories
Intervention Mapping
Example: Aids Prevention
Conclusions
Planning
•
•
•
•
Problem
Determinants of the Problem
Interventions
Evaluation: Reduction of the Problem
Planned Behaviour Change
•
•
•
•
•
Problem
Behaviour & Environment
Determinants of Behaviour/Environment
Intervention
Implementation
• Evaluation
SUPRANATIONAL
SOCIETY
COMMUNITY
ORGANISATION
INTERPERSONAL
INDIVIDUAL
Planned Behaviour Change
•
•
•
•
•
Problem
Behaviour & Environment
Determinants of Behaviour/Environment
Intervention
Implementation
• Evaluation
Planning Example
•
•
•
•
•
Problem: HIV
Behaviour: Condom use
Determinants: Perceived skills
Intervention: Skills training
Implementation: School teachers
Development
•
•
•
•
Planning: +
Environment: +
Evaluation: +
Theories: +
• Applying Theories: ?
Reference
• Bartholomew, L.K., Parcel, G.S., Kok, G. &
Gottlieb, N.H., 2001. Intervention Mapping;
designing theory- and evidence-based
health promotion programs. Mountain
View, CA: Mayfield.
Intervention Mapping
• Needs assessment
• Intervention mapping
–
–
–
–
–
Learning and Change Objectives
Methods & Strategies
Program
Anticipating Implementation
Anticipating Evaluation
• Implementation & Evaluation
IM Example
• Goal behaviour: Condom use
•
•
•
•
•
Objectives: negotiation skills
Methods: modelling & feedback
Programme: video & discussion
Implementation: school teachers
Evaluation: self-report
Core Processes
•Problem focus vs theory generation
•Applying theories
Problem focus vs theory
generation
• All theories are right
– multiple theories
• All theories are wrong
– reduction of reality
Applying Theory
•
•
•
•
•
•
•
Posing questions
Brainstorming provisional answers
Searching the literature
Evaluating the evidence
Accessing and using theory
Addressing needs for new data
Formulating working answers
Theories
• Step
– Determinants: Planned Behaviour
– Interventions: Stages of Change
– Implementation: Diffusion of Innovations
Theories
• Level
– individual: Attribution
– environmental: Organizational change
• Problem & Action
– problem: Planned Behaviour
– action: Elaboration likelihood
Intervention Mapping
• Needs assessment
• Intervention mapping
–
–
–
–
–
Learning and Change Objectives
Methods & Strategies
Program
Anticipating Implementation
Anticipating Evaluation
• Implementation & Evaluation
HIV Prevention for Adolescents
• Quality of Life; Health
• Behaviour and Lifestyle
• Environment
–
–
–
–
Early Infection, Increased Risk
Early Intervention, Easy through Schools
Condom Use
Availability: very high (Vending machine?)
Programme Objectives
• Performance Objectives
X
• Determinants
X
• Subpopulations
=
• Programme Objectives
Performance Objectives
• What does the person need to do to perform
the health-related behaviour?
• Sequence of smaller, necessary steps
• Essential subparts of the behaviour
• Different determinants
Performance Objectives for
Condom Use?
•
•
•
•
•
•
-
Performance Objectives for
Condom Use
•
•
•
•
•
•
•
Make a decision and plan condom use
Buy condoms
Carry condoms regularly
Negotiate with partners
Use condoms correctly and consistently
Maintain condom use in teenage years
Use condoms in steady relationships
Performance Objectives for
Smoking Cessation?
•
•
•
•
•
•
-
Determinants of Behaviour
• Those factors that are associated with the
behaviour and that probably mediate
behavioural change
• Personal determinants
• External determinants
Determinants for Condom Use?
• Plan condom use
-
-
• Carry condoms
-
-
• Negotiate condoms
-
-
Determinants for Condom Use
• Plan condom use
-
Knowledge: basic facts
Risk perception: behaviour instead of group
Risk perception: situations
Attitude: health advantages
Attitude: non-health advantages
Attitude: anticipate + cope with disadvantages
Determinants for Condom Use
• Carry condoms
– Risk perception: unexpected situations
- Descriptive norm: peers carry condoms
- Self-efficacy: confidence in carrying condoms
regularly
- Self-efficacy: planning where to carry
Determinants for Condom Use
• Negotiate condoms
- Subjective norm: what others expect
- Subjective norm: arguments against unsafe sex
- Self-efficacy: perceived skills for negotiation
(Sub)Populations?
•
•
•
•
•
•
Educational level
Age:
Gender:
Ethnicity:
Religion:
Experience:
(Sub)Populations
•
•
•
•
Educational level: Vocational schools
Gender: both in the programme
Ethnicity/Religion: all
Age/Experience: included in the programme
Programme Objectives
• (Sub)Populations: Adolescents
• Performance objective: Make a decision and plan
• Determinant: Risk perception, behaviour in stead
of group
• Programme objective:
Adolescents will recognise that HIV/STD
infection is related to behaviour, not to risk group
(decision)
Programme Objectives (2)
•Describe peers as carrying condoms
(descriptive norm)
•Demonstrate/describe adequate condom use
(skills)
•Adduce arguments countering proposals to
have unsafe sex (for maintenance)
(knowledge/skills)
Methods and Strategies
• A Theoretical Method is a general technique
or process for influencing changes in the
determinants of behaviour
• A Practical Strategy is a specific technique
for the application of theoretical methods in
ways that fit the intended population and
context
Methods & Strategies
• Modelling
• Risk appraisal
• Role models on video
• Discussion of own
experiences
Methods for Determinants?
• Self-efficacy improvement:
-
Methods for Determinants
• Self-efficacy improvement:
- modelling
- re-attribution training
- goal setting
Parameters for Methods
• Modelling: identification, skills,
reinforcement, coping
• Goal setting: commitment, difficult but
available goal
Parameters for methods?
Risk perception
• Fear arousal: -
Parameters for methods
Fear arousal:
- high personal susceptibility in
combination with high self-efficacy
Modelling
•
•
•
•
Identify
Perceived skills
Perceived reinforcement
Coping model
Modelling: Example
•
•
•
•
Smoking cessation
Pregnant women
Modelling by video
Stories:
–
–
–
–
identify
skills
reinforcement
coping
Video
Modelling: Example 2
•
•
•
•
HIV prevention: drug users
Safe use; safe sex
Modelling by brochure
Stories:
–
–
–
–
identify
skills
reinforcement
coping
Methods and Strategies for
Condom Use
• Fear arousal: videotaped role-modelling
• Skills: modelling & discussion
Skills Training
•
•
•
•
•
•
Say no
Repeat with arguments
Postpone, alternative
Excuses
Avoid
Attack
Modelling: Example 3
•
•
•
•
•
Skills training: negotiating condom use
Video
Desired behaviour
Active learning: stop and think
Scenario
–
–
–
–
identify
skills
reinforcement
coping
Video
Programme Design
•
•
•
•
•
Scope
Sequence
Materials
Pre-testing
Production
HIV Programme Design
• Scope: positive, sexuality, love, first time,
homosexuality
• Sequence: risk-attitude-norms-skills
• Materials: four lessons, teacher manual,
student magazine, videotape
• Pre-testing & Production: linkage
Anticipating Implementation
Linkage
Group
Program
Developers
Program
Users
Anticipation of Evaluation
• Behaviour change: performance objectives
– Carry condoms
• Determinants change: programme
objectives
– Demonstrate/describe adequate condom use
– Adduce arguments countering proposals to have
unsafe sex
HIV Prevention in Schools
(SD’s)
1,2
1
0,8
individual
school
0,6
0,4
0,2
in
te n
ti o
n
be
ha
vio
r
cy
eff
ica
ng
mo
de
li
ms
no
r
efs
be
li
ris
k
kn
ow
led
ge
0
The Psychology of Behaviour
Change
• Theories and empirical data
• Translation of theoretical knowledge in
practical programs.
• The psychology of implementation