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