MARISENS HIV/AIDS BEHAVIOURAL MODIFICATION MODEL
BY MARISEN MWALE

LEVELS OF INTERVENTION

Step 1

Awareness appraisal

Aimed at assessing risk-perception and risk-appraisal [perceived susceptibility].

Address awareness of being at risk, and comprehension of modes of and dynamics of transmission. [Information about risk however is not enough- people may know they are indulging in risky behaviors but not change or downplay the risk- gap between knowledge and subsequent behavior often high].

Question being whether the targeted groups perceive themselves to be at risk of contracting HIV/AIDS or not.

Applicable theory WEISTEIN [1987] Risk-perception theory considers biases as optimistic and social-comparison biases relative to ones risk [due to either cognitive processes- e.g., precautions taken or motivational processes e.g., wishful thinking].

Step 2

Identification of and change of determinants of Behavior

Aimed at risk-reduction and subsequent behavioral change.

Question being what motives there are to change ones current behavior- do the benefits outweigh the barriers- e.g., poverty vs. prostitution, lifestyle vs. status.

Address determinants of behavior like attitudes, cultural and traditional practicies, poverty etc., and implement strategies to mitigate such determinants, their reinforcers, enabling factors and predisposing factors for example through social skills training especially with respect to responding to social pressure to conform to risky behaviors perpetrating the spread of HIV/AIDS e.g., multiple and concurrent partners and related resource and social interventions e.g., financing small-scale micro business ventures and promoting COMMUNITY EFFICACY.

Applicable theories -attitude change- PERSUASION- Traditional Yale approach, The cognitive approach to persuasion [PETTY and CACIOPPO, 1986]- people think about the message, the arguments it makes and [perhaps] the arguments it has left out- it is these thoughts not the message itself that lead to either attitude change or resistance- [in BARON and BYRNE, 1996- SOCIAL PSYCHOLOGY],

The elaboration likelihood model [ELM] of persuasion- CENTRAL ROUTE- persuasion occurs when recipients find a message interesting, important or personally relevant and when nothing else [distraction or prior knowledge of the message] prevents them from devoting careful attention to it. In such cases they may examine the message in a careful and thoughtful manner, evaluating the strength or rationality of the arguments it contains. If their reactions are favorable, their attitudes and other cognitive structures may be changed and persuasion occurs. PERIPHERAL ROUTE- under this route persuasion still occurs even if the recipients find the message uninteresting. This may occur when perhaps the message is delivered through something that induces positive feelings, such as a very attractive model or a scene of breathtaking natural beauty. Commonly used by politicians and advertisers who recognize how weak their arguments are to persuade people. They resort to the use of beautiful models, clever slogans or catchy tunes, music bands, drama groups- such subliminal appeals can be quite effective but short lived.











BARRIERS TO ANTICIPATED [ATTITUDE CHANGE]

Reactance- refers to negative reactions to efforts by others to limit our personal freedom by getting us to do what they want us to do. Research has shown that we shift away from the view someone else is advocating to the opposite.

Forewarning- prior knowledge of persuasion intent which provides an opportunity to formulate counter-argument that can lessen the messages impact and also provides us with more time in which to recall relevant facts and information- information that may prove useful in refuting a persuasive message [WOOD, 1984 in BARON and BYRNE, 1996].

Selective avoidance- referring to the tendency to direct our attention away from information that challenges our existing attitudes.












Step 3

Behavioral change maintenance and modification

Aimed at maintenance of new attitudinal and behavioral changes as well as relapse prevention.

Address social skills maintenance, enhancement and further behavioral modification as well as structural factors as social support, community support, as well as the political will and reinforcement of leaders.

Applicable theories SELF-EFFICACY THEORY BANDURA, 1986 and derivatives as well as BEHAVIOUR MODIFICATION THEORIES- RELAPSE PREVENTION THEORIES- MARLATT & GORDON, 1985.


In educational interventions we try to change determinants of behavior in order to change behavior, but we also use techniques that influence behavior rather directly, such as commitment procedures and systematic experiences with the behavior followed by feedback and reinforcement. Positive experiences with behavior, in turn, may change psychological determinants of behavior, thus creating reciprocal determinism. [BANDURA, 1986].


The educational interventions should change with each step. The choices that have to be made about the message, the target group, the channel, and the source, will be different, or may even be conflicting, depending on the particular step that is addressed [McGuire, 1985].

Theories for the different steps can suggest techniques, but the actual application of these techniques in the educational intervention requires practical experience, creativity and thorough pretesting [Bartholomew et. al., 1991; Parcel et al., 1989, Schaalma & Kok, 1994].
Summary

Problem- what is the targeted health problem. [Do not develop an intervention for a non-existent problem- pitfall]

Behavior- what is the relationship between the targeted behavior and health problem. [Do not develop an intervention addressing behavior that lacks a clear relationship with the problem, for instance, because that relationship is vague or the problem is mostly determined by environmental factors- pitfall]

Determinants of behavior- what are the determinants of the targeted behavior. [Do not develop an intervention on the basis of misconceived ideas about the determinants of the behavior- pitfall]

Intervention- what is the proposed intervention. [Do not develop an inadequate intervention- for example venturing into BCC while resources are still lacking or insufficient tailoring to the target group- pitfall]

Implementation- how do you intend to implement the intervention. [Do not develop a potentially effective intervention with the wrong implementation- for instance, a school programme on AIDS that is not used because teachers do not agree with the content- pitfall]

Evaluation- how do you evaluate the intervention in terms of success or failure- process, impact and outcome. In terms of process evaluation the central question being was the programme implemented as planned and was the supposed self-efficacy improvement actually realized? In terms of impact evaluation you consider the degree of success or failure of the intervention. In terms of outcome you consider whether the targeted problem has been mitigated although this may take sometime to determine for other problems. [Do not have unjustified satisfaction with an intervention that might not have been evaluated- pitfall]