Behavior Change:Behavior Change: from Theory to Practicefrom Theory to Practice

Gloria CoeOffice of HIV/AIDS

USAID

Julia Rosenbaum Academy for Educational Development

The CHANGE Project

May 12, 2003

Why Behavior Change?Why Behavior Change?

Key behavioral Key behavioral aspects of all health aspects of all health conditionsconditions

Must address if we Must address if we are to achieve are to achieve improved health improved health outcomesoutcomes

Behavior Change CommunicationBehavior Change Communication

Behavior changeBehavior change How to understand behavior change? How to understand behavior change? Robust theories to understand behavior across Robust theories to understand behavior across

cultures, diseases/conditions, and disciplines.cultures, diseases/conditions, and disciplines.• More than 300 theoriesMore than 300 theories• 4-6 widely used (references in handout)4-6 widely used (references in handout)

CommunicationCommunication Tools and strategies to facilitate behavior Tools and strategies to facilitate behavior

change.change.

AIDSCOM AIDSCOM FrameworkFramework

Some Common Factors Or Some Common Factors Or Behavioral DeterminantsBehavioral Determinants

EXTERNALEXTERNAL AccessAccess PolicyPolicy SkillsSkills CultureCulture

INTERNALINTERNAL KnowledgeKnowledge Perceived riskPerceived risk ConsequencesConsequences Self-efficacySelf-efficacy Perceived social normsPerceived social norms Attitudes Attitudes IntentionsIntentions

BEHAVEBEHAVE FrameworkFramework PRIORITY PRIORITY AUDIENCEAUDIENCE

BEHAVIORBEHAVIOR KEY KEY FACTORSFACTORS ACTIVITIESACTIVITIES

In order to help:

to: we will focus on:

through:

PRIORITY PRIORITY AUDIENCEAUDIENCE

BEHAVIORBEHAVIOR KEY KEY FACTORSFACTORS ACTIVITIESACTIVITIES

In order to help:

to: we will focus on:

through:

Mothers giving birth in hospitals

Begin breastfeeding within one hour of birth and breastfeed exclusively through 6 months

•Hospital policies •Knowledge that breast milk is sufficient •Proper BF skills•Supportive norms (family & other)•Import policies/ national policies on breast milk substitutes

•Policy change in hospitals•Monitoring & regulation of policies•Training/support of all birth personnel•Radio and IPC aimed at mothers -in-law•Mothers support groups

Exclusive BreastfeedingExclusive Breastfeeding

Different Factors are Importantfor Different Health Behaviors

Internal External

Breastfeeding Perceived social norms

Self-efficacy

Facility norms re rooming in

Marketing codes

Workplace policy

Immunization Perceived consequences (protection, side effects)

Accessibility

HW behavior

Contraception Cultural norms Service quality

Policies

The BEHAVE FrameworkThe BEHAVE FrameworkWorks at all LevelsWorks at all Levels

IndividualsIndividuals Family/householdFamily/household CommunityCommunity Institutional systemsInstitutional systems Policy makers/Health plannersPolicy makers/Health planners

Four Important Factors for Four Important Factors for HIV/AIDS-Related BehaviorsHIV/AIDS-Related Behaviors

•KNOWLEDGEKNOWLEDGE•SUBJECTIVE NORMSUBJECTIVE NORM•PERCEIVED RISKPERCEIVED RISK•SELF-EFFICACYSELF-EFFICACY

QuestionsQuestions

A. AIDS can be a serious health problem for each of us. People infected with AIDS can suffer a great deal. If you were a carrier of the AIDS virus, do you think you could be cured?

B. Can you do anything to protect yourself against AIDS? What can you do? Does knowing how to use a condom correctly protect you from AIDS?

C. How do you think people become infected with AIDS? Can an infected person who looks and feels well infect others with AIDS? You can tell by looking whether someone has AIDS.

D. Do you and your friends ever talk about using condoms? Do your friends use condoms? Has your sexual partner ever suggested using a condom?

Self-EfficacySelf-Efficacy

87%

73%

90% 94%

81%

96%

Yes one can do something toprotect

One can use condoms toprotect

Yes condoms prevent STDsand AIDS*

Never Users Ever Users

* Statistically significant at p<.05

Social NormsSocial Norms

14%

25%

43%

72%62%

77%

Talk with friends aboutcondoms***

Friends use condoms*** Sex partner suggested usingcondom***

Never Users Ever Users

*** Statistically significant at p<.001

Perceived RiskPerceived Risk

80%

92%

66%

81%

94%

70%

AIDS is most seriousproblem

AIDS causes great suffering There is NO cure

Never Users Ever Users

KnowledgeKnowledge

72%78%

67%78%

86%76%

One can get AIDS by havingsex with infected person*

Infected person who looksand feels well can infect

others

You can NOT tell by lookingwhether someone has AIDS

Never Users Ever Users

*** Statistically significant at p<.05

PRIORITY PRIORITY AUDIENCEAUDIENCE

BEHAVIORBEHAVIOR KEY KEY FACTORSFACTORS ACTIVITIESACTIVITIES

In order to help:

to: we will focus on:

through:

Pregnant women

Accept an HIV test during prenatal care

Comply w/ ARV regimen to prevent vertical transmission of HIV-

•Specific knowledge about transmission and treatment make a difference•Norms about sexuality•Perceived consequences of HIV+ diagnosis•Health worker attitudes and behaviors•Drug availability

PMTCTPMTCT

Understanding & Challenging StigmaUnderstanding & Challenging Stigma

Stigma/discriminationStigma/discrimination challenge to combating HIV/AIDSchallenge to combating HIV/AIDS

Research conducted by ICRW/CHANGE Research conducted by ICRW/CHANGE and local partners in 3 countriesand local partners in 3 countries root causesroot causes

• Non-awareness/denialNon-awareness/denial• Ignorance/fearIgnorance/fear• Shame/blameShame/blame

PRIORITY PRIORITY AUDIENCEAUDIENCE

BEHAVIORBEHAVIOR KEY KEY FACTORSFACTORS ACTIVITIESACTIVITIES

In order to help:

to: we will focus on:

through:

Pregnant women

Accept an HIV test during prenatal care

Accept ARV regimen to prevent vertical transmission of HIV-

•Specific knowledge about transmission and treatment make a difference•Norms about sexuality•Perceived consequences of HIV+ diagnosis•Health worker attitudes and behaviors

•Mass media•Interpersonal communication at various levels•Logistics•Advocacy (budget allocation/donation)

PMTCTPMTCT

HIV-AIDS Anti-Stigma ToolkitHIV-AIDS Anti-Stigma Toolkit

IntroductionIntroduction Naming the ProblemNaming the Problem Half Knowledge & FearHalf Knowledge & Fear Sex, Morality, Shame & BlameSex, Morality, Shame & Blame Living with and Caring for Living with and Caring for

PLWHAs within the FamilyPLWHAs within the Family PLWHAs Coping with StigmaPLWHAs Coping with Stigma Stigmatized ChildrenStigmatized Children Planning for ActionPlanning for Action

Mass Media ApproachMass Media Approach

PSI – AIDMARK Kenya SpotsPSI – AIDMARK Kenya Spots

Confronting Stigma: Mass MediaConfronting Stigma: Mass Media

Who are these targeting? Who are these targeting? Which determinants do they address?Which determinants do they address? Are they effective? Why/why not?Are they effective? Why/why not?