1. The Psychology of Behaviour Change • Planned Behaviour Change • Applying Theories • Intervention Mapping • Example: Aids Prevention • Conclusions

2. Planning • Problem • Determinants of the Problem • Interventions • Evaluation: Reduction of the Problem

3. Planned Behaviour Change • Problem • Behaviour & Environment • Determinants of Behaviour/Environment • Intervention • Implementation • Evaluation

4. SUPRANATIONAL SOCIETY COMMUNITY ORGANISATION INTERPERSONAL INDIVIDUAL

6. Planned Behaviour Change • Problem • Behaviour & Environment • Determinants of Behaviour/Environment • Intervention • Implementation • Evaluation

7. Planning Example • Problem: HIV • Behaviour: Condom use • Determinants: Perceived skills • Intervention: Skills training • Implementation: School teachers

8. Development • Planning: + • Environment: + • Evaluation: + • Theories: + • Applying Theories: ?

9. 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.

10. Intervention Mapping • Needs assessment • Intervention mapping • Learning and Change Objectives • Methods & Strategies • Program • Anticipating Implementation • Anticipating Evaluation • Implementation & Evaluation

11. IM Example • Goal behaviour: Condom use • Objectives: negotiation skills • Methods: modelling & feedback • Programme: video & discussion • Implementation: school teachers • Evaluation: self-report

12. Core Processes Problem focus vs theory generation Applying theories

13. Problem focus vs theory generation • All theories are right • multiple theories • All theories are wrong • reduction of reality

14. 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

15. Theories • Step • Determinants: Planned Behaviour • Interventions: Stages of Change • Implementation: Diffusion of Innovations

16. Theories • Level • individual: Attribution • environmental: Organizational change • Problem & Action • problem: Planned Behaviour • action: Elaboration likelihood

17. Intervention Mapping • Needs assessment • Intervention mapping • Learning and Change Objectives • Methods & Strategies • Program • Anticipating Implementation • Anticipating Evaluation • Implementation & Evaluation

18. 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?)

19. Programme Objectives • Performance Objectives X • Determinants X • Subpopulations = • Programme Objectives

20. 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

21. Performance Objectives for Condom Use? • - • - • - • - • - • -

22. 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

23. Performance Objectives for Smoking Cessation? • - • - • - • - • - • -

24. Determinants of Behaviour • Those factors that are associated with the behaviour and that probably mediate behavioural change • Personal determinants • External determinants

25. Determinants for Condom Use? • Plan condom use - - - - • Carry condoms - - - - • Negotiate condoms - - - -

26. 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

27. 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

28. Determinants for Condom Use • Negotiate condoms • Subjective norm: what others expect • Subjective norm: arguments against unsafe sex • Self-efficacy: perceived skills for negotiation

29. (Sub)Populations? • Educational level • Age: • Gender: • Ethnicity: • Religion: • Experience:

30. (Sub)Populations • Educational level: Vocational schools • Gender: both in the programme • Ethnicity/Religion: all • Age/Experience: included in the programme

31. 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)

32. 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)

33. 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

34. Modelling Risk appraisal Role models on video Discussion of own experiences Methods & Strategies

35. Methods for Determinants? • Self-efficacy improvement: - - -

36. Methods for Determinants • Self-efficacy improvement: - modelling - re-attribution training - goal setting

37. Parameters for Methods • Modelling: identification, skills, reinforcement, coping • Goal setting: commitment, difficult but available goal

38. Parameters for methods? Risk perception • Fear arousal: -

39. Parameters for methods Fear arousal: - high personal susceptibility in combination with high self-efficacy

40. Modelling • Identify • Perceived skills • Perceived reinforcement • Coping model

41. Modelling: Example • Smoking cessation • Pregnant women • Modelling by video • Stories: • identify • skills • reinforcement • coping

42. Video

43. Modelling: Example 2 • HIV prevention: drug users • Safe use; safe sex • Modelling by brochure • Stories: • identify • skills • reinforcement • coping

48. Methods and Strategies for Condom Use • Fear arousal: videotaped role-modelling • Skills: modelling & discussion

49. Skills Training • Say no • Repeat with arguments • Postpone, alternative • Excuses • Avoid • Attack

50. Modelling: Example 3 • Skills training: negotiating condom use • Video • Desired behaviour • Active learning: stop and think • Scenario • identify • skills • reinforcement • coping