Individual-Level Approaches Behavior Change

1. Individual-Level Approaches Behavior Change Jill Hoxmeier H671 Advanced Theories of Health Behavior

2. Individual Level Approaches • Intrapersonal Theories of Behavior Change • “…they explain health and illness as an outcome of one’s genes or genotype or as a result of personal behavior and lifestyle choices, motivation levels, and confidence to change unhealthy behaviors.” (Goodson, 2010) • In regard to TTI, at which level of the three streams do Intrapersonal level theories work? • Guide vs. Blind: The double-edged sword of theory • They guide our thinking in a specific direction • They blind us to other routes and alternative paths

3. “Shooting in the Dark”HIV Prevention of the 1980s and Early 90s • Fisher & Fisher (IMB) identify the following shortcomings of HIV prevention programs: • Intuitively based, rather than theoretically • Lack of systematic assessment of pre-intervention information, motivation, and behavior • A focus on GENERAL rather than SPECIFIC behavior patters • Information-only interventions • Lack of attention paid to increasing motivation or skill-building • Lack of attention paid to high or at-risk populations • Lack of thorough evaluation of the program

4. Informational – Motivation – Behavioral Skill Model of Behavior Change • Created in response to HIV epidemic • To prevent HIV, people… • Need to know…? • Need to feel compelled to…? • Need to feel confident performing…? Do these concepts sounds like any other constructs of a theory we may know?

5. Behavioral Intentions Theory of Reasoned Action and Theory of Planned Behavior • Behavioral beliefs • Evaluations of behavioral outcomes • Normative beliefs • Motivation to comply • Control beliefs • Perceived power Information Motivation Behavior

6. The Health Belief Model From an Explanatory Theory to a Change Process Theory… IMB • Barriers • Benefits • Perceived Severity • Perceived Susceptibility • Self-Efficacy • Cue to Action • Information • Motivation • Skills

7. Information-Motivation-Behavior • If Fisher & Fisher just told us that one shortcoming of HIV prevention interventions rely too much on information, then why is information relied upon in IMB?

8. Information… tied to prevention behavior • “The 4 modes of HIV transmission are…” Vs. “Condoms are an effective way to prevent HIV when they are used correctly and consistently.” Building off HBM (and using pre-intervention assessment data!) • Barrier to getting tested: not knowing where testing sites are • Prevention-based information provided: Testing services are available at campus health center.

9. Motivation • “15-24 year olds have high rates of STIs.” Vs. “You may be at risk for contracting an STI if you have engaged in any of the following behaviors…” Building off TPB (and using pre-intervention assessment data!) • Attitude toward Behavior: “I don’t like using condoms.” • Evaluation of Behavioral Outcome: “Using condoms will help me be healthy and safe in my dating relationships.”

10. Behavioral Skill • “Talk to your partner about the importance of getting tested.” Vs. Role-plays that allow students to practice negotiating getting tested, monogamy, and condom use. Building off HBM & TPB (and using pre-intervention assessment data!) • A survey item that measures confidence in ability to negotiate condoms or asking partner to get tested… then role-plays • A survey item that measures their motivation to use condoms, get tested, talk to their partner, etc.

11. Theory of Triadic Influence &Information – Motivation - Behavior

12. Theory of Triadic Influence &Information – Motivation - Behavior • How do you see IMB fitting into / running parallel with TTI? • Which stream(s) of TTI do/does IMB operate within? • Is there any overlap? • What factors from other streams impact the influences on behavior presented in IMB? • Does your familiarity with TTI give insight into how IMB could be used in intervention development?

13. Activity • Break into groups of two or three • Develop (a simple) intervention based on IMB: • Group 1: • Health Program: Promoting Bike Safety • Population: Elementary-Aged Children in suburban community • Group 2: • Health Program: Promoting Breast Cancer Screening / Mammography • Population: African-American women in urban area • Group 3: • Health Program: Promoting Physical Activity • Population: College Students • Questions to consider: • What information would you need to find out pre-intervention? • How could you link information to the desired behaviors? • How could you impact motivation to perform desired behaviors? • And what skills are necessary for target population to perform the desired behaviors?

14. Elaboration Likelihood Model of Persuasion • “There is a growing awareness of the importance of health promotion programs that establish sustained behavioral change.” (DCK, 2009) • To understand why certain interventions fail to provide sustained change, researchers and practitioners examine the influence process. • What has experimental research shown to represent one of the most important theoretical constructs that determine behavior?

15. Attitudes • Other factors that also play a role: • Social norms • Strength of attitude • Feelings of self efficacy and competence • Prior behaviors and habits • Intrapersonal vs. Interpersonal • “… when attitudes of many people change, this changes social norms.” • “Positive attitudes toward the self can increase feelings of self-efficacy making behavioral change more likely.” (DCK, 2009)

16. Elaboration Likelihood Model • Useful to measure attitudes: • Toward a general idea (losing weight) • Toward a specific object (vegetables) • Toward a behavior (changing diet) • ELM organized multiple persuasion processes into two routes to attitude change: • Central route: people are relatively thoughtful in their consideration of the issue-relevant information presented • Peripheral route: processes requiring relatively little thought about issue-related information Cognitive vs. Affective?

17. Persuasion on a Continuum • How might the audience be impacted both by their peripheral-route when considering the source for health-related information? Audience Source 9-13 year olds teacher parent older sibling grandparent No thinking Peripheral-dominated decision-making Thinking Central Route-dominated decision-making Consider the Source

18. ELM: Pathway to Persuasion • For attitude shift (either positive or negative) to occur… Motivated to process Able to process Processing creates more favorable or unfavorable thoughts than before Reliable/ consistent thoughts Persuasion!

19. Targeted Messages & Elaboration Conditions Targeting: Messages aimed at groups of people based on identifiable characteristics Tailoring: Messages to match particular concerns of the recipient Matching Effects: Tailoring arguments to personal health concerns and other related characteristics can increase persuasion

20. Targeted Messages & Elaboration Conditions • Matching Under Low Elaboration Conditions • Linking messages to the self • Matching Under Moderate Elaboration Conditions • Increase perceived personal relevance, increase extent of careful thinking • Tailoring Under High Elaboration Conditions • Matching message to individual concerns How do we create a message that our audience can relate to, identify with, and appeals to their existing issue-relevant knowledge?

21. Health Communication Messaging • With a partner, consider the ways you might use concepts in ELM to design targeted messages for: 1. Teen pregnancy prevention 2. Testicular cancer screening 3. Cigarette smoking for middle school students 4. Nutrition for older adults

22. “Turning the Ship Around” • As a practitioner / researcher, what is your experience with individual-level approaches to behavior change? • What has shaped your practice – and theoretical approach – to health promotion? Are there circumstances which may be more beneficial for using Intrapersonal level theoretical approaches? • If we consider the irrational / affective component of decision-making, what would are intervention look like? • Cognitive-Experimental Self-Theory • Model of Interpersonal Behavior • Goodson asks, “What have you been blinded to by focusing on individual-level theories? Are you now able to see some of these elements you couldn’t see before?”