Using theory in behavior change efforts

1. Using theory in behavior change efforts By: Wendi L. Siebold, M.A., M.P.H. Strategic Prevention Solutions www.strategicpreventionsolutions.com

2. Topics Why theory? Types of theories Example: MOST Clubs Common behavior change theories Resources

3. Why theory?

4. Why theory? • Improve your capacity to implement comprehensive prevention • Comprehensive prevention efforts should: • Be evidence-based • Be theory-based • Address multiple levels of the social ecology • Include public health behavior change principles in program content DELTA: Guidance on developing a Comprehensive Primary Prevention Strategy (written by Pam Cox, CDC, 2004)

5. Why theory? We are trying to prevent the behavior of IPV by individuals. Theories provide guidance on how to affect the behavior of individuals by changing attitudes, knowledge, norms, practices, and policies at all levels of the social ecology DELTA: Guidance on developing a Comprehensive Primary Prevention Strategy (written by Pam Cox, CDC, 2004)

6. Why theory? Theories of change should guide the development of programs and activities by helping practitioners explain how their planned activities will change attitudes, knowledge, norms, practices, policies - and ultimately behavior DELTA: Guidance on developing a Comprehensive Primary Prevention Strategy (written by Pam Cox, CDC, 2004)

7. Why theory? It is not enough to say, “This program is based on feminist theory” Say it is “informed” by feminist theory and combine it with another theory that states the mechanisms by which behavior is changed You can use ‘formal’ or ‘informal’ theories DELTA: Guidance on developing a Comprehensive Primary Prevention Strategy (written by Pam Cox, CDC, 2004)

8. Which prevention activities are you implementing that are already connected to theories? What about you? Use chat to answer

9. Types of theories

10. Types of theories • Etiological theories • Why SV/IPV occurs in a given context • Example: a feminist analysis of male privilege and rigid gender control Perry, Brad (2009). Working From A Deliberate Basis: Theory & Primary SV/IPV Prevention. Moving Upstream, Vol. 5: 1, VSDVAA

11. Types of theories • Change theories • Explains how strategies will change the behavior of individuals, and the structures of institutions and communities • Example: social learning model Perry, Brad (2009). Working From A Deliberate Basis: Theory & Primary SV/IPV Prevention. Moving Upstream, Vol. 5: 1, VSDVAA

12. Types of theories • Process theories • Explain the interconnected steps through which a group, community, or institution would move in order to realize a goal, or set of goals • They are the ‘Roadmap’ of program implementation • Usually represented in a logic model Perry, Brad (2009). Working From A Deliberate Basis: Theory & Primary SV/IPV Prevention. Moving Upstream, Vol. 5: 1, VSDVAA

13. Types of theories Use Theory !! “Most SV/IPV programs do not incorporate deliberate, established rationales in the development of primary IPV prevention projects - the benefits of which can augment and exist alongside of those insights gleaned from intuition and practical experience” Perry, Brad (2009). Working From A Deliberate Basis: Theory & Primary SV/IPV Prevention. Moving Upstream, Vol. 5: 1, VSDVAA

14. Types of theories Remember… The roots of the feminist and social justice movement provide the context for change Change theories are based on studies of human behavior change

15. Example:Men can stop rape (most clubs)

16. Example: MOST clubs Etiological theory Link between sexual violence perpetration and peer support for sexually adversarial attitudes and behaviors among groups of young men (Gwartney-Gibbs. et al., 1987) Could address these problematic attitudes and behaviors by tapping into these peer bonds through honest and open male-to-male dialogues These peer bonds could be used to strengthen positive attributes of young men Perry, Brad (2009). Working From A Deliberate Basis: Theory & Primary SV/IPV Prevention. Moving Upstream, Vol. 5: 1, VSDVAA

17. Example: MOST clubs Change theory Social learning model Facilitates peer-to-peer learning where participants share stories, challenges, and successes, and receive reinforcement from each other on adopting behavior that is both affirming to themselves as men, and not harmful to the women or men in their lives Perry, Brad (2009). Working From A Deliberate Basis: Theory & Primary SV/IPV Prevention. Moving Upstream, Vol. 5: 1, VSDVAA

18. Example: MOST clubs Process theory Logic model Perry, Brad (2009). Working From A Deliberate Basis: Theory & Primary SV/IPV Prevention. Moving Upstream, Vol. 5: 1, VSDVAA

19. What are other examples from your own prevention activities? What about you?

20. Common behavior changetheories

21. Social learning / cognitive theory US Surgeon General's Report on Physical Activity and Health, Chapter 6 - Understanding and Promoting Physical Activity Behavior is affected by environmental influences, personal factors, and attributes of the behavior itself Self-efficacy is key - A person must believe in his or her capability to perform the behavior A person must also value the outcomes or consequences that he or she believes will occur as a result of their behavior (immediate or long-term benefits) Self-efficacy can be increased by providing clear instructions, providing the opportunity for skill development or training, and modeling the desired behavior

22. Theory of reasoned action / planned behavior • Behavior is determined by a person's intention to perform that behavior • Intention is determined by two major factors: the person's attitude toward the behavior and the influence of the person's social environment or subjective norm • The theory of planned behavior adds the concept of perceived control over the opportunities, resources, and skills necessary to perform a behavior US Surgeon General's Report on Physical Activity and Health, Chapter 6 - Understanding and Promoting Physical Activity

23. Health belief model • Behavior depends on the person's perception of four areas: • the severity of a potential illness • the person's susceptibility to that illness • the benefits of taking a preventive action • the barriers to taking that action • Also incorporates cues to action (e.g., leaving a written reminder to oneself to walk) • Self-efficacy has been added US Surgeon General's Report on Physical Activity and Health, Chapter 6 - Understanding and Promoting Physical Activity

24. transtheoretical model • Also called “stages of change” • Behavior is a five-stage process or continuum related to a person's readiness to change: precontemplation, contemplation, preparation, action, and maintenance • Stages are spiraling or cyclical, not linear • Change depends on doing the right thing (processes) at the right time (stages) • Tailoring activities to match a person's readiness or stage of change is essential US Surgeon General's Report on Physical Activity and Health, Chapter 6 - Understanding and Promoting Physical Activity

25. Big picture US Surgeon General's Report on Physical Activity and Health, Chapter 6 - Understanding and Promoting Physical Activity Most behavior change theories highlight the role of: The outcomes of behavior Perceptions of control over behavior Social influences Most theories do not address the influence of the environment (this is why we focus on the ecological model to frame our prevention efforts in a more comprehensive way)

26. Any other theories that you are considering? What are your next steps? What about you?

27. resources • Overview of theories • http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html • Theory of Planned Behavior • http://people.umass.edu/aizen/tpb.html • CDC document outlining main components of comprehensive prevention • Public health textbooks • Prevention Principles handout – “Theory”