Overview of The Popular Opinion Leader Community-level HIV Prevention Intervention

1. Overview of The Popular Opinion Leader Community-level HIV Prevention Intervention For those considering implementing or funding implementation of the POL intervention. (P O L)

2. Sally, Tom, Larry, and Joan's most trusted and admired friends influenced them to regard the popular opinion in their social circles as one supportive of HIV risk reduction behaviors. Popular and credible friends indicated to Sally, Tom, Larry, and Joan that they strongly believe in and practice HIV risk reduction. Other “opinion leaders” also influenced admiring peers across all the social circles in this community. Social norms supporting HIV risk reduction now predominate as the popular opinion across the whole of Sally, Tom, Larry and Joan's community.

3. Summary of the Popular Opinion Leader (POL) intervention • Identify, recruit, support, and deploy popular and credible social network opinion leaders (POLs) to model and promote risk reduction supportive opinions and practices to their friends and acquaintances within their shared social networks. • Social network peers are influenced by POLs to take up the risk reduction opinions and practices. • Network by network the opinion diffuses (spreads and is "taken up") in the community so that HIV risk reduction/safer sex becomes the popular opinion and prevalent norm. • Norms influence the behavior of community members. POL targets perceptions of the acceptability of safe practices in the community.

4. Objectives of this Overview Presentation To help you learn about POL and consider implementing or funding implementation of the POL intervention: 1. Describe the POL intervention. 2. Describe capacity needed and technical assistance available to support implementation of POL.

5. Background: What is the POL intervention? • Community-level intervention. • Based on diffusion of innovation theory. • Evidence of effectiveness.

6. Community-level • Conceptually targets collectively held element(i.e., a social norm), rather than the individual as unit. • Social norms (factors that exist at the level of the community)shape individual behavior. • Efficiency of targeting social norms(basic influence on behavior; hence, efficiently impact behaviors).

7. Diffusion of Innovation Rogers, EM. (1983) Diffusion of Innovations. New York: Free Press. • Behavior trends typically and predictably follow adoption by opinion leaders. • Mechanisms: modeling; observational learning; personal influence; belief that adopting the behavior will be beneficial; and creation of new or strengthening existing social norms. • Sufficient numbers (15%) and connectedness of credible, well-liked, trusted, trend setters (POLs) model the norm.

8. Major tasks in implementing POL • Formative research to establish and adapt intervention, identify population (including its subgroups/social networks), risk behaviors, and Popular Opinion Leaders (POLs). • 2. Recruit, train, support, and deploy POLs. • 3. Evaluation (process evaluation to monitor adherence to the model so that desired effect can be achieved).

9. Who are the POLs? • POLs belong to the social networks that exist in a community. • Local assessment needed to identify the POLs who are specific to each subgroup. • Important to be able to "map" the social networks and indigenous trend setters (POLs) within the networks. • Respected, credible, relevant life experiences, trustworthy, empathetic to friends, well-spoken, articulate, and self-confident.

10. EVIDENCE OF EFFECTIVENESS

11. 9 Core Elements of POL 1. POL is directed to identifiable target population in well-defined community venues where the population's size can be estimated. 2. Ethnographic techniques are systematically used to identify segments of the target population and to identify those persons who are most popular, well-liked, and trusted by others in each population segment. 3. Over the life of the program, 15% of the target population size found in the intervention venues are trained as POLs.

12. Core elements cont’d 4. The program teaches POLs skills for initiating risk reduction messages to friends and acquaintances in everyday conversations. 5. The training program teaches POLs characteristics of effective behavior change communication messages targeting risk related attitudes, norms, intentions, and self efficacy. In conversations, POLs personally endorse the benefits of safer behavior and recommend practical steps needed to implement change. 6. Groups of POLS meet together weekly in sessions that use instruction, facilitation modeling, and extensive role exercises to help POLs refine their skills and gain confidence in delivering effective HIV prevention messages to others. Groups are small enough to provide extensive practice opportunities for all POLs to shape their communication skills and create comfort in delivering conversational messages.

13. Core elements cont’d 7. POLs set goals to engage in risk reduction conversations with friends and acquaintances in the target population between weekly sessions. 8. POLs conversational outcomes are reviewed, discussed, and reinforced at subsequent training sessions. 9. Logos, symbols, or other devices are used as "conversation starters" between POLs and others.

14. POL tasks and characteristics.

15. Formative research, and tailoring and adapting strategies: • Describe the population members, social networks, popular opinion leaders, and HIV prevention-related norms in need of promotion. • • Use rapid ethnographic assessment/formative research methods • (e.g., sociometric survey; • observational studies; • gatekeeper/key informant interviews (and support); • focus groups; • KAB surveys; and • existing needs and risk assessments; market and census studies) • to develop support for the intervention and a description of the: • a. population, • b. subgroups (social networks), • c. popular and credible opinion leaders, • d. HIV risk reducing norms for promotion, and e. appealing and relevant intervention marketing strategy.

16. II. Recruitment, training, deployment and support of POLs. Recruit POLs from the populations' social networks. •Identify and develop an appropriate recruitment strategy. •Recruit POLs.

17. II. POL recruitment, training and support, continued: Train the POLs. • Use the POL participants' manual and POL training manual. • Utilize formative information to tailor population specific content. • Teach POL intervention theory and philosophy; provide accurate HIV risk reduction information; practical advice on implementing HIV risk reduction behavior changes; communication skills training, including modeling and role playing; initiation of risk reduction conversations with peers.

18. II. POL recruitment, training and support, continued: 4. Deploy and continually support the POLs to model the risk reduction normative opinions. • POLs engage in at least 14 conversations with different friends and acquaintances among whom they are popular and trusted. • Provide enticing opportunities - like reunion meetings or parties - for POLs to encourage and maintain POLs in continuing to model risk-reduction supportive opinions. • Need to maintain the intervention as POL cadres are deployed and supported, and opinion diffuses through the population.

19. NOTE A: POLs are to be recruited, trained, deployed, and supported in cadres or cohorts over the course of the program. \ • POLs augment and support POL recruitment through referrals of other POLs. • Training groups need to be small enough to allow for sufficient practice by POLs to effectively model risk reduction supportive opinions. • Resources for your POL intervention will help to dictate the logistics of your recruitment, training, deployment and ongoing support of POLs in cadres or cohorts.

20. NOTE B: Logos, symbols or other devices like social marketing support your intervention. • Such "branding" can help advertise and promote your intervention. • Assists in spreading the message to the extent that they promote and reinforce recognition and belief in the opinions that are promoted to be popular. • Supports the POLs by providing them with recognizable "conversation starters."

21. Four formal training sessions, 1 1/2 - 2 hours each session, and Time between sessions needed for practice. Session 1: Teaching POLs about HIV and Risk Reduction Issues. Session 2: Teaching POLS about effective communication strategies to change norms. Session 3: Practicing risk reduction conversations. Session 4: Continuing risk reduction conversations and inspiring maintenance.

22. Capacity and Technical Assistance to Support Implementation of POL

23. Agency commitment and capacity needed • Support from within agency. • Access to population at risk and population in need of intervention services, community partners, community locales and venue staff. • Funding: 1 - 2 program staff (part- or full- time), 1 administrative staff (part-time). • Space to run training and support events. • Knowledge of and skills related to conducting the intervention.

24. What are the costs? • Level of resources your agency is willing or able to commit relates to the intervention population size your agency can intervene with using the POL intervention. • Estimate your resources and costs to plan your intervention. • Breakdown of cost items and units based on original research trial - volunteer, donated facilities, and existing overhead can reduce estimates while other (miscellaneous) expenses like staff training for POL may increase estimates. • Possible to estimate a per POL cost (which can help estimate the population size with which you can intervene).

25. Breakdown of cost items and units based on original research trial [handout] Unit Cost1 #of Units Total costs Salary1 Senior/supervisory staff $/hour 200 hours $ _______ Junior staff $/hour 202 hours $ _______ Administrative staff $/hour 19 hours $ _______ “Bar staff”2 $/hour 16 hours $ _______ Total Salary Cost $ _______ Incentive payments3 POL incentives $/POL 43 POLs $ _______ Other Expenses4 Meeting room rental $/session 8 sessions $ _______ Staff local travel $/roundtrip 36 roundtrips $ _______ Refreshments POL trainings $/session 8 sessions $ _______ Pamphlets $/pamphlets 1500 pamphlets $ _______ Posters $/poster 20 posters $ _______ Miscellaneous costs $ --- ---- $ _______ Subtotal Overhead (25%)5 + subtotal Total $ _______ 1 Insert total hourly rate, including fringe benefits costs 2 This refers to incentives paid to key informants related to nominating POLs 3 Optional expenses 4 Expense may vary 5 Excludes utilities, office rental, maintenance, and general administrative costs www.effectiveinterventions.org

26. Technical Assistance to Support Implementation • Training, including relevant supportive trainings (skill sets needed). www.effectiveinterventions.org • Published resources. • Web resources. • CDC technical assistance system. • Implementation challenges: strengths and weaknesses of the POL intervention.

27. Intervention challenges • Emerging empirical knowledge of the theoretical and methodological challenges to replication and implementation of community level interventions. • Non-traditional intervention! Role change from that in traditional individual interventions. It is different than teaching individuals alone or in small groups. • Labor intensive! Commitment, skill, creativity, perseverance, and positive attitude needed to reach and engage community. • Attitudes in HAART era may pose new challenges to community and individual interest in participation.

28. Intervention strengths (features recap) • Efficient: can reach many people in a short amount of time. • Emphasizes community empowerment. • Uses an empirically-tested, effective model. • Based on “friends influencing friends” approach. • Model can address other pertinent issues. • Broad adaptability to populations.