(Fishbein) University of Pennsylvania, (Triandis and Kanfer) University of Illinois, (Becker) Univeristy of Michigan, (Middlestadt) Academy of Educational Development, (Eichler) National Insitute of Mental Health (NIMH) Office on Aids
In this 15-page document from the book "Handbook of Health Psychology", the results of a National Institute of Mental Health (NIMH) workshop of theorists analysed behaviour change theory regarding theory-based intervention for converting individual choices from risky to healthy AIDS-related behaviours. Each participant discussed his or her theory related to AIDS prevention. Participants identified a set of key variables, and finally operationally defined those variables. This document describes the five theories, discusses main points of consensus and the 8 identified variables, illustrates how to assess them, and considers some unresolved issues.
As stated here, the three dominant models in behaviour theory on AIDS are: the health belief model (a public health theory), social cognitive theory (a clinical theory), and the theory of reasoned action (a social psychology theory). The theories of self-regulation and self-control (clinical theory) and of subjective culture and interpersonal relations (social psychology theory) are the others recognised. Included in these 5 theories, there are, as stated here, most of the variables in attempts to understand and change a wide variety of human behaviours.
From these theories, participants focused on identifying key variables that would enable the prediction and understanding of behaviour, seeking the possibility of measuring the variables and examining the strength of associations between a variable and a behaviour in question. The goal was to identify a few strong variables that influence decisions to perform or not perform a given behaviour.
The 8 variables are:
anticipated outcomes (or attitude);
The participants concluded that the first three are necessary and sufficient factors for producing a behaviour. The example given is injected drug use and needle sharing. "If a ...user is committed to using bleach every time he shares injection equipment, has bleach available, and has the necessary skills to use the bleach, the probability is close to 1.0 that he will use the bleach..." The remaining five variables are described as influencing the strength and direction of intention.
The document then describes the development of assessment instruments, particularly those using content analysis of open-ended questions. It looks at terminology that might influence subjective responses, such as "will always use...", "intend to always use...", and will try to always use..." and how those terms may cause conceptual difficulty in surveying across cultures. The document points out the difficulty of assessing environmental constraints on behaviour, such as condom availability, because there is no standardised procedure to measure such constraints. In assessing the relationship between behaviours and perceived outcomes or consequences, the recommendation is to use two questions for each outcome, one assessing the respondent's belief that performing the behaviour leads to the outcome, and the other assessing the value the respondent places on the outcome.
In measuring social pressure, the group recommends first identifying the source of the pressure, and then weighing the respondents’ beliefs about the pressure. For identifying and assessing self-standards, the instrument described is a rating scale for various personal characteristics, such as, cautious or macho or responsible. Similarly, emotional reactions might be measured as a scale to rank feelings, such as positioning a choice between anxious and calm or between frightened and relaxed. A self-efficacy assessment might be devised as a rating of how confident the individual is that they regularly perform the desired or undesirable behaviour.
Consensus on the 8 behaviours was reached by participants, but consensus on the causal model linking variables to behaviours was not. However, the document concludes the following: If a person has not yet formed a strong intention to perform a given behaviour, the goal of an intervention should be to strengthen that person's intention to perform the behaviour. If the person has formed the strong intention but is not acting on it, "the intervention should probably be focused upon improving the skills and/or removing or helping one overcome environmental constraints." As stated here, agreement was reached that interventions, given the limited resources available for prevention and change programmes, should focus on strengthening intentions for desirable behaviours (rather on goals or outcomes), increase skills, and remove environmental constraints.
This document is available through the purchase of the text "Handbook of Health Psychology”, by Baum, Revenson, and Singer (eds.), published by Lawrence Erlbaum, 2001.
Email from Gloria Coe to The Communication Initiative on August 16 2007.