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How to Use Social and
Behavioral Theory in Your HIV Prevention Programs
Going from Theory to
Practice
Like the CDC, the State Planning Group strongly recommends using
HIV prevention interventions that are based on social and behavioral
theory. CDC also stipulates these interventions must have been proven
to be effective through a thorough evaluation of the program.
If your
desired population fits into the intervention chosen, you may
replicate the intervention without any changes and feel confident that
the outcome of the intervention will have the same positive outcome as
the original intervention. However, if for any reason you must adapt
the intervention, you must maintain the core elements of the
originally evaluated intervention.
Fortunately, if you have
modeled your program after an evidenced-based intervention, ensuring
you have maintained the core elements, your program will likely
be effective in reducing the risk of HIV transmission.
Evidenced-based means that the behavioral, social, and structural
interventions that are relevant to HIV risk reduction, have been
tested using a methodologically rigorous design, and have been shown
to be effective in research settings.
These evidence- or science- based interventions:
-
have been evaluated
using behavioral or health outcomes;
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have been compared to a
control/comparison group(s) (or pre-post data without a comparison
group(s) if a policy study);
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have no apparent bias when assigning
persons to interventions or control groups or were adjusted for any
apparent assignment bias; and,
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produce significantly greater positive
results when compared to control/comparison group(s), while not
producing negative results.
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For Example, let’s say you
want to institute Safety Counts.
This is a
cognitive-behavioral intervention to reduce HIV risk among
active drug users. The intervention is a GLI (with ILI and SCO
activities). The literature states that you are able to use this
intervention with HIV-positive or HIV-negative active drug
users.
If you need/want to adapt this
intervention, you must maintain the core elements.
The intervention also contains key characteristics that
could be changed based on the needs/input of your population.
The core elements of this
intervention are as follows:
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1) Two group sessions
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identify the client’s HIV risk and
current stage of change,
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hear risk reduction stories,
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set personal goal and
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identify first step to reduce HIV
risk.
2) One individual counseling session
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discuss/refine risk-reduction goal,
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assess client’s needs, and
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provide indicated referrals to C&T
and medical/social services.
3) Two (or more) group social events
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share meal and socialize,
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participate in planned HIV related
risk-reduction activities,
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receive reinforcement for personal
risk reduction.
4) Two (or more) follow-up contacts
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review client’s progress
in achieving risk-reduction goal,
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discuss barriers encountered,
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identify concrete next steps and discuss possible
barriers/solutions,
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make referrals to C&T and medical/social services.
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The key characteristics
that can be changed are:
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Key Characteristics |
How They Can Be Changed |
| Provide planned HIV-related risk
reduction component in the group social event. |
The component can be in the form
of educational games, workshops, roundtables, or a featured
speaker. The form used should be based on community involvement
in the intervention planning process. |
| The Safety Counts kit comes with
a video of risk-reduction success stories. |
Make your own video, produce audio
tapes, written stories or arrange live testimonials describing
personal risk-reduction successes using the local IDU
population. |
| Individual contracting sessions are
15-30 minutes in length. |
Increase the length of the
contracting sessions based on community and participant
needs/input. |
Top of Page
Defining Intervention and
Strategy
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Intervention - a specific activity (or set of related
activities) intended to change the knowledge, attitudes, beliefs,
behaviors, or practices of individuals and populations, to reduce
their health risk. An intervention has a distinct process, outcome
objectives, and a protocol outlining the steps for implementation.
Strategy – a strategy is a particular method or approach
consistently used in the course of the intervention. An example of
a strategy would be to use peers to provide the instruction during
a group level intervention presentation. |
Regardless if you are using an evaluated intervention which demonstrates effectiveness or one that you are creating using a
scientifically based theory, there are five important things that
you must know about your population.
1) What community or
prioritized population are you trying to reach?
2) What specific behaviors place them at risk
?
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MSM engaging in
unprotected anal intercourse;
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IDUs sharing needles and/or having
unprotected sex with multiple partners;
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those engaging in unprotected
intercourse with multiple partners; or
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heterosexually identified MSM
engaging in unprotected anal intercourse
3) What factors impact their
risk taking behavior ?
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Risk appraisal – stereotype
who is at most risk, fatalism, hierarchy;
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Self-protection –
self-efficacy expected outcome;
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Emotion and arousal:
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Relationship issues – gender
roles, peer pressure, interpersonal power dynamics;
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Structural and environmental
factors – racism, sexism, and social policy
4) What intervention type
best addresses these factors?
and
5) What theories or models best address these factors?
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Committee Members
2006
State Planning Group
Activities/Effective Interventions and Strategies Committee Members
Charles Fann, Tacoma-Pierce County Health
Department, Committee
Co-Chair (At-large member)
M. Madeline Sanchez, Committee
Co-Chair (At-large member)
Mary Lou Briceno, Yakima Health District (Region 2)
Jerry Carlin, Community Member (Region 5)
Barry Hilt, Spokane Regional Health District (Region 1 AIDSNET
Coordinator)
David Richart, Lifelong AIDS Alliance (At-Large Member)
Department of Health, HIV Prevention and Education Services Staff
Frank E. Hayes
The 2006 Committee would
like to give a special thanks to the work accomplished on this
document by the 1999 and 2004 State Planning Group's Effective
Interventions and Strategies Committee.
Top of Page
Original Draft presented to State Planning Group on February 25,
1999
Updated and presented to the State Planning Group in February 2004
Updated and
presented to the State Planning Group on May 31, 2007
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HIV/AIDS
Prevention and Education Services
