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Using Theory
Going from Theory to
Practice
How to Use Social and Behavioral Theory in Your HIV Prevention
Programs
Like the Centers for Disease Control and Prevention, the State
Planning Group strongly recommends using HIV prevention
interventions that are based on social and behavioral theory.
Centers for Disease Control and Prevention
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:
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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.
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 Group Level Intervention with Individual Level
Intervention and Street Community Outreach 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 Counseling
and Testing
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 Counseling
and Testing 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 Injection Drug User population. |
| Individual contracting sessions are 15-30
minutes in length. |
Increase the length of the contracting sessions
based on community and participant needs/input. |
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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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Men who have sex with men engaging in unprotected
anal intercourse;
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Injection Drug Users 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
Men who have sex with men 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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