Stages of Change A Model for Understanding Behavior Change

Target Behaviors  Abstinence (penetration)/ delay in sexual debut  Reduction in # of sexual partners  Correct, consistent condom use with all partners  Mutual fidelity  Use of water-based lubricants  STI testing and treatment seeking behavior  Voluntary HIV testing and counseling (VCT)  Promotion of human rights for groups vulnerable to HIV

Target Populations Messages must be tailored to the needs of the group. Messages must be tailored to the needs of the group. Adolescents (male & female, age appropriate) Adolescents (male & female, age appropriate) Migrants (farm workers, young people, wives) Migrants (farm workers, young people, wives) Mobile populations (truckers, taxi drivers, etc.) Mobile populations (truckers, taxi drivers, etc.) Young men, young women (18 – 30 years old) Young men, young women (18 – 30 years old) Garifuna populations (Belizean, Honduran) Garifuna populations (Belizean, Honduran) People who are infected with HIV People who are infected with HIV MSM (open, bisexual, closeted, MSWs, transvestites) MSM (open, bisexual, closeted, MSWs, transvestites) CSWs (fixed-site, ambulatory, transactional) CSWs (fixed-site, ambulatory, transactional) Uniformed populations (police, military, etc.) Uniformed populations (police, military, etc.) Prisoners (males, females, adolescents) Prisoners (males, females, adolescents)

The model: Transtheoretical Model of Behaviour Change  Frequently used in Public Health as a basis to motivate people to adopt healthier behaviors.  Recognizes that human behavior change is a multi-stage process.  Breaks it down as a series of “steps” needed to reach the desired behavior  Stresses the need for individualized interventions, taking into account a person’s stage, attitudes and influencing factors.

The Stages of Change  Precontemplation  Contemplation  Preparation  Action  Maintenance  Termination  Relapse

1. Precontemplation  When the individual has no interest in adopting the new, healthier behavior and/or identifies no personal risk that would motivate him/her to adopt a new behavior.

2. Contemplation  The person identifies some risks of not changing, and/or begins to identify the benefits of adopting a new behavior.  He/she begins to consider adopting the behavior, but hasn’t done anything yet to change.

3. Preparation  The person has a firm intention to adopt the new behavior in the near future and begins to identify actions to take in order to initiate change.  A person in this phase begins to experiment with the change.

4. Action  The person adopts a new behavior and implements it during a period of 6 months.

5. Maintenance  The person has been implementing the healthy behavior for more than 6 months and has taken measures to avoid a relapse.

6. Termination  The behavior is automatic for the person; he/she doesn’t question the need for the healthier behavior at all.

Relapse/Regression  In any one of the stages, a person may regress to a previous stage, or back to precontemplation.  This is very common and should not be treated as a failure.

Exercise  What new behavior have you adopted?  What made it easier/more difficult for you to adopt the change?

Open Questions What?Who?Where?Which? How many? When?How?Why?

Influencing Factors  Factors that facilitate or impede advancement to the next stage during the process of change.

Influencing Factors Personal Risk Perception  The person is convinced that a specific behavior poses a risk with consequences that can affect him/her personally.

Influencing Factors Self – Efficacy (a person’s ability)  The person is convinced of his/her ability to take the necessary actions to reduce his/her risk, even in difficult circumstances.

Influencing Factors Effectiveness of the response (trust in the solution)  The firm belief that the actions taken are an effective means of protecting yourself.

Influencing Factors Socialnorms  Perception of the approval or disapproval from other people about the new behavior.

Influencing Factors Attitude  Favorable or unfavorable beliefs and feelings about the adoption of the specific behavior.

Influencing Factors Accessibility to resources  The ability to obtain the means necessary to protect yourself.

Influencing Factors  Which factors influence our target populations, encouraging or impeding their progress?  What should we be asking them to help them identify and evaluate these factors?

Risk Reduction  We should recognize that we won’t be able to motivate everyone to adopt new, healthier behaviors permanently.  Any behavior that helps to reduce the risks of our target populations should be considered as an achievement.

Achievable Goals Abstain from sex if you’ve taken drugs or alcohol Use condoms with your casual partners Talk to your sexual partner(s) about condoms/lubricants/STI testing Buy a bottle of water-based lubricant Try non-penetrative relations Try non-penetrative relations

Achievable Goals  We should suggest a variety of options for acheiveable goals, and allow the participants to pick the options that work best for them.  It is easier to adopt new, healthier behaviors if you see that small, easier ones work.

Thank you!