1. Behavior Change: from Theory to Practice from Theory to Practice Gloria Coe Office of HIV/AIDS USAID Julia Rosenbaum Academy for Educational Development The CHANGE Project May 12, 2003

2. Why Behavior Change?  Key behavioral aspects of all health conditions  Must address if we are to achieve improved health outcomes

3. Behavior Change Communication  Behavior change How to understand behavior change? How to understand behavior change? Robust theories to understand behavior across cultures, diseases/conditions, and disciplines. Robust theories to understand behavior across cultures, diseases/conditions, and disciplines. More than 300 theoriesMore than 300 theories 4-6 widely used (references in handout)4-6 widely used (references in handout)  Communication Tools and strategies to facilitate behavior change. Tools and strategies to facilitate behavior change.

4. AIDSCOM Framework

5. Some Common Factors Or Behavioral Determinants  EXTERNAL Access Access Policy Policy Skills Skills Culture Culture  INTERNAL Knowledge Perceived risk Consequences Self-efficacy Perceived social norms Attitudes Intentions

6. BEHAVEFramework BEHAVE Framework PRIORITY AUDIENCE PRIORITY AUDIENCE BEHAVIOR KEY FACTORS ACTIVITIES In order to help:to:we will focus on:through:

7. PRIORITY AUDIENCE BEHAVIOR KEY FACTORS ACTIVITIES In order to help:to:we will focus on:through: Mothers giving birth in hospitals Begin breastfeeding within one hour of birth and breastfeed exclusively through 6 months Hospital policies Knowledge that breast milk is sufficient Proper BF skills Supportive norms (family & other) Import policies/ national policies on breast milk substitutes Policy change in hospitals Monitoring & regulation of policies Training/support of all birth personnel Radio and IPC aimed at mothers -in-law Mothers support groups Exclusive Breastfeeding

8. Different Factors are Important for Different Health Behaviors InternalExternal Breastfeeding Perceived social norms Self-efficacy Facility norms re rooming in Marketing codes Workplace policy Immunization Perceived consequences (protection, side effects) Accessibility HW behavior Contraception Cultural normsService quality Policies

9. The BEHAVE Framework Works at all Levels  Individuals  Family/household  Community  Institutional systems  Policy makers/Health planners

10. Four Important Factors for HIV/AIDS-Related Behaviors KNOWLEDGEKNOWLEDGE SUBJECTIVE NORMSUBJECTIVE NORM PERCEIVED RISKPERCEIVED RISK SELF-EFFICACYSELF-EFFICACY

11. Questions A. A. AIDS can be a serious health problem for each of us. People infected with AIDS can suffer a great deal. If you were a carrier of the AIDS virus, do you think you could be cured? B. B. Can you do anything to protect yourself against AIDS? What can you do? Does knowing how to use a condom correctly protect you from AIDS? C. C. How do you think people become infected with AIDS? Can an infected person who looks and feels well infect others with AIDS? You can tell by looking whether someone has AIDS. D. D. Do you and your friends ever talk about using condoms? Do your friends use condoms? Has your sexual partner ever suggested using a condom?

12. Self-Efficacy * Statistically significant at p<.05

13. Social Norms *** Statistically significant at p<.001

14. Perceived Risk

15. Knowledge *** Statistically significant at p<.05

16. PRIORITY AUDIENCE BEHAVIOR KEY FACTORS ACTIVITIES In order to help:to:we will focus on:through: Pregnant women Accept an HIV test during prenatal care Comply w/ ARV regimen to prevent vertical transmission of HIV- Specific knowledge about transmission and treatment make a difference Norms about sexuality Perceived consequences of HIV+ diagnosis Health worker attitudes and behaviors Drug availability PMTCT

17. Understanding & Challenging Stigma  Stigma/discrimination challenge to combating HIV/AIDS challenge to combating HIV/AIDS  Research conducted by ICRW/CHANGE and local partners in 3 countries root causes root causes Non-awareness/denialNon-awareness/denial Ignorance/fearIgnorance/fear Shame/blameShame/blame

18. PRIORITY AUDIENCE BEHAVIOR KEY FACTORS ACTIVITIES In order to help:to:we will focus on:through: Pregnant women Accept an HIV test during prenatal care Accept ARV regimen to prevent vertical transmission of HIV- Specific knowledge about transmission and treatment make a difference Norms about sexuality Perceived consequences of HIV+ diagnosis Health worker attitudes and behaviors Mass media Interpersonal communication at various levels Logistics Advocacy (budget allocation/donation) PMTCT

19. HIV-AIDS Anti-Stigma Toolkit  Introduction  Naming the Problem  Half Knowledge & Fear  Sex, Morality, Shame & Blame  Living with and Caring for PLWHAs within the Family  PLWHAs Coping with Stigma  Stigmatized Children  Planning for Action

20. Mass Media Approach  PSI – AIDMARK Kenya Spots

21. Confronting Stigma: Mass Media  Who are these targeting?  Which determinants do they address?  Are they effective? Why/why not?