|Facilitating Sustainable Behaviour Change, a Guidebook for Designing HIV Programs (UNDP, 1999, 59 p.)|
What kinds of programs best help to facilitate behaviour change? How can we know where to start?
This guidebook suggests issues to consider when designing programs to facilitate behaviour change. It is written to help people who want to understand the HIV epidemic, consider how it relates to their own lives, and work out effective responses in their own settings.
Behaviour change is central to most effective responses to the HIV epidemic. It can be important to:
· reduce further transmission of HIV
· reduce discrimination against the people most directly affected by HIV
· mobilise community-wide responses
· build consensus about legal, ethical and human rights concerns
· minimise harm associated with drug use and expansion of the sex industry
· organize community-based care for those who are ill, their dependents and the survivors of those who die.
No single method works to facilitate behaviour change to address all issues in all settings. This is because of the nature of the HIV epidemic and the way it interacts with the world. In each different setting, the epidemic has different effects on the individuals, families, communities and nations involved. It is entwined with various aspects of our lives including the social, cultural, economic, political and developmental circumstances in which we live.
However, much is now known about what approaches work best. The most effective programs are those that encourage and nurture change; the least effective are those relying on coercion and force. There are common issues worth considering in designing programs to facilitate behaviour change, and this guidebook presents and explains those issues.
Behaviour change that works in response to HIV is not the result of special processes relating just to the epidemic. The way programs can facilitate HIV-related changes is consistent with the way programs can facilitate changes in other fields. Effective change emerges from the various ways we understand our own worlds and then act within them.
This guidebook draws together theories from various disciplines and life experiences. It does not present entirely new theories or programming models, but does introduce some recent developments not widely understood. In addition, it puts recent theories together in a framework that makes them accessible, and suggests ways to proceed with program design.
Three sources of understanding inform the framework presented here:
· recent developments in psychological explanation of how individuals undertake behaviour change, particularly the stages of change model1
· recent advances in understanding the nature of sustainable human development, suggesting ways to promote development consistent with people's needs and building on their own capacities2
· the authors' own experiences in undertaking changes and in facilitating change amongst others3.
1 JO Prochaska, CC DiClemente, JC Norcross, (1992) In search of how people change: applications to addictive behaviours. American Psychologist 47 (9): 1102-1114
2 Informed especially by the work of the United Nations Development Programme (UNDP) and UNDP's HIV and Development Programme
3 The authors were part of the Australian response to the HIV epidemic in the 1980s and early 1990s, however this resource is also relevant to other countries
The guidebook begins with a critical look at models often used to explain how programs facilitate behaviour change. It then describes how important new developments can inform the design of more effective programs. First, it introduces the stages of change model, which explains how individuals undertake change. Second, it shows how different aspects of people's environments can enable or hinder change. Third, it demonstrates how people can develop the capacity to influence their own environments. Finally, it explains the role programs can play in facilitating such changes, and outlines a framework to consider when designing programs.
To assist with the design of programs using this framework, the authors have developed a workshop outline. This starts on page 45 of this guidebook, and can be used by group facilitators to:
· enhance workshop participants' understanding of how behaviour change comes about in their own settings
· assist group participants to design context-relevant programs
· provide a framework for participatory and developmental evaluation of programs.
Both the guidebook and the workshop curriculum complement the manual Community Action on HIV4 a resource for non-government organisations in Australia and their regional collaborative partners.
4 T Kwarteng, R Moodie, W Holmes, (Eds) (1999) Community Action on HIV a resource manual for HIV prevention and care. Second Edition. Melbourne, Macfarlane Burnet Centre for Medical Research
This guidebook aims to stimulate discussion and reflection amongst those who design programs. It suggests ways of looking at things rather than providing fixed answers. As the epidemic evolves, so does understanding of the complex components that contribute to effective responses. The framework presented here is one more step in the ongoing exploration of what works to facilitate behaviour change.