Theory-Based Framework for Intervention and Evaluation in STD/HIV Prevention

By Fisher, William A. | The Canadian Journal of Human Sexuality, Annual 1997 | Go to article overview

Theory-Based Framework for Intervention and Evaluation in STD/HIV Prevention


Fisher, William A., The Canadian Journal of Human Sexuality


William A. Fisher

Department of Psychology

Department of Obstetrics & Gynaecology

University of Western Ontario

London, Ontario

ABSTRACT: This paper examines the fundamental role of social science theory as a basis for the construction of STD/HIV prevention interventions and as a basis for the evaluation of such interventions. Theoretically based approaches to STD/HIV prevention have the potential to specify critical factors to target for change, to suggest methods for effecting change, and to guide us in evaluating STD/HIV prevention intervention process and outcome. Examples of theory-based approaches to the creation and evaluation of STD/HIV prevention interventions involving the Information-Motivation-Behavioural Skills Model, the Theory of Reasoned Action/Theory of Planned Behaviour, and Social Network Theory are presented and discussed.

[Part 1 of 2]



Key words:  HIV prevention        STD prevention
            Elicitation research  Evaluation strategies

[Part 2 of 2]



Key words:  Theory-based interventions

ACKNOWLEDGEMENTS: Work on this manuscript was supported by research grants from Health Canada, the U.S. National Institutes of Health, and Janssen-Ortho Inc.

Correspondence concerning this paper should be directed to William A. Fisher, Ph.D., Department of Psychology and Department of Obstetrics and Gynaecology, Social Science Centre, University of Western Ontario, London, Ontario, Canada, N6A 5C2. email: FISHER@SSCL.UWO.CA.

THE ROLE OF SOCIAL SCIENCE THEORY IN STD/HIV PREVENTION

Social science theory is of fundamental importance to STD/HIV prevention because it specifies probable determinants of STD/HIV risk and preventive behaviour. As such, theory can designate factors that should be targeted for change in intervention attempts, and by extension, factors that should be assessed in evaluation research efforts to determine intervention efficacy. In the following sections, theoretical accounts of the determinants of STD/HIV preventive behaviour are outlined and used as a basis for discussing the construction of targeted prevention interventions and the creation of evaluation research strategies appropriate to such interventions.

AN INFORMATION--MOTIVATION--BEHAVIORAL SKILLS APPROACH TO STD/HIV PREVENTION The Information--Motivation--Behavioral Skills model of STD/HIV preventive behaviour (J. Fisher & Fisher, 1992; W. Fisher & Fisher, 1993) proposes that information that is directly relevant to the personal practice of preventive behaviour, motivation to practice prevention, and behavioural skills for practising prevention effectively, are the fundamental determinants of STD/HIV preventive behaviour. The theory suggests that at present, most persons at risk possess inadequate information about the personal practice of preventive behaviour, insufficient personal and social motivation to practice prevention, and inadequate behavioural skills for practising prevention effectively, and that prevailing high levels of STD/HIV risk are the result of this situation. On the basis of this analysis, the theory designates information, motivation, and behavioural skills as critical factors to target for change in intervention efforts to promote preventive behaviour. Evaluation research should therefore monitor these factors, as well as levels of preventive behaviour per se both before and after intervention.

A THEORY OF REASONED ACTION--THEORY OF PLANNED BEHAVIOUR APPROACH TO STD/HIV PREVENTION The Theory of Reasoned Action (Ajzen & Fishbein, 1980; Fishbein & Middlestadt, 1989) and the Theory of Planned Behaviour (Ajzen & Madden, 1986, Basen-Enquist & Parcel, 1992) assert that attitudes towards the personal practice of preventive behaviours, social norms concerning the performance of these behaviours, and perceptions of personal control or ability to successfully enact these behaviours, are critical determinants of STD/HIV prevention. …

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