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IDEATION
AND
INDIVIDUAL
BEHAVIOR CHANGE
D. Lawrence Kincaid and Maria Elena Figueroa
JHU/HCP/CCP/BSPH
HCP Seminar, April 23, 2004
Strategic Communication
Source: DEMOGRAPHY
Cleland & Wilson, 1987
How is ideation related to communication
and behavior change?
Social Self-
Support & Image
Influence BEHAVIOR
Emotions Perceived
Risk
Self-
Norms Implies
Efficacy
communication
can effect all
JOHNS HOPKINS
U N I V E R S I T
O
M IDEATION
COGNITIVE
M DIRECTIVE
Dissemination Beliefs
Promotion Attitudes
U Prescription
Values
Perceived Risk
N Subjective Norms INTENTION
Self-Image
I EMOTIONAL
Emotional Response
confirmation
C NONDIRECTIVE
Dialogue
Empathy BEHAVIOR
Counseling Self-Efficacy
A Entertainment SOCIAL
Social Networks Support & Influence
T Personal Advocacy
I
O PUBLIC
ENVIRONMENTAL
Advocacy
N Regulation SUPPORTS & CONSTRAINTS
Source:
Adapted from
Kincaid (2000)
MODES OF COMMUNICATION
FOR BEHAVIORAL CHANGE
INSTRUCTION
DIRECTIVE NONDIRECTIVE
Dissemination Dialogue
Promotion Counseling
Prescription Entertainment
Social Networks
PUBLIC
Advocacy
Regulation
Ideational Elements Related to Condom
Use in Tanzania 2003
• 1. Knowledge of condom brands
• 2. Perceived efficacy of condoms for AIDS
• prevention
• 3. Social approval for condom use
• 4. Discussion of condom use with others
• 5. Condom use self-efficacy
• 6. Social influence to use condoms
• 7. Personal condom use advocacy
• 8. Impulsivity
• 9. Motivation for sex
• 10. Perceived norm of condom use.
Cumulative increase in condom use among
male and female adolescents by level of
ideation
Tanzania, 2003
80 Percent
58
60
39
40
28
20 16
5
0
One Two Three Four Five
Ideation Quintile
Direct and Indirect Effects of Communication
on Condom Use in Tanzania 2003
0.12
AIDS Prevention Condom
Campaign Recall Use
N.S.
AIDS Prevention Condom
Campaign Recall Use
0.33 0.46
IDEATION
Ideational Elements Related to
Condom Use in Zambia
• 1. Knows where to purchase condoms
• 2. Knows at least three ways to protect self
• from HIV/AIDS
• 3. Has positive attitude towards people who
• use condoms
• 4. Has talked with at least three people about
• safe sex
• 5. Has an above-average sense of confidence
• regarding ability to use condoms even
• when facing opposition from partner
(13-19 year-old males)
Cumulative increase in condom use
among male adolescents in Zambia by the
number of ideational elements that apply
80 Percent
60
60
43
40
28
22
20
8
0
One Two Three Four Five
Number of Elements
Ideational elements related to
contraceptive use among women in
Tanzania
1. No. of modern FP methods known
2. Respondent’s approval of FP
3. Discussion of FP with husband
4. Husband’s approval of FP practice
5. Talks about FP with friends
6. Advocates FP to others
Note: 1996 DHS,
Women ages 15-49
Cumulative increase in contraceptive use by
the number of ideational elements that apply
to married women in Tanzania
60 Percent Traditional Modern 54.5
50 43.9
40 33.0
30
20 13.7
7.6
10 4.2
1.1
0
0 1 2 3 4 5
6
Modern 0.5 1.2 3.2 8.3 26.2 35 46.1
Traditional 0.6 3 4.4 5.4 6.8 8.9 8.4
N = 5,401married women
Chi2; p<.001
CUMULATIVE RISK ANALYSIS
These elements affect behavior in
much the same way that risk factors
affect the probability of getting a
disease:
The greater the number of factors
that apply to an individual, the
greater the likelihood that he/she will
get the disease.
Each one of these influences is
strongly related to adoption and
continuation of modern contraceptive
use. When they are summed into a
combined index, they are highly
predictive of contraceptive behavior.
CONCLUSION
The more ideational elements that
apply to someone, the greater the
probability that they will adopt a
health behavior.
Feelings Feelings
Action Action
Mutual
Agreement
MUTUAL
UNDERSTANDING
SOCIAL REALITY
and RELATIONSHIP
A&B
Effective dialogue
Effective dialogue (Rapoport, 1967) occurs when:
• Participants listen to one another
(paraphrasing to the other’s satisfaction)
• Each acknowledges the conditions to accept
the other’s argument as valid
• Each acknowledges the similarity of both
points of view
Individual Social
Outcomes Outcomes
Societal Impact
Figueroa & Kincaid, 2/2001
CFSC Model
• Not a model for Social Change
Policies Technology
Collective Action
Assignment of Mobilization of
Responsibilities Organizations Implementation Outcomes Participatory
Evaluation
• Individuals
• Existing Community • Media • Outcomes vs.
Groups • Health Objectives
• New Community • Education
Task Forces • Religious
• Others • Other
Social Outcomes
• Leadership
• Degree & Equity of Participation
• Shared Information
• Collective Self-Efficacy
• Sense of Ownership
• Social Cohesion
• Social Norms
Individual Change
• Skills
• Ideation
Knowledge, Attitudes, Perceived
Risk, Subjective Norms, Self-Image,
Emotion, Self-Efficacy, Social
Influence, & Personal Advocacy
• Intention
• Behavior
Interaction of Individual and Social
Outcomes on Health
Individual Health Behavior Change
NO YES
Maintenance Limited
NO of the status Health
quo Improvement
Collective
Change
Increased Self-sustained
potential for health
YES health improvement
improvement
“Those who authentically commit
themselves to the people must
re-examine themselves constantly.”
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