Behaviour Change Theory in Practice: A review of four HIV organisations

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The brief for this report was to produce case studies of behaviour change for HIV risk from Oxfam-partnered non-governmental organisations from the Limpopo province, in the ‘far north’ of South Africa. The research process aimed at locating behaviour change in social science theory and developing case studies of four organisations with a focus on the following issues: The nature of behaviour change used in the organisations’ programmes, identifying where, when, how and with whom behaviour change strategies are used, development of behaviour change programmes in these organisations, examples from the organisations’ work of effective and less effective strategies for behaviour change in an HIV context, lessons learned from the development of behaviour change programmes.
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  Behaviour Change Theory in Practice: A Review of Four HIV Organisations. Report Commissioned by JOHAP, Durban, South Africa Prepared by:   Prof. G.C. Lindegger Mr. V.P. Solomon Ms. Z. Essack Mr. D. R. Blackbeard School of Psychology Pietermaritzburg November 2007  Introduction...........................................................................................................3 1. Literature Review: Theories of Behaviour Change........................................4 1.1. Individual theories of change and their implications for HIV programmes..5 Box 1: Social Marketing and the Love Life Programme........................................6 1.2. Models based on communication for change.............................................8 1.3. Gender-based interventions.......................................................................9 Box 2: Transforming men’s behaviour through participation...............................10 1.4. Integrative approaches to behaviour change...........................................10 Box 3: Problematising ‘participation’ and ‘empowerment’...................................12 Box 4: Community-based gender intervention: Stepping Stones........................12 1.5. Conclusion...............................................................................................13 2. Introducing the Organisations......................................................................14 2.1. Bela-Bela HIV and AIDS Prevention Group.............................................14 2.2. Centre for Positive Care...........................................................................14 2.3. Phelang Community Programme.............................................................15 2.4. Thohoyandou Vicitim Empowerment Programme....................................16 3. Behaviour Change Interventions: Analysis of Programmes.........................17 3.1. Comparative Aims of Organisations........................................................17 Box 5: Integrated Aims at Bela-Bela...................................................................19 3.2. Mechanisms for Determining Programme Aims.......................................19 3.3. Recipients of Organisations.....................................................................21 Box 6: Targeting Victims of Domestic Violence in Ivhembe District....................22 Box 7 Bridging Social Capital as Facilitating an Enabling Environment.............23 3.4. Target Behaviours...................................................................................23 Box 8: Targeting Abstinence and Delayed Sexual Debut...................................24 Box 9: Processes for Tailoring Programmes to Meet Local Needs....................25 Box 10: Identities and Brands in a Social Marketing Strategy............................26 3.5. Interventions............................................................................................26 Box 11: Skills-Transfer and Mentoring at the Centre For Positive Care.............28 Box 12: Peer Educators at the Phelang Community Centre...............................29 3.6. Risks........................................................................................................30 Box 13: Integration of Programme Clusters in Thohoyandou.............................31 3.7. Criteria of Effectiveness...........................................................................32 Box 14: Participant Perspectives on Support Group Effectiveness....................33 3.8. Emerging Lessons...................................................................................34 3.9. Sources of Intervention Strategies...........................................................35 Box 15: Transformatory Praxis...........................................................................35 3.10. Challenges...........................................................................................36 Box 16: Conversations with Traditional Healers.................................................38 1  4. Conclusion...................................................................................................39 References.........................................................................................................42  Appendix 1: Interview respondents across the four organisations......................46  Appendix 2: Summary tables of content analysis results....................................47 Table 1: Comparative aims of organisations......................................................47 Table 2: Recipients of organisations...................................................................48 Table 3: Target behaviours.................................................................................49 Table 4: Interventions.........................................................................................50 Table 5: Risks.....................................................................................................50 Table 6: Criteria of effectiveness........................................................................51 Table 7: Indicators of effectiveness....................................................................52 Table 8: Sources of behaviour change strategies...............................................53 Table 9: Emerging lessons.................................................................................53 Table 10: Challenges in implementing interventions Table 11: Local risk factors and community challenges.................................................................................54 Table 11: Local risk factors and community challenges.....................................55  Appendix 3: Selected Diagrammes of content analysis results..........................56 Figure 1: Comparative Aims of Organisations....................................................56 Figure 2: Intervention recipients.........................................................................57 Figure 3: Emerging Lessons..............................................................................58 Figure 4: Local Risk Factors and Community Challenges.................................59 2  Introduction The brief for this report was to produce case studies of behaviour change for HIV risk from Oxfam-partnered non-governmental organisations from the Limpopo province, in the ‘far north’ of South Africa. The research process aimed at locating behaviour change in social science theory and developing case studies of four organisations with a focus on the following issues: ã  The nature of behaviour change used in the organisations’ programmes ã  Identifying where, when, how and with whom behaviour change strategies are used ã  Development of behaviour change programmes in these organisations ã  Examples from the organisations’ work of effective and less effective strategies for behaviour change in an HIV context ã  Lessons learned from the development of behaviour change programmes Following ethical approval of the research from the University of KwaZulu-Natal, preliminary email contact and telephonic interviews with each organisation took place, followed by visits by the research team to the sites of each of the four organisations. Following processes of individual informed consent, interviews took place at the visits to each organisation. Interviews were conducted with respondents from the organisation to include all levels such as beneficiaries, community stakeholders, volunteer implementers, implementers employed by the organisation, coordinators and programme leaders, management representatives and community members. Interviews took place at the administrative offices of organisations and important service sites in the community such as several primary health centres (PHCs), a school, and community meeting places in rural villages. Volunteer interview respondents were identified by organisation members and participated either individually or in groups. Following individual informed consent, semi-structured interviews took place using individual or focus-group formats, contingent upon what was appropriate for the respondents. The option of an interpreter was made available to all respondents and 3
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