PUBLICACIÓN DE PRIMERA VEZ CAMIONES Y REMOLQUES S A.

Fishbein as cited by Philander (2007) is of the opinion that it is important for scholars working in the behavioural sciences to engage with theory in order to plan and evaluate programmes that could help reduce risk behaviour. Theoretical models may have the ability to facilitate an understanding of health behaviour, direct research and facilitate ‘the transferability of an intervention from one health issue, geographical area or health care setting to another’ (Munro, Lewin, Swart & Volmink, 2007, p ).

As identified earlier in the literature review, there is limited research conducted in relation to disabled adolescents and their risk of HIV/AIDS. Little of this research has engaged with theoretical models of behaviour change. Munro et al. (2007) identify challenges in selecting

appropriate theoretical models for their research on adherence to treatment for HIV/AIDS and tuberculosis given that there are over thirty models of behavioural change. Therefore this section of the literature review describes four theoretical models that are useful underpinnings to HIV prevention programmes and can be applied to both able-bodied and disabled people. These models are: the health belief model (HBM), the AIDS risk reduction model (ARRM), stages of change and theory of reasoned action. The health belief model in particular is considered useful to this study as its key variables focus on perceptions of risk of disease including sexually transmitted infections and HIV/AIDS. I will revisit the HBM in the discussion section of the thesis and draw on its variables in relation to the data for the educators’ and adolescents’ phases:

Health belief model:

The HBM was developed in the USA during the 1950s by social psychologists who were concerned about the limited uptake of free screening programmes for TB available to the public sector. Subsequent to that, the HBM was adapted to HIV/AIDS related risk behaviour. According to this model, the perceived seriousness of a disease such as HIV/AIDS as well as one’s perceived susceptibility or risk influence one’s health behaviour. Demographic and social variables also influence perceived susceptibility and perceived seriousness of disease (Munro et al., 2007). Therefore the key variables of the model as defined by Rosenstock, Strecher and Becker (1994) are:

Perceived threat- this variable consists of two parts: perceived susceptibility and perceived severity of a health condition (e.g. HIV/AIDS).

Perceived susceptibility refers to the individual’s subjective perception of the risk of contracting a health condition while perceived severity refers to the perceptions of the medical and social consequences of the disease.

Perceived benefits: this refers to how the individuals concerned view strategies to reduce the risk of contracting the illness (e.g. condoms to prevent HIV transmission).

Perceived barriers: this refers to how individuals perceive consequences of illness including social stigma or financial problems.

Cues to action: These are events that encourage people to take action on disease prevention e.g. media advertising.

Self -efficacy: the belief in being able to enact the behaviours. The AIDS reduction model

The ARRM is similar to the HBM and also provides a framework of behaviour change of individuals in relation to preventing sexual transmission of HIV/AIDS. This model is a three- stage model and incorporates several variables from other behaviour change theories, including the HBM. These include "efficacy" theory, emotional influences, and interpersonal processes. The stages, as well as the hypothesized factors that influence the successful completion of each stage are as presented below as outlined by Catania, Kegeles and Coates (1990):

STAGE 1: Recognition and labeling of one's behaviour as high risk

This stage consists of hypothesized influences including belief that one is at risk of HIV/AIDS, that HIV/AIDS is socially undesirable and of knowledge of HIV transmission.

STAGE 2: Making a commitment to reduce high-risk sexual contacts and to increase low- risk activities

This stage consists of cost and benefits and response efficacy (i.e. will the behavioural changes reduce risk of HIV infection), self efficacy as well as group norms or social support.

STAGE 3: Taking action.

This stage is broken down into three phases and includes :

1) information seeking; 2) obtaining remedies; 3) enacting solutions.

Stages of Change:

The stages of change theory was developed in 1982 in the USA. Psychologists were researching means of developing appropriate interventions for smokers. The stages of the model try to develop appropriate change for particular stages of the behaviour. As a result, the four original components or stages of the Stages of Change Theory (pre- contemplation, contemplation, action, and maintenance) were identified and presented as a linear process of change. Later, a fifth stage (preparation for action) has been incorporated into the theory, as well as ten processes that help predict and motivate individual movement across stages. In addition, the stages are no longer considered to be linear. Instead they are viewed as components of a cyclical process that is moderately different for each individual. The stages and processes, as described by Prochaska, DiClemente and Norcross (1992), are listed below:

Pre-contemplation: Individual has the problem (whether he/she recognizes it or not) (e.g. sexual risk behaviour) and makes no effort to change their behaviour.

Processes: Consciousness raising. In this phase the individual begins to absorb information and knowledge about the risk behaviour.

Contemplation: In this stage the individual recognizes the problem and begins to think seriously about changing.

Processes: Self-reevaluation (assessing one's feelings regarding behavior)

Preparation for Action: Individual recognizes the problem and intends to change the behavior within the next month. The individual reports behaviour change (e.g. condom usage) However, the defined behavior change criterion has not been reached fully (i.e., consistent condom usage).

Processes: Self-liberation (commitment or belief in ability to change)

Action: Individual has enacted consistent behavior change (i.e. consistent condom usage) for less than six months.

Processes: Reinforcement management (overt and covert rewards). This includes social support networks and access to self-help groups.

Maintenance: Individual sustains new behaviour for six months or more. Theory of reasoned action (TRA):

The TRA is ‘Based on the premise that humans are rational and that the behaviors being explored are under volitional control, the theory provides a construct that links individual beliefs, attitudes, intentions, and behaviour’ (Fishbein, Middlestadt & Hitchcock, 1994). The TRA assumes that a person’s intention to perform a specific behaviour is the only predictor of that behaviour. The intention to perform the behaviour is influenced by attitudes towards the action concerned e.g. beliefs as well as the evaluations of the behaviour. Furthermore it is influenced by

subjective norms including the perceived expectations of others. Behavioural intention then leads to action (Munro et al., 2007).

Components of the theory in more detail are presented below:

Behaviour: A specific behaviour defined by a combination of four components: action, target, context, and time (e.g., implementing a sexual HIV risk reduction strategy (action) by using condoms with partners (target) every time.

Intention: The intention to adhere to behaviour (e.g. condom usage) is the best predictor that the desired behavior will actually occur. In order to measure it accurately and effectively, intent should be defined using the same components used to define behavior: action, target, context, and time. Both attitude (person’s feelings towards performing the defined behaviour) and norms (a person’s perceptions of other people’s perceptions of the behaviour).

In the discussion section, I will revisit how the HBM is most applicable to this study. Perceived benefits, the component of the HBM which refers to how the individuals concerned view strategies to reduce the risk of contracting the illness (e.g. condoms to prevent HIV transmission) is relevant to the ways in which educators and adolescents interviewed for this study respond to the threat of the HIV epidemic.