FACILITATING BEHAVIOURAL CHANGE

Facilitating Behavioural Change

Facilitating Behavioural Change

Reproductive health issues account for numerous serious consequences in the adolescent population. Sexually transmitted diseases are a leading cause of morbidity in this age group, and unwanted pregnancy is both a social and a health concern . Despite educational efforts in human immunodeficiency virus/sexually transmitted disease (HIV/STD) prevention and a trend toward increasing condom use among youth within the United States, some three million teenagers acquire a sexually transmitted disease every year .

Although teen pregnancy has decreased in the past five years, there are still almost one million teenagers who become pregnant each year .

It is surprising that pregnancy and disease prevention have not been routinely integrated into prevention programs given the common behavioral risk factors, similar intervention strategies, and client benefits . In part, this lack of integration may be due to the fact that the dollars supporting these efforts often depend on completely separate funding streams, thus making amalgamation difficult. However, developing a more comprehensive approach that would allow providers to target all three outcomes—HIV/AIDS, STDs, and pregnancy—simultaneously would be a welcome innovation.

In 1999 the Greater Options for Adolescent Lives (GOAL) partnership received funding from the Centers for Disease Control and Prevention to implement an innovative service delivery project that integrated STD, HIV/AIDS, and pregnancy prevention efforts. GOAL collaborated with the Boston Public Health Commission and other partner agencies to implement and evaluate a counseling practice for adolescents. The counseling intervention was based on Prochaska and DiClemente's model of transtheoretical behavioral change (stages of change) and .

The transtheoretical model (TTM) has been applied to a variety of psychosocial behaviors including tobacco , exercise , and more recently, condom use and contraceptive compliance and . This model posits that individuals move through a series of motivational stages before achieving a particular target behavior. The five stages of change (SOCs) are precontemplation, in which an individual shows no intention to adopt the health behavior; contemplation, in which an individual shows awareness of personal risk and the need to change; preparation, in which an individual expresses intention to change; action, in which an individual has actively adopted the behavior for a period of less than six months; and maintenance, in which the behavior is sustained for more than six months .

At each stage emotional, cognitive, and behavioral processes influence forward movement. Behavioral change can be facilitated by the use of intervention strategies tailored to an individual's stage of readiness to change.

Although many studies have focused on determining relationships between sexual practices and SOC in both adolescents and adults and , only a few have looked at the impact of using this model as an intervention. Project Cares examined the application of SOCs to HIV/AIDS prevention in adult female populations and found that it was effective in increasing and sustaining consistent condom use among HIV-positive women . Project Respect found that a brief intervention using SOC could promote change in condom use .

The Boston Public Health Commission worked with eight school-based health centers ...