Change Process

Change: Definitions Cognition Change- a change in knowledge and/or perception of a person Attitude Change- a change in individual's beliefs, predisposition, intentions, and tendencies toward an idea/object Change: Definitions Behavior Change- an alteration in an individual/group's knowledge, attitude and practices/activities Social Change- a departure from existing ways and means of doing things which results in a change of relationships in the system Elements of Change INNOVATION TARGET OF CHANGE CHANGE AGENT STRATEGIES OF CHANGE INNOVATION An idea, set of behavior, new technology, project, or program introduced to effect change TARGET OF CHANGE An individual, group of people, or segment of the community or the entire community itself TARGETS / APPRAISERS Innovators- first to adopt the new practice; tend to be independent, risk-taking and change-oriented individuals Early Adopters- usually the opinion leaders; strong influence on other potential adopters Early Majority Adopters- people influenced by the opinion leaders and mass media Late Majority Adopters- those afraid to embrace change during the trial stage Laggards and Late Adopters- those adamant not to adopt the change even when most people have confirmed the advantages of the innovation CHANGE AGENT A person or group of people introducing the innovation Desirable Qualities and Actions of a Change Agent One must first believe there is a need to change the present state of affairs in health One must have the desire and commitment to be involved in the process of social change One must be willing to go through normative re-educative experiences or processes Once a critical consciousness is attained, one must channel this new sense of consciousness to organization Strengthen existing organizations or form new ones if the old has consistently failed to respond to the expressed needs and interests of its members Learn to integrate with others in doing your information-education work Aggregate these concerns in the organization and plan on how these can be translated to action Establish open lines of communication Avoid grabbing credit or recognition for change efforts Learn to draw important lessons from experiences that would guide you in future change efforts Be willing to take risks STRATEGIES OF CHANGE Deliberate actions, set of activities, approaches, tactics or processes designed to effect change

THEORIES AND MODELS OF CHANGE Why Theory is Important Goes beyond trying to explain actions or inactions of specific individuals. Provides a unified basis for understanding, predicting to the extent possible, and influencing human behavior in general In Reality It would be artificial and impossible to analyze individual's behavior without considering the social context in which they live, or to analyze group behavior without appreciating differences among the individuals who compose that group Before.. The task of changing health-related behavior was thought to be simply a matter of sending health messages Today, Sound Health Promotion Programs Encompass. Extensive research on relevant audiences Skill-building Multi-channeled education Advocacy using influential persons Policy development Community mobilization Organizational, economic, and environmental change An Ecological Perspective: Levels of Influence Adapted from the National Cancer Institute, Health Bulletin No. 2, 2005 An Ecological Perspective: Levels of Influence CONCEPT DEFINITION Individual Factors Individual characteristics that influence behavior such as knowledge, attitudes, beliefs, and personality traits Interpersonal Interpersonal processes, and primary groups including family, friends, and Factors peers that provide social identity, support and role definition Institutional Rules, regulations, policies and informal structures that may constrain or Factors promote recommended behaviors Community Factors Public Policy Factors Social networks and norms or standards that exist formally or informally among individuals, groups and organizations Local and national policies and laws that regulate or support healthy actions and practices for diseaseprevention, early detection, control, and management

ATTITUDE CHANGE Kelman's Three Processes of Social Influence (HERBERT C. KELMAN, 1958) also known as Kelmans Process of Opinion Change Herbert Kelman was an early social psychologist who investigated how people influenced one another, particularly within situations of conflict or stress. He noted the difference between external compliance and internal agreement. Kelman's Three Processes of Social Influence Change can be distinguished into three processes characterized by a distinct set of antecedent and a distinct set of consequent conditions: COMPLIANCE IDENTIFICATION INTERNALIZATION

Processes of Social Influence Compliance Occurs when an individual accepts the authority of another person Identification Change adopted remains attached to an external person (be like influencing agent, reciprocal relationship, group relationship) Internalization Change is congruent with to own value system Example A soldier complies with his colonel's command. He identifies with comrades as they share common values. He internalizes the army training and so believes that armed force is necessary. Theory of Cognitive Dissonance by Festinger Leon Festinger an American social psychologist, responsible for the development of the theory of cognitive dissonance, and the social comparison theory. Festinger is perhaps best known for the theory of cognitive dissonance, which suggests that when people are induced to behave in ways that are inconsistent with their beliefs, an uncomfortable psychological tension is aroused. This tension will lead people to change their beliefs to fit their actual behavior, rather than the other way around, as popular wisdom may suggest.[1] Festinger's (1957) cognitive dissonance theory suggests that we have an inner drive to hold all our attitudes and beliefs in harmony and avoid disharmony (or dissonance). Cognitive dissonance refers to a situation involving conflicting attitudes, beliefs or behaviors. This produces a feeling of discomfort leading to an alteration in one of the attitudes, beliefs or behaviors to reduce the discomfort and restore balance etc. Theory of Cognitive Dissonance by Festinger Utilized the notion that people cannot tolerate discrepancy or inconsistency between their own and other similar person's attitudes - Cognitive dissonance motivates change Dissonance may be reduced by: Changing the internal environment (attitudes and perceptions) Altering the external environment BEHAVIOR CHANGE Health Belief Model by Hochbaum (Godfrey Hochbaum, Rosenstock and Kegels) Behavior is a function of three sets of factors Psychological state of readiness including beliefs about susceptibility and benefits of desired action Situational factors like appearance of symptoms and influence exerted by people whether to take or decline action Environmental condition which includes availability and access to health service Health Belief Model by Hochbaum An individual will change his or her health behavior based on the following Perceived threat Perceived susceptibility Perceived severity Perceived benefits Perceived barriers

Health Belief Model : Other Variables Socio-demographic factors, particularly educational attainment, are believed to have an indirect effect on behavior by influencing the perception of susceptibility, severity, benefits and barriers. Health concern or motive and cue to action HBM Self-Efficacy (Must be Added) Self-efficacy - conviction that one can successfully execute the behavior required to produce the outcomes Outcome expectation - person's estimate that a given behavior will lead to certain outcomes Similar to concept of perceived benefits Implications for HPE Practice Assess educational needs of target population to strengthen program planning add patient's perceived competency to carry out prescribed action over long periods of time and the strength of their conviction in their competence Conduct skills training to enhance self-efficacy for complex behavior Conduct more work Experimental interventions to modify health beliefs and health behavior than on surveys that reconfirm established correlations Factors that need to be added to increase its predictive power Develop awareness of specific situations in which self-efficacy may be low Theory of Reasoned Action (Ajzen and Fishbein) Martin Fishbein and Icek Ajzen (1975, 1980) Theory of Reasoned Action suggests that a person's behavior is determined by his/her intention to perform the behavior and that this intention is, in turn, a function of his/her attitude toward the behavior and his/her subjective norm. The best predictor of behavior is intention. Intention is the cognitive representation of a person's readiness to perform a given behavior, and it is considered to be the immediate antecedent of behavior. Underscored importance of behavioral intention Attitudes (feelings of personally performing behavior) Subjective norm (person's perception of social influence about performing the behavior) Perceived control over the behavior Behavior Change Spiral (TTM) Transtheoretical Model (Prochaska and DiClemente)
The Transtheoretical Model of Behavior Change assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual through the stages of change to Action and Maintenance.

People go through stages before a final change is made Pre-contemplation Contemplation Preparation Action Maintenance Stages of Change Model CONCEPT DEFINITION Pre-contemplation Unaware of the problem; hasnt thought about change Contemplation Thinking about change in the near future Decision/Determination Making a plan to change Action Implementation of specific action plans Continuation of desirable actions, or repeating periodic recommended steps

Maintenance

APPLICATION Increase awareness of need for change, personalize info onrisks & benefit Motivate, encourage to make specific plans Assist in developing concrete action plans; setting gradual goals Assist with feedback, problem solving, social support, reinforcement Assist in coping, reminders, finding alternatives, avoiding slips/relapses (as applies)

Theory of Unfreezing, Moving and Refreezing (Lewin) Unfreezing- create awareness of the problem and the need for change Moving- alternative action and goals are established Refreezing- change is generalized; follow up is needed to reinforce practice SOCIAL CHANGE Strategies for Effecting Social Change Empirical-rational strategies Adopt change if it can be rationally justified and person can benefit Normative reeducative Through influence of sociocultural norms to which he belongs Power coercive Based on application of power, economics, political or morals (nonviolenece, use of political institutions, recomposition and manipulation of power elites) Barriers to Change Cultural Social Psychological

Language Difficulties Motivation to Change Problem of Fit

Cultural Barriers Tradition Fatalism Cultural Ethnocentrism Pride and Dignity Norms of Modesty Unforeseen Consequences of Planned Change Relative Value Social Barriers Mutual obligations within the framework of family, fictive kin and friendship patterns Small group dynamics Public opinion Factionalism Vested Interest Lack of Authority within the Family Lack of Authority in the Political Structure Psychological Barriers Perception of the problem Perception of the role of government Perception of gifts Differential role perception Differing perception of purpose Pointers on Bringing About Change Nature of change should be made clear to those who will be influenced Identify strong forces advocating change and those deterring change Persons affected should be involved in determining the nature and direction of change In case of resistance Locate the source. Find out why change is perceived as a threat. Get other people's viewpoint Go beyond the surface reasons. Examine change as it affects one's relationship with others. Reducing Resistance to Change Provide an atmosphere of acceptance and respect Correct faulty, inaccurate or misinterpreted information Ventilate feelings of opposition