*Factors that Influence Behavior Change: Topics to Assess*

This document provides a guide for the factors that influence a change
in behavior, such as becoming health information literate. Assessing an
audience with behavior theories in mind can help order to understand
what type of factors to address when developing outreach activities and
strategies.

Below are four tables that each list the factors that affect behavior
change, according to the named theory. Included is a list of "Topics to
Assess" which could be used in the pre-planning stage of an outreach
program.

+-----------------------------------+-----------------------------------+
| **Bandera's Social Learning       |                                   |
| Theory** -- This theory           |                                   |
| identified factors that influence |                                   |
| learning.                         |                                   |
+-----------------------------------+-----------------------------------+
| > **Behavioral Capability**       | People must have the prerequisite |
|                                   | skills and knowledge to change or |
|                                   | learn.                            |
+-----------------------------------+-----------------------------------+
| > **Expectations**                | Participants must believe that    |
|                                   | their behaviors will lead to      |
|                                   | given results.                    |
+-----------------------------------+-----------------------------------+
| > **Self-Efficacy**               | People must believe they can      |
|                                   | carry out and maintain an action. |
+-----------------------------------+-----------------------------------+
| > **Observational Learning**      | When people see their role models |
| >                                 | engaging in activities and        |
| > **(modeling)**                  | getting positive results, they    |
|                                   | are more likely to engage in such |
|                                   | activities.                       |
+-----------------------------------+-----------------------------------+
| **Topics to explore:**            |                                   |
|                                   |                                   |
| 1.  Assess participants' baseline |                                   |
|     knowledge and skill about     |                                   |
|     finding health resources they |                                   |
|     need. What are their primary  |                                   |
|     sources?                      |                                   |
|                                   |                                   |
| 2.  Investigate their             |                                   |
|     expectations about whether    |                                   |
|     the sources they use have the |                                   |
|     information they need. How    |                                   |
|     about their confidence in     |                                   |
|     their own capabilities of     |                                   |
|     finding what they need?       |                                   |
|                                   |                                   |
| 3.  Learn whom they respect. If   |                                   |
|     their role models are local,  |                                   |
|     see if they are available to  |                                   |
|     support and participate in    |                                   |
|     your programs.                |                                   |
+-----------------------------------+-----------------------------------+

+--------------------+-------------------------------------------------+
| **Stages of Change |                                                 |
| Model** -- If you  |                                                 |
| are targeting a    |                                                 |
| change in behavior |                                                 |
| in participants,   |                                                 |
| you first must     |                                                 |
| assess where the   |                                                 |
| audience is along  |                                                 |
| a continuum of     |                                                 |
| desire to change.  |                                                 |
| Planning programs  |                                                 |
| around their stage |                                                 |
| of change          |                                                 |
| increases your     |                                                 |
| chances of success |                                                 |
+--------------------+-------------------------------------------------+
| #                  | Not thinking of changing their behavior         |
| # Precontemplation |                                                 |
+--------------------+-------------------------------------------------+
| **Contemplation**  | Thinking about changing behavior                |
+--------------------+-------------------------------------------------+
| **Preparation**    | Planning to change behavior                     |
+--------------------+-------------------------------------------------+
| **Action**         | Currently engaging in the behavior              |
+--------------------+-------------------------------------------------+
| **Maintenance**    | Has been engaging in the behavior and ready to  |
|                    | become more advanced, learn more, etc.          |
+--------------------+-------------------------------------------------+
| Topics to explore: |                                                 |
|                    |                                                 |
| 1.  Does the       |                                                 |
|     target         |                                                 |
|     audience       |                                                 |
|     perceive any   |                                                 |
|     problems in    |                                                 |
|     finding or     |                                                 |
|     getting        |                                                 |
|     answers and    |                                                 |
|     information    |                                                 |
|     about health   |                                                 |
|     questions they |                                                 |
|     have? If so,   |                                                 |
|     what are their |                                                 |
|                    |                                                 |
|   reasons/barriers |                                                 |
|     for not        |                                                 |
|     finding health |                                                 |
|     information    |                                                 |
|     they need?     |                                                 |
|     What do they   |                                                 |
|     currently do   |                                                 |
|     when needing   |                                                 |
|     answers or     |                                                 |
|     information    |                                                 |
|     re: health     |                                                 |
|     questions?     |                                                 |
|                    |                                                 |
| 2.  What do they   |                                                 |
|     think is the   |                                                 |
|     ideal way to   |                                                 |
|     get quality    |                                                 |
|     health         |                                                 |
|     information?   |                                                 |
|     What might be  |                                                 |
|     keeping them   |                                                 |
|     from using     |                                                 |
|     Web-based      |                                                 |
|     resources?     |                                                 |
|                    |                                                 |
| 3.  How motivated  |                                                 |
|     is the         |                                                 |
|     targeted       |                                                 |
|     audience to    |                                                 |
|     change the     |                                                 |
|     ways they find |                                                 |
|     and use health |                                                 |
|     resources?     |                                                 |
|     What is the    |                                                 |
|     best way to    |                                                 |
|     move them to   |                                                 |
|     the next       |                                                 |
|     level? Why     |                                                 |
|     would they     |                                                 |
|     change?        |                                                 |
+--------------------+-------------------------------------------------+

+-----------------------------------+-----------------------------------+
| **Diffusion of Innovation         |                                   |
| Theory** -- The extent to which   |                                   |
| new products, procedures, or      |                                   |
| behaviors catch on in a group     |                                   |
| depends on a number of factors.   |                                   |
| The factors below predict the     |                                   |
| likelihood that something new     |                                   |
| will be adopted by a community.   |                                   |
+-----------------------------------+-----------------------------------+
| ## Relative Advantage             | People must see an innovation as  |
|                                   | better than the product, process. |
|                                   | etc., that it is replacing        |
+-----------------------------------+-----------------------------------+
| **Compatibility**                 | An innovation will accepted more  |
|                                   | readily if it is compatible with  |
|                                   | adopters' habits, beliefs,        |
|                                   | experiences, or values            |
+-----------------------------------+-----------------------------------+
| **Complexity**                    | The difficulty of understanding   |
|                                   | or using an innovation will       |
|                                   | determine the extent of its       |
|                                   | adoption in a community           |
+-----------------------------------+-----------------------------------+
| **Trialability**                  | People are more likely to adopt   |
|                                   | an innovation if they can         |
|                                   | experiment with it before         |
|                                   | committing to it                  |
+-----------------------------------+-----------------------------------+
| **Observability**                 | Innovations that will lead to     |
|                                   | tangible or visible results are   |
|                                   | more likely to be adopted         |
+-----------------------------------+-----------------------------------+
| Topics to explore:                |                                   |
|                                   |                                   |
| 1.  Who are the key people who    |                                   |
|     will be fascinated with using |                                   |
|     the Internet for health       |                                   |
|     information?                  |                                   |
|                                   |                                   |
| 2.  What leaders in the community |                                   |
|     are likely to support your    |                                   |
|     effort?                       |                                   |
|                                   |                                   |
| 3.  What are the specific ways    |                                   |
|     that Internet access might be |                                   |
|     compatible---e.g. resonate or |                                   |
|     not resonate with their       |                                   |
|     habits, need, values?         |                                   |
|                                   |                                   |
| 4.  How and how much will         |                                   |
|     participants have to change   |                                   |
|     to adopt the innovation?      |                                   |
|                                   |                                   |
| 5.  How difficult will the        |                                   |
|     innovation be for             |                                   |
|     participants to learn to use  |                                   |
|     it?                           |                                   |
|                                   |                                   |
| 6.  What resources are available  |                                   |
|     to allow participants to play |                                   |
|     or work with the innovation?  |                                   |
|                                   |                                   |
| 7.  What will participants get or |                                   |
|     achieve if they adopt this    |                                   |
|     innovation?                   |                                   |
+-----------------------------------+-----------------------------------+

+-----------------------------------+-----------------------------------+
| **Community                       |                                   |
| Organization---**Outreach         |                                   |
| programs with a community         |                                   |
| perspective see success as        |                                   |
| involving more than changes at    |                                   |
| the individual level. Individuals |                                   |
| will more likely sustain new      |                                   |
| attitudes or behaviors if         |                                   |
| reinforced in policies,           |                                   |
| decisions, and support within     |                                   |
| their community or organizational |                                   |
| environment                       |                                   |
+-----------------------------------+-----------------------------------+
| **Empowerment**                   | Gaining mastery to produce change |
+-----------------------------------+-----------------------------------+
| **Community Competence**          | Ability to engage in problem      |
|                                   | solving                           |
+-----------------------------------+-----------------------------------+
| **Participation and Relevance**   | Problem solving that "starts      |
|                                   | where the people are"             |
+-----------------------------------+-----------------------------------+
| **Issue Selection**               | Identifying winnable, simple,     |
|                                   | specific concerns                 |
+-----------------------------------+-----------------------------------+
| Topics to explore:                |                                   |
|                                   |                                   |
| 1.  What are the health issues of |                                   |
|     most concern for this         |                                   |
|     community?                    |                                   |
|                                   |                                   |
| 2.  How is health information     |                                   |
|     viewed in this community? Are |                                   |
|     people inclined to view       |                                   |
|     health information as         |                                   |
|     something that will make a    |                                   |
|     difference in their own       |                                   |
|     health?                       |                                   |
|                                   |                                   |
| 3.  If yes: Can you give me       |                                   |
|     examples of ways that         |                                   |
|     information has made a        |                                   |
|     difference?                   |                                   |
|                                   |                                   |
|     a.  If no or maybe: Can you   |                                   |
|         explain why not?          |                                   |
|                                   |                                   |
| 4.  How might an outreach program |                                   |
|     help people change their      |                                   |
|     views about health            |                                   |
|     information?                  |                                   |
|                                   |                                   |
| 5.  What are the barriers that    |                                   |
|     prevent people from getting   |                                   |
|     the health information they   |                                   |
|     need; things that get in the  |                                   |
|     way?                          |                                   |
|                                   |                                   |
| 6.  Overall, what do people in    |                                   |
|     the community view as the     |                                   |
|     best ways to get health       |                                   |
|     information?                  |                                   |
|                                   |                                   |
| 7.  What are best ways to give    |                                   |
|     out good health information   |                                   |
|     in this community?            |                                   |
+-----------------------------------+-----------------------------------+