Allison Earl

A Test of Major Assumptions About Behavior Change: A Comprehensive Look at the Effects of Passive and Active HIV-Prevention Interventions Since the Beginning of the Epidemic.

This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIV-prevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts.

Conceptualizing the Influence of Social Agents of Behavior Change: A Meta-Analysis of the Effectiveness of HIV-Prevention Interventionists for Different Groups.

A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse demographic and behavioral backgrounds.

Empirical and Theoretical Conclusions of an Analysis of Outcomes of HIV-Prevention Interventions

Over two decades of HIV-prevention attempts have generated a most impressive ecological data set for the test of behavioral-change and persuasion theories in the domain of condom use. An analysis of this evidence has yielded five important empirical and theoretical conclusions. First, interventions are more successful at achieving immediate knowledge and motivational change than they are at achieving immediate behavioral change. Second, the immediate motivational change decays over time, whereas behavior change increases over the same period. Third, interventions that engage audiences in particular activities, such as role-playing condom use, are more effective than presentations of materials to passive audiences. Fourth, interventions consistent with the theories of reasoned action and planned behavior, with self-efficacy models, and with information-motivation and behavioral-skills models prove effective, whereas interventions designed to induce fear do not. Fifth, expert intervention facilitators are more effective than lay community members in almost all cases. When populations are unempowered, expert facilitators are particularly effective, and they are most effective if they also share the gender and ethnicity of the target audience.

Nature, Decay, and Spiraling of the Effects of Fear-Inducing Arguments and HIV Counseling and Testing: A Meta-Analysis of the Short- and Long-Term Outcomes of HIV-Prevention Interventions

OBJECTIVE To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use. DESIGN Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. MAIN OUTCOME MEASURES The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use. RESULTS Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk [corrected] decreased over time, but the effects on knowledge [corrected] condom use became more pronounced. CONCLUSION Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally.

From Brochures to Videos to Counseling: Exposure to HIV-Prevention Programs

This research tested the prediction that reading a preventive brochure leads people to watch a preventive video, and that watching this video in turn leads to an increase in the likelihood of participating in a preventive counseling session. A sample of men and women from a southeastern community in the United States was recruited for a general health survey with the objective of examining participation in HIV-prevention interventions. Unobtrusive measures of exposure to HIV-prevention brochures, an HIV-prevention video, and an HIV-prevention counseling session were obtained. Findings indicated that reading the brochures increased watching the video and that watching the video increased participation in the counseling session. The association between exposure to the video and exposure to the counseling was mediated by expectations that the counseling would be useful. Findings are discussed in terms of the need to ensure exposure to interventions to achieve intervention effectiveness.

Participation in Counseling Programs: High-Risk Participants are Reluctant to Accept HIV-Prevention Counseling.

HIV-prevention intervention effectiveness depends on understanding whether clients with highest need for HIV-prevention counseling accept it. With this objective, a field study with a high-risk community sample from the southeastern United States (N = 350) investigated whether initial knowledge about HIV, motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use correlate with subsequent acceptance of an HIV-prevention counseling session. Ironically, participants with high (vs. low) motivation to use condoms, high (vs. low) condom-use-relevant behavioral skills, and high (vs. low) prior condom use were more likely to accept the HIV-prevention counseling. Moreover, the influence of motivation to use condoms, condom-use-relevant behavioral skills, and prior condom use on acceptance of the counseling was mediated by expectations that the counseling session would be useful. Methods to reduce barriers to recruitment of clients for counseling programs are discussed.

Stigma Cues Increase Self-Conscious Emotions and Decrease Likelihood of Attention to Information about Preventing Stigmatized Health Issues

Health communications are only effective if target audiences actually receive the messages. One potential barrier to effective health communication is the potential stigma of attending to health information, particularly for stigmatizing health issues. The purpose of the present paper was to examine when participants report self-conscious emotions (e.g., shame, embarrassment) in response to health communications, as well as likelihood of reading health information associated with these emotions. Across three studies, participants read information about preventing diseases that are either highly stigmatized or non-stigmatized. Increased accessibility of stigma cues by (a) manipulating the perceived absence vs. presence of others, or (b) measuring lower vs. higher rejection sensitivity resulted in increased self-conscious emotions in response to information about stigmatized health issues. In addition, stigma cues decreased the likelihood of reading information about stigmatized (but not non-stigmatized) health information. Implications for health outcomes and intervention design are discussed.

Disparities in attention to HIV-prevention information.

Compared to European-Americans, African-Americans have greater probability of becoming infected with HIV, as well as worse outcomes when they become infected. Therefore, adequate health communications should ensure that they capture the attention of African-Americans and do not perpetuate disadvantages relative to European-Americans. The objective of this report was to examine if racial disparities in attention to health information parallel racial disparities in health outcomes. Participants were clients of a public health clinic (Study 1 n = 64; Study 2 n = 55). Unobtrusive observation in a public health waiting room, message reading times, and response-time on a modified flanker task were used to examine attention to HIV- and flu-information across racial groups. In Study 1, participants were observed for the duration of their time in a public health clinic waiting room (average duration: 31 min). In Study 2, participants completed tasks in a private room at the public health clinic (average duration: 21 min). Across all attention measures, results suggest an interaction between race and information type on attention to health information. In particular, African-Americans differentially attended to information as a function of information type, with decreased attention to HIV- versus flu-information. In contrast, European-Americans attended equally to both HIV- and flu-information. As such, disparities in attention yielded less access to certain health information for African- than European-Americans in a health setting. The identified disparities in attention are particularly problematic because they disadvantage African-Americans at a time of great effort to correct racial disparities. Modifying the framing of health information in ways that ensure attention by all racial groups may be a strategy to increase attention, and thereby reduce disparities in health outcomes. Future research should find solutions that increase attentional access to health communications for all groups.

Seeing more and eating less:: Effects of portion size granularity on the perception and regulation of food consumption.

Overeating and resulting obesity is a public health concern in the United States, and portion size is a factor that contributes to these problems (Zlatevska, Dubelaar, & Holden, 2014). The present research demonstrates that the granularity of labels used to describe portions also influences food consumption, independent of previously documented portion size effects. Across 6 studies and 7 different food items, we find a robust and reliable effect of portion size granularity labels on consumption intentions and food consumption. Having people think about food using fine-grained labels leads them to decrease their consumption intentions (Study 1, n = 80) and ultimately eat less food (Study 2a, n = 79; Study 2b, n = 79). This process operates by shifting people’s perceptions of the size of foods (rather than changing levels of construal) whereby portions described with fine-grained labels (e.g., “15 gummy candies”) are perceived to be bigger than portions described with gross-grained labels (e.g., “one serving;” Study 3, n = 200). In addition, granularity facilitates self-regulation of consumption for individuals with a weight-loss goal both when self-regulation is measured (Study 4, n = 160) and when we manipulate that mediator (Study 5, n = 300). Finally, a high-powered registered report replicated effects of granularity on consumption via shifts in perception and intentions with a diverse community sample (Study 6, n = 323). Implications for theory and practice are discussed.

Regulating food consumption: Action messages can help or hurt

OBJECTIVE Previous research suggests that messages promoting active behavior change may inadvertently increase food consumption by promoting a general goal to act. We suggest that this is only the case for active-approach behaviors and that messages promoting active-avoidance behaviors may be used to effectively decrease food consumption. METHODS Participants were presented with healthy eating messages pretested to vary on the dimensions of direction (approach vs. avoid) and amount (action vs. inaction) of behavior. After viewing the messages, participants selected and consumed a healthy or unhealthy snack during a taste test. RESULTS There were no differences in snack selection (healthy vs. unhealthy) across message conditions. For messages promoting more active behavior, however, there was a significant difference in snack consumption such that participants viewing active-approach messages consumed significantly more food than participants viewing active-avoidance messages. This happened regardless of whether participants selected a healthy or unhealthy snack. For messages promoting less active behavior there was no difference in consumption between approach and avoidance based messages. CONCLUSIONS These findings suggest that when viewing health messages that promote active behavior change, individuals are sensitive to the direction of action advocated by the message (approach vs. avoidance) and modulate consumption accordingly.