Joanne E. Mantell

Applying Theory to HIV Prevention Interventions

Theory can inform evaluation research by guiding the development of effective behavior change interventions. This chapter discusses the benefits of incorporating theory with practice and reviews various conceptual frameworks for understanding why individuals engage in health-related behaviors and how health information is diffused. The applicability of particular elements of these theories and models to HIV prevention is also described.

Conducting Needs Assessments

The initial step in successful HIV prevention program planning and evaluation is to determine the HIV-related needs of a specific community or subset within that community (Sechrest et al., 1982, 1983). Needs assessment is the process by which the program planner identifies and measures the gap between what is and what ought to be. It catalogues and compares the wants of the community to those of the sponsoring organization. The term needs assessment is also referred to as community diagnosis (Green & Kreuter, 1991) and community analysis (Dignan & Carr, 1987). Organizations often are motivated by internal and external pressure to conduct needs assessments. In a time of limited monies for HIV interventions, many funders are requiring that needs assessments be completed before submitting a grant proposal.

Selecting an Evaluation Study Design

To conduct effective research, you have to know three things: what you are going to do, to whom you are going to do it, and when you are going to do it. The “who” refers to the sample or group of participants, the “what” to the evaluation design and protocol, and the “when” to over what period of time the data will be collected. The study design is the blueprint that addresses these three questions.

Quantitative Measures in Evaluation

This chapter reviews how one constructs quantitative measures to assess knowledge, attitudes, behaviors, and intentions associated with HIV/AIDS and how these measures can be used to evaluate an intervention. Specifically, it focuses on ways to ensure confidence in the evaluation results.

Involving Communities in Evaluation

Program evaluation can provide a target community with information on the effectiveness of prevention efforts. While an evaluator may believe that a community should be receptive to anyone willing to provide resources to improve members’ knowledge, satisfaction with their quality of life, and ultimately their health, this is not always the case. To develop realistic intervention goals and objectives and evaluation mechanisms, a community should be the focal point in identifying its own HIV/AIDS prevention needs. In the absence of community endorsement, external HIV/AIDS preventive interventions may be disconnected from the community.

Introduction to Evaluating HIV/AIDS Prevention Programs

In the first decade of the human immunodeficiency virus (HIV) epidemic, prevention of HIV infection was hampered by the stigmatization of groups and the dearth of scientific medical information. Little was known of how to change risk-related behaviors initially, let alone how to sustain behavioral change. Interventions were often based on trial and error rather than on theory-driven health behavior models. Despite the proliferation of health behavior change interventions, few had carefully thought-out evaluation components. Without evaluation, little generalizable knowledge useful for refining health behavior models was developed.

Evaluating Individual-Level and Community-Level Interventions

Evaluating an intervention is more than coming up with a scientifically sound design, data collection strategies, and measures. Before implementing an intervention, a number of decisions have to be thought through carefully. All components of the intervention have to fit and be closely linked. The evaluation protocol for the intervention also has to be practical. Whatever intervention is chosen is dependent on the behavior you want to promote, the audience to be reached, and the acceptability of the intervention to the population.

Using Qualitative Methods

Choosing the best types of data collection methods to carry out effective evaluation of HIV/AIDS preventive interventions depends on several factors: (1) the researcher’s philosophy and theoretical perspectives; (2) the research objectives and questions to be answered by the evaluation; (3) the study design; (4) the availability of personnel and financial resources; and (5) the urgency of determining the effectiveness of the intervention. Some evaluation questions can be more effectively addressed with a large-scale quantitative survey and others with individual in-depth interviews or focus groups.