Reconceptualising Behaviour Change in the HIV/AIDS Context

Abstract

In this chapter the authors look closely and critically at the concept of ‘behaviour change', aconcept which has been much used in programmes designed to reduce HIV transmission. It is argued that approaches to behaviour change are for the most part based on cognitive models of action and it is suggested that this is a problematic foundation for developing programmes of behaviour change, and particularly HIV/AIDS intervention programmes. Models of behaviour change often do not address the contingencies which bring intentions to fruition. A behavioural outcome which appears to derive from a cognitive intention because of its proximal association therewith, is often really a product of a complex interplay of intentionality, communality and sociality. The meaning of these three sub-systems of activity in the generation of actions is explored and their interplay is emphasised.

The philosophy of action towards which the authors are drawn in developing the argument, is influenced by ‘activity theory'. The problem of trying to will actions which are essentially by-products is focussed on, largely through understanding the communal and social character of action. The critique of cognitive self-agency models of action is found to be particularly inappropriate in the field of sexual activity which for reasons outlined is not readily brought within the bounds of self-agency. In developing an understanding of the implications of the proposed reconceptualisation of the concept of behaviour change for HIV/AIDS programmes, the authors move away from a message based model of health communication. The chapter closes with an outline of some elements of intervention which flow from the reconceptualisation. Although the paper discusses interventions which aim to improve response to HIV/AIDS the philosophy of action which is discussed is of importance in other areas too. Programmes of action or change need to be conceived in the context of the total framework out of which activity derives.

Whereas social psychology has developed a social analytical model of the mind and psychological life, its models of intervention remain largely tied to the concept of self-agency. Social psychology has been concerned with understanding rather than intervention and health behaviour change models are evidence that behaviour change methodologies have not been based on a coherent or sustainable social philosophy of action. The ideas presented in this paper represent a challenge arising out of an understanding of the communal and social character of action. The ideas lead to the possibility of developing programmes of action based on an understanding of how we manage the execution of states that are essentially by-products.