Hickey - Mapping

Hickey - Mapping

by Matt Hickey -
Number of replies: 2

1. Identify a patient or community group that contributes to or is involved in the principal behavior you are attempting to improve with your intervention.

The primary group I am interested in that is involved in the principal behavior I am trying to improve is patient social support networks.  I am trying to improve patient behavior to attend HIV clinic appointments.  By providing both emotional, physical and sometimes financial support, close social supports play a key role in helping patients attend their clinic appointments.

2. Using any of the individual explanatory theories in “Theory at a Glance”, develop an explanatory model for the target behavior (above) that you will be attempting to influence with your intervention.  This can be an extension/based on expected findings (or previously published literature) from your answers to Homework #3.  Figures are always very useful... keep it simple.

The theoretical model that best fits my proposed intervention is the "Community Organization" model.  Thinking of the individual social support group as the community, the intervention takes these group through an empowerment process.  Initial intervention components focus on building capacity among the group to address issue-specific challenges related to HIV.  Group learning sessions improve group participation and help make the issues relevant for all group members - not only patients.  Group status disclosure further increases participation and empowerment of the group to address HIV together.  As groups mature, they move toward self-selection of further issues to address as a group.

3. Identify how one or more of your specific interventions will target one or more of these key factors contributing to the behavior of interest.

Group empowerment to address HIV in a concrete way, combined with group status disclosure will hopefully lead to increased group support around ensuring that group members remain actively engaged in HIV care.

4. Create a framework that draws upon a socio-ecological framework to orient your target behavior within a larger context.  ie, what are some of broader, external forces that influence the individual behavior of interest...see Figure 2 of “Theory at a Glance.”

The intervention itself addresses individuals, their social relationships/networks and to some extent their communities.  The aggregate effect of active groups across the community further addresses community-level issues such as perceived stigma.  Institutions, such as the health care system, and our community-based organization are also involved in provision of HIV testing and treatment.  Social and economic policies at both the local and national level directly impact healthcare seeking behavior by determining availability and cost of health care services.

In reply to Matt Hickey

Re: Hickey - Mapping

by Lisa Thompson -

You definitely found the theory for your intervention. Do you think there will eventually be a "herd immunity" effect as the social networks increase in size and influence, such that those who aren't empowered (or the non-participants) will also become empowered to seek care/overcome stigma? It would be interesting to measure this in the as-yet-to-be-empowered. 

 

In reply to Lisa Thompson

Re: Hickey - Mapping

by Matt Hickey -

Thanks Lisa, this is an improtant point.  I think the "herd immunity" is an important strength of the intervention.  It also presents challenges for our evaluation.  Due to sample size issues and the limited geographic scope of our study area, we are conducting randomizing the intervention at the individual patient level.  This may lead to cross-over between study arms, or spill-over effect of the intervention.  Something we will try to measure as much as possible, but it is a definite limitation of this approach.