TEACHING CHANGE: A MIXED-METHOD STUDY OF INTERVENTIONS, RISK PERCEPTIONS, AND BEHAVIOR CHANGE AMONG THE GARIFUNA OF HONDURAS
Open Access
- Author:
- Bedford, Jason G.
- Graduate Program:
- Rural Sociology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- June 18, 2009
- Committee Members:
- Carolyn Elizabeth Sachs, Dissertation Advisor/Co-Advisor
Carolyn Elizabeth Sachs, Committee Chair/Co-Chair
Anastasia R Snyder, Committee Chair/Co-Chair
Leif Jensen, Committee Member
Leland Luther Glenna, Committee Member
Edward A Smith, Committee Member - Keywords:
- Garifuna
HIV/AIDS
Risk Perception
Mixed Methodology
Prevention - Abstract:
- Strategies to combat HIV/AIDS generally emphasize behavioral change models; theory-led health prevention programs are frequently based on cognitive-behavioral models that follow a set of linear stages to reach the proscribed behavior change. Although these models have shown great promise in increasing knowledge and awareness of the disease, they tend to fall short in their ability to heighten an individual’s risk perception and generate overall behavior change. This study examined Honduras as a case-study, utilizing mixed-methodology to investigate HIV/AIDS educational interventions being implemented in this country. First, the nationally representative 2006 Honduran Demographic and Health Survey data were used in a multivariate regression to examine how demographic characteristics, women’s perceived ability to refuse sex, HIV/AIDS knowledge, and the source utilized by Hondurans to gather their HIV/AIDS information affect abstinence, fidelity, and condom use (ABCs), which is the UN’s minimum package for containing the spread of HIV/AIDS. The findings concurred with prior HIV/AIDS educational evaluations. In other words, these interventions, although they have had positive results in increasing HIV/AIDS preventive knowledge and to some degree the attitudes of the individuals being targeted for HIV/AIDS risk, have limited effects on risky HIV/AIDS behavior. For this sample, mass media interventions had no effect on behavior change, and social networks had both positive and negative effects on reducing HIV/AIDS risk behavior. The variables found to be consistent with HIV/AIDS risk reduction behavior (the ABCs) were the sociodemographic variables of education, age, and marital status, while interpersonal social networks had mixed effects. The study then looked at a HIV/AIDS high risk group to see how the interventions were affecting their behavior, from whom they obtained their HIV/AIDS information and which sources they trusted, and their opinions concerning the reasons for high HIV/AIDS prevalence in their community. To investigate this aspect of the study, the Garifuna communities on the north shore of Honduras were selected because of their HIV/AIDS prevalence rate, which is estimated to be four times greater than that for the overall population of Honduras. This study was conducted during the summer of 2007 and included 17 interviews with Honduran development agency personnel and 12 focus groups in 6 Garifuna communities. Prior studies showed that HIV/AIDS knowledge has increased among the Garifuna, but risk perceptions remain low and behavior change lags behind. Findings from the qualitative stage of this study suggest that even though the Garifuna may not follow the proscribed behavior change model that includes abstinence, fidelity, and condom use, individuals are adapting their sexual behavior to better protect themselves from the disease. They are now utilizing “Sexual Reconnaissance” to investigate the HIV/AIDS risk of potential partners, to avoid the ABCs. Discrepancies were found in perceptions between the in-depth interviews of the development agency personnel implementing the HIV/AIDS interventions and the Garifunas’ reasoning about the high HIV/AIDS prevalence in their communities. The development agency personnel viewed the normative sexual behavior of the Garifuna as the reason for the high prevalence rates, while the Garifuna believed that outside influences were the reason. This discrepancy between the development agencies’ and Garifunas’ perceptions could be leading the Garifuna to distrust development agencies and affect the efficacy of HIV/AIDS interventions. Understanding current trends in behavior change among at-risk populations—how individuals are actively attempting to protect themselves from HIV/AIDS, and the discrepancies in perceptions between the target at-risk group and the agencies implementing the interventions—will greatly inform health prevention programs among the Garifuna and help to increase the efficacy of future interventions.