Toward a conceptual model of ‘the act’; an exercise in theory generation in the problematic space of school-based HIV prevention through behaviour change intervention.

Abstract

Health outcomes, whether due to infectious disease vectors or so-called diseases of lifestyle, appear to be the consequence of human behaviour. Simple behaviours such as wearing a condom, eating a balanced diet, or regular health screening appear to hold the key to drastically reducing global mortality and morbidity. And yet health interventions premised on behaviour change often fail to demonstrate significant effect on health outcomes. Perhaps we do not understand what behaviour is in the first place. I aimed to posit a conceptual model of ‘the act’, a unit through which to re-understand human behaviour, as a first step toward more effective interventions. The overall design was theory-generative research, including: (a) a critical review of three prominent cognitive behaviour change theories, (b) an applied exploration of the research philosophical implications of theory generative research, (c) a discourse analysis of assumptions about behaviour in school-based HIV prevention in Africa, (d) a critical analysis of assumptions about young people’s sexual behaviour in two school-communities in rural KwaZulu-Natal, South Arica, and (e) a comparative description of a normative and an alternative model of ‘the act’. I described the symphonic model of ‘the act’ for behaviour change intervention design. The symphonic model is premised on five assumptions about the ontology of behaviour: (1) intention follows the act, (2) the act is a synthesis of possibility, not a derivative eventuality, (3) the act is marginally predictable through imposing narratives of intentionality, (4) time is a necessary frame for imposing narrative intentionality onto the act, and (5) consummation of the act is always dialogically interpersonal. I demonstrated how these assumptions could be represented in a graphic model of the components of the act and the interaction of these components with each other. Finally, I presented how the symphonic model of the act could be applied to school-based HIV prevention in Africa. The symphonic model of the act is a viable avenue for further research. This should include practical demonstrations of its application. Future development should also include the expansion of the conceptual model into a theoretical framework – integrated with existing theories of behaviour and psychology.