the person’s developing skill set and their environment); and Time-specified(that is, we
know when or by what date action will be taken). A key part of realistic goal setting
is beginning with easier tasks and only moving to more challenging goals as these are
attained.
New motor skills constitute a second class of skills, which may be involved in
adopting health-related behaviours. For example, before using a gym, people need to
be taught to use exercise machines. Similarly, certain medication regimes necessitating
using devices such as inhalers or needles that patients may need to be taught how to
use (see Kools, 2012 for a discussion of how to provide such instruction in text). Even
apparently simple skills such as hand washing, to avoid infection, may need special
instruction to ensure competence (Pittet, 2002; Pittet et al., 2000). Thus analysis of
any health behaviour targeted in an intervention should involve an assessment of the
motor skills required and the extent to which the targeted recipients are proficient or
lacking in these skills. Of course, technological advances can make the skills involved
in health behaviours easier to learn. Extra-fine needles make it easier for diabetics to
inject themselves, alcohol wipes make hand washing easier and the development of a
once-a-day single pill for HIV control makes adherence much easier than if patients
have to take 36 pills a day! Sometimes skill deficits reveal an important role for
organisational or technological change in supporting behaviour change.
Finally, we also require social skills to negotiate change in behaviour patterns with
others and seek their support. For example, the skills to negotiate condom use with a
reluctant partner or the skills to explain why we will not take part in alcohol drinking
games or buying rounds of drinks, or eat traditional (but unhealthy) foods. These social
skills required are likely to be determined largely by the target behaviour and the social
resources available to individuals planning change. However, assertiveness training (that
is, being able to express one’s own wants and needs in an honest and non-aggressive
manner) and negotiation skills are often prerequisite to managing interactions, which
arise when individuals begin to change their behaviour patterns. Other useful
techniques include role play, especially with modelling and video feedback, and live
filming followed by video feedback and praise for interactions that demonstrate
desired skills. This approach to skills development is exemplified in the practice of
Video Interaction Guidance (Kennedy, Landor and Todd, 2011).
A number of successful behaviour change interventions have been based on the
IMB, particularly in relation to HIV-preventive behaviour (e.g. Fisher et al., 1994)
and some of these have been evaluated using longer-term follow up (e.g. at 12 months
in the case of Fisher et al., 2002). Focus 9.1 provides an illustration of an IMB-
based intervention. The IMB model is useful because it highlights the need to assess
behaviour-relevant deficits among the target group prior to intervention design
(stage 1 of intervention mapping) and provides a framework for defining the inter -
vention objectives (stage 2), identifying key regulatory processes and, thereby, candi-
date change techniques that may be crucial to intervention effectiveness (stage 3).
The model proposes that behaviour change intervention designers need to discover
whether the (precisely defined) target group lack any behaviour-relevant informa-
tion, whether the key determinants of motivation are in place among this target
group and whether the target group lack any skills required to translate motivation
into behaviour.
200 MOTIVATION AND BEHAVIOUR