Behaviour change interventions may employ multiple techniques targeting a range
of different regulatory processes tailored to particular audiences. For example, Schinke
and Gordon (1992) describe a culturally specific intervention including a self-
completion book using comic strip characters and rap music verse to encourage
effective safer sex regulation among black teenagers. The aim was to develop self-
monitoring, self-regulatory and planning skills as well as rehearsal of verbal resources,
which can be used to control and disrupt scripted interaction that could lead to
unprotected sex. The acronym SODAS, standing for Stop, Options, Decide, Act and
Self-praise, was used in this training. The first step, ‘stop’ explicitly elicits anticipated
regret (‘stop and think what these choices could really mean for you today, tomorrow
... and for years to follow’ – see Chapter 7) while the fourth step, ‘act’ involves the
reader in generating if-then plans in relation to five types of verbal responses, which
can be used when they are subjected to social pressure. This intervention highlights
selection of delivery methods in the intervention mapping process. Cartoons, rather
than questionnaires were used to deliver these techniques. Choice of delivery methods
is critical because these methods determine recipients’ engagement with the inter -
vention and how the intervention affects processing of messages – see Noar et al.’s
(2015) finding that use of pictures enhanced cognitive and emotional responses to fear
appeals on cigarette packets. For example, drama-based techniques may be more
engaging than reading written materials and so enhance intervention effectiveness (e.g.
Wyatt et al., 2013). Consequently, the same technique delivered differently may have
very different effects for the same target audience.
We have seen how many of the characteristics of an intervention listed in Table
9.1 become important during the intervention mapping process. The particular
behaviour targeted leads to selection of specific techniques designed to alter particular
change processes, which are delivered using methods appropriate to target group and
setting. We noted in Chapter 8 that credibility of a message source (that is, who delivers
the message – e.g. The Lancetarticle on MMRI) is critical to persuasion. Many
communication models (see e.g. Berlo’s Source, Message, Channel and Receiver
model) have emphasized that the way in which recipients view the source influences
how they respond (Hovland, Janis and Kelley, 1953). The title of a questionnaire or
the name of the organization that produced a leaflet (e.g. a political party or a
commercial organization) can critically affect how we process its content. This is even
more important in interventions delivered face-to-face. How facilitators are viewed
in terms of, for example, professional competence and whether they belong to the
same group as the recipient (e.g. matched gender or culture) can strongly affect the
way in which people respond to interventions (Durantini et al., 2006). The same
technique or complex intervention delivered by two different sources (or facilitators)
when viewed differently by intervention recipients may have very different effects on
engagement, cognitive and emotional processing and, therefore, behaviour change.
The characteristics of facilitators are important, not only because of how they are
viewed and responded to by recipients, but also because face-to-face intervention
delivery depends on their abilities. An intervention that is not delivered as designed
is said to have poor fidelity. The competence of those delivering interventions is critical
to fidelity and, for complex interventions, this may be challenging to ensure through
training. For example, a review of competence in motivational interviewing found
that of 11 studies that had assessed clinician competence only 2 studies reported that
CHANGING BEHAVIOUR 213