title: Health behavior change models for HIV prevention and AIDS care: practical recommendations for a multi-level approach.
abstract: Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social-structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the individual-structural spectrum, (2) to map out and compare the characteristics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly context-specific mechanisms, overall producing greater intricacies. We conclude with recommendations on how best to respond to this complexity, which include: using formative research and interdisciplinary collaboration to select the most appropriate levels and variables in a given context; measuring social and institutional variables at the appropriate level to ensure meaningful assessments of multiple levels are made; and conceptualizing intervention and research with reference to theoretical models and mechanisms to facilitate transferability, sustainability, and scalability.
authors.affiliation: *Johns Hopkins University Bloomberg School of Public Health, Center for Communication Programs, Baltimore, MD; †Department of Methodology, London School of Economics and Political Science, London, UK; ‡University of Missouri-St. Louis, College of Nursing; and §Department of Psychology, University of Connecticut and Center for Health, Intervention, and Prevention, Storrs CT.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Kaufman
authors.forename: Flora
authors.initials: F
authors.lastname: Cornish
authors.forename: Rick S
authors.initials: RS
authors.lastname: Zimmerman
authors.forename: Blair T
authors.initials: BT
authors.lastname: Johnson
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D015438:Health Behavior; D006801:Humans