IMPACT OF FAMILY PLANNING HEALTH EDUCATION ON THE KNOWLEDGE AND

ATTITUDE AMONG WOMEN IN BARANGAY POBLACION, MUTIA

CHAPTER 1

INTRODUCTION

Family planning is amongst the most widely controversial topics nowadays because its

one of the effective means in limiting the outgrowing population. The Philippine population

stood at 94.01 million in 2010 based on NSO projected population and is expected to grow

annually at 2.04%. Philippine population is expected to double in 29 years. Total contraceptive

prevalence rate has increased from 15.4% (1968) to 48.9% ( National Demographic and Health

Survey, 2003) to 50.6 (Family Planning Survey, 2006).

In Mutia, Province of Zamboanga del Norte Region IX with a population of 13,486 has a

Contraceptive Prevalence Rate of 45% as of September 2016. In barangay Poblacion one of the

most populated area and is the central barangay of the municipality has a projected population of

1868 and with a Contraceptive prevalence Rate of 46% which is very low.

Family Planning as defined by World Health Organization as Family Planning allows

individuals and couples to anticipate and attain their desired number of children and the spacing

and timing of their births. It is achieved through the use of contraceptive methods and the

treatment of involuntary infertility.

 In this research study Family Planning is viewed as the practice of controlling the number

of children in a family and the intervals between their births, particularly by means of artificial

contraception or voluntary sterilization.

The purpose of this study is to determine the effect of health education on the knowledge

and attitude regarding family planning and contraceptive methods among the women who

obligatory attended the premarital counselling.

THEORETICAL FRAMEWORK

The respondents in this study are the women who obligatory attended the Premarital

Counselling at Poblacion, Mutia. Their age ranges from 18-35 years old. The procedure of this

study is to know the impact of health education and knowledge and attitude towards family

planning. The variables to be considered in this study are the following Age,Level of Educaton,

and Beliefs.

Albert Bandura Social Learning Theory shows a direct correlation between a person's

perceived self-efficacy and behavioral change. Self-efficacy comes from four sources:

"performance accomplishments, vicarious experience, verbal persuasion, and physiological

states. Bandura argued that human behavior is caused by personal, behavioral, and

environmental influences.

Social cognitive theory is a learning theory based on the idea that people learn by observing

others. These learned behaviors can be central to one's personality. While social psychologists

agree that the environment one grows up in contributes to behavior, the individual person (and

therefore cognition) is just as important. People learn by observing others, with the environment,
behavior, and cognition all as the chief factors in influencing development in a reciprocal triadic

relationship.

Neal E. Miller and John Dollard revision of Holt's social learning and imitation theory argued

four factors contribute to learning: drives, cues, responses, and rewards. One driver is social

motivation, which includes imitativeness, the process of matching an act to an appropriate cue of

where and when to perform the act. A behavior is imitated depending on whether the model

receives a positive or negative response consequences.

The core concepts of this theory can be explained by Bandura's schematization of triadic

reciprocal causation in his book chapter.The schema shows how the reproduction of an observed

behavior is influenced by the interaction of the following three determinants:

1. Personal: Whether the individual has high or low self-efficacy toward the behavior (i.e.

Get the learner to believe in his or her personal abilities to correctly complete a

behavior).

2. Behavioral: The response an individual receives after they perform a behavior (i.e.

Provide chances for the learner to experience successful learning as a result of

performing the behavior correctly).

Environmental: Aspects of the environment or setting that influence the individual's ability to

successfully complete a behavior (i.e. Make environmental conditions conducive for improved

self-efficacy by providing appropriate support and materials.

Social cognitive theory revolves around the process of knowledge acquisition or learning directly

correlated to the observation of models. The models can be those of an interpersonal imitation or
media sources. Effective modeling teaches general rules and strategies for dealing with different

situations.

The program consisted of SOCIAL Cognitive Theory strategies that touched on all its three

determinants: personal showing models performing the use of condom correctly to improve

self-efficacy, behavioral monthly returned visit in the rural health unit reinforced participants'

skills, environmental mothers were given an observational checklist to make sure they

successfully completed the behavior in the use of Lactational Amenorrhea Method.

Concept Model

Personal Self-Efficacy

Desirable
Behavioral Attitude toward the behaviour
Behavior

Environmental Environmental
Conditions

Statement of the Problem

This study is intended to determine the level of understanding in Family Planning Health

Education of women attended the premarital counselling age 18-35 years of age in Poblacion,

Mutia Zamboanga del Norte.

Specifically it sought to answer the following questions:

1. What is the profile of the womens respondent in terms of the following variables?

1.1 Age
 1.2 Educational Level

2. What is the acquired beliefs on Family planning of womens respondent in Pobacion,

Mutia

Hypothesis

There is no significant difference between the profile variables and the acquired beliefs of

women in Poblacion, Mutia.

Schematic Diagram

Profile of respondent Knowledge and Attitude

*Age *Acquired beliefs

* Level Of Educational Attainment *Behavior

*Marital Status *Norms

Objective of the Study

1. Assess the respondents level of understanding in Family Planning as to age, marital

status, and educational level.

2. Assess the respondents knowledge and attitude as to acquired beliefs, norms and

behavior.

3. Determine the significant relationship between the respondents level of understanding

and the knowledge and attitude towards Family Planning Health Education.
Chapter 2

REVIEW OF RELATED LITERATURE

Despite the fact that contraceptive usage has increased over a period of time, there exist a

Knowledge Attitude and Practice-gap regarding contraception (Malek-Afzali 1998: Ramesh et al.

1996). The reasons for not using any family planning methods are lack of knowledge and

education, religious belief and fear of side effects. Family Planning has two main objectives;

firstly to have only the desired number of children and secondly, proper spacing of pregnancies

(Mao,1999).

Knowledge and practice of family planning is strongly related to higher level of

education (Ramesh et al.1996). In most of the studies it was found that education is the prime

influencing factor and education affects the attitudinal and behavioral patterns of the individuals

(Sajid and Malkr.2010:Mao, 1999). Based on a majority of researches, in most countries of the

world, female adolescents do not receive formal reproductive health education time, since their

puberty happens earlier than boys. Lloyd (2009:85) contends that all 13-15 years old should be

acquiring reading and writing fluency for lifetime learning, critical thinking skills, health and

reproductive health knowledge and skills for social and civic participation. Nevertheless, it offers

a standard to make informed and voluntary decisions in their lives, including their sexual, marital

and reproductive lives. Studies have showed that 63.4% of puberty disorders and complications

among females were because of their ignorance (Mohammadi et al. 2006). Considering the

above research results and the fact that the increasing number of population in Barangay

Poblacion, it is necessary to educate the women regarding family planning particularly during

puberty and before marriage. This study tried to educate female of reproductive age who tended
to married for the first time regarding family planning and find out how such education affects

their knowledge and attitude.

CHAPTER 2

RESEARCH DESIGN

An experimental design with an experimental and a control site using pre- and post-

intervention measurements will be used to investigate the effects of a planned family planning

health education on the participants knowledge and attitude. The interventional education is to

be perform in four one hour sessions covering related contents of contraception methods to be

lecture by four health trainer. To ensure their consistency in educational methods and contents

they were trained five consecutive days before staring intervention. Furthermore, the trainers will

be monitored directly using a video-cam recorder to ensure the consistency in educational

methods and contents. The educational method will consist of lecture and discussions panel

including questions and answers concerning family planning and contraceptive methods which

allows the women to express their ambiguity in understanding. Control group will underwent

traditional educational method which includes a single two hours educational sessions which

covers general issues of reproductive health issues consist of family planning, sexual health and

spousal communication.

RESEARCH SETTING

The research study will be conducted in Poblacion, Mutia Zamboanga del Norte. Mutia is

consist of 16 barangays and barangay Poblacion is the most populated amongst other barangay

and with this reason, the researcher decided to conduct her study in barangay Polacion.
RESEACH RESPONDENTS

Study population will include all couples who wish to married and attended to premarital

counselling during study period. There were fifty couples who attended to the Rural Health Unit

in 2015. A total of 10 women enrolled in the study using convenience sampling method.

RESEARCH INSTRUMENT

Pre and post interventional data is gathered with the use of structured questionnaire

develop based on previous studies on family planning. It will be consisted of three parts. The

first part of the questionnaire is the demographic data. The second part of the questionnaire will

consist of questions regarding knowledge on family planning and contraception methods and the

third part comprised of questions regarding attitude towards family planning on both positive and

negative statements regarding common issues on family planning with 5 point Likert Scale

questions.

RESEACH VALIDATION

Content validity will ascertain by an expert panel comprising professionals who were

health faculty members and health practitioners. Pilot study will be carried out on 20 women not

included in the study. It will performed as an initial step for the study to check the questionnaire.

Some modifications in some questions will be carried out after the pilot study.
Table 1
Knowledge questions

Definition Yes No Dont know

Family planning means spacing the birth of children.

Family planning is the same as abortion.

Family planning kills babies.

Family planning is a decision of both husband

Natural Family Planning method is a way of preventing pregnancy

without the use of drugs or devices.

A condom is a rubber that is inserted into the penis before sexual

intercourse.

Irregular menstruation is one of the possible side effects of IUD.

A pill is taken by a woman once a week to prevent pregnancy.

The pills prevent pregnancy by stopping the release of the sperm

from the testes.

Depo Provera injection is given to a woman every month to prevent

pregnancy.

The effect of injection is still present up to 4 months even though

injection has been stopped.

A condom prevents pregnancy by keeping the sperm from getting

into the vagina.

An IUD can travel to the different parts of the body.

Injection causes abnormal or deformed babies.

The string of an IUD traps the penis during sexual intercourse

Pills cause cancer.

IUD prevents pregnancy by blocking the sperm to come in contact
with the egg cell.

Vasectomy decreases a mans sexual satisfaction.

A woman who has undergone tubal ligation cannot do heavy work.

Tubal ligation involves tying and cutting of both fallopian tubes of a

woman.

A woman who is ligated will stop menstruating.

Vasectomy is a simple operation that makes a man sterile.

Vasectomy prevents pregnancy by blocking the sperm from reaching

the vagina.

Vasectomy is a simple operation that makes a man sterile.

Table 2
Attitude questions

Statements SA A NA/ND D SD

Do you want to know more about family planning?

Are you willing to practice family planning?

Family planning is only for young couples.

Bringing up a family is a shared responsibility of both husband and

wife.

Family planning improves maternal and child health.

Family planning is harmful.

Husbands should also participate in family planning decisions.

Family planning is important in ensuring a healthy family.

Statements SA A NA/ND D SD

OCPs can prevent ovarian cysts.

Depo Provera is suitable for couples at beginning marriage

Condom can prevent STDs.

Emergency Contraception is just usable for condom failure.

Emergency Contraception is usable for unprotected intercourse.

Weight gain and nausea are OCPs side effects.

IUD is suitable for forgetful women.

SA: Strongly Agree A: Agree NA/ND: Not Agree nor Disagree D: Disagree SD: Strongly
Disagree
Table 3
Demographic profile of the respondents

Characteristics Intervention Group Control Group

No. % No. %

Age

Mean SD

Educational Level

Primary School

Secondary School
Characteristics Intervention Group Control Group

No. % No. %

High school

College/ University
REFERENCES:

Mahamed, Fariba, Saadat Parhizkar, and Alireza Raygan Shirazi. "Impact of Family Planning

Health Education on the Knowledge and Attitude among Yasoujian Women." Global journal of

health science 4.2 (2012): 110.

Bandura, Albert. Social foundations of thought and action: A social cognitive theory. Prentice-

Hall, Inc, 1986.

REFERENCES:

Mahamed, Fariba, Saadat Parhizkar, and Alireza Raygan Shirazi. "Impact of Family Planning

Health Education on the Knowledge and Attitude among Yasoujian Women." Global journal of

health science 4.2 (2012): 110.

Fishbein, Martin, and Icek Ajzen. "Belief, attitude, intention, and behavior: An introduction to

theory and research." (1977).

The conceptual roots for social cognitive theory come from Edwin B. Holt and Harold Chapman
Brown's 1931 book theorizing that all animal action is based on fulfilling the psychological
needs of "feeling, emotion, and desire". The most notable component of this theory is that it
predicted a person cannot learn to imitate until they are imitated.[3]
In 1941, Neal E. Miller and John Dollard presented their book with a revision of Holt's social
learning and imitation theory. They argued four factors contribute to learning: drives, cues,
responses, and rewards. One driver is social motivation, which includes imitativeness, the
process of matching an act to an appropriate cue of where and when to perform the act. A
behavior is imitated depending on whether the model receives a positive or negative response
consequences.[4] Miller and Dollard argued that if one were motivated to learn a particular
behavior, then that particular behavior would be learned through clear observations. By imitating
these observed actions the individual observer would solidify that learned action and would be
rewarded with positive reinforcement.
The proposition of social learning was expanded upon and theorized by Canadian
psychologist Albert Bandura. Bandura, along with his students and colleagues conducted a series
of studies, known as the Bobo doll experiment, in 1961 and 1963 to find out why and when
children display aggressive behaviors. These studies demonstrated the value of modeling for
acquiring novel behaviors. These studies helped Bandura publish his seminal article and book in
1977 that expanded on the idea of how behavior is acquired, and thus built from Miller and
Dollard's research.[5] In Bandura's 1977 article, he claimed that Social Learning Theory shows a
direct correlation between a person's perceived self-efficacy and behavioral change. Self-efficacy
comes from four sources: "performance accomplishments, vicarious experience, verbal
persuasion, and physiological states".[6]
In 1986, Bandura published his second book, which expanded and renamed his original theory.
He called the new theory social cognitive theory. Bandura changed the name to emphasize the
major role cognition plays in encoding and performing behaviors. In this book, Bandura argued
that human behavior is caused by personal, behavioral, and environmental influences.[1]
In 2001, Bandura brought SCT to mass communication in his journal article that stated the
theory could be used to analyze how "symbolic communication influences human thought, affect
and action". The theory shows how new behavior diffuses through society by psychosocial
factors governing acquisition and adoption of the behavior.[7]
SCT has been applied to many areas of human functioning such as career choice and
organizational behavior[8] as well as in understanding classroom motivation, learning, and
achievement.

Current status[edit]
Social Cognitive Theory originated in psychology but based on an unofficial November 2013
Google Scholar search only 2 percent of articles published on SCT are in the psychology field.
About 20 percent of articles are from Education and 16 percent from Business. The majority of
publications using SCT, 56 percent, come from the field of Health Communication.
The majority of current research in Health Communication focuses on testing SCT in behavioral
change campaigns as opposed to expanding on the theory. Campaign topics include: increasing
fruit and vegetable intake, increasing exercise, HIV education, and breastfeeding.
Born 1925, Bandura is still influencing the world with expansions of SCT. His recent work,
published May 2011, focuses on how SCT impacts areas of both health and population effects in
relation to climate change.[9] He proposes that these problems could be solved through television
serial dramas that show models similar to viewers performing the desired behavior. Specifically
on Health, Bandura writes that currently there is little incentive for doctors to write prescriptions
for healthy behavior, but he believes the cost of fixing health problems start to outweigh the
benefits of being healthy. Bandura argues that we are on the cusp of moving from a disease
model (focusing on people with problems) to a health model (focusing on people being healthy)
and SCT is the theory that should be used to further a healthy society. Specifically on Population,
Bandura states population growth is a global crisis because of its correlation with depletion and
degradation of our planet's resources. Bandura argues that SCT should be used to get people to
use birth control, reduce gender inequality through education, and to model environmental
conservation to improve the state of the planet.

Overview[edit]
Social cognitive theory is a learning theory based on the idea that people learn by observing
others. These learned behaviors can be central to one's personality. While social psychologists
agree that the environment one grows up in contributes to behavior, the individual person (and
therefore cognition) is just as important. People learn by observing others, with the environment,
behavior, and cognition all as the chief factors in influencing development in a reciprocal triadic
relationship. For example, each behavior witnessed can change a person's way of thinking
(cognition). Similarly, the environment one is raised in may influence later behaviors, just as a
father's mindset (also cognition) determines the environment in which his children are raised.
The core concepts of this theory can be explained by Bandura's schematization of triadic
reciprocal causation in his book chapter,[2] The schema shows how the reproduction of an
observed behavior is influenced by the interaction of the following three determinants:

3. Personal: Whether the individual has high or low self-efficacy toward the behavior (i.e.
Get the learner to believe in his or her personal abilities to correctly complete a
behavior).
 4. Behavioral: The response an individual receives after they perform a behavior (i.e.
Provide chances for the learner to experience successful learning as a result of
performing the behavior correctly).
5. Environmental: Aspects of the environment or setting that influence the individual's
ability to successfully complete a behavior (i.e. Make environmental conditions
conducive for improved self-efficacy by providing appropriate support and materials).[10]

It is important to note that learning can occur without a change in behavior. According to J.E.
Ormrod's general principles of social learning, while a visible change in behavior is the most
common proof of learning, it is not absolutely necessary. Social learning theorists say that
because people can learn through observation alone, their learning may not necessarily be shown
in their performance.

Theoretical components[edit]
Modeling[edit]
Social cognitive theory revolves around the process of knowledge acquisition or learning directly
correlated to the observation of models. The models can be those of an interpersonal imitation or
media sources. Effective modeling teaches general rules and strategies for dealing with different
situations.[11]
To illustrate that people learn from watching others, Albert Bandura and his colleagues
constructed a series of experiments using a Bobo doll. In the first experiment, children were
exposed to either an aggressive or non-aggressive model of either the same sex or opposite sex as
the child. There was also a control group. The aggressive models played with the Bobo doll in an
aggressive manner, while the non-aggressive models played with other toys. They found that
children who were exposed to the aggressive models performed more aggressive actions toward
the Bobo doll afterward, and that boys were more likely to do so than girls.[12]
Following that study, Albert Bandura tested whether the same was true for models presented
through media by constructing an experiment he called Bobo Doll Behavior: A Study of
Aggression. In this experiment Bandura exposed a group of children to a video featuring violent
and aggressive actions. After the video he then placed the children in a room with a Bobo doll to
see how they behaved with it. Through this experiment, Bandura discovered that children who
had watched the violent video subjected the dolls to more aggressive and violent behavior, while
children not exposed to the video did not. This experiment displays the social cognitive theory
because it depicts how people reenact behaviors they see in the media. In this case, the children
in this experiment reenacted the model of violence they directly learned from the video.[13]
Observations should include:

Attention Observers selectively give attention to specific social behavior depending on

accessibility, relevance, complexity, functional value of the behavior or some observer's
personal attributes such as cognitive capability, value preference, preconceptions.
Retention Observe a behavior and subsequent consequences, then convert that
observation to a symbol that can be accessed for future reenactments of the behavior. Note:
When a positive behavior is shown a positive reinforcement should follow, this parallel is
similar for negative behavior.
 Production refers to the symbolic representation of the original behavior being translated
into action through reproduction of the observed behavior in seemingly appropriate contexts.
During reproduction of the behavior, a person receives feedback from others and can adjust
their representation for future references.
Motivational process reenacts a behavior depending on responses and consequences the
observer receives when reenacting that behavior.[1][2]

Modeling does not limit to only live demonstrations but also verbal and written behaviour can
act as indirect forms of modeling. Modeling not only allows students to learn behaviour that they
should repeat but also to inhibit certain behaviours. For instance, if a teacher glares at one
student who is talking out of turn, other students may suppress this behavior to avoid a similar
reaction. Teachers model both material objectives and underlying curriculum of virtuous living.
Teachers should also be dedicated to the building of high self-efficacy levels in their students by
recognizing their accomplishments.
Outcome expectancies[edit]
To learn a particular behaviour, people must understand what the potential outcome is if they
repeat that behaviour. The observer does not expect the actual rewards or punishments incurred
by the model, but anticipates similar outcomes when imitating the behavior (called outcome
expectancies), which is why modeling impacts cognition and behavior. These expectancies are
heavily influenced by the environment that the observer grows up in; for example, the expected
consequences for a DUI in the United States of America are a fine, with possible jail time,
whereas the same charge in another country might lead to the infliction of the death penalty.
For example, in the case of a student, the instructions the teacher provides help students see what
outcome a particular behaviour leads to. It is the duty of the teacher to teach a student that when
a behaviour is successfully learned, the outcomes are meaningful and valuable to the students.
Self-efficacy[edit]
Social cognitive theory posits that learning most likely occurs if there is a close identification
between the observer and the model and if the observer also has a good deal of self-efficacy.
Selfefficacy is the extent to which an individual believes that they have mastered a particular
skill. Self-efficacy beliefs function as an important set of proximal determinants of human
motivation, affect, and actionwhich operate on action through motivational, cognitive, and
affective intervening processes.[14]
According to Bandura, self-efficacy is "the belief in one's capabilities to organize and execute the
courses of action required to manage prospective situations".[15] Bandura and other researchers
have found an individual's self-efficacy plays a major role in how goals, tasks, and challenges are
approached. Individuals with high self-efficacy are more likely to believe they can master
challenging problems and they can recover quickly from setbacks and disappointments.
Individuals with low self-efficacy tend to be less confident and don't believe they can perform
well, which leads them to avoid challenging tasks. Therefore, self-efficacy plays a central role in
behavior performance. Observers who have high level of self-efficacy are more likely to adopt
observational learning behaviors.
Self-efficacy can be developed or increased by:
 Mastery experience, which is a process that helps an individual achieve simple tasks that
lead to more complex objectives.
Social modeling provides an identifiable model that shows the processes that accomplish
a behavior.
Improving physical and emotional states refers to ensuring a person is rested and
relaxed prior to attempting a new behavior. The less relaxed, the less patient, the more likely
they won't attain the goal behavior.
Verbal persuasion is providing encouragement for a person to complete a task or
achieve a certain behavior.[16]

For example, students become more effortful, active, pay attention, highly motivated and better
learners when they perceive that they have mastered a particular task. [17] It is the duty of the
teacher to allow student to perceive in their efficacy by providing feedback to understand their
level of proficiency. Teachers should ensure that the students have the knowledge and strategies
they need to complete the tasks.
Self-efficacy has also been used to predict behavior in various health related situations such as
weight loss, quitting smoking, and recovery from heart attack. In relation to exercise
science, self-efficacy has produced some of the most consistent results revealing an increase in
participation in exercise.[18]
Identification[edit]
Identification allows the observer to feel a one-to-one similarity with the model, and can thus
lead to a higher chance of the observer following through with the modeled action. [11]People are
more likely to follow behaviors modeled by someone with whom they can identify with. The
more commonalities or emotional attachments perceived between the observer and the model,
the more likely the observer learns and reenact the modeled behavior.[15]

Applications[edit]
Social cognitive theory is applied today in many different arease.g., mass media, public health,
education, and marketing. Examples of the theory in application include: Use of celebrities to
endorse and introduce products to specific demographics, in which social cognitive theory
encompasses all four domains. Miller's 2005 study found that choosing the proper gender, age,
and ethnicity for models ensured the success of an AIDS campaign to inner city teenagers. This
occurred because participants could identify with a recognizable peer, have a greater sense of
self-efficacy, and then imitate the actions to learn the proper preventions and actions. [19] A study
by Azza Ahmed in 2009 looked to see if there would be an increase in breastfeeding by mothers
of preterm infants when exposed to a breastfeeding educational program guided by SCT. Sixty
mothers were randomly assigned to either participate in the program or they were given routine
care. The program consisted of SCT strategies that touched on all three SCT determinants:
personal showing models performing breastfeeding correctly to improve self-efficacy,
behavioral weekly check-ins for three months reinforced participants' skills, environmental
mothers were given an observational checklist to make sure they successfully completed the
behavior. The author found that mothers exposed to the program showed significant
improvement in their breastfeeding skills, were more likely to exclusively breastfeed, and had
fewer problems then the mothers who were not exposed to the educational program.[20]

Morality[edit]
Main article: Social cognitive theory of morality
Social cognitive theory emphasizes a large difference between an individual's ability to be
morally competent and morally performing. Moral competence involves having the ability to
perform a moral behavior, whereas moral performance indicates actually following one's idea of
moral behavior in a specific situation.[21] Moral competencies include:

what an individual is capable of

what an individual knows
what an individual's skills are
an individual's awareness of moral rules and regulations
an individual's cognitive ability to construct behaviors

As far as an individual's development is concerned, moral competence is the growth of

cognitive-sensory processes; simply put, being aware of what is considered right and wrong. By
comparison, moral performance is influenced by the possible rewards and incentives to act a
certain way.[21] For example, a person's moral competence might tell them that stealing is wrong
and frowned upon by society; however, if the reward for stealing is a substantial sum, their moral
performance might indicate a different line of thought. Therein lies the core of social cognitive
theory.
For the most part, social cognitive theory remains the same for various cultures. Since the
concepts of moral behavior did not vary much between cultures (as crimes like murder, theft, and
unwarranted violence are illegal in virtually every society), there is not much room for people to
have different views on what is morally right or wrong. The main reason that social cognitive
theory applies to all nations is because it does not say what is moral and immoral; it simply states
that we can acknowledge these two concepts. Our actions in real-life scenarios are based on
whether we believe the action is moral and whether the reward for violating our morals is
significant enough, and nothing else.[21]

See also[edit]

Social cognition

References[edit]

1. ^ Jump up to:a b c Bandura, A., Social foundations of thought and action : a social
cognitive theory. 1986, Englewood Cliffs, N.J.: Prentice-Hall.
2. ^ Jump up to:a b c Bandura, A. (2002). Social cognitive theory of mass
communication. In J. Bryant & M. B. Oliver (Eds.), Media Effects: Advances in Theory
and Research (pp. 94-124). New York, NY: Routledge.
3. Jump up^ Holt, E.B. & H.C. Brown (1931). Animal drive and the learning
process, an essay toward radical empiricism. New York: H. Holt and Co.
4. Jump up^ Miller, N.E.; J. Dollard & R. Yale University (1941). Institute of
Human, Social learning and imitation. New Haven; London: Pub. for the Institute of
human relations by Yale university press; H. Milford, Oxford University Press.
5. Jump up^ Evans, R.I. & A. Bandura (1989). Albert Bandura, the man and his
ideasa dialogue. New York: Praeger.
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a Unifying Social Cognitive Theory of Career and Academic Interest, Choice, and
Performance". Journal of Vocational Behavior. 45 (1): 79
122. doi:10.1006/jvbe.1994.1027.
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Evaluation. (pp. 33-70). New York, NY:Guilford Press.
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11. ^ Jump up to:a b Bandura, A. (1988). "Organizational Application of Social
Cognitive Theory" (PDF).Australian Journal of Management. 13 (2): 275
302. doi:10.1177/031289628801300210.
12. Jump up^ Bandura, Albert; Ross, D.; Ross, S. (1961). "Transmission of
aggression through imitation of aggressive models". Journal of Abnormal and Social
Psychology. 63: 575582.doi:10.1037/h0045925. PMID 13864605.
13. Jump up^ Bandura, Albert; Ross, D.; Ross, S. (1963). "Imitation of film-
mediated aggressive models". Journal of Abnormal and Social Psychology. 66: 3
11. doi:10.1037/h0048687.
14. Jump up^ Bandura, A. (1989). "Human Agency in Social Cognitive
Theory" (PDF). American Psychologist. 44 (9): 11751184. doi:10.1037/0003-
066X.44.9.1175. PMID 2782727.
15. ^ Jump up to:a b Bandura, A. Self-efficacy in changing societies. Cambridge; New
York: Cambridge University Press.
16. Jump up^ McAlister AL, Perry CL, Parcel GS (2008). "How Individuals,
Environments, and Health Behaviors Interact: Social Cognitive Theory". Health
Behavior and Health Education: Theory, Research, and Practice (4th ed.). San
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 17. Jump up^ Bandura, Albert (1993). "Perceived Self Efficacy in Cognitive
Development and Functioning". Educational Psychologist. 28 (2): 117
148.doi:10.1207/s15326985ep2802_3.
18. Jump up^ Weinberg, Robert S.; Gould, Daniel (2007). Foundation of Sport and
Exercise Psychology (4th ed.). Champaign, IL: Human Kinetics. p. 422.
19. Jump up^ Miller, Katherine (2005). Communication Theories: Perspectives,
Processes, and Contexts (2nd ed.). New York, New York: McGraw-Hill.
20. Jump up^ Ahmed, A. (2009). Effect of Breastfeeding Educational Program
Based of [sic] Bandura Social Cognitive Theory on Breastfeeding Outcomes among
Mothers of Preterm Infants. Midwest Nursing Research Society Conference. Accessed
November 2011.http://hdl.handle.net/10755/160761
21. ^ Jump up to:a b c Santrock, J.W. (2008). A Topical Approach to Lifespan
Development (M. Ryan, Ed., 4th ed.). New York, NY: McGraw-Hill Companies, Inc.
(Original work published 2002), pp. 26, 30, 478

Further reading[edit]

Bandura, Albert (1976). Social Learning Theory. Englewood Cliffs, NJ: Prentice
Hall. ISBN 978-0138167448
Bandura, Albert (1985). Social Foundations of Thought and Action. Englewood Cliffs,
NJ: Prentice-Hall. ISBN 978-0138156145
Berg, Insoo Kim; Miller, Scott D. (1992). Working with the Problem Drinker: A Solution-
focused Approach (pp. 733735). New York: Norton. ISBN 978-0393701340
Pajares, Frank; Prestin, Abby; Chen, Jason; Nabi, L. Robin. "Social Cognitive Theory and
Media Effects". In Nabi, Robin L.; Oliver, Mary Beth, The SAGE Handbook of Media
Processes and Effects. Los Angeles: SAGE, 2009. 283-297. ISBN 978-1412959964
Bandura, Albert (2001). Social Cognitive Theory: An Agentic Perspective. Annual
Review of Psychology.

External links[edit]

Library resources about

Social cognitive theory

Resources in your
library

Resources in other
libraries
 "Albert Bandura Bobo Doll Experiment: A Study of Aggression." YouTube, Web. 29 Mar.
2010
"Albert Bandura speaking at Everett M. Rogers Award Colloquium 2007" YouTube,
(1h33)

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ARCHIVED - Canadian Guidelines for Sexual Health Education

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Theory and Research in Sexual Health Education

Sexual health education can range from public health messages that provide basic information to
comprehensive interventions with precise behavioural objectives. While most forms of sexual
health education have potential benefits, many are still missing the main elements needed to
effectively address the diverse sexual health needs that may be relevant to Canadians.
Research continues to make progress in distinguishing the essential elements required to develop
more effective sexual health education programs that can meet the needs of its intended
audience(s) and that can appropriately contribute to the reduction of negative sexual health
outcomes. The approach to sexual health education presented in theCanadian Guidelines for
Sexual Health Education is supported by such research. It demonstrates the importance and
encourages the incorporation of current research and evaluation as the basis for further
development of sexual health education programs and policy.
Programs that are exclusively directed at increasing the knowledge of an individual are often
successful in reaching this objective. Although useful in this regard, focusing only on providing
factual information about sexual health may not be sufficient or effective in reducing negative
sexual health outcomes. While an individual exposed to this type of educational programming
may possess a high level of sexual health knowledge, it is unclear whether that knowledge will
translate into behaviours that can enhance sexual health.

Theoretical Models to Guide Effective Sexual Health Education

Theoretical models derived from research enable program planners to determine the teaching
methods that most effectively result in behaviours that will enhance sexual health. In the case of
STI/HIV prevention, one of the characteristics of nearly all effective interventions is the
incorporation of theoretical models that are well supported by a body of research and that
effectively encourage sexual health promotion and behavioural change.
In the process of creating and implementing sexual health education programs, it is important for
program planners and policy-makers to rely on well-tested and empirically supported theoretical
models as a foundation for sound program development.
Several theoretical models meet these standards and can be used to develop programs consistent
with the Canadian Guidelines for Sexual Health Education. Examples of models which have
provided the theoretical basis for behaviourally effective programs include the Social Cognitive
Theory, Transtheoretical Model, Theory of Reasoned Action & Theory of Planned Behaviour,
and Information, Motivation and Behavioural Skills (IMB) Model. A brief summary of these
models is provided on the following below.
Social Cognitive Theory
Evaluation research indicates that health interventions informed by the Social Cognitive
Theory (SCT) can help to positively modify an individuals behaviour in a number of
domains including STI/HIV prevention. Reference Number 2424, Reference Number 2828
The Social Cognitive Theory Reference Number 2929 states that people learn from one another by
observation, imitation and modelling. The theory provides a framework for understanding,
predicting and changing human behaviour. It identifies human behaviour as an interaction
of:
personal factors (e.g., knowledge, understanding, expectations, attitudes,
confidences),
behavioural factors (e.g., skills, practice, self-effi cacy), and
environmental factors (e.g., social norms, access in community, infl uence of
others).
Social Cognitive Theory can be applied to sexual health education in a number of ways. For
example, a recent study applied SCT in an HIV prevention program for fathers and their
sons. The program activities targeted fathers and were designed to promote the development
of self-efficacy, positive expectations and intentions to discuss sexual topics with their sons.
The program included relevant and current information about listening and communication
skills, adolescent development, puberty, and HIV and STI risk-reduction practices.
Consistent with SCT, it was found that developing an understanding about HIV and STI
prevention practices among fathers and increasing their communication skills, resulted in
more positive outcomes such as higher levels of self-efficacy in their sons decision
making. Reference Number 2727
Transtheoretical Model
The Transtheoretical Model has also provided the basis for effective STI/HIV
interventions. Reference Number 3030, Reference Number 3232
 This model considers behaviour change as a process rather than as an isolated event.
According to the model, individuals participating in behaviour change interventions should
be guided through a five-stage continuum Reference Number 3333:
ii Precontemplation: little or no intention to change the behaviour in the near future;
iii Contemplation: intention to change behaviour in the near future (e.g., within the next 6
months);
iiii Preparation: intention to take steps to changes (e.g., within the next month);
ivi Action: engaging in the health behaviour within the past 6 months; and
vi Maintenance: consistent practice of desired health behaviour and working to prevent
relapse (e.g., 6 months to 5 years).
The transtheoretical model has been shown to have promise for use at an adolescent sexual
health and STI/HIV clinic. In one study, having a supportive partner and being older in age
made it more likely that the client would move forward through the stages of change. It was
also noted that the transtheoretical model helped clinic staff to structure and personalize
their counselling sessions. Reference Number 3232
Theory of Reasoned Action & Theory of Planned Behaviour
The Theory of Reasoned Action & Theory of Planned Behaviour is a well-tested model that
has provided the theoretical basis for effective interventions targeting STI/HIV
prevention Reference Number 3434, and condom use. Reference Number 3535, Reference Number 3737
The Theory of Reasoned Action Reference Number 3838, Reference Number 3939 is a theory that focuses on an
individualsintention to behave a certain way. This intention is determined by one or both of
two major factors:
ATTITUDE the individuals positive or negative feelings towards performing a
specific behaviour.
SUBJECTIVE NORM associated with the behaviour. An individuals
perception of other peoples opinions regarding the defined behaviour will influence
their behavioural intention.
The Theory of Planned Behaviour Reference Number 4040 is an extension of the Theory of Reasoned
Action, which additionally considers that behavioural intention is a function of attitudes
toward a behaviour, subjective norms toward that behaviour and perceived behavioural
control, or the feeling that the individual can indeed perform the behaviour in question.
A study guided by the Theory of Reasoned Action has demonstrated the theorys
applicability when targeting condom use in university students. The study found that
students had greater intentions of using condoms when the educational intervention focused
on: (1) positive attitudes towards condom use and their protective effect against STIs,
 including HIV, and also (2) students perceptions that their sexual partner(s) and peers were
likely to approve of condom use. Reference Number 3535
Information, Motivation and Behavioural Skills (IMB) Model
Within sexual health education programs (including those informed by other models),
evidence supports the inclusion of elements of information, motivation and behavioural
skills. Reference Number 4141 Information, motivation and behavioural skills are basic concepts that
are easily understood by educators and program audiences. The Information, Motivation and
Behavioural Skills (IMB) Model is well supported by research demonstrating its efficacy as
the foundation for behaviourally effective sexual health promotion interventions. Reference Number
4242, Reference Number 4444

Top of Page

Integrating Theory into Practice: Utilizing the IMB Model

While there are a number of very good theoretical models that can be used in the development of
sexual health education curriculum and programming, the Guidelines are based on the IMB
model because there is significant empirical evidence which demonstrates the models
effectiveness.
Evidence of the IMB models effectiveness in the area of sexual risk reduction has been
demonstrated in a number of diverse populations including young adult men, Reference Number 4545 low
income women Reference Number 4646, Reference Number 4747 and minority youth in high school settings. Reference
Number 4848
Furthermore, a meta-analysis strongly supports the need to include elements of
information, motivation and behavioural skills in interventions that target sexual risk behavioural
change. Reference Number 4949

Figure 2. The IMB Model

Text Equivalent - Figure 2

Note: Adapted from Fisher, W.A., & Fisher, J.D. (1998). Understanding and promoting sexual
and reproductive health behavior: theory and method. Annual Review of Sex Research, 9,39-76.
The fundamental elements of sexual health education proposed by the Guidelines can be readily
incorporated into an IMB model. Using the IMB model, sexual health education programs are
based on the three essential elements:
Information helps individuals to become better informed and to understand information
that is relevant to their sexual health promotion needs and is easily translated into action;
Motivation motivates individuals to use their knowledge and understanding to avoid
negative risk behaviours and maintain consistent, healthy practices and confidences; and
Behavioural skills assists individuals to acquire the relevant behavioural skills that will
contribute to the reduction of negative outcomes and, in turn, enhance sexual health.
The IMB model can help individuals to reduce risk behaviours, prevent negative sexual health
outcomes and guide individuals in enhancing sexual health. Programs based on the three
elements of model provide theory-based learning experiences that can be readily translated into
behaviours pertinent to sexual and reproductive health.

Top of Page

Elements of the IMB Model

INFORMATION For sexual health education programs to be effective, they need to provide
evidence-based information that is relevant and easy to translate into behaviours that can help
individuals to enhance sexual health and avoid negative sexual health outcomes.

Information included in sexual health education programs should be:

Directly linked to the desired behavioural outcome and will result in the enhancement of
sexual health and/or the avoidence of negative sexual health outcomes.
Example: Acquiring information about how a specific form of birth control works, including
how it is used effectively, how it may be paid for, how it may be discussed with a health care
provider and with a partner, and information that is relevant to actual use of the method of
contraception is essential for programs targeting pregnancy prevention. Acquiring such
information may be directly linked to reducing cases of unintended pregnancies.
Easy to translate into the desired behaviour.
Example: Creating a directory of all local, easily accessible sexual and reproductive health
centres may translate into a desired positive behaviour when it results in individuals
identifying accessible, appropriate, user-friendly sexual health care resources and visiting
such a health centre or clinic more frequently.
Practical, adaptable, culturally competent and socially inclusive.
 Example: Programs targeting groups with diverse backgrounds must provide information
that is clear, practical and situated within the social context and environment experienced by
the target population. For example, a safer sex promotion program might identify risky
behaviourrather than membership in a sexual or ethnic minorityas the basis for the
practice of prevention.
Age, gender and developmentally appropriate.
Programs should be tailored to meet the mental, physical and emotional needs of people at
different ages and stages of their lives.
Example: Programs targeting prevention of STI/HIV risk behaviours among adolescents
with disabilities must take into account their unique needs.

MOTIVATION Even very well informed individuals who have received sexual health
information that is easy to translate into action need to be motivated sufficiently to act upon what
they have learned to promote their sexual health. Accordingly, in order for sexual health
education programs to achieve their goals, planners should address the motivational factors that
are needed to bring about behavioural change.

Where sexual and reproductive health behaviours are concerned, motivation takes three forms:
Emotional Motivation An individuals emotional responses to sexuality (the
individuals degree of comfort or discomfort with the issues surrounding sex and sexual
health) as well as to specific sexual health-related behaviours, may heavily infl uence
whether or not that individual takes the necessary actions to avoid negative sexual health
outcomes and to enhance sexual health.
Example: Men who have negative emotional responses to sexuality may be less likely to
benefit from educational programs designed to encourage them to undertake a testicular
self-examination.
Personal Motivation An individuals attitudes and beliefs in relation to a specific sexual
and reproductive health behaviour strongly predict whether or not that individual engages in
that behaviour.
Example: An individual who has strong negative feelings about a method of contraception
(condoms are awful because they reduce feeling, the pill is bad because it will make me
gain weight) are unlikely to adopt the method of contraception in question, unless they
come to accept offsetting positive beliefs that alter their negative attitudes.
Social Motivation An individuals beliefs regarding social norms, or their perceptions
of social support pertaining to relevant sexual and reproductive health behaviours are also
likely to infl uence behavioural change.
Example: Individuals who are questioning their sexual orientation are more likely to seek
out and speak openly in an environment they feel is supportive of all sexual orientations. In
 such a setting, they may realize that many individuals seek similar kinds of support and
thereby be motivated to pursue information or services consistent with their needs.

BEHAVIOURAL SKILLS Individuals should be aware of and acquire practice enacting the
specific behavioural skills that are needed to help them adopt and perform behaviours that
support sexual health.

While relevant information and motivation are essential elements infl uencing adoptionof
behaviours that support sexual health, having appropriate behavioural skills to act effectively is
also essential for behavioural change. This is why sexual and reproductive health skills training
are key elements of effective sexual health education programs.
Behavioural skills consist of the following:
i. The practical skills for performing the behaviour (e.g., knowing how to
negotiate); and
ii. The self-efficacy to do so (e.g., personal belief in ones ability to successfully
negotiate).
Example: An individual who has been given information on how to use a condom, and
is motivated to use it, must also have the technical skills to properly put it on, and the
negotiation skills to get their partner to agree to use or to support the use of one.
Behavioural skills training for the prevention of STI/HIV and if applicable, unintended
pregnancy, should include the skills to negotiate safer sex (e.g., condom use) as well as the
ability and confidence to set sexual limits (e.g., to delay first intercourse). Behavioural skills for
self-reinforcement and for partner-reinforcement for maintaining sexual health promoting
behaviour over time is also critical in the long run.
Applying the IMB Model to sexual health education programs
A comprehensive application of the IMB model to sexual health education programs involves a
basic three-step process:
Text Equivalent - Applying the IMB Model to sexual health education programs

Top of Page

ASSESSMENT AND PLANNING

Identify the level of information, motivation and behavioural skills that the target
population has related to specific health behaviours and outcomes. To assess this
information, conduct focus groups, interviews or administer a survey questionnaire to a
representative sub-sample of the target population.
Example: In the assessment phase of a sexual health education program for pre-teens that
includes the objective of delaying first intercourse, a sub sample of pre-teens may be
selected to fill out a questionnaire to measure their:
knowledge related to the implications of first intercourse (Information);
 attitudes and perceptions of peer pressure and social norms related to sexual
activity (Motivation); and
skills as well as beliefs in their own ability to follow through on a decision to
delay first intercourse (Behavioural skills).
Make evidence-based decisions for program planning based on the current research, other
program evaluations as well as assessment of need.
Program evaluation is an integral part of program management. There are several types of
program evaluation, both in the program planning and implementation stages. Program
planners should consider conducting a needs analysis, and/or a feasibility study. Information
from a needs analysis and a feasibility study will provide planners with information on the
type of programming that is required, and if the program is appropriate in terms of timing,
resources and audience. Program implementation evaluation consists of two forms: process
and outcome evaluation. The purpose of process evaluation is to improve the operation of an
existing program, and focuses on what the program does and for whom. The purpose of
outcome evaluation is to assess the impact of a program, and focuses on examining the
changes that occurred as a result of the program and whether it is having the intended effect.
The plan for process and outcome evaluation should be built into the overall program
plan, prior to its actual launch. This is especially important for outcome evaluation. In order
to determine whether a program made a difference or not, there needs to be an
understanding of how things were before the program was implemented (e.g., knowledge,
attitudes, beliefs, etc).
INTERVENTION
Design and implement the sexual health education program based on the assessment
findings.
For each target group, address where gaps exist in information, motivation and
behavioural skills in relation to the program objectives and needs of the individual.
Use assets that the group has in the area of information, motivation and behavioural
skills. These assets should be used to reach program objectives.
Example: The intervention phase of a sexual health education program is designed to
increase the use of condoms among sexually active adolescents. This could fill knowledge
gaps among the target group (Information), reinforce the groups personal views about
condom use and help them to personalize the risks of teen pregnancy and/or STI/ HIV
(Motivation) and incorporate role playing exercises to help individuals learn how to
negotiate condom use with sexual partners while also teaching them where to access free
condoms (Behavioural skills).
EVALUATION
 Evaluation is required to determine if the program has had the intended effect on the
target groups information, motivation and behavioural skills in relation to the program
objectives. Evaluation research enables program planners to identify strengths and
weaknesses in the program so that, if necessary, modifications may be made to increase the
programs effectiveness. Reference Number 50-5350-53
Evaluation should also include a mechanism to capture any unintended outcomes that
emerge separate from the stated objectives of the program. Such unintended outcomes may
also identify particular strengths and weaknesses in the program that are not revealed by an
analysis of just the stated objectives.
It is important for program planners to consider and address factors that can have an
impact on the validity of the evaluation findings. When possible, the evaluation should
include a control group to ensure that observed changes are actually the result of the
program and not the result of external infl uences. Use of different types of measures can
increase confidence in the evaluation data collected.
Example: The evaluation phase of a sexual health education program focusing on cervical
cancer prevention and screening might include the following steps:
At the beginning of the program, have participants fill out a questionnaire that
assesses their knowledge of the prevalence, causes and preventive measures
associated with cervical cancer (Information), their personal attitudes towards taking
the necessary precautions to reduce their risk of cervical cancer (Motivation) and their
perceived ability and skills to change risk behaviours and seek screening/ vaccination
services to reduce the risk of cervical cancer (Behavioural skills).
The questionnaire should directly assess the occurrence and frequency of risk
behaviours. In this case, the questionnaire would determine the participants level of
behavioural risk for cervical cancer, whether the individual has received an HPV
vaccine and whether they have been screened for cervical cancer and, if so, how
frequently.
Randomly split individuals that have completed the questionnaire into two
groups: a control group that does not receive the new sexual health education program
and an intervention group that does.
As part of the evaluation process, re-administer the questionnaire to both groups
after the program has been completed to measure the degree of effectiveness.
Identify parts of the program that require modification.

Top of Page

Environments Conducive to Sexual Health

 The Guidelines identify Environments Conducive to Sexual Health as a fourth key
element of sexual health education.
A variety of environmental factors have been recognized as determinants of sexual and
reproductive health. These include:
social and economic circumstances (e.g., income, education, employment, social
status and social supports);
access to/knowledge of health services; and
community norms, values and expectations related to sexuality, gender identity,
sexual orientation and reproduction. Reference Number 5454
Programs based on the IMB model have the ability to infl uence sexual health promotion
behaviour change. However, these programs must also address the infl uence of
environmental factors on individual efforts to acquire and apply the knowledge, motivation
and skills needed to maintain or enhance sexual health.
Example: A study in Winnipeg found that teen birth rates were strongly related to
socioeconomic status (the social and economic circumstances which include factors such as
unemployment, high school completion and single parent households). The rate of teen
births was over 13 times higher in the low socioeconomic status (SES) areas when
compared to the high SES areas. Reference Number 5555
Similarly, a geographic mapping study of census tracts in Toronto found that higher birth
rates among teens and higher chlamydia and gonorrhea rates in young adults were
associated with lower income. Reference Number 5656 Income and access to services are only two of
the many examples of the different ways in which the social environment, and particularly
social inequality, can affect sexual health.
International Comparisons. An in-depth international comparative study of adolescent
sexual and reproductive health in five developed countries (Canada, United States, France,
Great Britain and Sweden) has provided convincing evidence of the role of environmental
factors in infl uencing sexual health. Reference Number 5757
Example: Countries that scored high or very high in levels of economic equality, had access
to reproductive health services and sexual health education, and used the media to promote
responsible sexual behaviour were more likely to have lower teen pregnancy and STI rates
compared to countries that scored low or very low on these indicators. Data collected for the
Canadian component of the study suggested that in Canada, for both early teen pregnancies
and STIs, rates vary by geographic region and economic status. Additionally, the age of first
intercourse also varies by economic and social status as well as by region of
residence. Reference Number 58-6058-60,
In the United States a comprehensive review of research on teenage pregnancy found that
environmental factors such as community disadvantage and disorganization, family
 structure and economic situation, as well as peer, partner and family attitudes towards
sexuality and contraception are directly linked to determinants of adolescent sexual
behaviour, use of contraception, pregnancy and attitudes toward childbearing. Reference Number 6161
Media. The media, including television, movies, music, magazines and the Internet, have
become an increasingly powerful force in communicating norms about sexuality and sexual
behaviour. However, these messages are often barriers to the creation of environments
conducive to sexual health.
Example: Several studies have suggested that exposure to sexual content in the media is one
of the many factors that may infl uence the timing of onset of sexual behaviours. Reference Number
6262, Reference Number 6363
Effective sexual health education programming should address media
messages and help individuals to evaluate critically what they see, hear and read in the mass
media while simultaneously relating to diverse sexual norms and practices.
Critical evaluation of the impact of the media, and of the environment that such information
creates, should also be a key part of sexual health education in both the public and not-for-
profit sectors.
Community/Cultural Appropriateness. Research on program evaluation illustrates how
sexual health education programs that are culturally appropriate and sensitive to community
needs are more likely to be effective.
Example: An effective STI/HIV risk reduction program for low-income women living in
housing developments can be adapted to that environment by conducting elicitation research
among its residents. This can also be done by identifying and using organizers within the
housing developments as educators and by using housing development events as
opportunities to provide effective sexual health education. Reference Number 6464 Professionals who
recognize that educational program participants are likely the most expert about what it
might take to change their behaviour, might well turn to the participants and ask them what
would have to happen in order for change to take place.
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