This meta-analysis tested the major theoretical assumptions about behavior change by examining the outcomes and mediating mechanisms of different preventive strategies in a sample of 354 HIVprevention interventions and 99 control groups, spanning the past 17 years. There were 2 main conclusions from this extensive review. First, the most effective interventions were those that contained attitudinal arguments, educational information, behavioral skills arguments, and behavioral skills training, whereas the least effective ones were those that attempted to induce fear of HIV. Second, the impact of the interventions and the different strategies behind them was contingent on the gender, age, ethnicity, risk group, and past condom use of the target audience in ways that illuminate the direction of future preventive efforts. Keywords behavior change; active intervention; HIV; health; communicationThe development of effective health behavior interventions and adequate understanding of the processes that underlie change to risky behavior continues to top the agenda for reducing disease and death among at-risk populations. For example, infection with HIV has been diagnosed in almost 1 million people in the United States (Centers for Disease Control [CDC], 2003) as well as an estimated 40 million worldwide (UNAIDS/ WHO Working Group, 2002). In some countries, the epidemic continues to escalate, and even in nations that have successfully Copyright 2005 by the American Psychological AssociationCorrespondence concerning this article should be addressed to Dolores Albarracín, Department of Psychology, University of Florida, Gainesville, FL 32611. E-mail: E-mail: dalbarra@ufl.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript curbed the spread of the disease, certain groups still show increases in infection rates (see, e.g., CDC, 2003). Given these distressing figures, it is no surprise that research on HIV prevention has become increasingly important and progressively more sophisticated. Indeed, HIV prevention presently constitutes one of the most significant paradigms for the discovery of health behavior change techniques and for the understanding of the theoretical processes that underlie such change.In fact, the HIV epidemic of the 1980s stimulated the uniting of funds and expertise from various disciplines in the development of a shared behavior-change paradigm. As a key example, in 1992, a group of behavioral researchers joined forces-upon request from the National Institutes of Health-to develop a paradigm for behavior change that would guide research and practice in the prevention of HIV (see Fishbein et al., 1992). Various models were examined, and the key assumptions were condensed into a limited number of premises that illuminated preventive efforts.Although the various models had independently received broad support, this support was derived almost entirely from behavior prediction studies. However, the formulation of these general assumptions contributed to...

General action and inaction goals can influence the amount of motor or cognitive output irrespective of the type of behavior in question, with the same stimuli producing trivial and important motor and cognitive manifestations normally viewed as parts of different systems. A series of experiments examined the effects of instilling general action and inaction goals using word primes, such as “action” and “rest.” The first 5 experiments showed that the same stimuli influenced motor output, such as doodling on a piece of paper and eating, as well as cognitive output, such as recall and problem solving. The last 2 experiments supported the prediction that these diverse effects can result from the instigation of general action and inaction goals. Specifically, these last 2 studies confirmed that participants were motivated to achieve active or inactive states and that attaining them decreased the effects of the primes on behavior.

A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse demographic and behavioral backgrounds.

Objective-To examine the long-term efficacy of both fear-inducing arguments and HIV counseling and testing at encouraging and maintaining knowledge about HIV transmission and prevention, as well as condom use.Design-Analyses were conducted with a sample of 150 treatment groups and 34 controls and included measures of change at an immediate follow-up and a delayed follow-up. Main outcome measures-The main outcome measures were perceived risk of HIV infection, knowledge about HIV, and condom use.Results-Results indicated that receiving fear-inducing arguments increased perceptions of risk at the immediate follow-up but decreased knowledge and condom use, whereas resolving fear via HIV counseling and testing decreased perceptions of risk and increased knowledge and condom use at both the immediate and delayed follow-ups. The effects on perceived risk and knowledge decreased over time, but the effects on condom use became more pronounced.Conclusion-Inducing fear is not an effective way to promote HIV-relevant learning or condom use either immediately following the intervention or later on. However, HIV counseling and testing can provide an outlet for HIV-related anxiety and, subsequently, gains in both knowledge and behavior change immediately and longitudinally.

Objective Enrollment in HIV-prevention interventions is more likely when the audience has safer rather than riskier HIV-relevant behavior. Thus, a meta-intervention was designed to increase participation by an audience of infrequent condom users in Florida. Design Participants (N = 400) were randomly assigned to 1 of 4 conditions varying the introduction to a counseling program. In the experimental condition, participants were told that the intervention gave participants options but might not change their behavior. In a standard-introduction condition, participants were told that the program was highly effective at changing participants’ behaviors. There was also an information-control group containing a description of the program, and a no-information-control group solely containing an invitation. Main outcome measures The outcome measure was actual participation in the offered counseling. Results Findings indicated that the experimental introduction was the most successful at yielding participation in the counseling program when the audience had low intentions to use condoms in the future. Conclusion Intervention introductions countering participants’ resistance to change increase participation in HIV-prevention counseling among reluctant clients. Other meta-interventions may be explored to systematically augment the effectiveness of evidence-based health-promotion interventions.