A conceptual framework for developing and evaluating behavior change interventions for injury control

Abstract

This paper addresses issues and research needs in the domain of behavior modification for injury control. Although much of the discussion focuses on traffic safety, the concepts and principles are applicable to all areas of injury control (e.g. on the job and in the home). Field research that has increased safety belt use is reviewed briefly to illustrate a tripartite classification of injury control factors (i.e. environmental, individual, or behavioral variables), and to introduce a heuristic framework for categorizing and evaluating behavior change strategies. A multiple intervention level hierarchy depicts a progressive segmentation of the target population as more effective (and costly) interventions are implemented; and a taxonomy of 24 behavior change techniques includes a scoring system for predicting short and long term effects of intervention programs. It is presumed that more risk-prone individuals require higher-level interventions, which are those that provide specific response information and extrinsic controls, while also eliciting active participant involvement, social support, and perceptions of autonomy. Although extrinsic controls increase the immediate impact of an intervention program, these techniques may jeopardize response maintenance when the program is withdrawn. ARTICLEInjury is physical harm to a person caused by exchanges with environmental energy; the mechanicalenergy exchanges in falls, shootings and motor vehicle crashes are the most common causes of severe and fatal injuries (Robertson, 1983). In the United States, injury is the prime cause of lost years of productive life (Waller, 1987). In fact, the number of years lost annually to injuries of Americans exceed those lost from cancer by 2.4 million years and from heart disease by 2.0 million years of life (Injury in America, 1985). The factors contributing to an injury can be categorized as person, behavior and environment variables. Figure 1 illustrates these three factors wiui examples from the domains of occupational and vehicle safety. Geller et al. (1989) termed this figure "The Safety Triad', and developed this model as a foundation for a training program to prevent occupational injuries.The person factors are the most difficult to identify as causes of injury, since these factors are numerous and most are not directly observable. For example, an individual's prior training or experience, or his/her attitude may have influenced the injury producing incident. Alternatively, a person's particular skills, abilities, intelligence or physical condition (e.g. as affected by lack of sleep or substance abuse) could have an impact. Furthermore, a risky lifestyle or personality (e.g. Donovan et al., 1983;Wilson and Jonah, 1988) increases one's propensity to emit injury-prone behaviors.The environmental conditions that are potential contributors to injury are relatively easy to identify and modify because they are observable and finite. The presence of equipment hazards fall under this category, as well as the availability ...

The Socio-Demographic and Psychological Predictors of Residential Energy Consumption: A Comprehensive Review

“…Such interventions have typically targeted many of the individual-level factors (or the individual's immediate environment) reviewed in this paper. Interventions have ranged from so-called "antecedent strategies" aimed at changing the factors that precede consumer behavior-such as basic information provision and education; goal-setting and commitment strategies; and the use of social/group norms, peer influence and social modeling-through to more "consequence" strategies aimed at changing the outcomes of such behavior-such as self-monitoring; delivering feedback (on one's behavior or performance); and the use of rewards (intrinsic and extrinsic) and other incentives [14,165]. While the literature suggests that all of these strategies have the potential to motivate pro-environmental behavior, the effects have been far from robust and consistent across studies-certain strategies have been found to be effective in some contexts, for some people, and for some types of behavior, but not others (for an overview, see [166]).…”

Predicting propensity to actively care for occupational safety

“…A key proposition in the multiple intervention level model proposed by Geller et al (1990) and refined by Geller (1992) is that individuals influenced by an intervention program (at a particular level of cost effectiveness and intrusiveness) should not be targeted for further intervention, but rather should be enrolled as intervention agents for the next (i.e., higher) level of behavior change intervention. In other words, "preaching to the choir" is not as beneficial as enlisting the "choir" to preach to others (cf.…”

“…Three of the six correlations (i.e., risky lifestyles at both sites and cognitive failures at Site 1) were not significant. Geller et al (1990) introduced a system for categorizing behavior change techniques and developing a more systematic approach to designing intervention programs to fit a particular behavioral problem, target audience, and organizational culture (see also Geller, 1992). Interventions were categorized into multiple levels or tiers, each level defined by its intrusiveness and cost-effectiveness.…”

Effecting Durable Change

“…Subsequently, De Young (1996) argued that durable proenvironmental changes can be facilitated by devising techniques that combine (a) detailed procedural information, (b) feedback about one's performance, and (c) a supportive social environment. Similar conditions to increase intervention effectiveness were proposed by Geller et al (1990). Geller (2002, p.534) incorporated these intervention elements in a scheme, the "flow of behavior change" model, that described how to move an individual through the stages in which environmentally unfriendly habits are changed into environmentally friendly behavior and ultimately into environmentally friendly habits.…”