The 'Logical Levels' Behavioural Model Applied to Condom Use

This description of the Logical Levels of Change, a behavioural model by Robert Dilts, details strategies of using it as a framework for designing, reviewing, and enhancing health promotion interventions, illustrated with the example of condom use and the tools of "The Complete Condom Training Kit" from Bridges of Hope Training, a South African organisation whose goal is the empowerment and motivation of individual "to maintain their health, live positively and realize their life goals and dreams.

According to the model, change or maintenance of a particular behaviour must be supported at various "neurological levels", labeled "Environment", "Skills and Capabilities", "Beliefs and Value", and "Identity", with selected examples of statements and questions as follows:

• Identity - "[If a young man] thinks of himself as "I am a trendy, cool, macho stud" or "I am worthless", this self-image will not support condom use.   Even if he can get condoms easily (Environment), can use them properly and negotiate their use with a sexual partner (Skills and Capabilities) and believes they are effective (Beliefs and Values), this sense of identity may prevent him from actually using them.
• Beliefs and Values - "Do you believe that a woman or girl has the right to insist on condom use, or to refuse sex if a man does not agree to use a condom? "
• Skills and Capabilities - "Can you confidently negotiate condom use with your sexual partner(s)?"
• Environment - "Are good quality condoms that suit you readily available at an affordable price in your area?  "

Strategies to address each level include some of the following:

• Environment - On a national level the South African Department of Health has a set of Standard Operating Procedures (SOPs) for the purchase, distribution and quality control of both male and female condoms, making them freely available and more appealing and acceptable in design. Locally, if there are challenges for adolescents, "we must address the Values and Beliefs of those providing condoms and education about how to use them, including nurses and teachers of high school Life Orientation curricula."
• Skills and Capabilities - A multi-sensory, experiential learning which simulates reality (as far as is practical) can train individuals for the use of condoms.  "[I]nteractive, participatory role-play activities [can] build skills and strategies for negotiating condom use.  An adapted version of the Forum Theatre interactive drama technique pioneered by Boal  proves effective for this."
• Beliefs and Values - These include: risk/benefit, efficacy, and normative beliefs. Limiting beliefs can be challenged with "what if" and "who says" questions to engage people to develop skills and strategies. Participatory activities are included, such as a condom wall activity, a chewing gum activity, and a bushfire activity. The chewing gum activity, for example, involves handing out chewing gum and then collecting the chewed pieces and attempting to hand them out again.
• Identity - Shifting identities that make decisions on condom use difficult can be done, according to the example, with the activity “Be the person you want to be” which explains and illustrates how to create an empowering identity statement.

In conclusion, Bridges of Hope Training suggests that "the logical levels framework proves simple to understand, and can be applied at different scales, from the design and management of SBCC [social and behaviour change communication] programmes down to one-to-one consultations and counselling."