Overview of

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Overview of The Popular Opinion
Leader Community-level HIV Prevention
Intervention For those considering implementing
or funding implementation of the POL
intervention.
(P O L)
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Sally, Tom, Larry, and Joan's most trusted and
admired friends influenced them to regard the
popular opinion in their social circles as one
supportive of HIV risk reduction behaviors.
Popular and credible friends indicated to Sally,
Tom, Larry, and Joan that they strongly believe
in and practice HIV risk reduction. Other
opinion leaders also influenced admiring peers
across all the social circles in this community.
Social norms supporting HIV risk reduction now
predominate as the popular opinion across the
whole of Sally, Tom, Larry and Joan's community.
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• Summary of the Popular Opinion Leader (POL)
  intervention
• Identify, recruit, support, and deploy popular
  and credible social network opinion leaders
  (POLs) to model and promote risk reduction
  supportive opinions and practices to their
  friends and acquaintances within their shared
  social networks.
• Social network peers are influenced by POLs to
  take up the risk reduction opinions and
  practices.
• Network by network the opinion diffuses (spreads
  and is "taken up") in the community so that HIV
  risk reduction/safer sex becomes the popular
  opinion and prevalent norm.
• Norms influence the behavior of community
  members. POL targets perceptions of the
  acceptability of safe practices in the community.

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Objectives of this Overview Presentation To help
you learn about POL and consider implementing or
funding implementation of the POL intervention
1. Describe the POL intervention. 2.
Describe capacity needed and technical
assistance available to support
implementation of POL.
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• Background What is the POL intervention?
• Community-level intervention.
• Based on diffusion of innovation theory.
• Evidence of effectiveness.

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• Community-level
• Conceptually targets collectively held element
  (i.e., a social norm), rather than the
  individual as unit.
• Social norms (factors that exist at the level of
  the community) shape individual behavior.
• Efficiency of targeting social norms (basic
  influence on behavior hence, efficiently impact
  behaviors).

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Diffusion of Innovation Rogers, EM. (1983)
Diffusion of Innovations. New York Free Press.

• Behavior trends typically and predictably follow
  adoption by opinion leaders.
• Mechanisms modeling observational learning
  personal influence belief that adopting the
  behavior will be beneficial and creation of new
  or strengthening existing social norms.
• Sufficient numbers (15) and connectedness of
  credible, well-liked, trusted, trend setters
  (POLs) model the norm.

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Major tasks in implementing POL

• Formative research to establish and adapt
  intervention, identify population (including its
  subgroups/social networks), risk behaviors, and
  Popular Opinion Leaders (POLs).
• 2. Recruit, train, support, and deploy POLs.
• 3. Evaluation (process evaluation to monitor
  adherence to the model so that desired effect can
  be achieved).

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Who are the POLs?

• POLs belong to the social networks that exist in
  a community.
• Local assessment needed to identify the POLs who
  are specific to each subgroup.
• Important to be able to "map" the social
  networks and indigenous trend setters (POLs)
  within the networks.
• Respected, credible, relevant life experiences,
  trustworthy, empathetic to friends, well-spoken,
  articulate, and self-confident.

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EVIDENCE OF EFFECTIVENESS
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9 Core Elements of POL
1. POL is directed to identifiable target
population in well-defined community venues where
the population's size can be estimated. 2.
Ethnographic techniques are systematically used
to identify segments of the target population and
to identify those persons who are most popular,
well-liked, and trusted by others in each
population segment. 3. Over the life of the
program, 15 of the target population size found
in the intervention venues are trained as POLs.

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Core elements contd
4. The program teaches POLs skills for initiating
risk reduction messages to friends and
acquaintances in everyday conversations. 5. The
training program teaches POLs characteristics of
effective behavior change communication messages
targeting risk related attitudes, norms,
intentions, and self efficacy. In conversations,
POLs personally endorse the benefits of safer
behavior and recommend practical steps needed to
implement change. 6. Groups of POLS meet
together weekly in sessions that use instruction,
facilitation modeling, and extensive role
exercises to help POLs refine their skills and
gain confidence in delivering effective HIV
prevention messages to others. Groups are small
enough to provide extensive practice
opportunities for all POLs to shape their
communication skills and create comfort in
delivering conversational messages.
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Core elements contd
7. POLs set goals to engage in risk reduction
conversations with friends and acquaintances in
the target population between weekly
sessions. 8. POLs conversational outcomes are
reviewed, discussed, and reinforced at subsequent
training sessions. 9. Logos, symbols, or other
devices are used as "conversation starters"
between POLs and others.
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POL tasks and characteristics.
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• Formative research, and tailoring and adapting
  strategies
• Describe the population members, social
  networks, popular opinion leaders, and HIV
  prevention-related norms in need of promotion.
• Use rapid ethnographic assessment/formative
  research methods
• (e.g., sociometric survey
• observational studies
• gatekeeper/key informant interviews (and
  support)
• focus groups
• KAB surveys and
• existing needs and risk assessments market
  and census studies)
• to develop support for the intervention and a
  description of the
• a. population,
• b. subgroups (social networks),
• c. popular and credible opinion leaders,
• d. HIV risk reducing norms for promotion, and
  e. appealing and relevant intervention
  marketing strategy.

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II. Recruitment, training, deployment and support
of POLs. Recruit POLs from the populations'
social networks. Identify and develop an
appropriate recruitment strategy.
Recruit POLs.
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II. POL recruitment, training and support,
continued Train the POLs. Use the
POL participants' manual and POL training
manual. Utilize formative information
to tailor population specific content.
Teach POL intervention theory and philosophy
provide accurate HIV risk reduction
information practical advice on implementing
HIV risk reduction behavior changes
communication skills training, including
modeling and role playing initiation of risk
reduction conversations with peers.
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II. POL recruitment, training and support,
continued 4. Deploy and continually support
the POLs to model the risk reduction normative
opinions. POLs engage in at least 14
conversations with different friends and
acquaintances among whom they are popular and
trusted. Provide enticing opportunities -
like reunion meetings or parties - for POLs to
encourage and maintain POLs in continuing to
model risk-reduction supportive opinions.
Need to maintain the intervention as POL
cadres are deployed and supported, and opinion
diffuses through the population.
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NOTE A POLs are to be recruited, trained,
deployed, and supported in cadres or cohorts over
the course of the program. \ POLs augment
and support POL recruitment through referrals
of other POLs. Training groups need to be
small enough to allow for sufficient practice
by POLs to effectively model risk reduction
supportive opinions. Resources for your
POL intervention will help to dictate the
logistics of your recruitment, training,
deployment and ongoing support of POLs in
cadres or cohorts.
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NOTE B Logos, symbols or other devices like
social marketing support your intervention.
Such "branding" can help advertise and promote
your intervention. Assists in
spreading the message to the extent that they
promote and reinforce recognition and belief in
the opinions that are promoted to be popular.
Supports the POLs by providing them with
recognizable "conversation starters."
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Four formal training sessions, 1 1/2 - 2 hours
each session, and Time between sessions needed
for practice. Session 1 Teaching POLs about
HIV and Risk Reduction Issues. Session 2
Teaching POLS about effective communication
strategies to change norms. Session 3
Practicing risk reduction conversations. Session
4 Continuing risk reduction conversations and
inspiring maintenance.
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Capacity and Technical Assistance to Support
Implementation of POL
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Agency commitment and capacity needed
Support from within agency. Access to
population at risk and population in need of
intervention services, community partners,
community locales and venue staff. Funding
1 - 2 program staff (part- or full- time), 1
administrative staff (part-time). Space to
run training and support events. Knowledge
of and skills related to conducting the
intervention.
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What are the costs? Level of resources your
agency is willing or able to commit relates to
the intervention population size your agency
can intervene with using the POL
intervention. Estimate your resources and
costs to plan your intervention. Breakdown
of cost items and units based on original
research trial - volunteer, donated facilities,
and existing overhead can reduce estimates
while other (miscellaneous) expenses like staff
training for POL may increase estimates.
Possible to estimate a per POL cost (which can
help estimate the population size with which
you can intervene).
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Breakdown of cost items and units based on
original research trial handout Unit
Cost1 of Units Total costs Salary1 Senior/
supervisory staff /hour 200 hours
_______ Junior staff /hour 202 hours
_______ Administrative staff /hour 19
hours _______ Bar staff2 /hour 16
hours _______ Total Salary Cost
_______ Incentive payments3 POL
incentives /POL 43 POLs _______ Other
Expenses4 Meeting room rental /session 8
sessions _______ Staff local
travel /roundtrip 36 roundtrips
_______ Refreshments POL trainings /session 8
sessions _______ Pamphlets /pamphlets 1500
pamphlets _______ Posters /poster 20
posters _______ Miscellaneous costs ---
---- _______ Subtotal Overhead (25)5
subtotal Total _______ 1 Insert total
hourly rate, including fringe benefits costs 2
This refers to incentives paid to key informants
related to nominating POLs 3 Optional expenses 4
Expense may vary 5 Excludes utilities, office
rental, maintenance, and general administrative
costs
www.effectiveinterventions.org
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Technical Assistance to Support
Implementation Training, including relevant
supportive trainings (skill sets needed).
www.effectiveinterventions.org
Published resources. Web resources.
CDC technical assistance system.
Implementation challenges strengths and
weaknesses of the POL intervention.
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Intervention challenges Emerging empirical
knowledge of the theoretical and
methodological challenges to replication and
implementation of community level
interventions. Non-traditional
intervention! Role change from that in
traditional individual interventions. It is
different than teaching individuals alone or in
small groups. Labor intensive!
Commitment, skill, creativity, perseverance,
and positive attitude needed to reach and
engage community. Attitudes in HAART era may
pose new challenges to community and
individual interest in participation.
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Intervention strengths (features recap)
Efficient can reach many people in a short
amount of time. Emphasizes community
empowerment. Uses an empirically-tested,
effective model. Based on friends
influencing friends approach. Model can
address other pertinent issues. Broad
adaptability to populations.