PRIME is based on the Health Action Process Approach (HAPA), a theory of adult behavior change from the health psychology literature. Implementation of the majority of school-based interventions requires adults to commit to behavior change. For example, to implement a behavior support plan, a teacher must remember to review behavior expectations during circle time, praise and provide a ticket when the student demonstrates appropriate behavior, and deliver a back-up reinforcer when earned. Just these three steps require the teacher to incorporate a lot of new behaviors into his or her everyday routine. Thus, promoting high levels of treatment integrity can be thought of as an adult behavior change activity or process.
The HAPA model describes how adults engage in this behavior change (see Figure above). Before people change their behavior, they need to be motivated to do so. This process of developing a behavioral intention is captured in the Motivational Phase of the HAPA model. Three variables are considered to play a role in this process: (a) perception of a problem that needs to be addressed; (b) outcome expectancies, beliefs about the positive and negative outcomes of alternative behaviors; and (c) action self-efficacy, one’s confidence in being capable of performing a difficult or novel behavior. But intention alone does not change behavior and the process of how people actually initiate and maintain a new behavior is captured in the Volitional Phase of the HAPA model. New behaviors are promoted by planning, as completed through Action and Coping Planning, as well as adequate maintenance and recovery self-efficacy, one’s confidence in being capable to implement over time and after disruption, respectively. Research in health psychology has demonstrated that Action and Coping Planning can facilitate initiation of a new behavior, and that individuals with higher levels of self-efficacy are more likely to sustain the behavior.
The HAPA model informed the development PRIME in several ways. First, PRIME addresses treatment integrity from the development of an intention to implement to maintenance of the implementation behaviors. Second, a key hallmark of the PRIME Implementation Supports is Implementation Planning, which combines Action and Coping Planning from the HAPA model. Third, the Implementation Beliefs Assessment includes items that address the variables described in the HAPA model. Based on this assessment, treatment integrity data, and student outcome data, consultants may provide targeted implementation support to address specific areas of difficulty per the HAPA model.