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Understanding behavior

A review of influences on health and illness behaviors Tewfik Daradkeh

Human behaviors important for health promotion


Community action - actions by communities to change their surrounds includes community participation in health decision-making Health behaviors actions people undertaken to be healthy Utilization behaviors utilisation of health services Illness behaviors - recognition of symptoms and prompt self-referral Compliance (adherance) following course of prescribed medicines

Rehabilitation behaviors what people need to do after an illness/surgery to recover

Types of behaviors
Decision-based behaviors where a person goes through a conscious decision-making process before deciding to perform (or not to perform the behavior)

One-time behavior a behavior that a person is expected to do only a few times in their life. (also usually a decision-based behavior).
Routine behavior something people do regularly - usually without a conscious decision (a behavior might start as decision-based and then become a routine as it is integrated into their pattern of life) Addictive behavior when there is some physiological reinforcement of the behavior through a biological adaptation in the person who becomes dependent on regular use of the substance.

Defining the behavior


It is important to carefully define the precise behavior/actions you are wanting to influence

Exercise: Produce a list of the specific behaviors that might be promoted for the following topics: family planning, smoking, immunization

Family planning Smoking

Not becoming pregnant before 18 Using contraception until want to have the first child Using contribution to space births Using contraception to stop having children
Immunization

Not starting to smoke Stopping smoking Not starting up after quitting

Bringing a child to clinic for immunization Allowing a child to be immunized by health worker

Just by defining the behavior precisely you can tell a great deal about the likely influences, feasibility of change and appropriateness as a target for for a health education

Actions to be promoted

What are we asking people to do? When should they do it? How often?

Selection of actions to promote


Epidemiological study of risk factors Strength of evidence that changing behavior will lead to improved health Feasibility of changing the behavior Evidence from evaluations of other interventions and impact achieved Research studies on perception of community (understandings, priorities, felt needs)

Origins of beliefs
Personal experience Communication
other persons (especially trusted sources) media

Part of other beliefs


culture/religion/traditional belief systems

Important beliefs
Beliefs about

Cause Prevention Seriousness personal risk/susceptibility feasibility of being able to take action consequences of taking action likely response of other people.

Health Belief Model


For a person to take action he/she must: believe they are susceptible

believe the health problem is serious


believe that the advantages of taking action outweigh the disadvantages
A trigger may be needed to encourage the person to act

Origins of beliefs
Personal experience Communication
other persons media

Part of other beliefs


culture/religion/traditional belief systems

Personal experience is a powerful influence on beliefs

Lay and traditional health systems


Herbalist

Lay beliefs on self medication

Healers using ceremonies

Health Belief Model and the selection of message


Acording to HBM people will only take action if they believe they are susceptible believe the health problem is serious believe that the advantages of taking action are greater than the disadvantage If a person does not believe that the/she is susceptible, a message that the problem is serious will not lead to change A message advising someone to take action will not be effective if the person does not believe that the problem is serious

A message has to cover beliefs that are the most important

Social networks
relationships between people based on personal contact

Who makes the decisions


in the family? in the community?

about care of children? use of health services? use of medicines?

Social networks
Information
on health, disease and sources of help

Influence
pressure to act in particular ways

Significant others in family friends - peers partners in relationships, opinion leaders in community

Support
help and support in times of crisis, difficulty and solving problems

Target groups
secondary target groups persons with influence over the primary target groups - gate-keepers

primary target groups persons making the decisions for themselves

Theory of reasoned action (Fishbein)


Beliefs about the consequences of taking action and judgement of those consequences
Beliefs whether others in their networks would approve or disapprove of them taking action

Attitude

behavioral Intention Subjective Norm

behavior Change

behavioral intention
Enabling factors
money materials time skills services

behavior change

BASNEF Model Builds upon the Fishbein model by adding enabling factors

Beliefs Atttitudes Subjective Norms Enabling Factors

Stages of change model


Making changes
Ready to change

Maintaining safer lifestyle

Maintaining changes

Thinking about change not interested in changing risky behavior Relapsing

Prochaska & DiClemente

World Health Organizations Definition of Health (1948)


Health is a complete state of well-being: Physical well being , Mental well being, and Social well being Health is NOT merely the absence of disease or infirmity. This state of optimum health is called wellness

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