Health and Human Behavior

Wubet Taklual (MPH)

November,2017

OUTLINE

Introduction Definition of behavior

Component of behavior Determinate of behavior

•  Behavior change approach

Type of Health behaviors

Level of disease prevention

Introduction

Health is determined, not by medical services and drugs, but also by ordinary human actions and behaviors.

E.g. Feeding children with diarrhoea.

bottle put

them

at

risk

of

Many health education programs have failed because:

•  They put too much emphasis on individual behavior

•  Neglected to understand the cultural, social, economic and political factors that influence his/her behaviors or actions.

•	Life style: Refers to the collection of behaviours that make up a person’s way of life-including diet, clothing, family life, housing and work.
•	Customs: It represents the group behaviour. It is the pattern of action shared by some or all members of the society.

• Traditions: Are behaviours that have been carried out for a long time and handed down from parents to children.

•

Culture: Is the whole complex of knowledge, attitude, norms, beliefs, values, habits, customs, traditions and

any other capabilities and skills acquired by man as a member of society.

Research Evidence(WHO-2009)

•

Around 32% of children less

than

5

years

of

age

in

developing countries are stunted and 10% are wasted.

Reason

•

Non-exclusive breastfeeding in the first 6 months of life(1.4 million deaths and 10% of the disease burden)

Worldwide, it is estimated that only 34.8% of infants are exclusively breastfed for the first 6 months of life.

Pregnant women(Ethiopia)  27% avoided at least one type of food due to food taboos.

•  Milk and cheese were regarded as taboo foods by nearly

half of the women (44.4%)

•  linseed and fatty meat (16%, 11.1%).

Definition of Behavior

Behavior: is an action that has specific frequency,

duration,

and

unconscious.

purpose,

whether

conscious

or

It is both the act and the way we act. Action –types of overt behavior, such as drinking, smoking, etc. To say a person has drinking/smoking behavior

•  Duration –it is the time spent since the action started or noticed such as for a week/months.

•  Frequency- how it is repeated in a certain period of time.

•  Purpose –is he/she doing consciously or not

What is Human Behavior??

Human behavior is the sum total / result of physical & mental factors influenced by social/cultural factors.

The study of human behavior is how people behave and why they behave in just the way they do.

Behavior components

A) Cognitive domain: stored information

•  Knowledge

•  Perception

•  Thinking

B) Affective domain: cognition +feeling (connation)

•  Attitude

•  Beliefs

•  Value

C) Psychomotor domain

•  Psycho – mind

•  Motor – action

Changes in behavior

• Changes in behavior - our behavior changes all the time

• 1. Natural change - some changes take place because of natural events or processes

•

Such as age-sex related behaviors, Pregnancy

related behaviour

• 2. Planned change - we make plans to improve our lives or to survive and we act accordingly

• Example: plan to stop smoking or drinking

Continue…

•

Planned change in behavior can be faster or

slower depending on the response of the acceptor and adapter of the behavior

• People stay healthy or become ill as a result of their own action

• The following are examples of how people’s actions can affect their own health

Continue…

Feeding children with bottle put them at risk of diarrhea

Defecating in an open field will lead to parasitic infection

Using mosquito nets and insect sprays helps to keep mosquito away

Unsafe sex predisposes people to unwanted pregnancy, HIV/AIDS and other STDs

Continue…

•	It	is	Hard	to	change	people’s behavior,
	particularly those practiced for a long time.
•	E.g. Ato fekadu is a 53 years old and he smoke

cigarette and chewing chat for the

past 25

years with his friends. After he practiced such

kind of unhealthy behavior for a long period of

time it will become difficult

to

behavior. Why

behavior?

it

is

hard

to

change his

change

his

Continue…

Types of Health Behaviors

•	WHO	define	health	behavior	as	‟any activity
	undertaken by an individual regardless of actual
	or perceived health status, for the purpose of
	promoting, protecting or maintaining health, whether or not such behavior is objectively effective towards the end.”
•	It is any activity undertaken by a person to keep

himself or others healthy and prevent disease

Continue…

• Three

key

focus

of

health behavior are

maintenance of health, restoration of health and improvement of health.

•

The study of health behavior is based upon

two assumptions:



A

substantial

proportion

of

mortality

and

morbidity are caused due to a particular

pattern of behavior and These behavior patterns are modifiable

Factors affecting human behavior

A. Predisposing factors

Are antecedents or prior to behavior that provide the rationale or creation of motivation for the behavior to occur.

This type of factors include:

• Knowledge Attitude • Perception • Belief
•	Value
•	And existing personal skills that facilitate or hinder motivation

for change.

Predisposing…

Knowledge

Knowledge can be defined as the perception and cognition of oneself, the immediate surrounding or environment and the universe as a whole.

Cognitive Ability is defined as the capacity to perceive, reason, or use instinct by an individual.

Cognition is an individual activity

Knowledge is a relationship between an individual and reality.

Predisposing…

There fore, Perception and Intuition /instinct lead us into mental thinking in which later will be stored in our memory in the form of meaning, symbols, pictures, etc.

This stored memory is known as knowledge. The means of acquiring knowledge by the brain is

perception.

Perception: Is giving meaning and interpretation of data and information received by the five sense organs of the body available to the brain.

Perception

+

Knowledge

Storage

of

information

in

the

brain

=

Predisposing…

Perception

Is

there

thinking?

any

difference

between

perception

and

In perception the stimuli are originated from outside the body and are received by sensory organs, and then the stimulus reaches the brain and gets interpreted in meaningful ideas. At this stage thinking starts.

In other words, perception ends with thinking.

Thinking can be the product of perception or can be by itself internal mental process or exercises.

Belief

It also refers to a conviction that a phenomenon or object is true or real. Faith, trust, and truth are words used to express or imply belief.

They are derived from parents, grandparents, and other

people we respect to listen and are accepted as true. But we accept beliefs without trying to prove that they are true

or false.

Difficulty index of changing beliefs.

Usually easier to influence

Are held by individuals

•  Have been acquired recently

Come from not highly respected sources

Are not part of religion

Not part of traditional medical system

Usually difficult to change

Are held by the whole community

Have been deep rooted in the culture

Come from highly respected and trusted sources

Are part of the a religion

•  Are part of traditional medical system

Types of beliefs

As beliefs can be held very strongly, they are often difficult to change.

One big wrong is that the health workers them selves

believe

that any traditional

changed.

belief

is

bad

and

must be

To overcome this, health workers must categorize beliefs in advance as harmful, neutral and useful.

Then, they can concentrate on trying to change only the harmful and encourage the helpful ones.

Type of belief

•	Hot food items will cause abortion.
•	Cold foods might affect the quality and quantity of
	milk production.
•	Pregnant mother should eat less to keep the size of the baby minimum for easy delivery.
•	Prohibits intake of water at the time of delivery of a
	baby
•	Pregnant woman should eat less egg so as to produce
	a small fetus and an easy labor.
•	Milk and cheese, linseed and fatty meat were avoided during pregnancy in Ethiopia. Due to fear of difficult delivery (51%), discoloration of the fetus (20%) and

fear abortion (9.7%).

Attitude

One of the vaguest yet most frequently used and misused words in the behavioral sciences word list is attitude.

While there is no total consensus among behavioral scientists, to keep matters short and simple it is better look at three definitions that, in combination, cover the principal elements of attitude.

Mucchielli (1970) describes attitude as “a tendency of mind or of a relatively constant feeling towards a certain category of objects, people, or situation.”

Kirscht viewed attitudes as a collection of beliefs that always includes an evaluative aspect.

Kiesler, Collins, and Miller (1969) defined attitude as a learned predisposition to respond in a consistently

favorable or unfavorable manner with respect to a given object.

Characteristics of Attitude 1) Predisposition: Exposure related to an attitudinal object.

e.g.

It is not sensible to ask about the attitude (inclination)

about

condom

for

those

who

do

not

know

it

(not

predisposed). 2) Has directions: Polar, +ve or _ve, good or bad.

3. Evaluation: Can be evaluated by intensity or judgment. e.g. Favorable or unfavorable 4) Changeability: Can be changed, adopted, modified, not static.

5) Stability or consistency. Stability=related to time Consistency= the sameness of attitude

•

•

e.g. “Mood” changed quite often.

Relation ship between beliefs and attitudes

It is certain that our beliefs about things affect the way we think about them. Our beliefs, in turn, are influenced by our attitudes.

The judgment as good or bad and worth carrying out a

behavior

will

depend

on

the

beliefs

about

the

consequences of performing the behavior.

Generally, • Beliefs perceived to have good outcomes • Beliefs perceived to have bad outcomes

• +ve attitude _ve attitude

Attitude

beliefs

Therefore, rather than just asking respondents how they feel

(attitude) about a particular attitudinal object, attitudes

can be measured by asking what they believe about the object.

Sequential Relationship among KAP

The general trend or normal way of thinking and acting the

proper sequence among KAP is that knowledge (K) is followed by attitude (A) and is followed by practice (P).

But this rule is not universally applicable to every behavior.

A	P	K
P	K	A
K	P	A

When P or A precedes K, it is due either to an imitation

(modeling) or compulsion.

Value

Every individual places or gives a relative worth to every thing around. This worth or preference or judgment is known as value.

It is defined as the regard that something is held to be

important

or worth;

community.

and prized

by an individuals

or

Examples:

• Being a good mother • Having many children •

Being approved by friends

• Being attractive to opposite sex

•

Academically success

Being a man of God • Being healthy

•

Criteria of value

•  Free choice

•  Alternatives

•  Selection by reason and consideration made advantages and disadvantages

•  Proud of selection

•  Accept openly/frankly

•  Act upon it

•  Act consistently

from its

NB. In terms of difficulty of changing:

Beliefs < attitudes < values

Outcome efficacy (outcome expectation): the beliefs that undertaking the behaviors will bring a desired health

benefit.

Example, the belief that taking a prescribed medication will reduce your pain.

 Self-efficacy or self-confidence: It is your belief in your ability or competence to perform a behavior.

•  For example, can you remember to take the medication? And can you discipline your self to exercise regularly?

Behavioral intention: Is the willingness to perform a certain behavior provided that the enabling factors are readily available.

B. Enabling factors

Enabling factors are those antecedents to behavior that facilitate a motivation to be realized.

They help individuals to choose, decide and adopt

behaviors

changes.

and

may be

barriers and

This category of factors include:

The health care environment:

assets to needed

Availability

•  Accessibility

•  Affordability

New skills

Resources. E.g. Facilities, money, time, labor services, skills, transportation, materials and the distribution and their location.

Other environmental factors such as community and /or governmental laws, policy, rules, regulations, priority and commitment can be a barrier or a facilitator of the behavior change to be occurred

Examples:

Food Availability: Food is within reach of households (local shops and markets), both in terms of sufficient quantity and quality.

• Determined by domestic food production, commercial food imports ,food aid and domestic policies regarding food production.

Food Access: Determined by:

• Food prices • Household resources

• Socio-political factors such as ethnic favoritism, social discrimination and gender inequality

Food Utilization: An individual’s dietary intake. • Both quantity and quality of food . Outcomes

Positive

• Healthy Physical and mental development • Productive • Healthy person Negative • Dual burden: co-existence of over and under nourished • Shift in dietary pattern • Demographic shifts (mortality and fertility ) • Epidemiologic shifts (infectious disease to Non- infectious Disease)

C. Reinforcing Factors

Reinforcing factors are those factors subsequent to a behavior that provide the continuing reward or incentives for the behavior to be persistent and repeated.

Are those consequences of actions that determine whether

the actor receives positive or negative

feedback and is

supported socially or by significant others after it occur.

Significant Others

Can also be called relevant others or influential others. These are people who are significant (determine or influence) the behavior of others to encourage or discourage to do something.

Among these important people are elders, friends, peers, parents, grandparents, village leaders, religious leaders

and people with a lot of experience and skills (teachers,

health workers, etc.).



Types of Health Behaviors

Health Behaviors: are actions that healthy people undertake to keep themselves or others healthy and prevent disease.

• A number of studies have looked at the relationship between health behaviours and a variety of health outcomes.

• Seven features of lifestyle: not smoking, moderate alcohol intake, sleeping 7–8 hours per night, exercising regularly, maintaining a desirable body weight, avoiding snacks, and eating breakfast regularly, which together were associated

with lower morbidity and higher subsequent long-term

survival.

1) Promotive Behaviors:

Physical exercise Use of latrine Child spacing Proper disposal of dirty water Good nutrition Clean storage of food Breast feeding

2) Preventive Behaviors

•  Taking anti—malaria drugs

•  Immunization

•  Using mosquito bed nets

3) Utilization behaviors

Is concerned with utilization of health services such as:

ANC services Immunization services Child health services Screening programs FP service

4) At risk behaviors:

It refers to the activities undertaken by an individuals,

who believes himself to be health but at a greater risk of developing a specific health condition, for the purpose of

preventing

that

condition

or

detecting

it

in

an

asymptomatic state. For example, HIV/AIDS testing

5) Illness behaviors

The action people take before consulting health care workers, including recognition of symptoms, taking home remedies (self—medication), consulting family and healers are called illness behaviors.

It is recognition of early symptoms and prompt self— referral for treatment before the disease becomes serious

6) Compliance behaviors

A behavior following a course of prescribed drugs (taking too much drug or too less or no drug because of severity and short recovery). Best example is TB –prolonged drug use.

7) Rehabilitation behaviors

A type of behavior that prevent further disabilities after a serious illness.

E.g. counseling after lung cancer surgery to exercise or quit

smoking

8.

Mutual—aid behavior

Activity in which people support each other in relation to their common health problems.

• 9. Parenting health behaviors:

Any action performed by individuals/family for the purpose of ensuring, maintaining, improving of the

health of their children 10. Community action

Action undertake by the individuals and groups to change or improve their surroundings to meet special needs.

•  Installation of improved water supply

•  Building of latrines and upgrading the unimproved

Behavior Change Approaches

Persuasion Approach: is the deliberate attempt to influence the other person to do what we want them to do. (Often called the ‘directive’ approach or, when done forcefully, coercion).

Such approach is used in situations where there is serious treat such as epidemics and natural disasters, and the actions needed are clear—cut.

Behavior change…

The informed decision making approach

Giving people information, problem—solving and decision— making skills to make decision but leaving the actual

choice	to	the	person		(‘open’	or	‘non	judgmental’
approach).
Such approach			is	used	with groups		who have been

disadvantaged or oppressed by promoting awareness, conscious raising and building confidence that they have

the power to make their appropriate decisions and control their own lives called empowerment.

Levels of Disease Prevention

Primary Prevention

Is comprised of those preventive measures that forestall the onset of illness or injury during the pre—pathogenesis period (before the disease process begins).

Aimed specifically at forestalling the onset of illness or injury among apparently health individuals.

Examples

•  Wearing safety belt

•  Immunization

•  Physical exercise

•  Brushing one’s teeth

•  Breast feeding

levels of disease…

Secondary Prevention

Illness and injury can not always be prevented. In fact, many diseases such as cancer and heart diseases can establish themselves in humans and cause considerable

damages before they are detected and treated.

Aimed at promoting early diagnosis and prompt treatment of a disease to cure or to limit disability and prevent more serious pathogenesis.

levels of disease…

Example

Breast—cancer screening

•  Blood pressure examination

•  Cholesterol level examination

•  Treating malaria patients

Tertiary Prevention

It is at this level the health educator work to retain, reeducate, and rehabilitate the individual who has already incurred disability, impairment, or dependency

levels of disease…

The aim is to limit further disability Example Educating after lung cancer surgery

•  Working with the diabetes individual to ensure

daily Injections are taking

the

Thank You