INTRODUCTION TO BEHAVIOURAL

SCIENCES AND HEALTH CARE

MODELS




BY DR HASIBA RASHEED
WHAT ARE BEHAVIOURAL
SCIENCES
BEHAVIORAL SCIENCES

• Behavioral science is a branch of the sciences which is concerned

with the study of human behavior.
• Behavioral science looks at individuals and their behavior along with
the behavior of societies, groups, and cultures, and processes which
can contribute to specific behaviors.
• The key effort of the behavioral sciences
is to understand, predict, and influence
behavior.
• The chief academic disciplines of the
behavioral sciences are Psychology,
Sociology and Anthropology.
PSYCHOLOGY
It is the study of human mind and the role played by
its various functions such as emotions, cognitions
(thoughts), motivation, perceptions and intelligence
in maintaining health or causing disease.
OR
Psychology is the scientific study of behaviour and
mental processes and the application of that
knowledge to human problems.
SOCIOLOGY
Sociology is the study of human social behaviour,
social institutions, rules and processes that bind and
separate people as individuals.

It helps the doctor to understand the role of society

and its various units and institutions on the processes
of health and how they can cause disease.
Sociology includes the study of
following factors to maintain health or
disease states.
1. Family
2. Gender
3. Social classes
4. Socioeconomic circumstances
5. Housing
6. Employment
7. Social supports
8. Social policies
ANTHROPOLOGY

 ANTHROPOLOGY

It is the scientific study of the origin, development and behaviour of

various societies and cultures and how they influence the causation
and treatment of various diseases.
Anthropology includes the study of
following factors to maintain health or
disease states.

1. Culture
2. Racial classification
3. Geographic distribution
4. Cultural methods of dealing with
diseases
5. Stigmatization of illness
BEHAVIOURAL SCIENCES IN MEDICAL
PRACTICE
• Workers in the public health field have learned to integrate behavioral
science into their practice to promote healthy behaviors and
encourage people to access health care.
• Psychologists and other mental health professionals may also
incorporate behavioral science into their treatment of patients.
TEACHING OF BEHAVIOURAL SCIENCES TO
DENTAL STUDENTS
• The need for a formal behavioural sciences teaching programme in
the dental undergraduate curriculum was identified in the 1980s.
• The General Dental Council (GDC) has had a pivotal role in developing
behavioural sciences teaching in the dental curriculum across the UK
in 1990
• However, the nature and extent of this teaching remains unclear and
indications are that it varies greatly between schools with varying
individual perspectives on how it should be taught.
• Medical science over the last few decades has
undergone vast changes. Technologically it has
advanced at a rapid pace. There has been a
realization as well that the behaviour of individuals
and communities also influences the occurrence of
disease.
• Medical schools around the globe have realized the
need for incorporating behavioural sciences as an
integral part of the basic sciences taught to medical
students.
CONCEPT OF TRADITIONAL MEDICINE
CONCEPT OF HOLISTIC APPROACH

• HOLISTIC APPROACH, from theory of Holism, treats person as a whole.

• HEALTH (Dynamic state of body-mind-spirit balance)
• PERSON (Mind-Body- Spirit)
• ENVIRONMENT (Doctor, Family, Culture, Society)
• Holistic medicine is responsible for restoration of health and wellness to
the person as a whole , rather than focusing on the diseased part alone
TRADITIONAL ALLOPATHIC MEDICINE

• It works on a biomedical model that aims to treat the diseased part

of the human being
THE BIOPSYCHOSOCIAL
REVOLUTION

• There is strong evidence to link biological, behavioural,
psychological, and social variables to health, illness and
disease.

• George Engel in 1970s for the first time started to emphasize

the importance of integrating the traditional biological
aspects of medicine with the behavioural sciences and put
forward the concept of Bio-Psycho-Social perspective of
health and disease.

Cont….
ELEMENTS OF HOLISTIC APPROACH
• Person: A human being with well integrated
mind, body and spirit in a dynamic balance
• Environment: Set of external forces that influence our
experience of health and disease
• Health: Dynamic state of well being of mind-body-spirit
balance
• Physician: Who supports health rather than one who
merely treats the disease
HEALTH CARE MODELS
• Bio-Psycho-Social (BPS) model of health and illness
• The integrated model of health care; correlation of Body,
Brain, Mind , Spirit and BS

• The Public Health Care Model

 BPS MODEL OF HEALTH AND
ILLNESS
• 1977 George Engel, an American Psychiatrist introduced it
• Based on 3 Principles
• Disease is a result of multiple factors and not a consequence of
biological factors alone
• An individual is composed of complex combined system of Mind-
Body-Spirit and social relationships any change in one will effect
other
• Biological, Psychological and Social factors form a triad of
determinants of disease
CLINICAL APPLICATIONS OF BPS

• Biomedical and behavioural factors come into play in infectious as well as

non-infectious disorders:
• A patient suffering from dengue fever is having ;
• 1. Breakdown of reticuloendothelial system of the body (biological level)
• 2. Social issues related to drainage of fresh water , poor disposal of waste
• 3. Psychological & anthropological factors such as risk taking behaviour
and inappropriate dressing in high risk settings are equally important in the
CLINICAL APPLICATIONS OF BPS

• Spread of infectious disease

• STDs , HIV-AIDS, and hepatitis epidemics may also occur due to risk
taking behaviour and poor protection strategies
• Non-infectious disorders are also affected by biopsychosocial factors
including heart disease, DM, cancer and depression
• This is mainly because of changes in ;
• 1. hormones
CLINICAL APPLICATIONS OF BPS

• 2. immune factors
• 3.metabolism
• 4. neurotransmitters
• Socioeconomic stressors are;
• Occupational hazards, dietary habits, child rearing practices, personality
development, exposure to childhood trauma
• Many metabolic disorders…. Lifestyle disorders because of connection of
CLINICAL APPLICATIONS OF BPS

• Socio-cultural & psychological factors that work together with

biological factors
• Example of BPS model determining disease is seen in road traffic
accidents
Due to drug and alcohol abuse
ADVANTAGES OF BPS MODEL

• A variety of factors are considered in health and illness.

• The mind and body are not separated when considering matters of
health and illness.

• Emphasis is both on health and illness.

31
 THE INTEGRATED MODEL OF HEALTH
CARE

• It suggests a dynamic functional link between 5 domains

of human beings
• Biological
• Cognitive
• Behavioral
• Socio-Cultural
• Environmental
INTEGRATED MODEL OF HEALTH CARE:
CORRELATION OF BODY , BRAIN, SPIRIT &
BEHAVIORAL SCIENCES
• In this model HEALTH is a state of harmonious equilibrium between
these domains which occur in response to ;
• 1. EUSTRESS
• 2. DISTRESS
• This state is achieved through processes called HOMEOSTASIS and
ALLOSTASIS
INTEGRATED MODEL OF HEALTH CARE:
CORRELATION OF BODY , BRAIN, SPIRIT &
BEHAVIORAL SCIENCES
• HOMEOSTASIS:
• It is a reactive state that ensures harmony within the body systems
through adaptive negative feedback loops.
• It also uses reactive behavioural adjustments in domains operating
outside the body
• Example; increased intake of salt and fluids while working on hot
days
INTEGRATED MODEL OF HEALTH CARE:
CORRELATION OF BODY , BRAIN, SPIRIT &
BEHAVIORAL SCIENCES
ALLOSTASIS:
• It is an adaptive mechanism in which individual makes the
adaptations by predicting changes in advance, rather than in reaction
• Adaptations are creative & organised multisystem changes made in
anticipation of a possible challenge to health
• Example; to organise work schedule in advance to be undertaken at
the time of the day when it is least hot so that may not need extra salt
& fluid
INTEGRATED MODEL OF HEALTH CARE:
CORRELATION OF BODY , BRAIN, SPIRIT &
BEHAVIORAL SCIENCES
EUSTRESS:
• It is seen as moderate , motivating and inspiring
• Ensures optimum functioning of homeostatic and allostatic
mechanisms that keeps all 5 domains working in synergy
•
INTEGRATED MODEL OF HEALTH CARE:
CORRELATION OF BODY , BRAIN, SPIRIT &
BEHAVIORAL SCIENCES
DISTRESS:
• It is a state in which the homeostatic and allostatic mechanisms
of;
• Biological
• Behavioural
• Cognitive
• Environmental & sociocultural domains are challenged by
extrinsic & intrinsic factors
INTEGRATED MODEL OF HEALTH CARE:
CORRELATION OF BODY , BRAIN, SPIRIT &
BEHAVIORAL SCIENCES
DISTRESS:
• If the system responds with effective homeostatic and allostatic
responses health response health is restored
• If the stressor worsens to result in distress, a failure of
homeostatic and allostatic mechanisms results in disease and
illness
INTEGRATED MODEL OF HEALTH CARE:

CLINICAL APPLICATIONS

 SEPARATING DISEASE FROM SICKNESS, DISTRESS AND STRESS:

 All patients reporting to hospitals are not suffering from disease
 The body, mind and spirit respond to any disturbance in any domain
by unpleasant experience which is called SYMPTOMS
 Symptoms are adaptive mechanisms and haemostasis is restored
INTEGRATED MODEL OF HEALTH CARE:

CLINICAL APPLICATIONS

 Its important to separate disease from distress, sickness and illness

 DISTRESS:
 Earliest unpleasant departure from the state of health and happiness
 Appears when homeostatic and allostatic mechanisms in the body
and mind are challenged by stress
INTEGRATED MODEL OF HEALTH CARE:

CLINICAL APPLICATIONS

 DISTRESSING symptoms include are;

Headache, backache, vague bodily discomforts, indigestions,
heaviness in abdomen, sleep disturbances, loos of appetite, fatigue,
weakness dizziness and light headiness. May remain silent and
avoid responsibility at home or work and feeling of inability to cope
 Self limiting and improves by sharing of feelings, indulging in
hobby, NSAIDS use
INTEGRATED MODEL OF HEALTH CARE:

CLINICAL APPLICATIONS
 SICKNESS:
Feeling of unwell or nauseous which can occur without disease
 SICK ROLE:
This is a state that an individual may assume at home or office to show
inability to perform duties and this role may succeed freeing the individual
from
Duties
•
INTEGRATED MODEL OF HEALTH CARE:

CLINICAL APPLICATIONS
ILLNESS:
 is an overall view that an individual, the family and the society
take of a person who is feeling sick or unwell
 Explanation that each has of sickness decides the course of
action and treatment plan that will follow
 Family may take the sick to spiritual healers if no obvious reason
present
INTEGRATED MODEL OF HEALTH CARE:

CLINICAL APPLICATIONS
 Especially patients of epilepsy & behavioural disorders
 Anxiety & depressive patients suffering from physical symptoms
prefer to be investigated and consulted by with physicians and
neurologists rather than psychiatrists
 DISEASE:
The diagnosis of disease is made when the symptoms of an
individual
INTEGRATED MODEL OF HEALTH CARE:

CLINICAL APPLICATIONS
Are attributed to cause
• It can be injury, organism, a substance, a pathological or structural
change or defect leading to changes in functioning in biological,
behavioural and social spheres
• Destroy haemostatic and allostatic mechanism
• Example include DM, typhoid fever or fracture and reversal to health
require
INTEGRATED MODEL OF HEALTH CARE:

CLINICAL APPLICATIONS

medical and surgical intervention

All medical and surgical interventions only used when diagnosis
about disease is confirmed
 THE PUBLIC HEALTH CARE MODEL

• WHO promotes public health care approach in addition to

hospital based care
• Aim is not only to treat but also prevent the disease
• Aims to treat common diseases and basic health issue at
grass root level through primary health care centers
• It includes immunization campaigns, mother and child
health programs, National program of Mental Health etc
• BPS model provides a comprehensive clinical approach
towards the practice of Holistic Medicine.
NON-PHARMACOLOGICAL INTERVENTIONS
(NPIS)

• NPIs are used to reduce pain and disease along with

medicine
• They enhanc e p at i ent s sat i sfac t i on, i m p roves
adherence to treatment and strengthen bond between
doctor and patient
• These NPIs are
• Communication skills
• Counselling
• Informational care
• Handling difficult patients and their families
NON-PHARMACOLOGICAL INTERVENTIONS
(NPIS)

Breaking the bad news

NON-PHARMACOLOGICAL INTERVENTIONS
(NPIS)

– Breaking the bad news

– Crisis intervention and

disaster management
NON-PHARMACOLOGICAL INTERVENTIONS
(NPIS)

– Breaking the bad news

– Crisis intervention and
disaster management
– Conflict resolution
MEDICAL ETHICS AND PROFESIONALISM

The study of moral aspects

of doctor’s professional life
PRINCIPLES OF MEDICAL ETHICS

Common ethical issues in medical practice

Common ethical dilemmas in health
professionals life
Doctor-Patient relationship
Rights and responsibilities of patients and
doctors
TO BE STUDIED IN DUE COURSE OF TIME

Psychology and its principles in Medical Practice

Neurobiological basis of behavior

Psychosocial aspects of health and disease

Psychiatric disorders in Special and General Health
settings
Psychosocial aspects of Gender and Sexuality

Psychosocial aspects of Pain, Aging, Death and Dying

Psychosocial aspects of Terrorism