Models of Health Behavior: DR Yusuf Abdu Misau

Models of health behavior
Dr Yusuf Abdu Misau

MBBS (ABU), MPH(UM), PhD Student(UM)
Department of Social and Preventive Medicine,
University of Malaya
Acknowledgement
I wish to acknowledge A/P Nabilla Al-Sadat for
permission to use her slides in this presentation
Wednesday,
September 27, 2017 Models of Health Behavior_Yusuf Misau 2
Learning objectives:
1. Understand what is human behavior and its relation to health

2. Understand assumptions underlying theories as it is used in a
scientific context
3. Describe the different models of behavioral change
4. Be able to apply these models in the development of
preventive and promotive programmes towards health as
well as effective doctor-patient relationship.
Wednesday,
Contents of Presentation
Definitions
Model
Human behavior
Applications of models in health
Theories/ Models of Health Behaviour :
The Health Belief Model
Theory of planned behaviour (TPB) aka TRA
Stages of Change Model -TTM
Social Cognitive Theory/ (SCT) aka Social Learning Theory (SLT)
Diffusion of Innovation theory
Precede-Proceed Model
Case study
Wednesday,
Case study 1
Lee is a 21 year old Malaysian student involved
in Intravenous drug addiction (IDA). There are
many cases of IDA among Lees peers.
However Lee thought IDA has harmed his life
and wishes to change for the better.
Lee is also worried that his family views his
IDA as an embarrassment to the whole family
How will you help Lee?
Wednesday,
Case study 2
Women in the predominantly Muslim Northern
Nigeria are generally known to reject western
style contraception techniques. As a public
health specialist, you have been requested to
design a study that will serve as a basis for
addressing this issue.
Which of the models of health behaviors will
best fit? Justify.
Wednesday,
Case study 3
A 60yrs old Sudanese man who smoke cigarette
for over 30 years said he is still healthy despite
smoking for long time. He also said he has
never seen any one killed by cigarette smoking
so he sees no harm in smoking.
Explain his attitude using one of the health
models that you deemed right.
Wednesday,
What is a model?
Wednesday,
Model: literary definition
A model is a conceptual framework which conveys
critical component of one's vision of the possibilities
for human learning and development as well as
defines the important variables to consider and the
relationships among those variables.
It is a template which depicts a specific issue and

entities that relate to it.
Wednesday,
What is behavior ?
Wednesday,
BEHAVIOUR: Dictionary definitions
The way one reacts to external or internal stimulus (under natural

settings)
The way one behaves
The aggregate of all the responses made by an organism in any
situation
Specific response of a certain organism to a specific stimulus or
group of stimuli
The action, reaction, or functioning of a system, under normal or
specified circumstances
Wednesday,
BEHAVIOUR
The response of an organism to a stimulus
Wednesday,
HUMAN BEHAVIOUR
A complex interaction between personal and
environmental factors, often related to the
situation.
Characterised by complex biological, behavioural

and socio-cultural determinants that are
imperfectly understood.
Wednesday,
What is Health Behaviour?
Any activity undertaken by an individual who

believes himself to be healthy, for the purpose
of prevention or detecting illness in an
asymptomatic state.
Wednesday,
So far.
We have discussed about:
What a model is
What is behavior
What is human behavior..
What is health behavior
Wednesday,
What influences behavior?
Wednesday,
Field Theory (1951)
Behaviour is the function of the

psychological field which in turn, is the
product of interaction between the person
and his/her environment.
Kurt Lewin
B = f(PE)
Wednesday,
A Generally accepted assumption is that most
behaviours are the products of multiple causes.
They are influenced by a multitude of:
social
environmental
psychological and
genetic factors.
Wednesday,
Multiple Risks Behavioural Model(1982)
Behaviour is the function of direct,

additive and interaction effects of
specific behaviour intentions, social
support, accessibility of information
and services, personal autonomy
and actual situation.
S.B.Kar
B=f(BI)+(SocSup)+(Acc IS)+(PA)+(AS)
Wednesday,
THEORY
What is a theory ?
A fully developed theory is one that is characterised by
three major elements. It would explain:
1. The major factors that influence the phenomena
of interest
2. The relationship between these factors
3. The conditions under which these relationships do
or do not occur
Wednesday,
DEFINITION OF A THEORY
Systematically organised knowledge applicable in
a relatively wide array of circumstances devised
to analyse, predict, or otherwise explain the
nature or behaviour of a specified set of
phenomena that could be used as the basis of
action.
Wednesday,
Notes:
Most health promotion theories come from the
behavioural and social sciences: Psychology, sociology,
management, consumer behaviour
Reflects diversity from simple human behaviour
Many theories used are not highly developed, nor have

they been rigorously tested
They are more accurately referred to as theoretical

frameworks or models
Wednesday,
Why do we need health behaviour theories/
models?
1. Complex
2. Resistant to change
3. Influencing behaviour beyond knowledge
Wednesday,
Why do we need health behaviour
theories/ models?
Theories and models of human behaviour can guide
the development and refinement of health
promotion and education efforts.
Individual level
Social/Environmental level
Community level
Wednesday,
The Nitti gritty:
How do we translate the models/theories into
practice?
At individual level:
Clinical decision
Rehabilitations
Society/community level:
Research(quantitative vs qualitative)
Programme implementation/evaluation
Wednesday,
So far.
We have discussed about:
Factors influencing human behavior
What a theory is
Why we need health behavior
models/theories..
How we can translate the theories into
practice
Wednesday,
HEALTH BELIEF MODEL
Wednesday,
HEALTH BELIEF MODEL
Godfrey Hochbaum
Irwin Rosenstock
HBM stipulates that a persons health related behavior

depends on the persons perception of four critical areas:
- the severity of potential illness
- the persons susceptibility to that illness
- the benefits of taking a preventive action
- the barriers to taking action
Wednesday,
HEALTH BELIEF MODEL
Premise:
Health behavior is a function of
specific health belief; all must
be operating for a (risk reduction/
health promoting) behavior to occur.
Wednesday,
HEALTH BELIEF MODEL
A person motivation to undertake a health
behavior can be divided into three categories:
- Individual perceptions
- Modifying factors
- Likelihood of action
Wednesday,
Modifying Factors Likelihood of Action
Individual Perceptions
- Age, sex, ethnicity Self-efficacy
- Personality
- SES
- Knowledge Perceived benefits
vs.
Perceived barriers
to behavioral change
-Perceived susceptibility
to disease X Perceived threat of
-Perceived seriousness disease X Likelihood of
of disease X taking action (beh.
change)
Cue to action
- Internal (symptoms)
HEALTH BELIEF - external (media)
MODEL
Wednesday,
THEORY OF REASONED ACTION
Wednesday,
Icek Ajzen
Marten Fishbein
TRS states that individual performance of a given behaviour

is primarily determined by a persons intention to perform
that behaviour. This intention is in turn determined by two
major factors:
- the persons attitude toward the behaviour

(beliefs and values of the outcomes)
- the influence of the persons social

environment or subjective norms
Wednesday,
Premise:
In order for the behavior to occur, one must
have an intention to change; intentions are
influenced by two major factors:
- attitude toward the behavior
- subjective norm about the behavior
Wednesday,
Beliefs and
Attitude
Evaluations of
toward the
Behavioural
Behaviour
Outcomes
Behavioural
Behaviour
Intention
Normative Subjective
Beliefs Norms

Wednesday,
SOCIAL LEARNING THEORY
Wednesday,
It suggests that most human behaviour is learned
observationally from others. The theory focuses on the
learning that occurs within a social context.
It considers that people learn from one another including

such concept as observational learning, imitation and
modeling.
In this process learning occurs when individuals

observes and imitate others behavior.
Wednesday,
Nigerian culture: 1970 vs 2009
Wednesday,
There are four processes that form the basis of Social
Learning Theory which according to Bandura are the
conditions that are necessary before an individual can
successfully model the behaviour of someone else:
Attention
Retention
Motivation, and
Motor Reproduction
Wednesday,
i. Attention
This is the first component of observational learning.
The person must first pay attention to the model. This
process surrounds the acquisition of attention of learner.
Acquisition can be based on such factors as sensory
capacity, arousal level and past enforcement.
Individuals cannot learn much by observation unless they
perceive and attend to the significant features of the
modeled behavior.
Wednesday,
ii. Retention
The observer must be able to remember the behaviour
that has been observed.
Retention process involves the learner accessing symbolic
coding of the behaviour that has caught their attention.
In order to reproduce the modeled behavior, the
individuals must code the information into long-term
memory
Wednesday,
iii. Motor Reproduction
The ability to replicate the behaviour that the model had
just demonstrated. This process includes the physical
reproduction of the observed activity through physical
capability, self-observation and feedback.
The observer must be able to reproduce the models

behaviour. The observer must learn and possess the
physical capabilities of the modeled behavior.
Wednesday,
iv. Motivation
The final process is motivation or reinforcement.
The observer/learner expects to receive positive

reinforcements for the modeled behavior.
This process includes external, vicarious and/or self-
reinforced motivation.
Wednesday,
General principles of Social Learning Theory:
People can learn by observing the behaviors of

others and the outcomes of those behaviours.
Learning can occur without a change in behaviour.
The consequences of behaviour play a role in
learning.
Cognition plays a role in learning.
Wednesday,
THE TRANSTHEORETICAL MODEL
Wednesday,
THE TRANSTHEORETICAL MODEL
James O. Prochaska
and
Carlo C. DiClemente
Habit is habit, and not to be flung out of window but

coaxed downstairs a step at a time.
Mark Twain
The TTM:
Behavior change is a process that takes place over

time. Its never simple, nor straight forward.
People go through stages before final changes are

made, and many things happen after they start to
make changes.
This Stages of Change model suggesting stages of behavior change and

processes that influence peoples progression through those stages
Wednesday,
The TTM
Is an Integrative Model of Behavior Change
Model of intentional change

Change implies phenomena occurring over
time
Focuses on decision making of the individual
Involves emotions, cognitions and behavior
Involves progress through a series of five stages
Wednesday,
The TTM: Background
Consist of different stages which help identify where
a person is regarding the change of behavior.
It may relate to several different things such as

smoking, exercise, diet, sexual orientation,
immunization, screenings, etc.
It consists of several different processes but it is

divided into five main stages.
Wednesday,
THE TRANSTHEORETICAL
MODEL
Stages of change:
Precontemplation
Contemplation
Preparation
Action
Maintenance
Wednesday,
Precontemplation
Relapse
Contemplation
Maintenance
Preparation
Action
Wednesday,
MODEL
Stage 1: Pre-contemplation
Individuals are not intending to take action in the foreseeable future

(usually measured as the next 6 months)
- unaware of the problem , unwilling to
change
- might not realize that change is possible,
desirable, or relevant to them,
- feeling discouraged/demoralised,
- defensive about particular behavior,
- has not began to contemplate change or need
for change,
- least responsive to interventions.
Wednesday,
Predominant Answer in pre-contemplation stage:
My weight is OK! I dont need to exercise.

Smoking makes me feel cool, I wont stop!
I cant do HIV Test when I am feeling healthy, because
it can be false positive!
Intervention:
Increase awareness
Provision of information
Wednesday,
Stage 2: Contemplation
At this stage, the individuals are aware of the problem but not
prepared/intended to change/take any action in the next 6 months.
- involve the process of self-reevaluation,
- active consideration of the prospect
to change,
- looking for more info. about the problem,
- weighing pros and cons (costs and
benefits)
- evaluating options
The person has started the process of contemplating changes
Wednesday,
Predominant Answer:
I know smoking is bad, but Ive difficulties to quit.
I know early HIV test is good, but what happen to my
job if my employer knows?
Intervention:
Motivation
Goal setting
Counseling
Wednesday,
Stage 3: Preparation
The stage in which the person is intending to take action in the

immediate future. He prepares to undertake the change.
- readiness to change (A & B)
- gathering info. About the change
- learned the previous lesson
- on the verge to take action
- initiate behavior change
- begin reducing their problem behavior
ex: reduce/delay smoking
Wednesday,
Predominant Answer in the stage of preparation:
I would like very much to reduce my blood pressure,
and I am confident that I can do it.
In sha Allah I will stop smoking, but I dont know when
Intervention:
Action plan with specific strategies
Goal setting
Provision of assistance
Wednesday,
MODEL
Stage 4: Action
A new behavior has been adopted.

Individuals have specific overt modification in
their-lifestyle within the past 6 months.
- modification of the problem
behavior
Wednesday,
Predominant Answer in the stage of action:
Currently, I am physically active, but not on regular basis.
Intervention:
Social support
Assist with feedback
Reinforcement
Motivation
Wednesday,
MODEL
Stage 5: Maintenance
The stage in which the individuals are working to prevent

relapse
- Final stage in the process of change
- Maintenance occurs when the behavior
has been incorporated into the persons life
- The new behavior is not yet firmly
established.
Wednesday,
Predominant Answer:
I have stopped smoking for the last 6 months, and
I am putting on weight now.
Well. I stopped for almost the 6months you
recommended, but just yesterday, I had a stick
because my friend offered to me and I feel I cant say
no!
Intervention:
Assist in coping
Avoid relapse
Wednesday,
Relapse??
The process is not yet complete and it may never be complete.

Many things can affect behaviour change.
A person may want to maintain a new behaviour, but other
things might make this difficult.
It may later become hard to sustain:
- available resources might disappear
- strong supporters might move away or withdraw support
- a new situation might make old behaviour seem more
appealing.
For all sort of reasons, people might move back to the earlier
stage of behaviour change and work through the stages again .
Wednesday,
Processes influencing movement through the stages of change
Pre-contemplation Contemplation Preparation Action Maintenance

Becoming aware
Emotional response
Environmental analysis
Thinking through the issues
Seeing other options
Self-efficacy
Social support
Helping relationship
Reinforcement
Seeing other options
Being in control
Wednesday, Social support

Diffusion of innovation Theory
Wednesday,
Diffusion of innovation
Roger (1983) defined
an innovation as an idea, practice or object that is
perceived as new by an individual or other unit of adoption
diffusion as the process by which an innovation is
communicated through certain channels over time among
the members of a social system
The process of diffusion involves five stages:
1. innovation development,
2. dissemination,
3. adoption,
4. implementation
5. maintenance
Wednesday,
Adopter
Adopter Categories
Categories

34% 34%
16%
13.5%
2.5%
Early Early Late

Laggards
Innovators
Wednesday,
Adopters Majority Majority
Diffusion of tech in weaponry:
Nigerian warriors in the 18th
century
American drone in the

21st century
Wednesday,
Diffusion of tech in transport systems:
Local Water transport then
Local Water transport now
Wednesday,
Diffusion of technology in transport:
Wednesday,
Transition of cultural diffusions:
Wednesday,
PRECEDE PROCEED
MODEL
Wednesday,
PRECEDE PROCEED MODEL
Lawrence W. Green
Marshall W. Kreuter
Premise: The factors causing health behavior

are seen to be of three distinct kinds:
- predisposing
- enabling
- reinforcing
Wednesday,
Predisposing
Factors
Specific behavior
by individuals
Enabling
Factors
HEALTH
Environment
Reinforcing (conditions of
living)
Factors
Wednesday,
Predisposing factors:
Knowledge
Attitudes
Beliefs
Values
Perceptions
Wednesday,
Reinforcing factors:
Attitude and behavior of health and other personnel,

community leaders, peers, parent, employers, etc.
Wednesday,
Enabling factors:
Availability of resources
Accessibility of resources
Referrals
Rules or laws
Health related skills
Community/government, priority and commitment to
health
Engineering
Wednesday,
Case study 1
Lee is a 21 year old Malaysian student involved
in Intravenous drug addiction (IDA). There are
many cases of IDA among Lees peers.
However Lee thought IDA has harmed his life
and wishes to change for the better.
Lee is also worried that his family views his
IDA as an embarrassment to the whole family
How will you help Lee?
Wednesday,
Case study 2
Women in the predominantly Muslim Northern
Nigeria are generally known to reject western
style contraception techniques. As a public
health specialist, you have been requested to
design a study that will serve as a basis for
addressing this issue.
Which of the models of health behaviors will
best fit? Justify.
Wednesday,
Case Study
Ayesha is a 22 year old university student who lives with her
parents. When she was in school, she played several sports and
got plenty of exercise by walking to and fro school. She now
notices that she is not exercising anymore. She drives
everywhere, even to close shops. As a result, she is aware that
she is feeling unfit and is beginning to gain weight.
Why might Ayeshas exercise behavior changed?

How can you help her to exercise again?
Wednesday,
Wednesday,

Models of Health Behavior: DR Yusuf Abdu Misau

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Models of health behavior

Dr Yusuf Abdu Misau

1. Understand what is human behavior and its relation to health

It is a template which depicts a specific issue and

The way one reacts to external or internal stimulus (under natural

The response of an organism to a stimulus

Characterised by complex biological, behavioural

Any activity undertaken by an individual who

Behaviour is the function of the

Behaviour is the function of direct,

Reflects diversity from simple human behaviour

Many theories used are not highly developed, nor have

They are more accurately referred to as theoretical

3. Influencing behaviour beyond knowledge

HBM stipulates that a persons health related behavior

TRS states that individual performance of a given behaviour

- the persons attitude toward the behaviour

- the influence of the persons social

THEORY OF REASONED ACTION

It considers that people learn from one another including

In this process learning occurs when individuals

The observer must be able to reproduce the models

The observer/learner expects to receive positive

People can learn by observing the behaviors of

Habit is habit, and not to be flung out of window but

Behavior change is a process that takes place over

People go through stages before final changes are

This Stages of Change model suggesting stages of behavior change and

Model of intentional change

It may relate to several different things such as

It consists of several different processes but it is

Individuals are not intending to take action in the foreseeable future

My weight is OK! I dont need to exercise.

The stage in which the person is intending to take action in the

A new behavior has been adopted.

The stage in which the individuals are working to prevent

The process is not yet complete and it may never be complete.

Pre-contemplation Contemplation Preparation Action Maintenance

Thinking through the issues

Seeing other options

Seeing other options

Wednesday, Social support

Early Early Late

American drone in the

Local Water transport now

Premise: The factors causing health behavior

Attitude and behavior of health and other personnel,

Why might Ayeshas exercise behavior changed?

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