Health and Behaviour

Neetu Purohit
IIHMR
 Definition of Health

• Health is a state of complete physical, mental

and social well-being and not merely the
absence of disease or infirmity.
– Preamble to the Constitution of the World Health Organization
as adopted by the International Health Conference, New York,
19-22 June, 1946; signed on 22 July 1946 by the
representatives of 61 States (Official Records of the World
Health Organization, no. 2, p. 100) and entered into force on 7
April 1948.
 How do we attain it

Understand Causes of ill health

 History of causes of Ill health

• Humoral Theory of Greek Scholars

(Galen and Hippocrates)
• Religious theory of Dark Ages
• Germ theory of Pasteur (1864)
 Bloodletting

Points for blood-letting, Hans von Gersdorff

(surgeon), Field book of wound medicine,
1517
 Poultice and Purge
• A poultice, also called cataplasm, is a
soft moist mass, often heated and
medicated, that is spread on cloth over the
skin to treat an aching, inflamed, or painful
part of the body. It can be used on wounds
such as cuts.
• Purge: to rid of whatever is impure or
undesirable; cleanse; purify
 Emergence of Biomedical Model

• Advances in medical understanding

• Huge improvement in life expectancy
• Decrease in infectious illness rate
 The age of chronic conditions

• Perception on Degenerative diseases

• Setting up of large scale epidemiological
studies
• Causes of ill health more complicated than
what the biomedical model suggested
• 1950: Doll and Hill
 Behavioural Medicine

• Behavioural factors linked to the likelihood

of developing illness
• Risk factors (such as age, sex or genes)
cannot be changed, there is potential
scope for changing people’s behaviour
and therefore their scope of ill health, if the
best ways to motivate people to change
can be understood
 Initial approaches

• Solution to ill health by

– Individual responsibility
– Social responsibility

– Victim blaming?
– Complete free will and positive environment?

– Individualistic Approach
– Collectivist Approach
 Emergence of Biopsychosocial Model

• Development of Psychosomatic medicines

• Engel (1977)proposed to take into account
biological, psychological and social factors to
understand health
• Biological and genetic factors cannot be
controlled, behavioural, psychological and social
factors can be modified and therefore worthy of
study in an effort to increase health and reduce
experience of illness
 Lung Cancer
• Behaviours
Genetic mutation
such as
which
heavy
causes
lifelong
thesmoking
cell reproduction
• to become
A social cancerousininwhich
background naturesmoking is the norm
• Low self-confidence in the ability to give up
• A coping strategy of using cigarettes to relax
 Understanding and changing Health
Behaviour
• Despite the obvious risks, many people continue
to engage in unhealthy behaviours.
• Important is to know what motivates one to
engage in healthy and unhealthy behaviours and
how one can be motivated to behave in a
manner more likely to keep him/her healthy.
• It is important to determine the factors that
underlie a person's decision to perform or not
perform a behaviour.
 How behaviour is formed

• Behaviour: It is individual's observable

response in a given situation with respect to a
given target

• The behavior of people falls within a range; with

some behavior being common, some unusual,
some acceptable, and some outside acceptable
limits
 Behaviour is influenced by
• Values
• Culture
• Attitudes
• Coercion
• Hypnosis
• Ethics
• Genetics
• Rapport
• Authority
• Persuasion
• Emotions
 Behaviour is influenced by
• Values: Enduring belief that a specific mode of
conduct is personally and socially preferable to
an opposite or converse mode of conduct

• Culture: Has been defined as ‘the way of life for

an entire society.’ It includes codes of manners,
dress, language, religion, rituals, norms of
behavior such as law and morality, systems of
belief
 Behaviour is influenced by
• Attitudes: results from experiential learning from
the environment. (observing, retaining and
replicating)

• Coercion: is the practice of compelling a person

to involuntarily behave in a certain way by use of
threats, intimidation, or some other form of
pressure or force.
 Behaviour is influenced by

• Hypnosis: A process in which critical

thinking faculties of the mind are bypassed
and a type of selective thinking and
perception is established

• Genetics: Specific traits that are inherited

 Behaviour is influenced by
• Ethics: code of conduct that tell us how to
judge
right from wrong
or
good from bad

• Authorities: It comprises power which is

justified by both powerful and powerless
 Behaviour is influenced by
• Rapport: It is commonality of perspective, being in
"sync", being on the same "wavelength" as the
person with whom one is interacting

• Persuasion: It is the process of guiding people

toward the adoption of an idea, or action by
providing rational for the same

• Emotions: A complex psycho-physiological

experience of an individual's state of mind as
interacting with biochemical (internal) and
environmental (external) influences
 Behavior change

• How to understand behavior change?

– More than 300 theories to understand
behavior across cultures, diseases/conditions,
and disciplines.
• 4-6 widely used
• Tools and strategies to facilitate behavior change
 Theories of Behaviour Change

• Behaviourist approach
• Social Learning approach
• Cognitive approach
 Behaviourist Approach
• Almost all behaviour is learned, developed
through experience with and feedback
from our environment.
• Mentalistic events (such as thoughts and
ideas) and mystical concepts (such as
instinct, will, feeling) which cannot be
observed or measured, cannot form part of
an objective, scientific explanation of
human behaviour.
 Classical Conditioning

• Learning by association
– Phobia
• Development of conditioned response
– Eating behaviour
– Other health behaviours
• Role of environmental cues
• Stimulus Control and Response
Substitution
 Operant Conditioning
• Learning which occurs by trail and error
and is dependent on the environmental
response to the behaviour
– A teenage smoking
– Inhibitions for male sterilization, Colostrum
feeding
• Contingency Contracting
• All incentive driven programmes/schemes
use operant conditioning principles
 Social Learning Theory

• Learning by observing
• Expectancy of other associated desirable
features
– Children/young adults watching adults
smoking
– Aggression/temper tantrums
– INP+
– Celebrity endorsement
 Cognitive theories

• Cognitive approach lays great emphasis

on the central role of mental process such
as memory, attention, perception,
language, thinking in determining
behaviour
 Health Belief Model
• Attempts to explain and predict health behaviors
by focusing on the attitudes and beliefs of
individuals

• Developed in the 1950s as part of an effort by

social psychologists in the United States Public
Health Service to explain the lack of public
participation in health screening and prevention
programs
 Health Belief Model

Attendance at TB X-ray screening session

– TB was very severe
– They were susceptible to developing the
condition
– X-ray screening was beneficial in early
detection
– Perception of few barriers
Health
Belief
Model
 Health Belief Model
• Perceived Susceptibility: subjective perception of the
risk of contracting a health condition

• Perceived Severity: feelings concerning the

seriousness of contracting an illness or of leaving it
untreated

• Perceived Benefits: believed effectiveness of strategies

designed to reduce the threat of illness

• Perceived Barriers: potential negative consequences

that may result from taking particular health actions
(physical, psychological, and financial)
 Health Belief Model
• Cues to Action: Events, either bodily (e.g.,
physical symptoms of a health condition) or
environmental (e.g., media publicity) that
motivate people to take action.

• Other Variables: Diverse demographic,

socio-psychological, and structural variables
that affect an individual's perceptions and
influence behavior.
 Health Belief Model
• Greatest success in predicting behaviours
which occur once or over a short period of
time (Eg:Immunization)
• Less successful in predicting long-term
behaviours (Eg: dieting, exercising,
behaviours with strong social influence)
• The most important predictor of the
likelihood of health behaviour is perceived
barriers followed by susceptibility, benefits
and severity
 Health Belief Model

• Study by Hawe, Mchinzie & Scurry (1998)

found use of principles of HBM to be
effective
• Those with greater belief in susceptibility
are more likely to take protective health
actions
 Health Belief Model
• Weinstein (1984) found that people are
unrealistically optimistic about their
susceptibility to health problem. This may
be due to:

– Lack of experience with the problem

– Belief in their ability to control or offset the risk
– Belief that it hasn’t happened, it won’t happen
– Belief that the problem is infrequent
 Theory of Planned Behaviour
• Research using the Theory of Reasoned Action
(TRA) has explained and predicted a variety of
human behaviors since 1967.
• With the addition of perceived behavioral control
the theory was called the theory of planned
behavior (TpB). (Ajzea, 1991)
• Based on the premise that humans are rational
and that the behaviors being explored are under
control, the theory provides a construct that links
individual beliefs, attitudes, intentions, and
behavior.
• Social Environment is given prominence in its
ability to influence behaviour
Theory of Planned Behaviour
 Theory of Planned Behaviour
• Attitude: A person's positive or negative
feelings toward performing the defined
behavior. Depends on a person's beliefs
regarding the outcomes of a defined behavior
and the person's evaluation of potential
outcomes

• Subjective Norms: Are a combination of a

person's beliefs regarding other people's views
of a behavior and the person's willingness to
conform to those views.
 Theory of Planned Behaviour
• Intention: The intent to perform a behavior is
the best predictor that a desired behavior will
actually occur.

• Perceived Behaviour Control: The belief in

being able to successfully execute the
behavior required to produce the desired
outcomes.
 Transtheoretical Model

• Transtheoretical or Stages of Change

model was developed by Prochaska and
DiClemente (1986)
• Combines the motivation and action stage
within one model
 Transtheoretical Model
• I PRECONTEMPLATION:

Not considering that change in behavior is

required or it might not be of interest to
them.
 Transtheoretical Model

• II CONTEMPLATION:

• Something happens to prompt the person to start

thinking about change.
• Perhaps hearing that someone has made
changes - or something else has changed –
resulting in the need for further change.
• Starts weighing up the pros and cons of changing
their behaviour
 Transtheoretical Model

• III PREPARATION:

• Person prepares to undertake the desired

change.
• Start gathering information, finding out how to
achieve the change, deciding when change
should take place.
• May include talking with others to see how they
feel about the likely change
• Start making some small changes
 Transtheoretical Model

• IV ACTION:

• People make changes, acting on decisions,

information, new skills, and motivations for
making the change.
 Transtheoretical Model

• V MAINTENANCE:

• Practice the new behaviour to be

consistently maintained