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Outline
 Behaviors
 Definitions and concepts
 Types of behaviors
 Factors affecting human behaviors
 Predisposing factors –psychosocial factors
 Enabling factors
 Reinforcing factors
 The role of human behaviors in disease prevention

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Leaning outcome
At the end of this session, you will be able to;

 Define correctly what behaviors mean?

 Describe determinants of human behaviors

 Discuss the role of human behaviors in disease

prevention

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Human Behavior: Definition

What is behavior ????

Behavior- is an action that has specific frequency,

duration, and purpose, weather conscious or
unconscious. It is both the act and the way we act.

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Behaviors ….
Eg.
Action – drinking/smoking

To say a person has drinking/smoking behavior

Duration –is it for a week/month?
Frequency- how it is repeated?
Purpose –is he/she doing consciously or not

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Determinant of Health…
Generally,
An important justification for health education and health
promotion comes from the fact that health is determined,
not by medical services and drugs, but by ordinary
human actions and behaviors.

Many health education programs have failed because

they put too much emphasis on individual behavior and
neglected to understand the cultural, social, economic
and political factors that influence his/her behaviors or
actions.

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Determinant of Health…

However, a proper understanding of the influences outside

the individual’s control will avoid the pitfall of victim-
blaming.

These outside influences could include advertising health-

damaging products such as cigarettes, government policies
such as promoting tobacco cultivation or location of health
services, poverty and unemployment.

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Components of Behavior
Basically human behavior has 3 domains;
A) Cognitive domain (knowledge, perception )
 Encodes, stores, retrieves, processes information;
 purpose is manipulation of information

B) Affective domain= cognition +feeling

eg. Attitude, Beliefs
 purpose is to create arousal
C) Psychomotor domain - Voluntary muscle
 Psycho-mind , Motor – action

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Behavior….
Note:

1. Involuntary (not purposeful) is not behavior

2. Voluntary (purposeful) act is behavior-In health

education we refer only to those voluntary
movements and purposive acts arising out of
decisions taken by the motor center of the brain.

3. The same words ( Behavior=Action= Practice)

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Behavior and health

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Burden: mortality, morbidity and modifiable risk
factors

The world is experiencing a shift in

 cause of ill- health: Bacteria to Behavior
 Risk factors: traditional risk to modern risk
 Disease burden: Communicable disease to non-
communicable –double burden (for developing
countries)

 Human behaviors plays significant role as a cause as well

as a solutions for existing and emerging problems
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Traditional risk Vs Modern risk

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According to WHO, 40% of deaths worldwide are due to
these 10 risk factors alone (behaviors).

Global life expectancy could be increased by 5-10 years if we

reduce these risks.

Estimates from the WHO (from 2008) indicated an NCDs-

related annual death rate of 34% in Ethiopia (WHO, 2010a).

In this report, cardiovascular diseases accounted for

15%, cancers for 4% and respiratory disease for 4% of all
causes of death.

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 A large percentage of NCDs are preventable through the
reduction of the four main shared behavioral risk factors:
tobacco use, physical inactivity, the harmful use of alcohol and
unhealthy diets (referred to as modifiable risk factors).

 Up to 80% of heart diseases, stroke, and type 2 diabetes and

about 40% of cancers could be prevented by controlling these
risk factors.
(HSTP, 2015/16 - 2019/20:p36)

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Modifiable….
Eg.
Tobacco-burden
 1 billion smokers in the world.
 6 trillion cigarettes consumed annually
 6 million people die from tobacco use and exposure
each year,
 By 2020, annual tobacco-related deaths =7.5 million
(17), accounting for 10% of all death
 Smoking cause about 71% of all lung cancer deaths

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Behaviours important for health promotion are;

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Stages of illness behaviors

Compliance

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Factors affecting human behavior

Lawrence Green identified three categories of

factors affecting individual or collective
behavior. These are;

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Determinants of human behaviors
Knowledge, attitude,
perception, beliefs, values,
self efficacy etc.

Availability,
affordability,
accessibility,
Peer pressure, influential
people, perceived social
resources to
pressures/significant accomplish the
others/discouragement/enco behaviors
uragement

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1. Predisposing factors , inside head factors
 Are antecedents or prior to behavior that provide the
rationale or motivation for the behavior to occur.
Eg. Knowledge, Perception, Belief , Attitude, Values etc.

They are generally referred to cognitive variables because they are

inside the mind –inside head factors and have to do with knowing or
believing
They are also called psychosocial because they are socially

influenced

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Predisposing con’t…..

E.g. an adolescent knows the untoward consequences

of smoking and may have a negative attitude towards

smoking and believe that it is harmful (predisposing
factors) which causes him/her not to smoke (the
behavior).

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Knowledge or awareness
• Knowledge is, “A clear and certain mental perception, understanding,
the fact of being aware of something, experience of acquaintance of
familiarity with information of, learning that which is known, facts
learned or study of.”

• Therefore, one`s knowledge of something include some combination

of ;
1. Simple awareness of facts and
2. understanding of how these facts relate to one another.

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 knowledge can be viewed as an accurate impression of some
phenomenon.
What one
knows

ENCODING STORAGE RETRIEVAL

Getting Retaining Taking

information information information
Perception into memory over time out of storage

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Knowledge ….

Knowledge is necessary but not sufficient in

behavior change.

It is necessary, because, without adequate

knowledge , people may unaware of and
concerned about health problem and unable to
manage their behavior.

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Knowledge…
Simple logic for the specific knowledge is that before act
voluntarily people need to know,

Why they should act?

What actions are needed?
When or under what circumstances?
How to act and where?

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Knowledge about/awareness Vs How-to/ essential
knowledge

Knowledge about/awareness: Knowledge about a topic

may be important in developing interest in the topic and
may even motivate the behavior

How-to/ essential knowledge: Intentional behavior

change depends on it
It is practical/applicable

Eg. Knowing about condom, its importance and benefits less

important for behavior change than knowing proper use or
how-to use condom

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Knowledge …
In general, knowledge about a problem is not as
critical to behavior change as knowledge how to
perform about the target behaviors.

How-to or essential knowledge is the major

components of skill.

Therefore, one of the main task in health education is

helping the learner to become knowledgeable about
some health topic and how to do th behavior

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 Perception
Perception: a process by which
individuals organize and interpret
their sensory information in order
to give meaning it.

Perception is a means of acquiring

knowledge.

And it is highly subjective

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Perception is subjective

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Perception is subjective …. And it influences
knowledge

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Attitude

• Social psychologists define an attitude as an enduring

evaluation, positive or negative, of people, objects, or
ideas.
We are not neutral observers of the world; we
evaluate what we encounter.

Attitudes are often a matter of good or bad; as soon

as you know what something is, you start to know
whether you like it or dislike it.

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

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Characteristics of attitude

1) Predisposition- exposure related to an

attitudinal object. No exposure, no attitude

2) Has directions- polar, +ve or -ve, good or bad.

Negative ……………… positive

3) Evaluation-can be evaluated by intensity or

judgment

e.g. Favorable or unfavorable

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Attitude….
4) Changeability-can be changed, not static.

5) Stability or consistency
Stability=related to time , constant over sometime

Consistency= sameness of attitude

e.g. “Mood” changed quite often.

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Link between knowledge(K) and Attitude (A)

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Link among knowledge(K) and Attitude (A) and Practice
(P)

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 Belief

Beliefs are what one perceive as a true; it may be

correct or not.
It also refers to a conviction that a phenomenon or

object is true or real.

It is different from knowledge in that it is perceived

whereas knowledge is accepted objective truth.

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 Belief…

Beliefs are derived from parents, grand parents, 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.

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Difficulty index of changing beliefs

It is usually difficult to change those beliefs that

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 or traditional medical

system
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Types of beliefs
Any traditional belief held by the community is
bad and must be changed!!
……………………..False
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.
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Harmful belief: is a belief which damage health.

Helpful beliefs: is a belief which preserves

health.

Neutral beliefs: is a belief which neither

damages nor preserves health.

What do you if you are unsure???

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Relationship between beliefs and attitudes

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 Beliefs Vs attitude ….
Our beliefs about things affect our attitude towards
it.

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.

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 Beliefs Vs attitude ….

If an individual beliefs the behaviors have good

outcomes (positive beliefs)…………………… +ve attitude

If an individual beliefs the behaviors have bad

outcomes (negative beliefs)…………………… -ve attitude

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 Value

The relative worthy/preference/judgment

individual gives every thing around is known as
value.
value is something is held to be important or

worth; and prized by an individuals or

community.

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Examples of characteristics that can be valued by the
communities
 Being a good mother
 having many children/cattle
Value exert strong and
 Being approved by friends enduring influence on
 masculinity and sexual prowess behaviors. It provides
 Being attractive to opposite sex
general guides to
behaviors.
 Having beautiful girl friend

 academically success

 Being a man of God /Allah, success in foot ball events , being ‘modern’ *

being healthy

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These values that have advantages for the

self and for the society are known as

positive values.
And these values that are harmful and

disadvantageous are known as negative

values.

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Difficult index;
In terms of difficulty of changing:

< < <

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Other concepts
1. 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 pain.

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2. 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?

3. Behavioral intention-is the willingness/ readiness

to perform a certain behavior provided that enabling
factor is in place.

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 2. 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 and may be barriers and assets to needed

changes.
The absence of enabling conditions inhibits action.

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Enabling ….

Sometimes a person may intend to perform but

still not do so. This is because of the influence of
enabling factors such as time, money,
equipment, skills and health services.

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They includes
Availability, accessibility and affordability health
care
New skills
Resources. Eg. Time, money, transportation etc.

1. What is enabling factors to exclusive breast feeding?

2. What are the enabling factors to regular physical
exercise?
3. What are enabling factors to family planning?

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Note: Behaviors which involve spending
much time, money, requiring new skills
or conflict with existing practices will
be more difficult to promote than those
which are simple to carry out or fit with
the existing practices.

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Enabling …

In behavior change communication be sure that

enabling resources are readily available in the
community of interest.

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3.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.
positive or negative feedback and is support

socially or by significant others after it occur.

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Significant others (influential people)
These are people who are significant (determine
or influence) the behavior of others to encourage
or discourage to do something.
Eg.
The woman does not adopt FP because her
husband disapproves.
The young man who starts smoking because his
friends encourage him to do so.

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 Friends Traditional
healers

Grand Religious
parents leaders

Husband

I want to use FP, but…

The influence of social pressure (circle of influence)

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 Summary of factors affect human behaviors

Predisposing
create intention to
factors
act

Realizes the
Enabling factors
intentions

Encourage behaviors
Reinforcing factors to persist

Sustainable behavior

Remember: Any given behavior can be explained as a function of

the collective influence of these three factors
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 Theoretical sequence to address determinants of
behaviors

In practice simultaneously
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Educational approaches to behavior change

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Further reading materials
1. Lawrence W. Green et al. 1980. Health education planning a
diagnostic approach

2. Randall R. Cottrell, James T. Girvan, James F. McKenzie

2006. Principles& foundations of health promotion and
education. Third ed. USA.

3. BruceG, Wlter H, Nell H. Introduction to Health education and

Health promotion;2nd edition, 1984
4. Ramachandran L. and Dharmalingam. T. 1995. Health
education’s new approach.
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