Foundations of Behavioral

Sciences (HML1205)
(
Dr. Simon Kizito
What Is Behavioral Science?

The simplest definition of behavioral

science is that it’s the study of human
behavior.

Understanding how people have behaved

in the past will help us understand how
people will behave in the future.
What is Behavioral Sciences?
Behavioral science is the study of human
habits, actions, and intentions (Behavior)

Itencapsulates multiple fields of study,

including psychology, sociology, social
neuroscience, and cognitive science, and
many others
Itfocuses primarily on controlled
observation of behavior patterns in
response to external stimuli.

Behavioral science differentiates itself

from fields in that it is driven by
rigorously obtained empirical data (data-
driven)
The Foundation of Behavioral
Sciences /Social Psychology
This course particularly focuses on Health
Psychology, Social Psychology and Medical
Sociology) to understand disease, health, and
health care in a time of social change.

Psychology is the scientific study of mind

(mental processes) and behavior;

Sociology is the systematic study of human

behavior in society.
The way we perceive health and
illness is constantly changing and
the medical field has adjusted by
integrating behavioural sciences
in the understanding of health
and disease to suit the demands
of the changing environment.
The course will elucidate how
individual characteristics
(profession, age, personality,
social class etc) influence
health behavior (prevention,
promotion, treatment, etc)
within society
Reasons for Integration of Behavioral Sciences
in the Medical curriculum

1)To understand the processes

behind an individual’s behavior in
relation to health and illness.

This includes understanding the

influence of one’s socio-economic
and cultural background in health
related behaviours
2) Global and Life Events whose
psychological consequences most often
end in the hands of medical practitioners.
Top 10 most stressful life events
1. Death of a spouse (or child*): 100
2. Divorce: 73
3. Marital separation: 65
4. Imprisonment: 63
5. Death of a close family member: 63
6. Personal injury or illness: 53
7. Marriage: 50
8. Dismissal from work: 47
9. Marital reconciliation: 45
10. Retirement: 45
3) Information Technology (i.e. h-health, e-
health, Tele-health) and the internet in
general provide easy access to
information about health care, symptoms,
etc which gives people prior knowledge
about their health condition before they
come to a health practitioner.
Thus medical practitioners need to be
equipped with adequate interpersonal
skills on how to handle an informed
client.
The key challenge
 The discipline deal with aspects of our
everyday experiences so we can easily
assume that we already know why
patients behave the way they do.

However, the disciplines provide

scientific evidence which enables us to
make informed judgments.
 
BIOPSYCHOSOCIAL MODEL
Brief History
Evidence for the application of the
biopsychosocial model was found in
ancient Asian (2600 B.C.) and Greek (500
B.C.) civilizations.

Itwas developed in University of

Rochester on 1941 by Drs. George Engel
and John Romano.
Brief History
George Engel was definitely influenced by
Adolf Meyer’s psychobiology. He came up
with the biopsychosocial model, which
approaches diagnosis and treatment from
the biological, psychological, and social
viewpoints. This well- rounded way of
thinking about disease came about around
the time of the DSM II and influenced the
way future editions defined disease, and
diagnosed it (Smith, 2002).
 George L. Engel
(1913-1999)
Believed that to better understand and help
patients, clinicians must attend simultaneously to
the biological, psychological and social
dimensions of illness.
Believed in the importance of biomedical model,
but still criticized it for being too narrowed and
focusing on patients as objects.
He is known for BIOPSYCHOSOCIAL
MODEL.
BIOPSYCHOSOCIAL MODEL
The biopsychosocial model is a general
model or approach stating that:
Biological (genes, nutrition, hormones,
toxins etc.),
Psychological (thoughts, emotions &
behaviors),
Social (socio-economical, socio-
environmental, and cultural)
BIOPSYCHOSOCIAL MODEL
These factors, all play a significant role in
human functioning in the context
of disease or illness.
The biopsychosocial approach
systematically considers biological,
psychological, and social factors and
their complex interactions in
understanding health, illness, and
health care delivery.
BIOPSYCHOSOCIAL MODEL
 BIOPSYCHOSOCIAL MODEL
Biological, psychological, and
social factors exist along a
continuum of natural systems,
as
depicted in the diagram below.
 BIOPSYCHOSOCIAL MODEL
THE HIERARCHY OF NATURAL SYSTEMS

 BIOPSYCHOSOCIAL MODEL
Systematic consideration of psychological
and social factors requires application of
relevant social sciences, just as consideration
of biological factors requires application of
relevant natural sciences.

Therefore, both the natural and social

sciences are important to medical practice.
 BIOPSYCHOSOCIAL MODEL
In other words, psychological and social
factors are not merely epiphenomena (a
secondary effect or by-product)

They can be understood in scientific ways at

their own levels as well as in regard to their
biological correlates.
 BIOPSYCHOSOCIAL MODEL
Humanistic qualities are highly valued
complements to the biopsychosocial
approach, which involves the
application of the scientific method to
diverse biological, psychological, and
social phenomena as related to human
health.
 BIOPSYCHOSOCIAL MODEL
The biomedical model was developed by
scientists as a way to study disease. So instead of
making the model fit the phenomena, the
phenomena must fit within the model.
This is a problem because the nature of disease is
so diverse in terms of how it presents, symptoms,
severity, response to treatment, and so forth, that
it is very difficult to make the phenomena of
disease fit into the biomedical model.
BIOPSYCHOSOCIAL MODEL
While the biomedical approach takes the
reductionistic view that all phenomena are
best understood at the lowest level of
natural systems (e.g., cellular or molecular),
the biopsychosocial approach recognizes
that different clinical scenarios may be most
usefully understood scientifically at several
levels of the natural systems continuum.
BIOPSYCHOSOCIAL MODEL
 BIOPSYCHOSOCIAL MODEL

To apply the biopsychosocial approach to

medical practice, we should:

Recognize that relationships are central to

providing health care

Use self-awareness as a diagnostic and

therapeutic tool
 BIOPSYCHOSOCIAL MODEL
Elicitthe patient’s history in the context of life
circumstances

Decide which aspects of biological,

psychological, and social domains are most
important to understanding and promoting the
patient’s health

Provide multidimensional treatment

Other Theoretical Frameworks
Social Psychology theories shall be adopted to
show how individual behaviours are shaped.

‘Social Psychology’ is the scientific study of

how individuals think, feel and behave in
relation to other people.
That is, how other people in the social
environment influence the way you think, feel
or behave.
The meaning of ‘Social’
The term SOCIAL in the word Social
Psychology has various interpretations.

(1)Present Other (Face –to Face)

(2)Absent or Imagine other

Absent Other
Merely thinking about someone
Author of Book /magazine / article,/ Newspaper
or radio and T. V. presenters
Spirits (Godly /Ungodly)
In a war situation we may hate an enemy
without ever having seen, met any member of
that group of people.
Influence by large-scale social groupings
Ideologies
Economic systems
Theories
A theory is a systematic
statement that seeks to explain
why two or more events are
related
Theories
Attributiontheory
Social comparison theory
The Exchange Theory
Social Judgment theory
Decision Making
Health Belief Model
Theory of Planned Behavior
Attribution theory
Attribution is the process of assigning
meaning to behaviours; i.e., deciding
whether behavior was caused by a personal
disposition of the actor or external
situational forces

In our case the theory may explain why one

feels ill, seeks health care, or giving a
referral to a patient, adheres to medicine,
etc.
Lippa (1994) argues that people attribute
behavior to either internal or external causes but
prefer to make internal attributions because a
person’s dispositions are likely to guide his/her
behavior over time and thus serve as a useful
reference point.
In relation to health problems we tend to attribute
our discomfort (health challenges) to internal
causes (i.e. I may be developing flue, fever) than
to external causes (demands from the
environment).
Social Comparison Theory
In many cases in life, we want to know how good
we are at performing particular tasks, in physical
appearance, health status, competences, and also in
our beliefs and attitudes.
The best way to do this would be to have an
objective physical standard.
However, in many cases objective standards are not
available.
In such situations, we take as our standards the
behaviour/status/ of other people.
How can the social comparison
theory apply to your profession
(DCM, MBChB) or understanding
health issues in general?
Social comparisons in the physical health
domain can serve several motives, including
self-evaluation, self-enhancement, and the
finding of common bonds.
Comparisons may be made with actual
people, media role models, or with implicit
“created-in-the-head” norms. Such norms,
including the false consensus effect and
unrealistic optimism, can undermine health-
promotive practices.
Comparisons also affect the interpretation of
ambiguous somatic changes that might be
indicative of physical illness.
Experiencing acute or chronic illness
produces uncertainty and threat, which elicit
both self-evaluation and self-enhancement
motives.
These instigate comparisons, leading to
assimilation or contrast with better- or worse-
off or more knowledgeable targets.
Exchange Theory
According to the Exchange Theory, when two
people are involved in a relationship, they are
giving to and receiving from each other.
An important idea of the Exchange theory is that
people expect the exchange in a relationship to
be fair.
Even though they are contributing very different
things, the norm of exchange must be perceived
as being fair according to the participants in the
relationship. This is called the norm of
reciprocity.
If people feel the exchange is unfair, they get
angry and unhappy.
Even though we do not normally think of
exchange in our everyday relationships in these
formal terms, the exchange theory makes
important predications about when the relations
will come under strain.
Fair exchange is like glue that holds
relationships together. When the exchange is
unfair, we tend to question the value of the
relationship.
How can the exchange theory apply to
your profession (DCM, MBChB) or
understanding health issues in general?
Decision Making Perspective
Ifyou have to make a decision for
yourself, then things are generally very
easy. You know yourself well enough to
know what works for you and what
doesn’t and carrying out internal debates
with yourself isn’t nearly as difficult as
doing the same with a whole other human
being when deliberating potential
solutions to a problem.
“Decision-making is usually defined as a
process or sequence of activities involving
stages of problem recognition,
1. search for information,
2. definition of alternatives and
3. the selection of an actor of one from two
or more alternatives consistent with the
ranked preferences”.
Decision making theory is a theory of
how rational individuals should behave
under risk and uncertainty.

Decision making goes through stages

Decision Making Perspective

How does the decision making theory

relate to our discipline and practice?

How can we involve our patients in

making decisions about their sickness
Social Judgment Theory
 The theory assumes that the structure of a particular
attitude determines how receptive the person who holds
the attitude will be to a persuasive message that is
pertinent to that attitude.

NOTE:
Structure of an attitude is the range of possible positions
that an individual can hold in relation to the attitude.
The range of positions that the person is willing to
accept is called the latitude of acceptance and the range
of positions that the person is willing to reject is called
the latitude of rejection.
 The theory assumes that an individual’s prior attitude on a
particular issue serves as the focal point around which latitudes of
acceptance and rejection are located.

 If a particular message falls within the individual’s latitude of

acceptance, attitude change occurs in the direction of the message;
but if the message falls within the individual’s latitude of rejection,
attitude change occurs in the opposite direction of the message or
does not occur.

 This implies that the wider the individual’s latitude of acceptance,

the more amenable he/she will be to persuasion. Individuals who
hold extreme views tend to have correspondingly narrow latitudes
of acceptance for messages related to those views, while persons
who hold moderate views have correspondingly wide latitudes of
acceptance.
Example
For instance, Joshua, Andrew, and Rose are all
born again Christians. Joshua believes that lying is
always justified; Andrew believes it is never
justified; and Rose believes that it is sometimes
justified. Andrew and Joshua are seen to have
extreme views about lying, although opposite. Their
latitude of acceptance will be narrow. None of them
is likely to be convinced by anything the other will
explain about lying. But Rose has wider latitude of
acceptance and, although unlikely to accept either
of their positions entirely, she may be amenable to
some of the arguments of both Joshua and Andrew.
How does the social judgment theory
relate to our discipline and practice?
Theory of Planned Behaviour
 The theory of planned behavior assumes that people’s
choices and behavior is governed by reason. It
emphasizes that human behaviors are governed not only
by personal attitudes, but also by social pressures and a
sense of control.
 These intentions partly, but not entirely, reflect the
personal attitudes of individuals, which is the extent to
which they perceive this act as desirable or favorable.
 These attitudes reflect both cognitive beliefs about the
act, such as whether they believe that smoking is
harmful, as well as affective evaluations, such as
whether they feel that smoking is unsuitable.
 In addition, the degree to which significant individuals,
such as relatives, friend, or colleagues, condone this act,
called subjective norms, also affects intentions
 The perceived importance or relevance of these
relatives, friends, or colleagues affects the extent to
which their approval will shape intentions.
 Furthermore, these weightings might vary across
contexts. For example, the beliefs of relatives are likely
to shape the intentions to engage in behaviors that relate
to family life. In contrast, the beliefs of managers might
be more likely to shape intention the intentions to
engage in behaviors that relate to work life.
 The extent to which individuals feel they can engage in
these behaviors, called perceived behavioral control
also impinges on their intentions and behaviors
 Perceived behavioral control comprises two main facets.
(1)perceived behavioral control depends on the degree to which
individuals conceptualize themselves as sufficiently
knowledgeable, skillful, disciplined, and able to perform some act,
called internal control which overlaps with the concept of self
efficacy.
(2) perceived behavioral control depends on the extent to which
individuals feel that other factors, such as the cooperation of
colleagues, resources, or time constraints, could inhibit or facilitate
the behavior, called external control.
 Furthermore, intentions to perform some act do not
always culminate in this behavior.
Perceived behavioral control is partly, but not absolutely,
related to actual behavioral control, which in turn affects
the extent to which intentions are associated with the
corresponding behaviors.
Perceived and actual behavioral control can sometimes
diverge, such as when individuals are oblivious to
factors that obstruct or facilitate the intended behavior.
 The theory of planned behavior has frequently been
applied to predict the likelihood that individuals will
engage in various pro-social behaviors, toward those
with health challenges i.e. blood donation, organ
donation., attending to the sick in hospital
 Health Belief Model
-It attempts to explain and predict health behaviors. This is
done by focusing on the attitudes and beliefs of individuals.

-The HBM is based on the understanding that a person will

take a health-related action (i.e., exercising) if that person:
1)feels that a negative health condition (i.e., diabetes) can be
avoided,
2)has a positive expectation that by taking a recommended
action, he/she will avoid a negative health condition (i.e.,
exercising will be effective at preventing diabetes), and
3) believes that he/she can successfully take a recommended
health action (i.e., he/she can exercise comfortably and with
confidence).
 The HBM was spelled out in terms of four constructs
representing the perceived threat and net benefits:
a) perceived susceptibility,
b) perceived severity,
c) perceived benefits, and
d) perceived barriers.
These concepts were proposed as accounting for people's
"readiness to act." An added concept, cues to action,
would activate that readiness and stimulate overt behavior.
A recent addition to the HBM is the concept of self-efficacy,
or one's confidence in the ability to successfully perform
an action
Health Belief Model
 The Health Belief Model (HBM) is a tool that scientists
use to try and predict health behaviors.
 it is based on the theory that a person's willingness to
change their health behaviors is primarily due to the
following factors:
 Perceived Susceptibility
People will not change their health behaviors unless
they believe that they are at risk.
Those who do not think that they are at risk of acquiring
HIV from unprotected sexual intercourse are unlikely to
use a condom.
 Perceived Severity
The probability that a person will change his/her health
behaviors to avoid a consequence depends on how serious
he or she considers the consequence to be.
If you are young and in love, you are unlikely to avoid
kissing your sweetheart on the mouth just because he has
the sniffles, and you might get his cold. On the other hand,
you probably would stop kissing if it might give you Ebola.
 Perceived Benefits
It's difficult to convince people to change a behavior if
there isn't something in it for them.
Your father probably won't stop smoking if he doesn't think
that doing so will improve his life in some way.
 The Health Belief Model, however, is realistic. It recognizes
the fact that sometimes wanting to change a health behavior
isn't enough to actually make someone do it, and
incorporates two more elements into its estimations about
what it actually takes to get an individual to make the leap.
These two elements are cues to action and self efficacy.
 Cues to action are external events that prompt a desire to
make a health change. They can be anything from a blood
pressure van being present at a health fair, to seeing a
condom poster on a train, to having a relative die of cancer.
A cue to action is something that helps move someone from
wanting to make a health change to actually making the
change.
Self efficacy looks at a person's belief in his/her
ability to make a health related change. It may
seem trivial, but faith in your ability to do
something has an enormous impact on your actual
ability to do it.

Thinking that you will fail will almost make

certain that you do. In fact, in recent years, self
efficacy has been found to be one of the most
important factors in an individual's ability to
successfully negotiate condom use.
The Health Belief Model has been applied to a
broad range of health behaviors namely:
1) Preventive health behaviors, which include
health-promoting (e.g. diet, exercise) and health-
risk (e.g. smoking) behaviors as well as
vaccination and contraceptive practices.
2) Sick role behaviors, which refer to compliance
with recommended medical regimens, usually
following professional diagnosis of illness.
3) Clinic use, which includes physician visits for a
variety of reasons.