Health and Human Behaviors

Mohammed Jemal (BSc, MPH)

Department of Health, Behavior and Society

Email:mahirmohammed159@gmail.com
 Learning Objectives

At the end of this class; you will be able to:

 Define Behaviors
 Types of behavior
 Understand determinants of human behaviors
 Discuss the role of human behaviors in disease prevention
What is behavior ???
Behavior

 Behavior- is an action that has specific frequency, duration, and purpose,

whether conscious or unconscious. It is both the act and the way we act

E.g. Action – drinking/smoking

Behavior…

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
 Behavior…

Dimensions of Behavior
1.Time and promptness of the behavior –when?
• Use condom when sexual intercourse with multiple partners
2. Frequency of behavior-how often?
• use condom every time having….
3. Quality of behavior-correct ?
• Check condom to make certain no leakage, use condom correctly
4. Range of behavior-how many?
• having monogamous relationship, use condom, avoid multiple partners,
abstinence
 Behavior…

Components of Behavior
Basically human behavior has 3 domains;
 Cognitive domain (Information)
• Encodes, stores, retrieves, processes information;
• purpose is manipulation of information
E.g. knowledge, awareness
 Affective domain= cognition +feeling
• purpose is to create arousal
• eg. Attitude, Beliefs
 Psychomotor domain - Voluntary muscle
Psycho-mind , Motor – action
Behavior…

Note:

 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.

 The same words ( behavior=action= practice)

 Behavior…

Determinants of health
 Broadly, health is determined by two major categories of determinants or factors.

These are
1 Behaviors and
2 Environmental determinants.
 Behaviors are those daily actions which are under the possibility of the control of
the person/individual/ where as environmental determinants are those factors
which are not easily under the control of the person.
 Behavior…

Types of behaviors:

1 Well/healthy behavior (behavioral immunogens) can promote health

Eg. Physical exercise, BF, seeking treatment, ………..
2 Ill/unhealthy behavior can harm health
 Smoking, chat chewing, excessive alcohol consumption, unsafe sex, sedentary
life style etc.
 These are called behavioral pathogens and are leading risk factors for
preventable death and disease worldwide
Human behavior and disease burden

The world is experiencing 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
The behavior-health link becomes clear when examining the 10 leading risk factors
for preventable death and disease worldwide
 Behavior…

 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.
 Risk factors translate into disease, disability, and death—collectively referred as the
“burden of disease”
 Addressing risky behaviors rather than specific diseases is cost-effective because
one risk factor can result in several diseases
Types of behaviours important for health promotion

Promotive behaviors

Preventive behaviors

Utilization behaviors

Illness behaviors

Compliance behaviors

Rehabilitation behaviors

Community action
Types of behaviours…

1) Promotive behaviors

Physical exercise , use of latrine, Child-spacing , proper disposal of dirty

water, Good nutrition, clean storage of food, Breast-feeding, tooth cleaning,
reduction/cessation of unhealthy practices such as cigarette smoking, and
excessive alcohol consumption

2) Preventive behaviors
Taking anti-malaria drugs , immunization, using mosquito bed nets
Types of behaviours…

3 Utilization behaviours – utilization of health services.

Eg. ANC service, Immunization services, Child-health service Screening programs,
FP service

4) Illness behaviours - recognition of symptoms and prompt self-referral.

 It is what people do when they feel ill.
 aimed to seek remedy
Types of behaviours…

4 Compliance (adherence) – following course of prescribed medicines

5) Rehabilitation behaviours – what people need to do after an illness/surgery

to recover

A type of behavior that prevent further disabilities after a serious illness

6) Community action - actions by communities to change their surroundings
include community participation in health decision-making
Stages of illness behaviors

Becoming aware of symptoms/ Illness

Reporting the symptoms to others in family

Medication
Self-medication Home remedies

Decision to go for treatment

Modern health care Traditional healers

Doctor –patient consultation

Following advice and taking prescribed drugs

Returning for follow up

Factors determining human behavior

 Human behavior is influenced by a huge range of factors.

 Lawrence Green identified three categories of factors affecting individual or

collective behavior. These are;
Factors determining human behaviors

Knowledge, attitude,
Predisposing perception, beliefs,
factors values, self efficacy etc.

Culture/norms Enabling
Behaviors
factors

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

Predisposing factors
 Are antecedents or prior to behavior that provide the rationale or motivation for the
behavior to occur.
 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
Predisposing…
 These include,

 Perceptions

 Knowledge

 Attitude

 Beliefs

 Values

 Confidence/self-efficacy (perceived)

 Motivation

 Previous experience (existing skills) that may form ‘perceived self-efficacy’, but not the actual
one (competence).

note: Perception predispose; competence enables

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
Perception…

 Perception is subjective and it influences knowledge

Knowledge

 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.
 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
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.
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?
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

E.g. Knowing about condom, its importance and benefits less important
for behavior change than knowing proper use or how-to use condom
Knowledge…

 Therefore, one of the main task in health education is helping the learner to
become knowledgeable about some health topic
 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

 Perception + Storage of information in the brain = Knowledge

Skills

 Skills is the capability of accomplishing something with precision and

certainty.

 Skills require practical knowledge and ability

 On many occasions inappropriate or ineffective health behavior may result

from the lack of mastery of specific skills.

 Knowledge and skills are interrelated in that skills are the practical
application of essential knowledge
Attitude

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.
Attitude…

 Mucchielli (1970) describes attitude as “a tendency of mind or of a relatively

constant feeling towards a certain category of objects, people, or situation.”

 A learned predispositions to respond in a consistently favorable or unfavorable

manner with respect to a given object
Attitude…

 There are internal as well as external factors involved in the formation and change
of attitudes
 The internal factors refer to the motives of the individual, perceptions, ideas,
values, and so on
 The external factors refers to the customs, other’s attitudes, values, superstitions in
the community which he or she receives from others
Characteristics of attitude

1) Predisposition- exposure related to an attitudinal object. No exposure, no

attitude
2) Evaluation-can be evaluated by intensity or judgment.
 The most unique characteristic of attitude that differs it from other concepts

e.g. Favorable or unfavorable

3. Has directions-, +ve or -ve, good or bad.
Negative ……………… positive
Characteristics…

4 Changeability-can be changed, not static.

5) Stability or consistency
 Stability=related to time/same response/set of responses in the presences of object
over time
 Consistency= sameness of attitude/ same response/set of responses in the
presences of object
e.g. “Mood” changed quite often.
 Formation of Attitude

 There are internal as well as external factors involved in the formation and change of
attitudes
 The internal factors refer to the motives of the individual, perceptions, ideas, values,
and so on
 The external factors refers to the customs, other’s attitudes, values, superstitions in the
community which he or she receives from others

 So, attitudes can be formed from one’s own and other people’s experience

Example ??
Link between knowledge(K) and Attitude (A)

Feeling/sense of
Knowledge Attitude
like or dislike
Link…

 With the knowledge or information that we have on things, the mind is able to
develop a sense of like or dislike, positiveness or negativeness/feeling.

 It is thus, the feeling component is added to the knowledge which keeps the
individual react to a stimulus positively or negatively.
Link…

 The general trend or normal way of thinking and acting the proper sequence and
linkage among KAP is that knowledge (K) is followed by attitude (A) and is
followed by practice (P).
 But this rule is not universally applicable to every behavior i.e. different
possibilities and combinations can come across with regard to KAP.
 When P or A precedes K, it is due either to an imitation (modeling) or compulsion
Link among knowledge(K) and Attitude (A) and Practice (P)/Behavior (B)

Learning
K A B
hierarchy

Other possibilities

B A K

K B A
 In Health education, we try is to
close these gaps by helping people
to practice at least what they know

Apply cognitive consistency

theory
Link…

 In health education, we try is to close these gaps by helping people to practice at

least what they know.

 Apply cognitive consistency theory (Fritz Heider,1946 )

 Cognitive consistency theory

 Cognitive consistency can be defined as the concept that individuals have a

preference for their thoughts, beliefs, knowledges, opinions, attitudes, and intents to
be congruent, which is to say that they don’t contradict each other

 Incongruency or asymmetry leads to tension and unpleasant psychological states,

and individuals will seek change in order to reach congruency, reduce tension, and
achieve psychological balance
Cognitive consistency theory

 Cognitions that are conflicting (asymmetrical) place individuals in an unpleasant

psychological state.
 Since pleasant states are preferred, individuals experience a pressure to have these
conflicting cognitions resolved, and they take action to reduce tension and reach
psychological balance.
 Attitude measurement

 Self-reported attitudes- asked direct questions about their feelings.

 The Likert Scale –is of one the mostly commonly used scale to measure attitude.
 In Likert scale, respondents are asked how strongly they agree or disagree with
carefully selected statements on five point scale.
 Attitude scale is usually stated in form of statement.

E.g. Condom use increase sexual pleasure.

1. Strongly disagree 2. disagree 3. undecided 4. agree 5.strongly agree

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
 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
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
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.
Types of beliefs

 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.

Relationship between beliefs and attitudes

 Our beliefs about things

affect our attitude towards
it.
Attitude Beliefs  Our beliefs, in turn, are
influenced by our
attitudes.
Relationship

 The judgment as good or bad and worth carrying out a behavior will depend on the
beliefs about the consequences of performing the behavior.
 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
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
 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
behaviors. It provides
 masculinity and sexual prowess general guides to
 Being attractive to opposite sex behaviors.

 Having beautiful girl friend

 academically success

 Being a man of God /Allah, success in foot ball events , being ‘modern’ * being
healthy
Value…

 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.
Value…

Value conflict and value clarification

 People value life, health. However, in opposite engaged in unhealthy behavior, for instance,

smoking. This reveals conflict of values=inconsistencies between two or more values.

 In health education one shouldn’t seek to change values rather should help people recognize

inconsistencies between and among their values.

 But we can sometimes bring about changes by emphasizing values which don’t involve health.

 We, often trying to encourage people to think about their values. This process is called value-

clarification
 Difficult index; Relationship between attitude and value

 Values are more permanent and resistant to change than attitudes and beliefs and they
determine attitude.

 In terms of difficulty of changing:

Knowledge < Beliefs < Attitude < Value

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?

Behavioral intention-is the willingness/ readiness to perform a certain behavior

provided that enabling factor is in place.
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
 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.
Enabling …

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

 What is enabling factors to prepare home made ORS?

 What are the enabling factors to promote condom use?
 What are enabling factors to promote quitting of smoking ?
Enabling …

 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
 In behavior change communication be sure that enabling resources are readily
available in the community of interest
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.
Significant others

 Can also be called relevant others or influential others.

 These are people who are significant (determine or influence) the behavior of
others to encourage or discourage to do something.
E.g.
 The woman does not adopt FP because her husband disapproves.
 The young man who starts smoking because his friends encourage him to do so.
 Friends Traditional
healers

Grand Religious
parents leaders

Husband

I want to use FP, but…

The influence of social pressure (circle of influence)

 Summary of factors affect human behaviors

Predisposing factors
create intention to act

Realizes the
Enabling factors
intentions

Encourage behaviors to
Reinforcing factors persist

Sustainable behavior

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

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

Enabling
• Knowledge,
factors • Peer influence Behaviors
attitude, • Availability, & social
beliefs, affordability, pressure
values accessibility &
others
Predisposing resources Reinforcing
factors factors

In practice simultaneously
 Educational approaches to behavior change

Determinants • Approaches to change

of behaviors
Direct communication with target individuals-
Predisposing factors educational approaches

• Organization change, avail services,

Enabling factors accessibility, advocacy , resource mobilization

• In direct communication with the social

Reinforcing factors environments , influential peoples
 Role of behaviors in disease prevention

Primary prevention
• Promotive behaviors
• Preventive behaviors
• Utilizations behaviors
• Community actions
•

Secondary prevention
• Illness behaviors
• Compliance behaviors

Tertiary prevention
• Rehabilitation behaviors
 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.
thank you