Module 2 - Health and Behaviors 2022

Health and Human Behaviors
June 26, 2024 MPH year I

By: Henok s.1
Outline
Behaviors
 Definitions and concepts
 Types of behaviors
Determinants of human behaviors

 Predisposing factors –psychosocial factors
 Enabling factors
 Reinforcing factors
Role of behaviors in disease prevention
June 26, 2024 MPH year I 2

Leaning outcome
 At the end of this session, you will be able to;
 Define what behaviors mean?
 Describe factors affect human behaviors
 Discuss the role of human behaviors in disease

prevention

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.

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

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?
 Use condom, avoid multiple partners, abstinence

Components of Behavior
Basically human behavior has 3 domains;

A) Cognitive domain (Information)
 Encodes, stores, retrieves, processes information;
 Purpose is manipulation of information
Eg. knowledge, awareness
B) Affective domain= cognition +feeling
eg. Attitude, Beliefs
 Purpose is to create arousal
C) Psychomotor domain - Voluntary muscle
 Psycho-mind , Motor – action

Behavior….
Note:
1. Involuntary (not purposeful) is 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)

Behavior and health
Well/healthy behavior can promote health
Eg. Physical exercise, BF, seeking treatment, ………..
Ill/unhealthy behavior can harm health
Smoking, chat chewing, excessive alcohol
consumption, unsafe sex, sedentary life style etc.

Why do we study health behaviour?
 The study of health behaviour is based upon two

assumptions:
 a substantial proportion of mortality and morbidity is

caused due to a particular pattern of behaviour
 and that these behaviour patterns are modifiable
 It is recognized that individuals are the major

producers/contributors of their health

Why do we study ...........
 Research on health behaviour is based on two main

aims:
i. To gain more general understanding of the reason why

individuals perform a variety of behaviours
ii. To design interventions to improve health

compromising behaviours

What do we focus on health behaviour studies?
 The focus health enhancing behaviours like:

√ regular exercise, screening, healthy eating etc.
 To health harming behaviours like:

√ smoking, alcohol and drug abuse, and sick role
behaviours such as non-compliance with medical
regimens

Focus cont…
 A unifying theme across these behaviours has been

that they have long–term effects upon the individuals
health and at least particularly with in the individuals
control
 Epidemiological studies have revealed considerable

variations in who perform these behaviours
 Broadly these factors are divided in to two

Focus cont…
 Intrinsic factors:
√ Socio-demographic factors, personality, social support,
cognition
 Extrinsic factors which can be divided into two again
as;
√ Incentive structures such as: taxing tobacco, and alcohol
and subsidizing sporting facilities
√ Legal restrictions such as: banning dangerous
substances, fining individuals for not wearing seat belts

Focus cont…
 The intrinsic factors have received attention in

psychological studies and among these the cognitive
factors have been focused upon as the most important
proximal determinants.

The role of health behaviours in health outcomes
 A number of studies have looked at the relationship b/n
the performance of a range of health behaviours and a
variety of health outcomes.
For example:
√ A study conducted in Alameda (California) on seven
life styles i.e., avoid smoking, moderate alcohol

intake, sleeping seven to eight hrs at night, regular
exercising, avoiding snacks and eating breakfast
regularly, maintaining a desirable body weight
√ Were together associated with lower morbidity and
higher subsequent long-term survival (Bellock and

Bereslow 1972; Belolock 1973; Berslow and Enstrom
1980).
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

Traditional risk Vs Modern risk

The behavior-health link becomes clear when
examining the 10 leading risk factors for
preventable death and disease worldwide.

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.

Healthy behavior
Health behaviour- is an action that healthy people
undertake to keep themselves or others healthy and
prevent disease.
Aimed to prevent disease
BCC aims to change and maintain behaviours to

healthy

Healthy behaviors…
In BCC we seek one or more of the following changes;
1 • To start or adapt a new behavior
• To prevent the adoption of a

2
negative or harmful behavior
• To change or modify an existing

3
behavior

Types of behaviours important for health promotion
Promotive behaviors
Preventive behaviors
Utilization behaviors
Illness behaviors
Compliance behaviors
Rehabilitation behaviors
Community action

Factors determine 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 determine human behaviors
Knowledge, attitude,
perception, beliefs, values,
self efficacy etc.
Cultures/ Predisposing
norms factors
Availability,
Behaviors affordability,
accessibility,
resources to
accomplish the
behaviors
Reinforcing
Peer pressure, influential Enabling
people, perceived socialfactors factors
pressures/significant
others/discouragement/enco
uragement

1. Predisposing 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
Knowledge or awareness
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 …
Therefore, one of the main task in health

education is helping the learner to become
knowledgeable about some health topic.

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 is subjective

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

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
Attitude….
4) Changeability-can be changed, not static.
5) Stability or consistency
Stability=related to time
Consistency= sameness of attitude
e.g. “Mood” changed quite often.

Link between knowledge(K) and Attitude (A)
Feeling/
Knowle sense of Attitude
dge like or
dislike

Link among knowledge(K) and Attitude (A) and Practice
(P)/Behavior (B)
Learning
hierarchy K A B
Other possibilities
B A K
K B A

KAP ….
In health education, we try is to close these gaps by
helping people to practice at least what they know.
Apply cognitive consistency theory

Cognitive consistency theory
States people prefer to be consistent in their
knowledge, attitude and practice.
“Happiness is when what you think, what you say and

what you do are in harmony”
Mohandas Gandhi
New information creates dissonance between

knowledge, attitude and behavior and this stimulates
alternation in their behaviors consistent with
knowledge and attitude.
Cognitive consistency …
HE To create dissonance
Kn
Atti Beh
owl
tud avio
edg
e r
e
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.
Eg. 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.

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.

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.

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???

Relationship between beliefs and attitudes
Attitude
Beliefs
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.
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

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
enduring influence on
 Being approved by friends
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

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 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
Relationship between attitude and value
Values are more permanent and resistant

to change than attitudes and beliefs and
they determine attitude.

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 < <

Individual ‘s sense of agency: believes about ones own
ability to perform the behavior and its effectiveness
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 your pain.

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.

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.
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.

They includes
√ Availability, accessibility and affordability health care
√ New skills
√ Resources. Eg. Time, money, transportation etc.
1. What is enabling factors to prepare home made ORS?

2. What are the enabling factors to promote condom use?
3. What are enabling factors to promote quitting of
smoking ?

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.

Enabling …
In behavior change communication be sure that

enabling resources are readily available in the
community of interest.

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.

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.
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.
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
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
Theoretical sequence to address determinants of
behaviors
• Knowledge, attitude, beliefs, values
Predisposing 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.
u !!
k yo
a n
Th

Module 2 - Health and Behaviors 2022

Uploaded by

Copyright:

Available Formats

You might also like

Module 2 - Health and Behaviors 2022

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Module 2 - Health and Behaviors 2022

Uploaded by

Copyright:

Available Formats

Health and Human Behaviors

June 26, 2024 MPH year I

Determinants of human behaviors

Role of behaviors in disease prevention

June 26, 2024 MPH year I 2

 Define what behaviors mean?

 Describe factors affect human behaviors

 Discuss the role of human behaviors in disease

June 26, 2024 MPH year I 3

What is behavior ????

Behavior- is an action that has specific frequency,

June 26, 2024 MPH year I 4

To say a person has drinking/smoking behavior

June 26, 2024 MPH year I 5

1. Time and promptness of the behavior –when?

June 26, 2024 MPH year I 6

Basically human behavior has 3 domains;

June 26, 2024 MPH year I 7

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

June 26, 2024 MPH year I 8

June 26, 2024 MPH year I 9

 The study of health behaviour is based upon two

 a substantial proportion of mortality and morbidity is

 and that these behaviour patterns are modifiable

 It is recognized that individuals are the major

June 26, 2024 MPH year I 10

 Research on health behaviour is based on two main

i. To gain more general understanding of the reason why

ii. To design interventions to improve health

June 26, 2024 MPH year I 11

 The focus health enhancing behaviours like:

 To health harming behaviours like:

June 26, 2024 MPH year I 12

 A unifying theme across these behaviours has been

 Epidemiological studies have revealed considerable

 Broadly these factors are divided in to two

June 26, 2024 MPH year I 13

June 26, 2024 MPH year I 14

 The intrinsic factors have received attention in

June 26, 2024 MPH year I 15

life styles i.e., avoid smoking, moderate alcohol

higher subsequent long-term survival (Bellock and

 Cause of ill- health: Bacteria to Behavior

June 26, 2024 MPH year I 17

June 26, 2024 MPH year I 18

June 26, 2024 MPH year I 19

Global life expectancy could be increased by 5-10

June 26, 2024 MPH year I 21

Addressing risky behaviors rather than specific

June 26, 2024 MPH year I 22

Aimed to prevent disease

BCC aims to change and maintain behaviours to

June 26, 2024 MPH year I 23

1 • To start or adapt a new behavior

• To prevent the adoption of a

• To change or modify an existing

June 26, 2024 MPH year I 24

June 26, 2024 MPH year I 25