models of health behaviors by yusuf abdu misau

Models of health behavior

Dr Yusuf Abdu MisauMBBS (ABU), MPH(UM), PhD Student(UM)

Department of Social and Preventive Medicine,

University of Malaya

Acknowledgement I wish to acknowledge A/P Nabilla Al-Sadat for

permission to use her slides in this presentation

Tuesday, April 11, 2023

2Models of Health Behavior_Yusuf Misau

Learning objectives:

1. Understand what is human behavior and its relation to health

2. Understand assumptions underlying theories as it is used in a scientific context

3. Describe the different models of behavioral change

4. Be able to apply these models in the development of preventive and promotive programmes towards health as well as effective doctor-patient relationship.



Contents of Presentation Definitions

Model Human behavior

Applications of models in health Theories/ Models of Health Behaviour :

The Health Belief Model Theory of planned behaviour (TPB) aka TRA Stages of Change Model -TTM Social Cognitive Theory/ (SCT) aka Social Learning Theory (SLT) Diffusion of Innovation theory Precede-Proceed Model

Case study



Case study 1 Lee is a 21 year old Malaysian student involved

in Intravenous drug addiction (IDA). There are many cases of IDA among Lee’s peers. However Lee thought IDA has harmed his life and wishes to change for the better.

Lee is also worried that his family views his IDA as an embarrassment to the whole family

How will you help Lee?



Case study 2 Women in the predominantly Muslim Northern

Nigeria are generally known to reject western style contraception techniques. As a public health specialist, you have been requested to design a study that will serve as a basis for addressing this issue.

Which of the models of health behaviors will best fit? Justify.



Case study 3 A 60yrs old Sudanese man who smoke cigarette

for over 30 years said he is still healthy despite smoking for long time. He also said he has never seen any one killed by cigarette smoking so he sees no harm in smoking.

Explain his attitude using one of the health models that you deemed right.



What is a model?



Model: literary definition A model is a conceptual framework which conveys

critical component of one's vision of the possibilities for human learning and development as well as defines the important variables to consider and the relationships among those variables.

It is a template which depicts a specific issue and entities that relate to it.



What is behavior ?What is behavior ?



BEHAVIOUR: Dictionary definitions

The way one reacts to external or internal stimulus (under natural settings)The way one behavesThe aggregate of all the responses made by an organism in any situationSpecific response of a certain organism to a specific stimulus or group of stimuliThe action, reaction, or functioning of a system, under normal or specified circumstances



BEHAVIOUR

The response of an organism to a stimulus



HUMAN BEHAVIOUR

A complex interaction between personal and environmental factors, often related to the situation.

Characterised by complex biological, behavioural and socio-cultural determinants that are imperfectly understood.



What is Health Behaviour?

Any activity undertaken by an individual who believes himself to be healthy, for the purpose of prevention or detecting illness in an asymptomatic state.



So far…. We have discussed about:

What a model is……… What is behavior…… What is human behavior….. What is health behavior……



What influences behavior?



Field Theory (1951)

Behaviour is the function of the psychological field which in turn, is the product of interaction between the person and his/her environment.

Kurt Lewin

B = f(PE)



A Generally accepted assumption is that most behaviours are the products of multiple causes.They are influenced by a multitude of:

• social• environmental• psychological and• genetic factors.



Multiple Risks Behavioural Model(1982)

Behaviour is the function of direct, additive and interaction effects ofspecific behaviour intentions, social support, accessibility of information and services, personal autonomy and actual situation.

S.B.Kar

B=f(BI)+(SocSup)+(Acc IS)+(PA)+(AS)



THEORY

What is a theory ?A fully developed theory is one that is characterised by three major elements. It would explain:

1. The major factors that influence the phenomena of interest

2. The relationship between these factors3. The conditions under which these

relationships do or do not occur



DEFINITION OF A THEORY

Systematically organised knowledge applicable in a relatively wide array of circumstances devised to analyse, predict, or otherwise explain the nature or behaviour of a specified set of phenomena that could be used as the basis of action.



Notes:Notes:

Most health promotion theories come from the behavioural and social sciences: Psychology, sociology, management, consumer behaviour

Reflects diversity from simple human behaviour

Many theories used are not highly developed, nor have they been rigorously tested

They are more accurately referred to as theoretical frameworks or models



Why do we need health behaviour theories/ models?

1. Complex

2. Resistant to change

3. Influencing behaviour – beyond knowledge



Theories and models of human behaviour can guide the development and refinement of health promotion and education efforts.

Individual levelSocial/Environmental levelCommunity level

Why do we need health behaviour theories/ models?



The Nitti gritty: How do we translate the models/theories into

practice? At individual level:

Clinical decision Rehabilitations

Society/community level: Research(quantitative vs qualitative) Programme implementation/evaluation



So far…. We have discussed about:

Factors influencing human behavior……… What a theory is…… Why we need health behavior

models/theories….. How we can translate the theories into

practice……



HEALTH BELIEF MODEL



HEALTH BELIEF MODELGodfrey Hochbaum Irwin Rosenstock

HBM stipulates that a person’s health related behavior depends on the person’s perception of four critical areas:

- the severity of potential illness- the person’s susceptibility to that illness- the benefits of taking a preventive action- the barriers to taking action



HEALTH BELIEF MODEL

Premise:

Health behavior is a function of specific health belief; all must

be operating for a (risk reduction/

health promoting) behavior to occur.



HEALTH BELIEF MODEL

A person motivation to undertake a health behavior can be divided into three categories:

- Individual perceptions- Modifying factors- Likelihood of action



-Perceived susceptibility to disease X -Perceived seriousness of disease X

- Age, sex, ethnicity - Personality - SES - Knowledge

Perceived threat ofdisease X

Cue to action- Internal (symptoms)- external (media)

Perceived benefits vs.Perceived barriersto behavioral change

Likelihood of taking action (beh. change)

Self-efficacy

HEALTH BELIEF MODEL

Individual PerceptionsModifying Factors Likelihood of Action



THEORY OF REASONED ACTION



THEORY OF REASONED ACTIONIcek AjzenMarten Fishbein

TRS states that individual performance of a given behaviour is primarily determined by a person’s intention to perform that behaviour. This intention is in turn determined by two major factors:

- the person’s attitude toward the behaviour (beliefs and values of the outcomes)

- the influence of the person’s social environment or subjective norms




Premise:In order for the behavior to occur, one

must have an intention to change; intentions are influenced by two major factors:

- attitude toward the behavior- subjective norm about the behavior




Beliefs and Evaluations of

BehaviouralOutcomes

Beliefs and Evaluations of

BehaviouralOutcomes

NormativeBeliefs

NormativeBeliefs

Attitude toward theBehaviour

Attitude toward theBehaviour

BehaviouralIntention

BehaviouralIntention

Subjective Norms

Subjective Norms

Behaviour

Behaviour



SOCIAL LEARNING THEORY



SOCIAL LEARNING THEORY

It suggests that most human behaviour is learned observationally from others. The theory focuses on the learning that occurs within a social context.

It considers that people learn from one another

including such concept as observational learning, imitation and modeling.

In this process learning occurs when individuals observes and imitate other’s behavior.



Nigerian culture: 1970 vs 2009



SOCIAL LEARNING THEORYThere are four processes that form the basis of Social Learning Theory which according to Bandura are the conditions that are necessary before an individual can successfully model the behaviour of someone else:

Attention Retention Motivation, and Motor Reproduction



SOCIAL LEARNING THEORYSOCIAL LEARNING THEORYi. Attention This is the first component of observational learning. The person must first pay attention to the model.

This process surrounds the acquisition of attention of learner.

Acquisition can be based on such factors as sensory capacity, arousal level and past enforcement.

Individuals cannot learn much by observation unless they perceive and attend to the significant features of the modeled behavior.



SOCIAL LEARNING THEORYii. Retention The observer must be able to remember the

behaviour that has been observed. Retention process involves the learner accessing

symbolic coding of the behaviour that has caught their attention.

In order to reproduce the modeled behavior, the individuals must code the information into long-term memory



SOCIAL LEARNING THEORYiii. Motor Reproduction

The ability to replicate the behaviour that the model had just demonstrated. This process includes the physical reproduction of the observed activity through physical capability, self-observation and feedback.

The observer must be able to reproduce the model’s behaviour. The observer must learn and possess the physical capabilities of the modeled behavior.



SOCIAL LEARNING THEORYiv. MotivationThe final process is motivation or reinforcement.

The observer/learner expects to receive positive reinforcements for the modeled behavior.

This process includes external, vicarious and/or self-reinforced motivation.



SOCIAL LEARNING THEORYGeneral principles of Social Learning Theory:

People can learn by observing the behaviors of others and the outcomes of those behaviours.

Learning can occur without a change in behaviour.

The consequences of behaviour play a role in learning.

Cognition plays a role in learning.



THE TRANSTHEORETICAL MODEL



THE TRANSTHEORETICAL MODEL THE TRANSTHEORETICAL MODEL

James O. Prochaska

and

Carlo C. DiClemente

“Habit is habit, and not to be flung out of window but coaxed downstairs a step at a time.”

Mark Twain

The TTM:

Behavior change is a process that takes place over time. Its never simple, nor straight forward.

People go through stages before final changes are made, and many things happen after they start to make changes.

This “Stages of Change” model suggesting stages of behavior change and processes that influence people’s progression through those stages



The TTMIs an Integrative Model of Behavior Change

Model of intentional change Change implies phenomena occurring over

time Focuses on decision making of the individual Involves emotions, cognitions and behavior Involves progress through a series of five stages



The TTM: Background

Consist of different stages which help identify where a person is regarding the change of behavior.

It may relate to several different things such as smoking, exercise, diet, sexual orientation, immunization, screenings, etc.

It consists of several different processes but it is divided into five main stages.



THE TRANSTHEORETICALMODEL

Stages of change:

Precontemplation Contemplation Preparation Action Maintenance



PrecontemplationPrecontemplation

ContemplationContemplation

PreparationPreparationActionAction

MaintenanceMaintenance

RelapseRelapse




Stage 1: Pre-contemplation

Individuals are not intending to take action in the foreseeable future (usually measured as the next 6 months)

- unaware of the problem , unwilling tochange

- might not realize that change is possible, desirable, or relevant to them, - feeling discouraged/demoralised,- defensive about particular behavior, - has not began to contemplate change or need

for change,- least responsive to interventions.



Predominant Answer in pre-contemplation stage:

My weight is OK! I don’t need to exercise.

Smoking makes me feel cool, I wont stop!

I cant do HIV Test when I am feeling healthy, because it can be false positive!

Intervention: Increase awareness Provision of information



Stage 2: Contemplation

At this stage, the individuals are aware of the problem but not prepared/intended to change/take any action in the next 6 months.

- involve the process of self-reevaluation,- active consideration of the prospect

to change,- looking for more info. about the problem,- weighing pros and cons (costs and benefits)- evaluating options

The person has started the process of contemplating changes



Predominant Answer:

I know smoking is bad, but I’ve difficulties to quit.

I know early HIV test is good, but what happen to my

job if my employer knows?

Intervention: Motivation Goal setting Counseling



Stage 3: Preparation

The stage in which the person is intending to take action in the immediate future. He prepares to undertake the change.

- readiness to change (A & B)

- gathering info. About the change

- learned the previous lesson

- on the verge to take action

- initiate behavior change

- begin reducing their problem behaviorex: reduce/delay smoking



Predominant Answer in the stage of preparation:

I would like very much to reduce my blood pressure, and I am confident that I can do it.

In sha Allah I will stop smoking, but I don’t know when

Intervention: Action plan with specific strategies Goal setting Provision of assistance




Stage 4: Action

A new behavior has been adopted. Individuals have specific overt modification in their-lifestyle within the past 6 months.

- modification of the problem behavior



Predominant Answer in the stage of action:Currently, I am physically active, but not on regular basis.

Intervention: Social support Assist with feedback Reinforcement Motivation




Stage 5: Maintenance

The stage in which the individuals are working to prevent relapse

- Final stage in the process of change

- Maintenance occurs when the behavior has been incorporated into the person’s life

- The new behavior is not yet firmly established.



Predominant Answer:

I have stopped smoking for the last 6 months, and

I am putting on weight now.

Well…. I stopped for almost the 6months you recommended, but just yesterday, I had a stick because my friend offered to me and I feel I cant say no!

Intervention: Assist in coping Avoid relapse



Relapse??

The process is not yet complete and it may never be complete. Many things can affect behaviour change. A person may want to maintain a new behaviour, but other

things might make this difficult. It may later become hard to sustain:

- available resources might disappear - strong supporters might move away or withdraw support - a new situation might make old behaviour seem more

appealing.

For all sort of reasons, people might move back to the earlier stage of behaviour change and work through the stages again .



Pre-contemplation Contemplation Preparation Action Maintenance

Becoming aware

Emotional response

Environmental analysis

Thinking through the issues

Seeing other options

Self-efficacy

Social support

Helping relationship

Reinforcement

Seeing other options

Being in control

Social support

Processes influencing movement through the stages of change



Diffusion of innovation Theory



Diffusion of innovationRoger (1983) defined

– an innovation as “ an idea, practice or object that is

perceived as new by an individual or other unit of adoption”

– diffusion as “the process by which an innovation is

communicated through certain channels over time among

the members of a social system

The process of diffusion involves five stages:1. innovation development,

2. dissemination,

3. adoption,

4. implementation

5. maintenance



InnovatorsEarlyAdopters

EarlyMajority

LateMajority Laggards

Adopter CategoriesAdopter Categories

2.5%

13.5%

34% 34%

16%



Diffusion of tech in weaponry:

American drone in the 21st century

Nigerian warriors in the 18th century



Diffusion of tech in transport systems:

Local Water transport then

Local Water transport now



Diffusion of technology in transport:



Transition of cultural diffusions:



PRECEDE – PROCEED MODEL



PRECEDE – PROCEED MODEL Lawrence W. Green

Marshall W. Kreuter

Premise: The factors causing health behavior are seen to be of three distinct kinds:

- predisposing- enabling - reinforcing




PredisposingFactors

EnablingFactors

ReinforcingFactors

Specific behaviorby individuals

Environment(conditions of

living)

HEALTHHEALTH



Predisposing factors:• Knowledge• Attitudes• Beliefs• Values• Perceptions




Reinforcing factors:

• Attitude and behavior of health and other personnel, community leaders, peers, parent, employers, etc.




Enabling factors:• Availability of resources• Accessibility of resources • Referrals• Rules or laws• Health related skills• Community/government, priority and

commitment to health• Engineering




Case study 1 Lee is a 21 year old Malaysian student involved

in Intravenous drug addiction (IDA). There are many cases of IDA among Lee’s peers. However Lee thought IDA has harmed his life and wishes to change for the better.

Lee is also worried that his family views his IDA as an embarrassment to the whole family

How will you help Lee?



Case study 2 Women in the predominantly Muslim Northern

Nigeria are generally known to reject western style contraception techniques. As a public health specialist, you have been requested to design a study that will serve as a basis for addressing this issue.

Which of the models of health behaviors will best fit? Justify.



Case Study Ayesha is a 22 year old university student who lives with her

parents. When she was in school, she played several sports and got plenty of exercise by walking to and fro school. She now notices that she is not exercising anymore. She drives everywhere, even to close shops. As a result, she is aware that she is feeling unfit and is beginning to gain weight.

Why might Ayesha’s exercise behavior changed? How can you help her to exercise again?



models of health behaviors by yusuf abdu misau

Health & Medicine