BEHAVIORAL DIAGNOSIS: ASSESSING HEALTH ACTIONS

Module 7

HEALTH PROMOTION & EDUCATION (DEMA 3253)DIPLOMA IN ENVIRONMENTAL HEALTHVICTORIA INTERNATIONAL COLLEGE

PREPARED BY: MR KHAIRUL NIZAM MOHD ISA

PRECEDE FRAMEWORK

Health education components of health program

Predisposing factors: knowledge, attitudes, values, perceptions

Enabling factors: Availability of resources, accessibility, referrals, skills

Reinforcing factors: Attitudes and behavior of health and other personnel, peers, parents, employers, ect.

Nonbehavioral causes

Behavioral causes

Behavioral indicators: utilization, preventive actions, consumption patterns, compliance, self-care

Indirect communication: staff development, training, supervision, consultation, feedback

Direct communication: public, patients Nonhealth factors

Health problems

Vital indicators: Morbidity, Mortality, fertility, disability

Dimensions: incidence, prevalence, distribution, intensity, duration

Quality of life

Subjectively defined problems of individuals or communities

Social indicators: illegitimacy, population, welfare, unemployment, absenteeism, alienation, hostility, discrimination, votes, riots, crime, crowding

Dimensions: Earliness, frequency, quality, range, persistence

Phase 6Administrative diagnosis

Phase 4-5Educational diagnosis

Phase 3Behavioral diagnosis

Phase 1-2Epidemiological & social diagnosis

BEHAVIOR

• Behavioral problems refers to the behaviors believed to cause health problems for the people for whom the educational intervention is intended.

• After considerable analysis, target behaviors are selected and the approach to changing them stated in term of behavioral objectives.

• Behavioral objectives are the means by which program objectives and programs goals are achieved.

BEHAVIOR

• Health problems have both behavioral and non-behavioral causes.

• Non-behavioral cause are personal and environmental factors that can contribute to health problem but that are not controlled by behavior of the target population.

• Non-behavioral causes include:▫Genetic ▫ Climate▫Work place▫ Residence▫ Environmental (air, water, soil, roads, fluoridation, food, ect.)▫ Technological (adequacy of medical care, facilities)

BEHAVIOR

Nonbehavioral causes

Behavioral causes

Health problems

Nonhealth factors

Quality of life

BEHAVIOR• Behavioral causes can be influenced by certain non-behavioral

causes, especially through collective action.• Eg. Communities, neighborhoods, or special interest groups

can organize, vote, boycott, lobby, or support and prevent certain environmental and technology changes.

• Thus, behavior can influence health in 3 ways:▫Direct▫ Indirect (2 ways)

Behavioral causes

Environmental causes

Technological causes

Health

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2

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5 BASIC STEPS IN BEHAVIORAL DIAGNOSIS

• Step 1: Differentiating between behavioral and non-behavioral causes of health problem

• Step 2 : Developing an inventory of behaviors• Step 3 : Rating behaviors in terms of importance• Step 4 : Rating behaviors in term of changeability• Step 5 : Choosing behavioral targets

Step 1: Differentiating between behavioral and non-behavioral causes of health problem

• Differentiate between the behavioral and non-behavioral causes of health problem by listing the known risk factors for that problems/diseases.

• eg. Risk factors for cardiovascular diseasesSmoking Heavy alcohol

consumptionGender DiabetesInactive life-style ObesityStress AgeHigh serum cholesterol Family history of diseasesHigh blood pressure High fatty-acid intake

Step 2 : Developing an inventory of behaviors

• Once the behavioral and non-behavioral factors have been listed, the list of behavioral factors should be refined.

• Procedure:a) Identify the behavioral associated with preventing the health

problem and state them in term of actions to be taken.b) Identify the treatment procedures of the health problem in

sequential order. What are the steps that people have to go through to comply with a recommended method of prevention treatment.

Inventory of behaviors

• Develop a flow chart of causation or transition from beginning to end of a behavioral process or event.

• Eg. The behavior of involve in recycling campaign:▫Taking care willing to separate/sort trash send to

recycling center

• It can be sabotaged at many points along the way, for example, when they mix up organic wastes and glasses.

• This level makes it possible to isolate concrete behavioral events from non-behavioral factors in such a way as to ensure that intervention-education and administrative- are highly targeted.

Inventory of behaviors

Preventive behaviors1. Maintain or attain desirable weight2. Stop smoking or don’t start3. Stop heavy or abusive drinking or don’t start4. Continue or begin regular exercise5. Avoid excessive, constant stress and/ or do relaxation exercise6. Participate in high blood pressure screening programs

Treatment behaviors1. Make informed decisions regarding medication, surgery and so forth2. Take prescribed medication3. Maintain or attain desirable weight4. Stop smoking5. Stop heavy or abusive drinking or don’t start6. Continue or begin regular exercise7. Avoid excessive, constant stress and/ or do relaxation exercise

Step 3 : Rating behaviors in terms of importance

• Reduce the extensive list of behavior to a manageable length by establishing which behaviors are the most important.

• Steps:▫Available data are linked to the behavior and health problems▫ Put them in sequence and rationality

• Behavior can be considered important if a strong theoretical cases available causally related to a health problem.

• The stronger the rationale, the greater the probability that the behavior selected for intervention program.

Rating behaviors

Important Smoking Eating foods with high fatty-acid content Over eating Lack of exercise Not relaxing

Basis for rating behavior Very strong association; high incidence Strong association; high incidence Moderate association; high incidence Moderate association; high incidence Moderate association; high incidence

Not (less) important Not monitoring blood pressure Not adhering to medical regimen Making uniformed decision about treatment matters

Basis for rating behavior Not related to the desired outcome of the program: primary prevention

Step 4 : Rating behaviors in term of changeability

• Guideline to determine the potential for behavior changeability:▫ Probably when behaviors are still in the development stages or

have only recently been establish▫When behaviors are still only superficially tied to established

cultural patterns or life-styles▫Have been successfully changed in other programs

• Behavior have low changeability when they:▫Have long been established▫Are deeply rooted in culture patterns or life-style▫Have not been changed in previous attempts

Step 5 : Choosing behavioral targets

• Time to select the behavior that will be focus of the educational intervention.

• To facilitate the selection, the results of the importance and changeability ratings are arranged in a simple matrix table.

Important Not (less) important

Changeable1. High priority for program

3. Low priority except to demonstrate change for “political” purposes

Not (less) Changeable2. Priority for innovative program: evaluation crucial

4. No program

Choosing behavioral targets

• Depending on the program objectives, the priority behaviors will be more likely come from quadrants 1 and 2.

• Behavior in quadrant 3 likely accepted when there is a political need to document change. Eg. Drive over limit among bus express drivers – installation of black box in buses.

Important Not (less) important

Changeable1. High priority for program

3. Low priority except to demonstrate change for “political” purposes

Not (less) Changeable2. Priority for innovative program: evaluation crucial

4. No program

Choosing behavioral targets

Important Not (less) important

Changeable 1. None 3. None

Not (less) Changeable

2. Smoking Eating food with high fatty-acid content Overeating Lack of exercise Not relaxing

4. None

• Matrix of health behavior in preventing cardiovascular diseases

Stating behavioral objectives

• This is the final step after the target health behavior has been identified.• The behavioral objective should answer these questions:▫ Who – the people expected to change▫ What – the action or change in behavior or health practice to be

achieved▫ How much – the extent of the condition to be achieved▫ When – the time in which the change is expected to occur

eg. Who – residents aged 15-25 in BTPWhat – the reduction in the incidence of cigarette smokingHow much – 20% decline in smoking prevalenceWhen – the time of the proposed follow-up evaluation, 2 years after the

program is initiated. Young adults aged 15-25 years in BTP will show a 20% reduction in

incidence of cigarette smoking within 2 years of program implementation.

Thank you