PSYCHOSOCIAL

DETERMINANTS OF
HEALTH
Sisay M. (MSc)
Debre Berhan University
School of Health science and medicine

Determinants of Health

Factors found to have the most significant influence

for better or worse

Definitions of Health
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Yesterday
Health = absence of illness

Health
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Today
Too traditional and outdated to think of health as:

freedom from diseases.

Goes beyond treating diseases

Health

A complete state of physical, mental, and social

well-being and not merely the absence of disease
and infirmity.

WHO 1947

The first time health meant more than absence of

illness.

Health

A complete state of physical, mental, and social

well-being and not merely the absence of disease
and infirmity and the ability to lead socially
acceptable and economically productive life.

WHO 1987 (?)

Health
body functioning
Multidimensional in(health),
Ability tonature
think clearly,
and reason objectively.
physical health,

Feeling state
mental health,
Ability
Feelingtoashave
part of a
satisfying
relationships.
emotional health,
greater spectrum
of
social health ,existence.Appreciation of the
external environment and
spiritual health and ones role in caring for it.

environmental health

Health

Practically, these components are interrelated with

one another.
A poor level of health in one component

adversely affects one or more components

So maintaining the balance is necessary for total

health (well being).

Wellness

The achievement of the highest level of health in each

dimension.

Psychosocial Health

Being Mentally, Emotionally, Socially, and

Spiritually Well
Includes 4 of the 6 Dimensions of Health

Psychosocial Health

Elements shared by psychosocially healthy people:

Feel good about themselves

Feel comfortable with other people
Control tension and anxiety
Curb hate and guilt
Maintain a positive outlook
Enrich the lives of others
Cherish the things that make them smile
Appreciate and respect nature
Able to meet the demands of life
Value diversity

Psychosocial Health

Elements shared by psychosocially unhealthy people:

Psychosocial Health
Mental Health
a state of subjective wellbeing-ness in which an
individual realizes his or her own abilities, can cope
with the normal stresses of life, can work productively
and is able to make a contribution to his or her
community
WHO

Psychosocial Health
Mental Health
The successful performance of mental functions, in
terms of thought, mood, and behavior that results in
productive activities, fulfilling relationships with
others, and the ability to adapt to change and to cope
with adversity.

A Report of the Surgeon General (US)

Psychosocial Health
Emotional Health
The feeling part of psychosocial health
Includes

love, hate,
Happiness, sadness
anxiety, and anger

Psychosocial Health
Social Health
The relating part of psychosocial health
Interaction with others
Ability to adapt to social situations
Ability to listen, express opinions and beliefs,
form relationships, and act responsibly

Psychosocial Health
Spiritual Health
The being part of psychosocial health

difficult-to-describe
meaning and purpose in life (spirituality)

Factors Influencing Psychosocial Health

External factors

Most reactions are a direct result of experiences and

expectations
3 important external factors

Family influences can be healthy and nurturing or

dysfunctional showing negative behaviors and/or physical
abuse
Environmental influences include schools, health care,
socioeconomic status
Social bonds and social supports

Factors Influencing Psychosocial

Health

Internal factors

Include hereditary traits, physical health and fitness,

and mental/emotional health
Self efficacy and self esteem

The belief in being able to successfully execute the behavior

required to produce the desired outcomes.
(I can use condom correctly).
Past success or failure leads to an expectation of further
success or failure in that particular task or skill
Positive self-efficacy gives a sense of personal control

Factors Influencing Psychosocial

Health

Self-esteem

Refers to a sense of self-respect or confidence

Different from self-efficacy in that it refers to the
whole individual, not simply task-related
confidence
Evaluation of oneself as worthwhile and cared
about by others
People with poor self-esteem do not like
themselves and lack confidence

Factors Influencing Psychosocial

Health

Personality

Determined by heredity, environment, culture, and

experiences

Is not static and changes through life

Traits of psychosocially healthy personalities:

Extroversion/sociability
Agreeableness
Openness to experience
Emotional stability
Conscientiousness/carefulness

Enhancing Psychosocial Health

Develop and Maintain Self-Efficacy and SelfEsteem

Find a support group

Complete required tasks

Maintain friendships and contact with family

Get involved politically, join a club or
recreational association
Create a history of success

Form realistic expectations

Enhancing Psychosocial Health

Develop and Maintain Self-Efficacy and SelfEsteem continued

Make time for you

Maintain physical health
Examine problems and seek help

Self-EfficacyIndividual Activity

Think of two different tasks or skills

One in which you have a high level of selfefficacy

One in which you have a low level of selfefficacy

List several reasons why self-efficacy is

more positive in the higher ranked task
List several reasons how you can raise selfefficacy in the lower ranked task

Enhancing Psychosocial Health

Sleep:- the great restorer

Serves 2 biological purposes

1.

Conservation of energy

2.

Restoration

Feeling rested
Re-supply of neurotransmitters

How much?

7-9 hours

Enhancing Psychosocial Health

Sleep continued

Establish a sleep schedule

Establish a good sleep environment
Exercise regularly
Limit caffeine and alcohol
Avoid heavy meals before bedtime
Establish a nighttime ritual
Nap only in the afternoon, if at all
Get up if unable to fall asleep

Mind-Body Connection
Happiness

Experts not entirely clear how to achieve

subjective well-being (SWB)

Composed of 3 central elements

1.

Satisfaction with present life

2.

Relative presence of positive emotions

3.

Sociable, outgoing, willing to share

Generally see the world as a positive environment

Relative absence of negative emotions

Experience less anger, depression, anxiety

Mind-Body Connection

Laughter is the best medicine

Limits negative effects of stressors

Positive coping mechanism
Helps battle depression and anxiety
Brings people together (especially with those having
shared experiences)

Mind-Body Connection

Does Laughter Enhance Health?

Studies have shown the following results:

Stressed people become less depressed with humor

Students who use humor as a coping mechanism
experience positive mood.
Senior citizens with a sense of humor often recover
from depression.
Jokes, especially shared, increase social cohesion

Health and behaviour

Identifying behavior will be very helpful to

understand the complex relationship between
health and behavior.
Healthy behavior contribute to the over all health
of an individual and community.
Unhealthy behavior, affect health of individuals,
communities and quality of life at different
levels.

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Introduction

Behavior can be defined as an action that has a

specific frequency, duration, and purpose.
It is associated with practice.
It is what we do and how we act.

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Factors affecting behavior

There are many factors that affect the behavior

of individuals or groups.
E.g. culture.
The following classification is helpful to make
a diagnosis of the factors affecting behavior.

Predisposing factors
Enabling factors
Reinforcing factors

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Predisposing factors

Pre disposing factors provide the rational or

motivation for the behavior to occur.

Knowledge
Beliefs
Attitude
Confidence/skill
Value

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Knowledge

Knowledge (Cognition) is a mental process that

includes
thinking,
remembering,
perceiving,
planning, and choosing.
Knowledge often comes from information collected
from written materials, mass media, teachers, parents,
friends, etc it could also come from personal and
other peoples experience.
E.g. knowledge about disease causation and
transmission
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Beliefs
A belief is a conviction that a phenomenon or
object is true or real.
Are usually derived from parents, grand
parents and other people we respect and they
are accepted as true.
Belief is often difficult to change.
It includes faith, truth, and trust.

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Attitudes

Attitudes are evaluated feelings. They are learned

predispositions to behavior.
They are related to feelings. Reflect our likes and
dislikes (can be positive or negative.
They often come from experience or from people
who are close to us (friends, parents, etc)
E.g. what is your attitude to wards nightclubs?

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Values

Value:- the regard that some thing is held to deserve;

important or worth; principles or standards of
behaviors.
They are cultural, intergeneration perspective on
matters of consequence; reflects the values people
hold.
Value has contextual application.

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Definitions

They are the basis for justifying ones action in

moral or ethical terms.
E.g. A married women is more respected than
unmarried one in Ethiopian context. Married is
highly valued and respected by many
communities in developing countries like
Ethiopia.

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Skills

Skills refers to a persons ability to perform tasks

that constitute a health related- behavior. E.g
condom use).
Culture
Culture constitutes the normal forms of behavior,
beliefs, values and use of resources.

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Enabling factors

1.

These factors enable a motivation to be realized.

They help an individual to choose, decide and
adopt behavior.
Availability and or accessibility of health
resources. E.g presence of family planning service
in the health center encourage a mother to utilize
the service once she is aware of and is interested
in the service.

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Enabling factors
2. Presence of health related skills.
Presence or absence of certain skills that are
important for behavior are essential once the
individual has decided to practice.
E.g. an individual has to know how to use
condoms in order to use it.

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Reinforcing factors

These factors come subsequent to the behavior.

They are important for persistence or repetition
of behavior. They apply pressure on people who
are intimate to these categories.
A mother who had started first ANC visit should
be reinforced to attend subsequent visits
including delivery and post delivery care.

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Reinforcing

These groups, who are most important in our lives

and that reinforce behavior include:

Family
Peers
Teachers
Employers
Health providers
Community leaders
Decision makers

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Health and behavior Changes

All communities do not have same behavior.

It is good to identify useful, harmful and neutral
practices and behaviors in communities where we
are working in.

Change in behaviour

1.

Changes in behavior could occur as a result of

natural events or based on plans.
Natural change
Our behavior changes all the time.
Some changes take place because of natural
events or processes such as age and sex related
behavior.

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Change in behavior
2. Planned change

These are change based on plan.

E.g. one can plan to stop smoking or drinking
alcohol.

There may be motives to start a new behavior,

such as cigarette smoking.

Planned changes in behavior can be faster or

slower depending on the response of the accepter
and adopter of the behavior.
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Assignment

Identify your own health problem(s),

prepare a plan, implement your plan and
evaluate it.

Behaviour change theory

A Theory is a set of inter-related propositions

containing concepts that describe, explain,
predict, or control behavior.
Theories explain why, what, how, and when a
particular behavior occurs.

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The Health belief Model

The health belief model has been developed by a

group of psychologists in the 1950 to help
explain why people would or would not use
health services.
It is one of the most frequently used in health
behavior application of health.
The theory help to explain different behaviors
related to health.

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Health belief

Researchers assumed that people feared diseases and

that the health actions of people were motivated by
the degree of fear (perceived threat) and the
expected fear reduction of actions, as long as that
possible reduction outweighed practical and
psychological barriers to take action (net benefits).

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Components on the health belief model

Perceived Susceptibility
It refers to the individuals perception of the risk of
contracting a health problem.
( am I at risk for HIV infection?)
Perceived Severity
It is the perceptions of the potential seriousness of
the condition in terms of pain or discomfort,
disability, economic difficulties, death, etc. ( how
serious is AIDS; how hard would my life be if I got
it?)
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Components
Perceived Benefits
This includes the perceived benefits of taking health
action and helpfulness. ( if I start using condoms, I
can avoid HIV infection).
Perceived Barriers
The potential negative consequences that may result
from taking particular health actions, including
physical, psychological, and financial demands.

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Components
Self-Efficacy: The belief in being able to
successfully execute the behavior required to
produce the desired outcomes.
(I can use condom correctly).

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Psychosocial Disorders

Depression

Major depression is one of the most common

psychiatric disorders
It is normal to feel down or depressed following
traumatic loss

Those with major depressive disorder experience extreme,

persistent sadness, despair and hopelessness, feelings of
intense guilt, and worthlessness
Approximately 15% attempt suicide

Facts and Fallacies About Depression

True depression is not a natural response to crisis and loss

People will not snap out of depression by using a little
willpower
Frequent crying is not a hallmark of depression
Depression is not all in the mind but is chemical in nature
Only in-depth psychotherapy can cure long-term clinical
depression

Psychosocial Disorders

Anxiety disorders

Number one mental health problem

Strikes 13% of all adults

Include generalized anxiety disorders, panic disorder, and
phobias

Psychosocial Disorders

Schizophrenia

a mental illness with biological origin

Characteristics

Alterations of the sense

Inability to sort incoming stimuli
Altered sense of self
Radical emotions, movements, behaviors

Commonly appears in late adolescence

Treatment includes medication and psychotherapy

Psychosocial Health Small Group

Activity
1. Why do you think the college environment may provide
2.

3.
4.
5.
6.

a real challenge to your psychosocial health?

Think of someone you know who has high self-esteem.
What characteristics does this person have? Do you
enjoy being with someone who has high self-esteem?
What role does laughter play in your daily life?
How do you react to bad news? Do you think about how
your reactions affect your mental and emotional health?
What is spirituality to you? Can your group agree on
three factors associated with spirituality?
Whats more important to you: long life or high quality
of life?

Thank you all!