Health and Human Behavior

Wubet Taklual (MPH)

November,2017
 OUTLINE
Introduction
Definition of behavior
Component of behavior
Determinate of behavior
 Behavior change approach
Type of Health behaviors
Level of disease prevention
 Introduction
Health is determined, not by medical services and drugs,
but also by ordinary human actions and behaviors.
E.g. Feeding children with bottle put them at risk of
diarrhoea.
Many health education programs have failed because:
 They put too much emphasis on individual behavior
 Neglected to understand the cultural, social, economic
and political factors that influence his/her behaviors or
actions.
• Life style: Refers to the collection of behaviours that
make up a person’s way of life-including diet, clothing,
family life, housing and work.
• Customs: It represents the group behaviour. It is the
pattern of action shared by some or all members of
the society.
• Traditions: Are behaviours that have been carried out
for a long time and handed down from parents to
children.
• Culture: Is the whole complex of knowledge, attitude,
norms, beliefs, values, habits, customs, traditions and
any other capabilities and skills acquired by man as a
member of society.
 Research Evidence(WHO-2009)
• Around 32% of children less than 5 years of age in
developing countries are stunted and 10% are wasted.
Reason
• Non-exclusive breastfeeding in the first 6 months of
life(1.4 million deaths and 10% of the disease burden)
Worldwide, it is estimated that only 34.8% of infants are
exclusively breastfed for the first 6 months of life.
Pregnant women(Ethiopia)
 27% avoided at least one type of food due to food taboos.
 Milk and cheese were regarded as taboo foods by nearly
half of the women (44.4%)
 linseed and fatty meat (16%, 11.1%).
 Definition of 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.
Action –types of overt behavior, such as drinking, smoking,
etc.
To say a person has drinking/smoking behavior
 Duration –it is the time spent since the action started or
noticed such as for a week/months.
 Frequency- how it is repeated in a certain period of time.
 Purpose –is he/she doing consciously or not
What is Human Behavior??
Human behavior is the sum total / result of physical &
mental factors influenced by social/cultural factors.

The study of human behavior is how people behave and

why they behave in just the way they do.
 Behavior components

A) Cognitive domain: stored information

 Knowledge
 Perception
 Thinking
B) Affective domain: cognition +feeling (connation)
 Attitude
 Beliefs
 Value
C) Psychomotor domain
 Psycho – mind
 Motor – action
 Changes in behavior
• Changes in behavior - our behavior changes all
the time
1. Natural change - some changes take place
because of natural events or processes
• Such as age-sex related behaviors, Pregnancy
related behaviour
2. Planned change - we make plans to improve our
lives or to survive and we act accordingly
• Example: plan to stop smoking or drinking
 Continue…
• Planned change in behavior can be faster or
slower depending on the response of the
acceptor and adapter of the behavior
• People stay healthy or become ill as a result of
their own action
• The following are examples of how people’s
actions can affect their own health
 Continue…
Feeding children with bottle put them at risk
of diarrhea
Defecating in an open field will lead to
parasitic infection
Using mosquito nets and insect sprays helps to
keep mosquito away
Unsafe sex predisposes people to unwanted
pregnancy, HIV/AIDS and other STDs
 Continue…
• It is Hard to change people’s behavior,
particularly those practiced for a long time.
• E.g. Ato fekadu is a 53 years old and he smoke
cigarette and chewing chat for the past 25
years with his friends. After he practiced such
kind of unhealthy behavior for a long period of
time it will become difficult to change his
behavior. Why it is hard to change his
behavior?
 Continue…
Types of Health Behaviors
• WHO define health behavior as ‟any activity
undertaken by an individual regardless of actual
or perceived health status, for the purpose of
promoting, protecting or maintaining health,
whether or not such behavior is objectively
effective towards the end.”
• It is any activity undertaken by a person to keep
himself or others healthy and prevent disease
 Continue…
• Three key focus of health behavior are
maintenance of health, restoration of health
and improvement of health.
• The study of health behavior is based upon
two assumptions:
 A substantial proportion of mortality and
morbidity are caused due to a particular
pattern of behavior and
These behavior patterns are modifiable
Factors affecting human behavior
A. Predisposing factors
 Are antecedents or prior to behavior that provide the
rationale or creation of motivation for the behavior to occur.
This type of factors include:
• Knowledge Attitude
• Perception
• Belief
• Value
• And existing personal skills that facilitate or hinder motivation
for change.
 Predisposing…
Knowledge
Knowledge can be defined as the perception and cognition
of oneself, the immediate surrounding or environment
and the universe as a whole.
Cognitive Ability is defined as the capacity to perceive,
reason, or use instinct by an individual.
Cognition is an individual activity
Knowledge is a relationship between an individual and
reality.
 Predisposing…
There fore, Perception and Intuition /instinct lead us into
mental thinking in which later will be stored in our
memory in the form of meaning, symbols, pictures, etc.
This stored memory is known as knowledge.
The means of acquiring knowledge by the brain is
perception.
 Perception: Is giving meaning and interpretation of data
and information received by the five sense organs of the
body available to the brain.
Perception + Storage of information in the brain =
Knowledge
Predisposing…
Perception
Is there any difference between perception and
thinking?
In perception the stimuli are originated from outside the
body and are received by sensory organs, and then the
stimulus reaches the brain and gets interpreted in
meaningful ideas. At this stage thinking starts.
In other words, perception ends with thinking.
Thinking can be the product of perception or can be by
itself internal mental process or exercises.
 Belief
It also refers to a conviction that a phenomenon or object
is true or real. Faith, trust, and truth are words used to
express or imply belief.

They are derived from parents, grandparents, 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.
Usually easier to influence

Are held by individuals

 Have been acquired recently

Come from not highly respected sources

Are not part of religion

Not part of traditional medical system

 Usually difficult to change

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

 Are part of traditional medical system

 Types of beliefs
As beliefs can be held very strongly, they are often
difficult to change.
One big wrong is that the health workers them selves
believe that any traditional belief is bad and must be
changed.
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.
 Type of belief
• Hot food items will cause abortion.
• Cold foods might affect the quality and quantity of
milk production.
• Pregnant mother should eat less to keep the size of
the baby minimum for easy delivery.
• Prohibits intake of water at the time of delivery of a
baby
• Pregnant woman should eat less egg so as to produce
a small fetus and an easy labor.
• Milk and cheese, linseed and fatty meat were avoided
during pregnancy in Ethiopia. Due to fear of difficult
delivery (51%), discoloration of the fetus (20%) and
fear abortion (9.7%).
Attitude
One of the vaguest yet most frequently used and misused
words in the behavioral sciences word list is attitude.

While there is no total consensus among behavioral

scientists, to keep matters short and simple it is better look
at three definitions that, in combination, cover the
principal elements of 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.”

Kirscht viewed attitudes as a collection of beliefs that

always includes an evaluative aspect.

Kiesler, Collins, and Miller (1969) defined attitude as a

learned predisposition to respond in a consistently
favorable or unfavorable manner with respect to a given
object.
 Characteristics of Attitude
1) Predisposition: Exposure related to an attitudinal object.
e.g. It is not sensible to ask about the attitude (inclination)
about condom for those who do not know it (not
predisposed).
2) Has directions: Polar, +ve or _ve, good or bad.
3. Evaluation: Can be evaluated by intensity or judgment.
e.g. Favorable or unfavorable
4) Changeability: Can be changed, adopted, modified, not
static.
5) Stability or consistency.
• Stability=related to time
• Consistency= the sameness of attitude
e.g. “Mood” changed quite often.
 Relation ship between beliefs and attitudes
It is certain that our beliefs about things affect the way we
think about them. 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.
Generally,
• Beliefs perceived to have good outcomes +ve attitude
• Beliefs perceived to have bad outcomes _ve attitude
 Attitude beliefs
Therefore, rather than just asking respondents how they feel
(attitude) about a particular attitudinal object, attitudes
can be measured by asking what they believe about the
object.
Sequential Relationship among KAP
The general trend or normal way of thinking and acting the
proper sequence 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.
A P K
P K A
K P A
When P or A precedes K, it is due either to an imitation
(modeling) or compulsion.
 Value
Every individual places or gives a relative worth to every
thing around. This worth or preference or judgment is
known as value.

It is defined as the regard that something is held to be

important or worth; and prized by an individuals or
community.
 Examples:
• Being a good mother
• Having many children
• Being approved by friends
• Being attractive to opposite sex
• Academically success
• Being a man of God
• Being healthy
 Criteria of value
 Free choice
 Alternatives
 Selection by reason and consideration made from its
advantages and disadvantages
 Proud of selection
 Accept openly/frankly
 Act upon it
 Act consistently
NB. In terms of difficulty of changing:
Beliefs < attitudes < values
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.
 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 to perform a

certain behavior provided that the enabling factors are
readily available.
 B. 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.
This category of factors include:
The health care environment:
Availability
 Accessibility
 Affordability
New skills
Resources. E.g. Facilities, money, time, labor services,
skills, transportation, materials and the distribution and
their location.
Other environmental factors such as community and /or
governmental laws, policy, rules, regulations, priority
and commitment can be a barrier or a facilitator of the
behavior change to be occurred
Examples:
Food Availability: Food is within reach of households
(local shops and markets), both in terms of sufficient
quantity and quality.
• Determined by domestic food production, commercial
food imports ,food aid and domestic policies regarding
food production.
Food Access: Determined by:
• Food prices
• Household resources
• Socio-political factors such as ethnic favoritism, social
discrimination and gender inequality
Food Utilization: An individual’s dietary intake.
• Both quantity and quality of food .
Outcomes
Positive
• Healthy Physical and mental development
• Productive
• Healthy person
Negative
• Dual burden: co-existence of over and under nourished
• Shift in dietary pattern
• Demographic shifts (mortality and fertility )
• Epidemiologic shifts (infectious disease to Non-
infectious Disease)
 C. 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.

Are those consequences of actions that determine whether

the actor receives positive or negative feedback and is
supported 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.

Among these important people are elders, friends, peers,

parents, grandparents, village leaders, religious leaders
and people with a lot of experience and skills (teachers,
health workers, etc.).

 Types of Health Behaviors
Health Behaviors: are actions that healthy people undertake
to keep themselves or others healthy and prevent disease.
• A number of studies have looked at the relationship
between health behaviours and a variety of health
outcomes.
• Seven features of lifestyle: not smoking, moderate alcohol
intake, sleeping 7–8 hours per night, exercising regularly,
maintaining a desirable body weight, avoiding snacks, and
eating breakfast regularly, which together were associated
with lower morbidity and higher subsequent long-term
survival.
1) Promotive Behaviors:
Physical exercise
Use of latrine
Child spacing
Proper disposal of dirty water
Good nutrition
Clean storage of food
Breast feeding
2) Preventive Behaviors
 Taking anti—malaria drugs
 Immunization
 Using mosquito bed nets
3) Utilization behaviors
Is concerned with utilization of health services such as:
ANC services
Immunization services
Child health services
Screening programs
FP service
4) At risk behaviors:
It refers to the activities undertaken by an individuals,
who believes himself to be health but at a greater risk of
developing a specific health condition, for the purpose of
preventing that condition or detecting it in an
asymptomatic state.
For example, HIV/AIDS testing
5) Illness behaviors
The action people take before consulting health care
workers, including recognition of symptoms, taking
home remedies (self—medication), consulting family and
healers are called illness behaviors.

It is recognition of early symptoms and prompt self—

referral for treatment before the disease becomes serious
6) Compliance behaviors
A behavior following a course of prescribed drugs (taking
too much drug or too less or no drug because of severity
and short recovery). Best example is TB –prolonged drug
use.
7) Rehabilitation behaviors
A type of behavior that prevent further disabilities after a
serious illness.
E.g. counseling after lung cancer surgery to exercise or quit
smoking
8. Mutual—aid behavior
Activity in which people support each other in relation to
their common health problems.
9. Parenting health behaviors:
Any action performed by individuals/family for the
purpose of ensuring, maintaining, improving of the
health of their children
10. Community action
Action undertake by the individuals and groups to change
or improve their surroundings to meet special needs.
 Installation of improved water supply
 Building of latrines and upgrading the unimproved
 Behavior Change Approaches
Persuasion Approach: is the deliberate attempt to
influence the other person to do what we want them to
do. (Often called the ‘directive’ approach or, when done
forcefully, coercion).

Such approach is used in situations where there is serious

treat such as epidemics and natural disasters, and the
actions needed are clear—cut.
 Behavior change…
The informed decision making approach
Giving people information, problem—solving and decision—
making skills to make decision but leaving the actual
choice to the person (‘open’ or ‘non judgmental’
approach).
Such approach is used with groups who have been
disadvantaged or oppressed by promoting awareness,
conscious raising and building confidence that they have
the power to make their appropriate decisions and
control their own lives called empowerment.
 Levels of Disease Prevention
Primary Prevention
Is comprised of those preventive measures that forestall
the onset of illness or injury during the pre—pathogenesis
period (before the disease process begins).
Aimed specifically at forestalling the onset of illness or
injury among apparently health individuals.
Examples
 Wearing safety belt
 Immunization
 Physical exercise
 Brushing one’s teeth
 Breast feeding
 levels of disease…
Secondary Prevention
Illness and injury can not always be prevented. In fact,
many diseases such as cancer and heart diseases can
establish themselves in humans and cause considerable
damages before they are detected and treated.
Aimed at promoting early diagnosis and prompt
treatment of a disease to cure or to limit disability and
prevent more serious pathogenesis.
 levels of disease…
Example
Breast—cancer screening
 Blood pressure examination
 Cholesterol level examination
 Treating malaria patients
Tertiary Prevention
It is at this level the health educator work to retain,
reeducate, and rehabilitate the individual who has
already incurred disability, impairment, or dependency
 levels of disease…
The aim is to limit further disability
Example
Educating after lung cancer surgery
 Working with the diabetes individual to ensure the
daily Injections are taking
Thank You