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Project Theoretical

The Conceptual Framework has been developed in order to achieve clear and in depth

understanding of the study being conducted. This framework highlights the socio-demographic

and behavioral risk factors regarding non communicable diseases among adult.

The risk factors assessment in this study will be based only from the step 1 of WHO

STEPS instrument. The steps framework’s first level on behavioral risk assessment involves

self-reporting questionnaire. The data that will be collected comprised the predictors variables

measured in this study are socio-demographic: age, gender and socio-economic status and the

behavioral risk factors which include the tobacco use, alcohol consumption, physical activity

level and dietary habits. The outcome variables which comprised cardiovascular disease,

cancer, chronic respiratory disease and diabetes make up the non-communicable disease.

The interaction of predictor variables may eventually lead to the development of non-

communicable disease or the outcome variables. The risk factors strongly influence the

outcome. The figure shows therefore that if prevention and intervention are carried out and

modifies the status of the health behaviors, the outcome will also be different thereby reducing

the probability of disease.

The Health Belief Model

The Health Belief Model (HBM) is the best-known theoretical model that emphasizes

the function of beliefs and attitudes in decision-making (Naidoo and Wills, 2016). Originally,

the health belief model (HBM) was designed to describe a model of disease prevention, not a

model of disease treatment. Health beliefs include an individual's perception of Susceptibility

to, and Severity of, diseases or disorders as well as the perception of Benefits of, and Barriers

to, taking action to prevent diseases or disorders . These perceptions can be modified by the
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physical, social, and cultural environment. The perceptions of Susceptibility and Seriousness

combine to form a perceived threat of a disease or disorder. If the perceived Benefits of taking

preventive action to avoid a disease are viewed as greater than the perceived threat of the

disease, the individual is likely to modify or engage in health behavior. If the perceived Barriers

to taking preventive action are viewed more negatively than the harm from the resulting disease

or condition, the individual is unlikely to modify or engage in healthy behavior. The perceived

Benefits of healthy behaviors minus the perceived Barriers to the healthy behavior determine

the likelihood of an individual taking preventative action. Health behaviour is expected to be

enacted in response to each individual’s meaning of his or her own health status.

Today, people’s health behaviours and lifestyles are considered to be the main causes

of many modern diseases (Naidoo and Wills, 2016). There are structural factors such as health

inequalities that are a consequence of social injustice which influence individuals’ lifestyle in

respect of health-related behaviours. Modifications to lifestyle through everyday patterns of

behavior can reduce the risk factors of chronic diseases (Sarafino, 2008). People who practice

healthy behaviours have been found to reduce their risk of illness and early death (Sarafino,

2008). Understanding the reasons for people’s behaviours and their role in maintaining and

promoting their health can contribute to understanding how people make decisions about their

health which in turn leads to the planning of health promotion interventions based on self-

empowerment (Naidoo and Wills, 2016). Behavioral risk factors such as smoking cigarettes

and eating an unhealthy diet are associated with the five leading causes of death, including

heart disease, cancer and stroke (Sarafino, 2008).

The HBM is used as a theoretical framework for explaining and understanding

individuals’ responses to health-related matters. The HBM is considered to be one of the

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frequently used frameworks for developing health interventions aimed at improving patients’

adherence to medical recommendations, and there is empirical support for the HBM in

predicting health beliefs (Anderson et al., 2011). The HBM considers beliefs about certain

behaviours to be essential indicators for those behaviours. Theories that focus on the beliefs

behind behaviours are more likely to predict behaviours than those that focus on illness (Jones

et al., 2014b). Carpenter (2010) argues that benefits and barriers appear to predict behaviors

better with the purpose of preventing a negative health outcome instead of determining if as

subject will comply with a treatment pregame.

Anderson (2011) suggested that the HBM could be used as a motivator for health care

behaviors to reduce stroke risks as part of lower-cost motivational interventions. Perceived

susceptibility to illness involves assessing an individual’s beliefs regarding their vulnerability

to getting an illness or condition such as a stroke. The perceived severity of the illness relates

to their perceptions regarding the potential threat posed by a stroke.

In this study, the HBM will utilized to explore students perception of their susceptibility

to non-communicable diseases and the seriousness of their risk of having a NCD in the future.

The concept of perceived benefits and barriers can enrich the study with the factors that

facilitate or restrict the students’ adoption of healthy lifestyles by taking into consideration the

students’ beliefs about the value of adopting a healthy lifestyle and the obstacles they face. The

influence of individuals’ surroundings on the adoption of risk-reduction behaviour will be also

explore. There are cues to action that comprise a diverse range of triggers, including

individuals’ perceptions of symptoms, social influences and health education campaigns

(Abraham and Sheeran, 2007). Moreover, the adoption of a healthy lifestyle is empowered by
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one’s ability to adopt the change. Self-efficacy involves an individual’s willingness to modify

their lifestyle behaviours.

The HBM assumes that an individual is more likely to engage in preventive health

behaviors when they perceive themselves to be susceptible to a certain disease or illness

(perceived susceptibility) and consider the potential serious consequences of the perceived

condition (perceived severity). Individuals may believe that a certain course of action will

produce a positive outcome (perceived benefit) or that the obstacles and barriers outweigh the

benefit (perceived barriers) (Charkazi et al., 2013)

Basically, the model is geared towards reducing or avoiding a disease condition and

aims to explain and predict healthy behaviours. The model assumes that individuals will act if

they feel their personal health is threatened and if they perceive the benefit of the health-

promoting activity to exceed that of their unhealthy behaviours. This assumption is congruent

with the model’s focus on health promotion and disease prevention (Rawlett, 2011). The model

considers the modifying factors that influence individuals’ perception of the risks and their

perceptions that lead to action or a change in their behaviour to reduce those risks. The HBM

constructs are as follows:

Perceived threat (Perceived susceptibility and perceived severity)

Perceived susceptibility refers to individuals’ beliefs regarding the possibility of them

getting a disease or a condition (Champion and Skinner, 2008). If the perceived risk is great,

then the likelihood of engaging in health-promoting behaviour may increase (Adams et al.,

2014). The perceived seriousness of contracting an illness and the consequences of leaving it

untreated, whether these are the medical consequences (death, disability or pain) and/or social

consequences (the impact of the condition on work, family life and social relationships),
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combine to make up the perceived severity (Champion and Skinner, 2008). This relates to an

individual’s belief regarding the negative effects that contracting a disease would have on his

or her overall existence (Adams et al., 2014). The HBM assumes that individuals who report a

greater perception of severity to a certain disease should also report a greater adherence to

preventive health behaviour (Jones et al., 2014b). The stronger an individual’s perception of

the severity of the negative health outcome, the stronger will be their motivation to act in such

a way as to avoid that outcome (Carpenter, 2010)

Perceived barriers versus perceived benefits

Perceived barriers refer to an individual’s beliefs that their participation in health

promoting behavior is restricted due to psychosocial, physical or financial factors (Adams et

al., 2014). These barriers can act as obstacles to them undertaking the recommended health

actions and involve them carrying out a cost–benefit analysis of the health action (Champion

and Skinner, 2008). Perceived barriers seem to predict behaviour better when the goal is the

prevention of a negative health outcome (Carpenter, 2010). Perceived benefits refer to personal

beliefs regarding the benefits of various available actions for reducing the disease threat

(Champion and Skinner, 2008). When individuals perceive the action as potentially beneficial

in reducing the threat, they can then be expected to recommend the health actions (Champion

and Skinner, 2008). Literally, it is the person’s opinion of the value or usefulness of a new

behaviour in decreasing the risk of developing a disease (Hayden, 2009). Individuals will be

more likely to adopt a preventive health behaviour when they value the benefits of it in

reducing the chance of getting the disease (Hayden, 2009). Perceived benefits play an

important role in the adoption of secondary screening prevention behaviours (Hayden, 2009).
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Although they may find some forms of screening to be uncomfortable or painful, for example,

screening for colon cancer, individuals value the benefits of such screening (Hayden, 2009).

Cues to action

The HBM suggests that individual behaviour is influenced by cues to action. Cues to

action include many examples of factors that might influence personal experience, including

the events, people or things that influence people to change their behaviours (Hayden, 2009).

Examples of cues to action include but are not exclusive to the illness of a family member,

media reports, mass media campaigns, advice from others, including that of a physician

(Hayden, 2009), and medical symptoms (Champion and Skinner, 2008). Family illness or

experiences of health issues are considered by the HBM to be cues to action. Having a family

history of cancer was seen to be related to high levels of cancer-related threat or anxiety among

women with a family history of breast cancer (Norman and Brain, 2005).

Self-efficacy

Self-efficacy refers to the confidence in one’s ability to perform a new health behaviour

(Orji et al., 2012). If an individual does not believe in his or her own ability, then that individual

will likely not pursue the course of action (Adams et al., 2014). Self-efficacy was a later

addition to the original HBM variables, Rosenstock et al. (1988) illustrated that for behavioral

change to succeed, an individual must have an incentive to take action by feeling the threat of

their current behaviour and believe that such an action can be beneficial by resulting in a valued

outcome at an acceptable cost and to feel he or she is competent to perform that change

(Rosenstock et al., 1988). Self-efficacy has predicted a range of health behaviours including

oral self-care, breast self-examination (Champion, 1984) and the self-efficacy of women with

osteoporosis to perform exercise (Hayden, 2009).

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Other modifying factors.

There are other modifying factors that can influence the performance of health

behaviours, such as demographic, psychological characteristics (personality and peer pressure)

(Conner, 2015), socio-economic status and other social support. In addition to these factors,

structural variables such as knowledge about and previous contact with the disease may also

influence individuals’ perceptions and indirectly influence their health-related behaviours

(Champion and Skinner, 2008).

Individual Perceptions Modifying Factors Likelihood of Action

Demographic variables
(age, gender, socio-
economic status)
Perceived benefits of
preventive action minus
perceived barriers to
preventive action

Perceived susceptibility
and severity of the NCD
and behavioral risk
factors
Perceived threat of disease
(NCD and risk factors)
Likelihood of taking
recommended
preventive health action.
ex: physical activity,
healthy diet

Cues to action
Mass media campaigns, Advice from
others including physician, Illness of
family member or friends,
newspaper/magazine

Health Belief Model

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Conceptual Framework

Independent Variables Dependent Variable

Socio-Demographic
Profile:

 Age

 Gender
Non-communicable Diseases:
 Economic status
 Cardiovascular

Behavioral Risk Factors: diseases

 Smoking  Cancer

 Alcohol  Chronic respiratory

consumption disease

 Physical  Diabetes Mellitus

inactivity

 Unhealthy diet
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Objective of the Study

This study aims to delineate the prevalence and identifies the Behavioral Risk Factors that are

significant with respect to increasing an individual’s risk for developing a NCDs. Furthermore,

this study investigate the association of these factors and the probability of having a NCDs among

Youth students.

Statement of the problems

Specifically this aims to answer the following questions:

1. What is the socio-demographic profile of the youth students in terms of:

1.1. Age

1.2. Gender

1.3. Socio-economic status

2. What are the behavioral risk factors for non-communicable disease among youthouth

students in the aspect of:

2.1. Smoking

2.2. Alcohol consumption

2.3. Physical inactivity

2.4. Unhealthy diet

3. What is the prevalence of non-communicable diseases?

4. Is there an association between the prevalence and?

4.1. socio-demographic factors

4.2. Behavioral risk factors?

5. Which of the variables predict the prevalence of non-communicable disease?

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Hypothesis

Ho1: There is no significant relationship between the prevalence of non-communicable

disease and the demographic profile and behavioral risk factors of college students.

Ho2: There is no variables that predicts prevalence of non-communicable disease.

Scope and Delimitations of the Study

This study will assess the prevalence of Behavioral risk factors of non-communicable

disease among Youth students of Northern Bukidnon Community College in a rural

community of Manolo Fortich. Despite the vast extension that this research may provide in the

Epidemiology literature, the scope of the study is focused only in one location with a small

sample size due to resource constraints. Since data gathering is done via a survey questionnaire,

there is a probability that revelation bias may be incurred as not all people prefer to reveal their

health perspective and information.

Significance of the study

In the Philippines, despite of the extensive campaign of the government on prevention

and control of non-communicable disease, there are evidences of increasing rates of

hypertension morbidity and mortality in the past years. Moreover, as to authors’ knowledge,

no empirical data investigating prevalence on Non-communicable disease within the locality

exists. Further, increasing number of cases in the rural community necessitated development

of this study. The knowledge that could be gained in this investigation would guide school

administrators to plan, design and initiate programs, and policies relative to non-communicable

disease prevention and control which could be used to address the ever-growing problems on

the disease. The study findings may also prompt government agencies, private sectors and
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various professions to collaborate in espousing development programs that address the needs

of the community, particularly in the environmental and health domains in order to promote

health.

Definition of terms

Understanding the concepts used in the review of the prevalence and risk factors for non-

communicable disease among college students is essential. Thus, the researcher has provided

conceptual and operational definitions of major concepts of the study.

Age refers to the length of time, most often in completed years, that a given person has been

alive.

Gender refers to the biological differences between male and female of a particular person

Socioeconomic status (SES) refers to the measure of one's combined economic and social

status and tends to be positively associated with better health.

Physical inactivity refers to any adults who will not meet the criteria of vigorous or moderate

activity as given in the WHO steps manual i.e. less than 600 MET minutes per week.

Unhealthy diet refers to consumption of less than 5 servings of fruits and vegetables per day

Smoking refers to those adult who consume both smoking products and smokeless tobacco

products

Alcohol consumption refers to participants taking any form of alcohol such as beer, lambanog,

whisky, gin, rum, wine .

Non communicable disease refers to a chronic diseases and generally slow progression and are

the result of a combination of genetic, physiological, environmental and behavior’s factors..

The four main types of non-communicable diseases are cardiovascular diseases, cancer,

chronic respiratory diseases and diabetes.

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Cardiovascular disease refers to disorders of the heart and blood vessels and include coronary

heart disease, cerebrovascular disease, rheumatic heart disease and other conditions.

Diabetes Mellitus refers to a chronic disease associated with abnormally high levels of the

sugar glucose in the blood characterized by hyperglycemia resulting from defects in insulin

secretion, insulin action, or both.

Cancer refers to a generic term for a large group of diseases that can affect any part of the body

characterized by the uncontrolled growth of abnormal cells in the body.

Chronic respiratory diseases refers to a long-term diseases of the airways and other structures

of the lung. Some of the most common are chronic obstructive pulmonary disease (COPD),

asthma, occupational lung diseases and pulmonary hypertension.