Change Process

Change: Definitions
• Cognition Change- a change in knowledge
and/or perception of a person

• Attitude Change- a change in the individual’s

beliefs, predisposition, intentions, and
tendencies toward an idea/object
 Change: Definitions
• Behavior Change- an alteration in an
individual/group’s knowledge, attitude and
practices/activities

• Social Change- a departure from existing ways

and means of doing things which results in a
change of relationships in the system
 Elements of Change
• INNOVATION

• TARGET OF CHANGE

• CHANGE AGENT

• STRATEGIES OF CHANGE
 Elements of Change
INNOVATION

• An idea, set of behavior, new technology,

project, or program introduced to effect
change
 Elements of Change
TARGET OF CHANGE

• An individual, group of people, or segment of

the community or the entire community itself
 TARGETS / APPRAISERS
• Innovators- first to adopt the new practice;
tend to be independent, risk-taking and
change-oriented individuals
• Early Adopters- usually the opinion leaders;
strong influence on other potential adopters
• Early Majority Adopters- people influenced by
the opinion leaders and mass media
 TARGETS / APPRAISERS
• Late Majority Adopters- those afraid to
embrace change during the trial stage

• Laggards and Late Adopters- those adamant

not to adopt the change even when most
people have confirmed the advantages of the
innovation
 Elements of Change
CHANGE AGENT

• A person or group of people introducing the

innovation
Desirable Qualities and Actions of a
Change Agent
• One must first believe there is a need to
change the present state of affairs in health

• One must have the desire and commitment to

be involved in the process of social change

• One must be willing to go through normative-

re-educative experiences or processes
Desirable Qualities and Actions of a
Change Agent
• Once a critical consciousness is attained, one
must channel this new sense of consciousness
to organization

• Strengthen existing organizations or form new

ones if the old has consistently failed to
respond to the expressed needs and interests
of its members
Desirable Qualities and Actions of a
Change Agent
• Learn to integrate with others in doing your
information-education work

• Aggregate these concerns in the organization

and plan on how these can be translated to
action
• Establish open lines of communication
Desirable Qualities and Actions of a
Change Agent
• Avoid grabbing credit or recognition for
change efforts

• Learn to draw important lessons from

experiences that would guide you in future
change efforts

• Be willing to take risks

 Elements of Change
STRATEGIES OF CHANGE

• Deliberate actions, set of activities,

approaches, tactics or processes designed to
effect change
THEORIES AND MODELS OF CHANGE
 Why Theory is Important
• Goes beyond trying to explain actions or
inactions of specific individuals…

• Provides a unified basis for understanding,

predicting to the extent possible, and
influencing human behavior in general
 In reality…
• It would be artificial and impossible to analyze
individuals’ behavior without considering the
social context in which they live, or to analyze
group behavior without appreciating
differences among the individuals who
compose that group
 Before…
• The task of changing health-related behavior
was thought to be simply a matter of sending
health messages
Today…Sound health promotion
programs encompass
– Extensive research on relevant audiences
– Skill-building
– Multi-channeled education
– Advocacy using influential persons

– Policy development
– Community mobilization
– Organizational, economic, and environmental
change
 An Ecological Perspective:
Levels of Influence

• Adapted from the National Cancer Institute,

Health Bulletin No. 2, 2005
An Ecological Perspective:
Levels of Influence
CONCEPT DEFINITION

Individual Individual characteristics

Factors that influence behavior
such as knowledge,
attitudes, beliefs, and
personality traits
Interpersonal Interpersonal processes,
Factors and primary groups incl
family, friends, and peers
that provide social
identity, support and role
definition
An Ecological Perspective:
Levels of Influence
CONCEPT DEFINITION

Institutional Rules, regulations,

Factors policies and informal
structures that may
constrain or promote
recommended behaviors
Community Social networks and
Factors norms or standards that
exist formally or
informally among
individuals, groups and
organizations
An Ecological Perspective:
Levels of Influence
CONCEPT DEFINITION

Institutional Rules, regulations,

Factors policies and informal
structures that may
constrain or promote
recommended behaviors
Community Social networks and
Factors norms or standards that
exist formally or
informally among
individuals, groups and
organizations
An Ecological Perspective:
Levels of Influence
CONCEPT DEFINITION

Public Policy Local and national

Factors policies and laws that
regulate or support
healthy actions and
practices for disease
prevention, early
detection, control, and
management
ATTITUDE CHANGE
 Kelman’s Three Processes of
Social Influence
• Change can be distinguished into three
processes characterized by a distinct set of
antecedent and a distinct set of consequent
conditions:
• COMPLIANCE
• IDENTIFICATION
• INTERNALIZATION
 Processes of Social Influence
• Compliance
– Occurs when an individual accepts the authority of
another person
• Identification
– Change adopted remains attached to an external person
(be like influencing agent, reciprocal relationship, group
relationship)
• Internalization
– Change is congruent with to own value system
 Theory of Cognitive Dissonance
by Festinger
• Utilized the notion that people cannot tolerate
discrepancy or inconsistency between their own and
other similar person’s attitudes
• Cognitive dissonance motivates change

• Dissonance may be reduced by:

– Changing the internal environment (attitudes and
perceptions)
– Altering the external environment
BEHAVIOR CHANGE
 Health Belief Model
by Hochbaum
• Behavior is a function of three sets of factors
– Psychological state of readiness including beliefs
about susceptibility and benefits of desired action
– Situational factors like appearance of symptoms
and influence exerted by people whether to take
or decline action
– Environmental condition which includes
availability and access to health service
 Health Belief Model
by Hochbaum
• An individual will change his or her health
behavior based on the following

– Perceived threat
• Perceived susceptibility
• Perceived severity
– Perceived benefits
– Perceived barriers
 Health Belief Model : Other Variables
• Socio-demographic factors, particularly
educational attainment, are believed to have
an indirect effect on behavior by influencing
the perception of susceptibility, severity,
benefits and barriers

• Health concern or motive and cue to action

HBM Self-Efficacy (Must be Added)
• Self-efficacy – conviction that one can
successfully execute the behavior required to
produce the outcomes

• Outcome expectation – person’s estimate that

a given behavior will lead to certain outcomes
– Similar to concept of perceived benefits
 Implications for HPE Practice
• Assess educational needs of target population
to strengthen program planning
– Add client’s perceived competency to carry out
prescribed action over long periods of time and
the strength of their conviction in their
competence
• Conduct skills training to enhance self-efficacy
for complex behavior
 Implications for HPE Practice
• Conduct more work
– Experimental interventions to modify health
beliefs and health behavior than on surveys that
reconfirm established correlations
– Factors that need to be added to increase its
predictive power

• Develop awareness of specific situations in

which self-efficacy may be low
 Theory of Reasoned Action
(Ajzen and Fishbein)
• Underscored importance of behavioral
intention
– Attitudes (feelings of personally performing
behavior)
– Subjective norm (persons’ perception of social
influence about performing the behavior)
– Perceived control over the behavior
 Behavior Change Spiral (TTM)
(Prochaska and DiClemente)
People go through stages before a final change
is made
– Pre-contemplation
– Contemplation
– Preparation
– Action
– Maintenance
 Stages of Change Model
CONCEPT DEFINITION APPLICATION
Pre-contemplation Unaware of the Increase awareness
problem; hasn’t of need for change,
thought about personalize info on
change risks & benefit
Contemplation Thinking about Motivate, encourage
change in the near to make spec plans
future
Decision/ Making a plan to Assist in dev
Determination change concrete action
plans; setting
gradual goals
 Stages of Change Model
CONCEPT DEFINITION APPLICATION
Action Implementation of Assist with
specific action plans feedback, problem
solving, social
support,
reinforcement
Maintenance Continuation of Assist in coping,
desirable actions, or reminders, finding
repeating periodic alternatives,
recommended steps avoiding
slips/relapses (as
applies)
 Theory of Unfreezing, Moving and
Refreezing (Lewin)
• Unfreezing- create awareness of the problem
and the need for change

• Moving- alternative action and goals are

established

• Refreezing- change is generalized; follow up is

needed to reinforce practice
SOCIAL CHANGE
 Strategies for Effecting Social Change
• Empirical-rational strategies
– Adopt change if it can be rationally justified and person
can benefit
• Normative reeducative
– Through influence of sociocultural norms to which he
belongs
• Power coercive
– Based on application of power, economics, political or
morals (nonviolenece, use of political institutions,
recomposition and manipulation of power elites)
 Barriers to Change
• Cultural

• Social

• Psychological

• Language Difficulties

• Motivation to Change

• Problem of Fit
 Cultural Barriers
• Tradition
• Fatalism
• Cultural Ethnocentrism
• Pride and Dignity
• Norms of Modesty
• Unforeseen Consequences of Planned Change
• Relative Value
 Social Barriers
• Mutual obligations within the framework of
family, fictive kin and friendship patterns
• Small group dynamics
• Public opinion
• Factionalism
• Vested Interest
• Lack of Authority within the Family
• Lack of Authority in the Political Structure
 Psychological Barriers
• Perception of the problem
• Perception of the role of government
• Perception of gifts
• Differential role perception
• Differing perception of purpose
 Pointers on
Bringing About Change
• Nature of change should be made clear to
those who will be influenced

• Identify strong forces advocating change and

those deterring change

• Persons affected should be involved in

determining the nature and direction of
change
 In case of resistance
• Locate the source.
• Find out why change is perceived as a threat.
• Get other people’s viewpoint.
• Go beyond the surface reasons.
• Examine change as it affects one’s relationship
with others.
 Reducing Resistance to Change
• Provide an atmosphere of acceptance and
respect

• Correct faulty, inaccurate or misinterpreted

information

• Ventilate feelings of opposition