THEORIES

AND MODELS
IN HP/DP
BEIMNET DK.(MPH/HPHB)
HEALTH & HUMAN BEHAVIOR

• Behavior: is an action which has SPECIFIC purpose, duration & frequency;

Consciously or Unconsciously done.
[ Recall ‘PSYCHOLOLY’ ]
• Health Behavior: is an action/activity undertaken by people to prevent or
avoid occurrence of Health or health related problems
[ Recall ‘ Social PSYCHOLOLY’ ]
HEALTH & HUMAN BEHAVIOR...

• I.E.C- is a process which involves the provision of information, conduct of

educational activities, and effective communication of health messages to
enable individuals, families or communities to promote their health as well as
to preserve their health.
• B.C.C- is a process of changing social and individual attitudes and behaviors
by providing relevant information, education and motivation through
appropriate communication strategies.
HEALTH & HUMAN BEHAVIOR...

Sustainable Behavior Change Process(1)

HEALTH & HUMAN BEHAVIOR...

Factors Affecting Human behavior:

The Green’s Classification:
• Predisposing factors
Motivate a behavior to occur---
• Enabling factors
Realize a motivation---
• Re-enforcing factors
Facilitate persistence of a behavior
HEALTH & HUMAN BEHAVIOR...
Application Exercise: CASE STUDY:
Suppose that Mr. X Planned to undertake VCT for HIV with his girlfriend after they
had ABSTAINED from SEX for the last Six months & three months prior to their
WEDDING CEREMONY. But unfortunately, his girlfriend REFUSED TO
UNERTAKE THE TEST stating that she is not currently MENTALLY READY to do
that and hence, her UNEXPECTED Response INFLUENCED him to Cancel the
Wedding Ceremony & their FREINSHIP all in all & made him plan for another
GIRLFRIEND .
Based on the CASE given above:
1. Which factor is affecting VCT uptake behavior of Mr. X’s girlfriend ? Why?
2. Which factor is AFFECTING the MARRIGE BEHAVIOUR of Mr. X? Why?
3. Which factor is AFFECTING the VCT uptake behavior of Mr. X? Why?
HEALTH & HUMAN BEHAVIOR...

Behavior change Process(2):

BEHAVIORAL CHANGE MODELS
Introduction
• Models: are generalized hypothetical concepts that directly or indirectly
interact one another in an organized manner.

• Theories: are explanations or accounts of some phenomenon, a way of

making sense out of things.
BASIC PURPOSE OF THEORY E.G FOR
H/BEHAVIOR

1. Describe-the behavior (what)

2. Explain- the causes of behavior (why)(how)

3. Predict-predict the behavior(when)

BEHAVIOR CHANGE MODELS…

Behavior Change Models for Individual Behavior Change

• Health Belief Model(HBM)
• Theory of Reasoned Action(TRA)
• Theory of Planned Behavior(TPA)
• Trans theoretical Model(TTM)
HEALTH BELIEF MODEL(HBM)

Health Belief Model

• has helped explain different behaviors related to health
Components of Health Belief model
• Perceived susceptibility (risk) refers to the individual’s perception of the risk of
contracting a health problem, which may, finally, lead the individual to examine his
own behavior.
• Perceived severity refers to an individual’s perception on the potential seriousness of
the condition (a health or health related problem) in terms of pain or discomfort,
disability, economic difficulties, death, etc which help the individual seriously
consider his behavior and its consequences.
HBM...

Components of Health Belief model

• Perceived benefit :- the perceived benefits of taking health action and its helpfulness which
lead the individual to maintain the act and raise his/her confidence.
• Perceived Barriers :- are events which may act as obstacle in adopting the recommended
behavior leading the individual not attaining the behavior.
For a health action to take place, therefore, barriers should be either removed or reduced to the
minimum. Some of the barriers could be cost, side effects, cultural influences, inconvenience,
etc.
• Cues to action :- which assumes that behavior is triggered by environmental or other events
• Self- efficacy :- which states that one’s confidence can successfully modify behavior
HBM...
• Various other factors might influence behavior
Eg., Socioeconomic status, gender, and environmental factors.
• This factors assumed to influence behavior by modifaying the level of one of the
existing HBM constricts.
e.g., level of education attained
Higher attained education = use different source for health information.
BEHAVIOR CHANGE MODELS…
Health Belief Model
THEORY OF REASONED ACTION(TRA)

Theory of Reasoned Action

• Assumes that behavioral intention is a basis for a behavior to be adapted
• Reasons or intentions behind an action determine the practice
• The intention comes from the values attached to the behavior
• Behavior performance is a function of attitude towards behavior and perception of
social or subjective norms favorable to the behavior
TRA...

Theory of Reasoned Action(TRA)

THEORY OF PLANNED BEHAVIOR(TPB)

Theory of Planned Behavior(TPB)

• This theory adds up on theory of reasoned action and includes construct called
Perceived Behavioral Control
• The theory states that your behavior is a function of three factors: attitudes,
subjective norms, and perceived behavioral control
TPB...

• Theory of Planned Behavior(TPB)

TRANS THEORETICAL MODEL (TTM)

Trans theoretical Model

• Describes individuals’ motivation and readiness to change a behavior
• This model critically assumes that behavior change is Complex and a process that
involves sequences of change
• The stages are both stable and open to change.
• The model has two dimensions
✓ Stage of change and
✓ process of change
TTM...

The stage of change includes:

• Pre contemplation stage: people do not intend to take action in the foreseeable future (defined as
within the next 6 months) or Force able, resistance to change
• Contemplation stage: Willing but poor commitment
• Preparation stage: Intending change(in one month)
• Action Stage: Overt modification of behavior(For greater than six months)
• Maintenance stage: Sustainable behavior change
• For each stage of change, different intervention strategies are most effective at
moving the person to the next stage of change and subsequently through the model to
maintenance, the ideal stage of behavior.
TTM...

Trans theoretical Model

BEHAVIOR CHANGE MODELS...

Behavior Change Models for Community Behavior Change

BEHAVIOR CHANGE MODELS...

• Social Cognitive theory(SCT)

• Diffusion of Innovation (IDT)
SOCIAL COGNITIVE THEORY(SCT)

Social Cognitive theory

• Social learning (Cognitive) theory examines behavior in relation to the environment
and personal factors
• Social learning theory (SLT) believes in that behavior is dynamic

• Social Cognitive Theory (SCT) describes a dynamic, ongoing process in which

personal factors, environmental factors, and human behavior exert influence upon
each other
INNOVATION DIFFUSION THEORY(IDT)

Diffusion of innovation
• Behavior change is analyzed over time, and the stages through which behavior
is adopted are observed at individual and societal level
• Individuals pass through stages labeled as awareness, interest, persuasion,
decision and adoption
• Diffusion is the process by which an innovation is communicated
through certain channels over time among the members of a social
system (Rogers, 2003).
 INNOVATION DIFFUSION THEORY(IDT)

Innovation Diffusion Theory

There are four main elements in the diffusion of new ideas:

1.The innovation
2.Communication channels
3.The social system
4.Time
ELEMENTS...
1. Innovation: An idea, practice, or object that is perceived as new by an
individual or other unit of adoption
2. Communication Channels: Means by which messages about innovation
spread; mass media, interpersonal, electronic communications.
3. Social System: structures, norms & leadership that provides boundary
within which innovation diffuses.
4.Time dimension: involved in three ways; adoption process,
innovativeness & rate of adoption.
IDT...

Adoption of innovation
• Decision to adopt an innovation is made after multiple contacts with a variety of
communication channels (media mix) over a long period
Stages in the adoption of innovation
✓ Stage of awareness- here, the individual learns the existence of an idea or practice but has little
knowledge about it.
✓ Stage of interest -here, the individual develops interest in the idea, and seeks more information about it
and considers its general merits.
✓ Stage of evaluation- here, the individual makes mental application of the idea and weighs its merit for
his/her own situation.
✓ Stage of trial- here, actual application of idea, usually on a small scale.
✓ Stage of adoption- here, the acceptance of the idea leads to continual use.
IDT...

Behavior change in population

Based on researchers’ findings, in any given society, there are four types of people taking their response
to change
• Innovators are active information seekers of new ideas
• Early adopters are very interested in the innovation but not the first to sign up
• Early majority need external motivation to get involved
• Late majority are sceptics and will not adopt an innovation until most people in
the social system have done so
• Laggards typically have limited communication networks and are the last to
become involved, usually with the help of a mentoring programme or through
constant exposure.
ROGERS (1995, 2003) DESCRIBED THE PROCESS
OF INNOVATION ADOPTION BY INDIVIDUALS AS A
NORMAL, BELL-SHAPED DISTRIBUTION
IDT...

Note: Each of the above group, fortunately, has group leaders. If health professionals
identify and use them, they can change behavior of others.
BEHAVIOR CHANGE MODELS...

Factors affecting Innovation diffusion:

• Relative advantage of an innovation shows its superiority over whatever it has been designed
to replace. Is the innovation perceived as better than the idea it attempts to replace?
• Compatibility refers to the appropriateness of the fit with the intended audience. Is the
innovation consistent with the existing values, past experiences and needs of the potential
adopters?
• Complexity is concerned with the ease of implementing the innovation
• Trialability asks whether the innovation can be tried on an experimental basis
• Observability examines whether the innovation will produce tangible results. Can the results
be seen by others?
REFERENCE

• Getnet M; Health Education for Health science students, Lecture series, Department
of community Health, Addis Ababa University,2003
• Karen G (etal); Health Behavior and Health Education, theory, research and practice,
third edition, 2002.
• Green, L.W and Kreuter, M.W, Health promotion planning, an Educational and
Ecological Approach, third edition, 1999.
• Berhan M; Hand out on health Education for health, medical & family science
students, Hawassa University,2008(REVIEWED & APPROVED)
THANK & SEE YOU !!