Ateneo de Davao University

School of Nursing

Faculty Development Program
Welcomes Everyone to a lecture on….. “Challenges of Non-Communicable Diseases Wellness Tree” and “Change Process, A Review”
November 6, 2012 Ateneo de Davao University Fundamental Laboratory

CHANGE PROCESS
Roy Cresencio R. Linao Jr., RN, MN. Community Extension and Advocacy Head School opf Nursing Ateneo de Davao University

Objectives
1. 2. 3. 4. 5. Definition of Change. Elements of Change. The Change Agent. Strategies of Change. Theories and Models of Change.

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

new technology. or program introduced to effect change . set of behavior.Elements of Change INNOVATION • An idea. project.

Elements of Change TARGET OF CHANGE • An individual. group of people. or segment of the community or the entire community itself .

TARGETS / APPRAISERS • Innovators .people influenced by the opinion leaders and mass media .first to adopt the new practice. tend to be independent.usually the opinion leaders. risktaking and change-oriented individuals • Early Adopters . strong influence on other potential adopters • Early Majority Adopters .

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 .

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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 .

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 • Once a critical consciousness is attained.

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 .

approaches. tactics or processes designed to effect change .Elements of Change STRATEGIES OF CHANGE • Deliberate actions. set of activities.

THEORIES AND MODELS OF CHANGE .

• Provides a unified basis for understanding.Why Theory is Important? • Goes beyond trying to explain actions or inactions of specific individuals. and influencing human behavior in general . predicting to the extent possible.

or to analyze group behavior without appreciating differences among the individuals who compose that group .In Reality…… It would be artificial and impossible to analyze individual's behavior without considering the social context in which they live.

The task of changing health-related behavior was thought to be simply a matter of sending health messages .Before…..

Sound Health Promotion Programs Encompass……. and environmental change . – Extensive research on relevant audiences – Skill-building – Multi-channeled education – Advocacy using influential persons – Policy development – Community mobilization – Organizational. economic.Today.

2005 .An Ecological Perspective: Levels of Influence • Adapted from the National Cancer Institute. 2. Health Bulletin No.

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

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

early detection. control.An Ecological Perspective: Levels of Influence CONCEPT DEFINITION Public Policy Factors Local and national policies and laws that regulate or support healthy actions and practices for diseaseprevention. 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. group relationship) Internalization – Change is congruent with to own value system . reciprocal relationship.

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 .

benefits and barriers • Health concern or motive and cue to action . particularly educational attainment. are believed to have an indirect effect on behavior by influencing the perception of susceptibility.Health Belief Model : Other Variables • Socio-demographic factors. severity.

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 patient'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 selfefficacy 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 (person's perception of social influence about performing the behavior) – Perceived control over the behavior .

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– Pre-contemplation – Contemplation – Preparation – Action – Maintenance .Behavior Change Spiral (TTM) (Prochaska and DiClemente) People go through stages before a final change is made.

Stages of Change Model CONCEPT Precontemplation DEFINITION Unaware of the problem. setting gradual goals . hasn’t thought about change APPLICATION Increase awareness of need for change. personalize info onrisks & benefit Contemplation Thinking about change in the near future Decision/ Determination Motivate. encourage to make specific plans Making a plan to Assist in developing change concrete action plans.

reinforcement Continuation of Assist in coping. social plans support. avoiding repeating slips/relapses (as periodic applies) recommended steps Maintenance .Stages of Change Model CONCEPT Action DEFINITION APPLICATION Implementation of Assist with feedback. finding actions. or alternatives. desirable reminders. problem specific action solving.

Moving and Refreezing (Lewin) • Unfreezing . follow up is needed to reinforce practice .create awareness of the problem and the need for change • Moving .alternative action and goals are established • Refreezing .Theory of Unfreezing.change is generalized.

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 .

recomposition and manipulation of power elites) . political or morals (nonviolence. economics. use of political institutions.Strategies for Effecting Social Change • Power coercive – Based on application of power.

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 .

• Examine change as it affects one's relationship with others. • Go beyond the surface reasons. .In case of resistance…… • Locate the source. • Find out why change is perceived as a threat. • Get other people's viewpoint.

inaccurate or misinterpreted information • Ventilate feelings of opposition .Reducing Resistance to Change • Provide an atmosphere of acceptance and respect • Correct faulty.

Thank You For Listening!!!! .

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