Health and Human Behaviors

and its determinants

Zelalem Desalegn (MPH)

Zolad_09@yahoo.com

Public Health Department, WU

Aug, 2017
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 Behaviors
 Definitions and concepts
 Types of behaviors
 Factors affecting human behaviors
 Predisposing factors –psychosocial factors
 Enabling factors

 Reinforcing factors

 The role of human behaviors in disease

prevention

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 At the end of this session, you will be able to;
 Define correctly what behaviors mean?
 Describe factors affect human behaviors
 Discuss the role of human behaviors in disease
prevention

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Human Behavior: Definition

What is behavior ????

Behavior- is an action that has specific frequency,

duration, and purpose, weather conscious or
unconscious. It is both the act and the way we act.

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Eg.
Action – drinking/smoking

To say a person has drinking/smoking behavior

Duration –is it for a week/month?
Frequency- how it is repeated?
Purpose –is he/she doing consciously or not

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1. Time and promptness of the behavior
 Use condom when sexual intercourse with multiple
partners
2. Frequency of behavior
 use condom every time having….
3. Quality of behavior
 Check condom to make certain no leakage, use
condom correctly
4. Range of behavior
 having monogamous relationship, use condom, avoid
multiple partners, abstinence
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Basically human behavior has 3 domains;
A) Cognitive domain (knowledge, perception )
 Encodes, stores, retrieves, processes information;
 purpose is manipulation of information

B) Affective domain= cognition +feeling

eg. Attitude, Beliefs
 purpose is to create arousal
C) Psychomotor domain - Voluntary muscle
 Psycho-mind , Motor – action

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Note:

1. Involuntary (not purposeful) is not behavior

2. Voluntary (purposeful) act is behavior-In health
education we refer only to those voluntary movements
and purposive acts arising out of decisions taken by
the motor center of the brain.
3. The same words ( Behavior=Action= Practice)

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 Behavior and health
Well/healthy behavior can promote health
Eg. Physical exercise, BF, seeking treatment,
………..
Ill/unhealthy behavior harms health
Smoking, chat chewing, excessive alcohol
consumption, unsafe sex, sedentary life style etc.
Human behavior is a key factor in determining health
because human behaviors are the main cause as well as
the main solution!

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 The world is experiencing a shift in

 cause of ill- health: Bacteria to Behavior

 Risk factors: traditional risk to modern risk
 Disease burden: Communicable disease to non-
communicable –double burden (for developing
countries)
 Human behaviors plays significant role as a cause as well
as a solutions for existing and emerging problems

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The behavior-health link becomes clear when
examining the 10 leading risk factors for
preventable death and disease worldwide.

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According to WHO, 40% of deaths worldwide are
due to these 10 risk factors alone (behaviors).

Global life expectancy could be increased by 5-10

years if we reduce these risks.

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 Healthy behavior

Health behavior; (overt and covert) definition;

“Those personal attributes such as beliefs, expectations, motives, values,
perceptions, and other cognitive elements; personality characteristics,
including affective and emotional states and traits; and overt behavior patterns,
actions, and habits that relate to health maintenance, to health restoration,
and to health improvement”

Gochman, 1982, 1997.

Healthy behavior : Overt health behavior: more used in practice

Kasl and Cobb (1966a, 1966b) 15

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Complia
nce

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 Lawrence Green identified three categories of
factors affecting individual or collective
behavior. These are;

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 Knowledge, attitude,
perception, beliefs, values,
self efficacy etc.

Availability,
affordability,
accessibility,
resources to
accomplish the
behaviors
Peer pressure, influential
people, perceived social
pressures/significant
others/discouragement/encoura
gement

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 Are antecedents or prior to behavior that provide the rationale or
motivation for the behavior to occur.
 Eg. Knowledge, Perception, Belief , Attitude, Values etc.
 They are generally referred to cognitive variables because they are
inside the mind –inside head factors and have to do with knowing or
believing
 They are also called psychosocial because they are socially
influenced

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• Knowledge is, “A clear and certain mental perception, understanding, the
fact of being aware of something, experience of acquaintance of familiarity
with information of, learning that which is known, facts learned or study
of.”

• Therefore, one`s knowledge of something include some combination of ;

1. Simple awareness of facts and
2. understanding of how these facts relate to one another.

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 knowledge can be viewed as an accurate impression of some
phenomenon.
What one knows

ENCODING STORAGE RETRIEVAL

Getting Retaining Taking

information information information
Perception into memory over time out of storage

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 Knowledge is necessary but not sufficient in
behavior change.

 It is necessary, because, without adequate knowledge ,

people may unaware of and concerned about health
problem and unable to manage their behavior.

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 Simple logic for the specific knowledge is that before act
voluntarily people need to know,

 Why they should act?

 What actions are needed?

 When or under what circumstances?

 How to act and where?

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 Knowledge about/awareness: Knowledge about a topic may be
important in developing interest in the topic and may even
motivate the behavior

 How-to/ essential knowledge: Intentional behavior change

depends on it
 It is practical/applicable

Eg. Knowing about condom, its importance and benefits less

important for behavior change than knowing proper use or how-
to use condom

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 In general, knowledge about a problem is not as
critical to behavior change as knowledge how to
perform about the target behaviors.

 How-to or essential knowledge is the major

components of skill.

 Therefore, one of the main task in health education is

helping the learner to become knowledgeable about
some health topic and how to do th behavior

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 Perception
Perception: a process by which
individuals organize and interpret
their sensory information in order to
give meaning it.

Perception is a means of acquiring

knowledge.

And it is highly subjective

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 Skills is the capability of accomplishing something with precision
and certainty.

 Skills require practical knowledge and ability

 On many occasions inappropriate or ineffective health behavior
may result from the lack of mastery of specific skills.
 Knowledge and skills are interrelated in that skills are the
practical application of essential knowledge
Thus, main of HE task: Improve/enhance skill

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 How do you know /measure the awareness/knowledge of an
individuals about certain health condition?

1. Usually knowledge questions are administered in yes or No OR

true/false format or in form of open ended questions.

2. Be sure that you have measured both awareness and essential

knowledge

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• Social psychologists define an attitude as an enduring
evaluation, positive or negative, of people, objects, or
ideas.
 We are not neutral observers of the world; we
evaluate what we encounter.

 Attitudes are often a matter of good or bad; as soon

as you know what something is, you start to know
whether you like it or dislike it.

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Mucchielli (1970) describes attitude as “a
tendency of mind or of a relatively constant
feeling towards a certain category of objects,
people, or situation.”

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1) Predisposition- exposure related to an attitudinal
object. No exposure, no attitude
2) Has directions- polar, +ve or -ve, good or bad.
Negative ……………… positive
3) Evaluation-can be evaluated by intensity or
judgment
e.g. Favorable or unfavorable
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4) Changeability-can be changed, not static.

5) Stability or consistency
 Stability=related to time , constant over sometime
 Consistency= sameness of attitude

e.g. “Mood” changed quite often.

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In HE, we try is to
close these gaps by
helping people to
practice what they
know.

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 Apply cognitive consistency theory to close gaps

 States people prefer to be consistent in their

knowledge, attitude and practice.

 New information creates dissonance between

knowledge, attitude and behavior and this
stimulates alternation in their behaviors
consistent with knowledge and attitude.

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HE

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 Self-reported attitudes- asked direct questions about their
feelings.

 The Likert Scale –is one the mostly commonly used scale to
measure attitude.
 In likert scale, respondents are asked how strongly they agree
or disagree with carefully selected statements on five point
scale.
 Attitude scale is usually stated in form of statement.

Eg. Contraception improves family well being.

1. Strongly disagree 2. disagree 3. undecided 4. agree 5.strongly agree

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 Beliefs are what one perceive as a true; it may be
correct or not.
 It also refers to a conviction that a phenomenon or
object is true or real.
 It is different from knowledge in that it is perceived
whereas knowledge is accepted objective truth.

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 Beliefs are derived from parents, grand parents, 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.

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It is usually difficult to change those beliefs that
 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 or traditional medical system

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 Any traditional belief held by the community is bad
and must be changed!!
……………………..False
 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.

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 Harmful belief: is a belief which damage health.

 Helpful beliefs: is a belief which preserves health.

 Neutralbeliefs: is a belief which neither damages nor

preserves health.

 What do you if you are unsure???

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 Our beliefs about things affect our attitude towards it.

 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.

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 If an individual beliefs the behaviors have good
outcomes (positive beliefs)……………………
+ve attitude

 If an individual beliefs the behaviors have bad

outcomes (negative beliefs)…………………… -
ve attitude
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 The relative worthy/preference/judgment individual
gives every thing around is known as value.
 value is something is held to be important or worth;
and prized by an individuals or community.

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 Being a good mother
 having many children/cattle
Value exert strong and
 Being approved by friends enduring influence on
 masculinity and sexual prowess behaviors. It provides
 Being attractive to opposite sex general guides to
 Having beautiful girl friend behaviors.
 academically success
 Being a man of God /Allah, success in foot ball events , being ‘modern’ * being

healthy

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 These values that have advantages for the
self and for the society are known as
positive values.
 And these values that are harmful and
disadvantageous are known as negative
values.

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 People value life, health. However, in opposite engaged in
unhealthy behavior, for instance, smoking. This reveals
conflict of values=inconsistencies between two or more
values.

 In health education one shouldn’t seek to change values rather

should help people recognize inconsistencies between and
among their values.

 But we can sometimes bring about changes by emphasizing

values which don’t involve health.
 We, often trying to encourage people to think about their
values. This process is called value-clarification
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1. 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 pain.

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2. 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?

3. Behavioral intention-is the willingness/ readiness to

perform a certain behavior provided that enabling
factor is in place.

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 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.
 The absence of enabling conditions inhibits action.

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 Sometimes a person may intend to perform but still not
do so. This is because of the influence of enabling
factors such as time, money, equipment, skills and
health services.

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They includes
 Availability, accessibility and affordability health care

 New skills

 Resources. Eg. Time, money, transportation etc.

1. What is enabling factors to prepare home made ORS?

2. What are the enabling factors to promote condom use?
3. What are enabling factors to promote quitting of smoking ?

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Note: Behaviors which involve spending
much time, money, requiring new skills or
conflict with existing practices will be more
difficult to promote than those which are
simple to carry out or fit with the existing
practices.

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 In behavior change communication be sure that enabling
resources are readily available in the community of
interest.

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 Reinforcing factors are those factors subsequent to a
behavior that provide the continuing reward or
incentives for the behavior to be persistent and
repeated.
 positive or negative feedback and is support socially or
by significant others after it occur.

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 These are people who are significant (determine or
influence) the behavior of others to encourage or
discourage to do something.
Eg.
 The woman does not adopt FP because her
husband disapproves.
 The young man who starts smoking because his
friends encourage him to do so.

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 Friends Traditional
healers

Grand Religious
parents leaders

Husband

I want to use FP, but…

The influence of social pressure (circle of influence)

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 Summary of factors affect human behaviors

Predisposing factors
create intention to act

Realizes the
Enabling factors
intentions

Encourage behaviors to
Reinforcing factors persist

Sustainable behavior

Remember: Any given behavior can be explained as a function of the

collective influence of these three factors
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In practice simultaneously
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Our behavior changes all the time, some are natural while others
are planned changes.

 Natural changes: When changes occur because of natural

events in the community around us, we often change with out
thinking much about it (unintentional change).

 Planned changes: When changes occur deliberately and/or

planned. E.g. quitting smoking (intentional change).

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 The persuasion approach-the deliberate attempt to influence
the other person to do what we want them to do. ‘directive’ /
forcefully/coercion.

 Used in situations where there is serious treat such as

epidemics and natural disasters, and the actions needed are
clear-cut.

 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)-empowerment.

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1. Lawrence W. Green et al. 1980. Health education planning a
diagnostic approach

2. Randall R. Cottrell, James T. Girvan, James F. McKenzie 2006.

Principles& foundations of health promotion and education.
Third ed. USA.

3. BruceG, Wlter H, Nell H. Introduction to Health education and

Health promotion;2nd edition, 1984
4. Ramachandran L. and Dharmalingam. T. 1995. Health
education’s new approach.

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Thank you!!

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