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Models Of Health Behaviors By Yusuf Abdu Misau
 

Models Of Health Behaviors By Yusuf Abdu Misau

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Describes common behavioral sciences' models used in health promotion and prevention strategies

Describes common behavioral sciences' models used in health promotion and prevention strategies

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Models Of Health Behaviors By Yusuf Abdu Misau Models Of Health Behaviors By Yusuf Abdu Misau Presentation Transcript

  • Models of health behavior Dr Yusuf Abdu Misau MBBS (ABU), MPH(UM), PhD Student(UM) Department of Social and Preventive Medicine, University of Malaya
  • Acknowledgement
    • I wish to acknowledge A/P Nabilla Al-Sadat for permission to use her slides in this presentation
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Learning objectives:
    • Understand what is human behavior and its relation to health
    • Understand assumptions underlying theories as it is used in a scientific context
    • Describe the different models of behavioral change
    • Be able to apply these models in the development of preventive and promotive programmes towards health as well as effective doctor-patient relationship.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Contents of Presentation
    • Definitions
      • Model
      • Human behavior
    • Applications of models in health
    • Theories/ Models of Health Behaviour :
        • The Health Belief Model
        • Theory of planned behaviour (TPB) aka TRA
        • Stages of Change Model -TTM
        • Social Cognitive Theory/ (SCT) aka Social Learning Theory (SLT)
        • Diffusion of Innovation theory
        • Precede-Proceed Model
    • Case study
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Case study 1
    • Lee is a 21 year old Malaysian student involved in Intravenous drug addiction (IDA). There are many cases of IDA among Lee’s peers. However Lee thought IDA has harmed his life and wishes to change for the better.
    • Lee is also worried that his family views his IDA as an embarrassment to the whole family
    • How will you help Lee?
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Case study 2
    • Women in the predominantly Muslim Northern Nigeria are generally known to reject western style contraception techniques. As a public health specialist, you have been requested to design a study that will serve as a basis for addressing this issue.
    • Which of the models of health behaviors will best fit? Justify.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Case study 3
    • A 60yrs old Sudanese man who smoke cigarette for over 30 years said he is still healthy despite smoking for long time. He also said he has never seen any one killed by cigarette smoking so he sees no harm in smoking.
    • Explain his attitude using one of the health models that you deemed right.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • What is a model? Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Model: literary definition
    • A model is a conceptual framework which conveys critical component of one's vision of the possibilities for human learning and development as well as defines the important variables to consider and the relationships among those variables.
    • It is a template which depicts a specific issue and entities that relate to it.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • What is behavior ? Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • BEHAVIOUR : Dictionary definitions
    • The way one reacts to external or internal stimulus (under natural settings)
    • The way one behaves
    • The aggregate of all the responses made by an organism in any situation
    • Specific response of a certain organism to a specific stimulus or group of stimuli
    • The action, reaction, or functioning of a system, under normal or specified circumstances
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • BEHAVIOUR The response of an organism to a stimulus Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • HUMAN BEHAVIOUR
    • A complex interaction between personal and environmental factors, often related to the situation.
    • Characterised by complex biological, behavioural and socio-cultural determinants that are imperfectly understood.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • What is Health Behaviour?
    • Any activity undertaken by an individual who believes himself to be healthy, for the purpose of prevention or detecting illness in an asymptomatic state.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • So far….
    • We have discussed about:
      • What a model is………
      • What is behavior……
      • What is human behavior…..
      • What is health behavior……
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • What influences behavior?
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Field Theory (1951) Behaviour is the function of the psychological field which in turn, is the product of interaction between the person and his/her environment. Kurt Lewin B = f(PE) Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • A Generally accepted assumption is that most
    • behaviours are the products of multiple causes.
    • They are influenced by a multitude of:
        • social
        • environmental
        • psychological and
        • genetic factors.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Multiple Risks Behavioural Model (1982) Behaviour is the function of direct, additive and interaction effects of specific behaviour intentions, social support, accessibility of information and services, personal autonomy and actual situation. S.B.Kar B=f(BI)+(SocSup)+(Acc IS)+(PA)+(AS) Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THEORY
    • What is a theory ?
      • A fully developed theory is one that is characterised by three major elements. It would explain:
        • The major factors that influence the phenomena of interest
        • The relationship between these factors
        • The conditions under which these relationships do or do not occur
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • DEFINITION OF A THEORY
    • Systematically organised knowledge applicable in a relatively wide array of circumstances devised to analyse, predict, or otherwise explain the nature or behaviour of a specified set of phenomena that could be used as the basis of action.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Notes:
    • Most health promotion theories come from the behavioural and social sciences: Psychology, sociology, management, consumer behaviour
    • Reflects diversity from simple human behaviour
    • Many theories used are not highly developed, nor have they been rigorously tested
    • They are more accurately referred to as theoretical frameworks or models
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Why do we need health behaviour theories/ models?
    • Complex
    • Resistant to change
    • 3. Influencing behaviour – beyond knowledge
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Theories and models of human behaviour can guide the development and refinement of health promotion and education efforts.
    • Individual level
    • Social/Environmental level
    • Community level
    Why do we need health behaviour theories/ models? Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • The Nitti gritty:
    • How do we translate the models/theories into practice?
    • At individual level:
        • Clinical decision
        • Rehabilitations
    • Society/community level:
      • Research(quantitative vs qualitative)
      • Programme implementation/evaluation
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • So far….
    • We have discussed about:
      • Factors influencing human behavior………
      • What a theory is……
      • Why we need health behavior models/theories…..
      • How we can translate the theories into practice……
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • HEALTH BELIEF MODEL Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • HEALTH BELIEF MODEL
    • Godfrey Hochbaum
    • Irwin Rosenstock
    • HBM stipulates that a person’s health related behavior depends on the person’s perception of four critical areas:
    • - the severity of potential illness
    • - the person’s susceptibility to that illness
    • - the benefits of taking a preventive action
    • - the barriers to taking action
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • HEALTH BELIEF MODEL
    • Premise :
    • Health behavior is a function of specific health belief; all must be operating for a (risk reduction/
    • health promoting) behavior to occur.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • HEALTH BELIEF MODEL
    • A person motivation to undertake a health behavior can be divided into three categories:
    • - Individual perceptions
    • - Modifying factors
    • - Likelihood of action
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Perceived susceptibility
    • to disease X
    • Perceived seriousness
    • of disease X
    - Age, sex, ethnicity - Personality - SES - Knowledge Perceived threat of disease X Cue to action
    • Internal (symptoms)
    • external (media)
    Perceived benefits vs. Perceived barriers to behavioral change Likelihood of taking action (beh. change) Self-efficacy HEALTH BELIEF MODEL Individual Perceptions Modifying Factors Likelihood of Action Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THEORY OF REASONED ACTION Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THEORY OF REASONED ACTION
    • Icek Ajzen
    • Marten Fishbein
    • TRS states that individual performance of a given behaviour is primarily determined by a person’s intention to perform that behaviour. This intention is in turn determined by two major factors:
    • - the person’s attitude toward the behaviour
    • (beliefs and values of the outcomes)
    • - the influence of the person’s social environment or subjective norms
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THEORY OF REASONED ACTION
    • Premise:
    • In order for the behavior to occur, one must have an intention to change; intentions are influenced by two major factors:
    • - attitude toward the behavior
    • - subjective norm about the behavior
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THEORY OF REASONED ACTION Beliefs and Evaluations of Behavioural Outcomes Normative Beliefs Attitude toward the Behaviour Behavioural Intention Subjective Norms Behaviour Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • SOCIAL LEARNING THEORY Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • SOCIAL LEARNING THEORY
    • It suggests that most human behaviour is learned observationally from others. The theory focuses on the learning that occurs within a social context.
    • It considers that people learn from one another including such concept as observational learning, imitation and modeling.
    • In this process learning occurs when individuals observes and imitate other’s behavior .
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Nigerian culture: 1970 vs 2009 Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • SOCIAL LEARNING THEORY
    • There are four processes that form the basis of Social Learning Theory which according to Bandura are the conditions that are necessary before an individual can successfully model the behaviour of someone else:
        • Attention
        • Retention
        • Motivation, and
        • Motor Reproduction
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • SOCIAL LEARNING THEORY
    • i. Attention
    • This is the first component of observational learning.
    • The person must first pay attention to the model. This process surrounds the acquisition of attention of learner.
    • Acquisition can be based on such factors as sensory capacity, arousal level and past enforcement.
    • Individuals cannot learn much by observation unless they perceive and attend to the significant features of the modeled behavior .
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • SOCIAL LEARNING THEORY
    • ii. Retention
    • The observer must be able to remember the behaviour that has been observed.
    • Retention process involves the learner accessing symbolic coding of the behaviour that has caught their attention.
    • In order to reproduce the modeled behavior, the individuals must code the information into long-term memory
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • SOCIAL LEARNING THEORY
    • iii. Motor Reproduction
    • The ability to replicate the behaviour that the model had just demonstrated. This process includes the physical reproduction of the observed activity through physical capability, self-observation and feedback.
    • The observer must be able to reproduce the model’s behaviour. The observer must learn and possess the physical capabilities of the modeled behavior.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • SOCIAL LEARNING THEORY
    • iv. Motivation
    • The final process is motivation or reinforcement.
    • The observer/learner expects to receive positive reinforcements for the modeled behavior.
    • This process includes external, vicarious and/or self-reinforced motivation.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • SOCIAL LEARNING THEORY
    • General principles of Social Learning Theory:
        • People can learn by observing the behaviors of others and the outcomes of those behaviours.
        • Learning can occur without a change in behaviour.
        • The consequences of behaviour play a role in learning.
        • Cognition plays a role in learning .
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THE TRANSTHEORETICAL MODEL Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THE TRANSTHEORETICAL MODEL James O. Prochaska and Carlo C. DiClemente “ Habit is habit, and not to be flung out of window but coaxed downstairs a step at a time.” Mark Twain
  • The TTM:
    • Behavior change is a process that takes place over time. Its never simple, nor straight forward.
    • People go through stages before final changes are made, and many things happen after they start to make changes.
    • This “Stages of Change” model suggesting stages of behavior change and processes that influence people’s progression through those stages
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • The TTM Is an Integrative Model of Behavior Change
    • Model of intentional change
        • Change implies phenomena occurring over time
    • Focuses on decision making of the individual
    • Involves emotions, cognitions and behavior
    • Involves progress through a series of five stages
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • The TTM: Background
    • Consist of different stages which help identify where a person is regarding the change of behavior.
    • It may relate to several different things such as smoking, exercise, diet, sexual orientation, immunization, screenings, etc.
    • It consists of several different processes but it is divided into five main stages.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THE TRANSTHEORETICAL MODEL
    • Stages of change :
        • Precontemplation
        • Contemplation
        • Preparation
        • Action
        • Maintenance
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Precontemplation Contemplation Preparation Action Maintenance Relapse Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THE TRANSTHEORETICAL MODEL
    • Stage 1: Pre-contemplation
    • Individuals are not intending to take action in the foreseeable future (usually measured as the next 6 months)
    • - unaware of the problem , unwilling to
    • change
    • - might not realize that change is possible, desirable, or relevant to them,
    • - feeling discouraged/demoralised,
    • - defensive about particular behavior,
    • - has not began to contemplate change or need for change,
    • - least responsive to interventions.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Predominant Answer in pre-contemplation stage:
    • My weight is OK! I don’t need to exercise.
    • Smoking makes me feel cool, I wont stop!
    • I cant do HIV Test when I am feeling healthy, because it can be false positive!
    • Intervention:
    • Increase awareness
    • Provision of information
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Stage 2: Contemplation
    • At this stage, the individuals are aware of the problem but not prepared/intended to change/take any action in the next 6 months.
    • - involve the process of self-reevaluation,
    • - active consideration of the prospect
    • to change,
    • - looking for more info. about the problem,
    • - weighing pros and cons (costs and benefits)
    • - evaluating options
    • The person has started the process of contemplating changes
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Predominant Answer:
    • I know smoking is bad, but I’ve difficulties to quit.
    • I know early HIV test is good, but what happen to my
    • job if my employer knows?
    • Intervention:
    • Motivation
    • Goal setting
    • Counseling
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Stage 3: Preparation
    • The stage in which the person is intending to take action in the immediate future. He prepares to undertake the change.
    • - readiness to change (A & B)
    • - gathering info. About the change
    • - learned the previous lesson
    • - on the verge to take action
    • - initiate behavior change
    • - begin reducing their problem behavior ex: reduce/delay smoking
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Predominant Answer in the stage of preparation:
    • I would like very much to reduce my blood pressure, and I am confident that I can do it.
    • In sha Allah I will stop smoking, but I don’t know when
    • Intervention:
    • Action plan with specific strategies
    • Goal setting
    • Provision of assistance
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THE TRANSTHEORETICAL MODEL
    • Stage 4: Action
    • A new behavior has been adopted.
    • Individuals have specific overt modification in their-lifestyle within the past 6 months.
    • - modification of the problem behavior
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Predominant Answer in the stage of action:
    • Currently, I am physically active, but not on regular basis.
    • Intervention:
    • Social support
    • Assist with feedback
    • Reinforcement
    • Motivation
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • THE TRANSTHEORETICAL MODEL
    • Stage 5: Maintenance
    • The stage in which the individuals are working to prevent relapse
    • - Final stage in the process of change
    • - Maintenance occurs when the behavior has been incorporated into the person’s life
    • - The new behavior is not yet firmly established.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Predominant Answer:
    • I have stopped smoking for the last 6 months, and
    • I am putting on weight now.
    • Well…. I stopped for almost the 6months you recommended, but just yesterday, I had a stick because my friend offered to me and I feel I cant say no!
    • Intervention:
    • Assist in coping
    • Avoid relapse
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Relapse??
    • The process is not yet complete and it may never be complete.
    • Many things can affect behaviour change.
    • A person may want to maintain a new behaviour, but other things might make this difficult.
    • It may later become hard to sustain:
      • - available resources might disappear
      • - strong supporters might move away or withdraw support
      • - a new situation might make old behaviour seem more appealing.
      • For all sort of reasons, people might move back to the earlier stage of behaviour change and work through the stages again .
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Pre-contemplation Contemplation Preparation Action Maintenance Becoming aware Emotional response Environmental analysis Thinking through the issues Seeing other options Self-efficacy Social support Helping relationship Reinforcement Seeing other options Being in control Social support Processes influencing movement through the stages of change Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Diffusion of innovation Theory Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Diffusion of innovation
    • Roger (1983) defined
      • – an innovation as “ an idea, practice or object that is
      • perceived as new by an individual or other unit of adoption”
      • – diffusio n as “the process by which an innovation is
      • communicated through certain channels over time among
      • the members of a social system
    • The process of diffusion involves five stages :
      • innovation development,
      • dissemination,
      • adoption,
      • implementation
      • maintenance
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Innovators Early Adopters Early Majority Late Majority Laggards Adopter Categories Adopter Categories 2.5% 13.5% 34% 34% 16% Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Diffusion of tech in weaponry: American drone in the 21 st century Nigerian warriors in the 18 th century Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Diffusion of tech in transport systems: Local Water transport then Local Water transport now Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Diffusion of technology in transport: Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Transition of cultural diffusions: Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • PRECEDE – PROCEED MODEL Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • PRECEDE – PROCEED MODEL
    • Lawrence W. Green
    • Marshall W. Kreuter
    • Premise : The factors causing health behavior are seen to be of three distinct kinds:
    • - predisposing
    • - enabling
    • - reinforcing
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • PRECEDE – PROCEED MODEL Predisposing Factors Enabling Factors Reinforcing Factors Specific behavior by individuals Environment ( conditions of living) HEALTH Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Predisposing factors:
      • Knowledge
      • Attitudes
      • Beliefs
      • Values
      • Perceptions
    PRECEDE – PROCEED MODEL Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Reinforcing factors:
      • Attitude and behavior of health and other personnel, community leaders, peers, parent, employers, etc.
    PRECEDE – PROCEED MODEL Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
    • Enabling factors:
      • Availability of resources
      • Accessibility of resources
      • Referrals
      • Rules or laws
      • Health related skills
      • Community/government, priority and commitment to health
      • Engineering
    PRECEDE – PROCEED MODEL Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Case study 1
    • Lee is a 21 year old Malaysian student involved in Intravenous drug addiction (IDA). There are many cases of IDA among Lee’s peers. However Lee thought IDA has harmed his life and wishes to change for the better.
    • Lee is also worried that his family views his IDA as an embarrassment to the whole family
    • How will you help Lee?
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Case study 2
    • Women in the predominantly Muslim Northern Nigeria are generally known to reject western style contraception techniques. As a public health specialist, you have been requested to design a study that will serve as a basis for addressing this issue.
    • Which of the models of health behaviors will best fit? Justify.
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Case Study
    • Ayesha is a 22 year old university student who lives with her parents. When she was in school, she played several sports and got plenty of exercise by walking to and fro school. She now notices that she is not exercising anymore. She drives everywhere, even to close shops. As a result, she is aware that she is feeling unfit and is beginning to gain weight.
    • Why might Ayesha’s exercise behavior changed?
    • How can you help her to exercise again?
    Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau
  • Terima kasih Tuesday, January 5, 2010 Models of Health Behavior_Yusuf Misau