This document discusses human behavior and factors that influence it. It begins by defining key concepts like behavior, its components, and types of health behaviors. It then discusses three main categories of factors that affect human behavior: 1) Predisposing factors - factors that provide motivation for behavior change, like knowledge, attitudes, beliefs, and values. 2) Enabling factors - skills and resources that facilitate behavior change like availability of services and new skills. 3) Reinforcing factors - consequences of behaviors that encourage or discourage repetition, like social support from significant others. Understanding how these factors influence behavior is important for health promotion and disease prevention efforts.

1. Application of HE-theories and
model
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2. Course content
• Application of health education theories and
models in behavior change
o Human behavior and health
o Health education theories and models
o Health Belief Model
o Social Learning Theory
o Stages of Change
o Theory of Planned Behavior

3. Health and Human Behavior
By Akine E.

4. Unit objectives: At the end of this chapter the
students will be able to:
• Define human behavior.
• List components of behavior.
• Discuss factors that affect human behavior.
• Discuss the role of human behaviors in disease
prevention
• Discuss types of health behaviors.

5. Brain storming
What Is Human Behavior??
What Are Determinants Of Human Behaviors?
What Are The Domains Of Human Behaviors??
What Are Factors Affecting Human Behavior??

6. Why do we need to study human behaviour?
Most health issues could not be addressed
by treatment alone
 The promotion of health and prevention
of diseases will usually involve some
changes in life styles or human behaviour
 Human behaviours are modifiable through public
health efforts

7. 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.
• Behaviour is an action or practice.
But
• Behaviour is NOT a
 thought, desire, wish to do,
 peoples talk

8. Human Behavior: Definition
• Action –types of overt behavior, such as drinking,
smoking, etc.
To say a person has drinking/smoking behavior
 Duration –it is the time spent since the action
started or noticed such as for a week/months (it
for a week/month)
 Frequency- how it is repeated in a certain period
of time.
 Purpose –is he/she doing consciously or not

9. How can behaviour affect health ?
People stay healthy or become ill, as a result of their
own action or behaviour.
 The following are examples of how people’s actions can
affect their health:
Using mosquito nets helps to keep mosquito away
Feeding child with bottle put them at risk of diarrhoea.
Defecating in an open field will lead to parasitic
infection.
Unsafe sex predisposes people to unwanted pregnancy,
HIV/AIDS and other STDs

10. Behavior components
 Basically human behavior has 3 domains;
A) Cognitive Domain (Information)
Encodes, stores, retrieves, processes information;
Purpose is manipulation of information
E.g. Knowledge, Awareness, Perception, Thinking
B) Affective Domain = cognition +feeling
E. g. Attitude, Beliefs, Value
Purpose is to create arousal
C) Psychomotor Domain - Voluntary muscle
Psycho-mind , Motor – action (related to Skill)

11. Behaviours that promote health and prevent
disease
 Health behaviors- are actions that healthy people
undertake to keep themselves or others healthy and
prevent disease.
 any Actions that keep themselves or others healthy
Eg - Exercise, good nutrition, breast feeding, child -spacing,
hygiene practices, taking anti-malaria
– Reduction of health damaging behaviors such as drug
abuse, alcohol abuse and so on
 It includes not only observable, overt actions but also the
mental events and feeling states that can be reported and
measured

12. Type health behavior
Discuses its with giving example
Group work 5 mint
1. Promotive and Preventive behavior
2. Utilization behaviour
3. Illness behaviour
4. Compliance behaviors
5. Rehabilitation behaviors
6. Community action behaviour

13. Type health behavior
1. Promotive and Preventive behaviors - any
activity undertaken by an individual who
believes himself (or herself) to be healthy, for
the purpose of preventing illness.
 For example, Physical exercise, reduction of
unhealthy practices such as cigarette
smoking and excessive alcohol consumption
2. Utilization behaviour: - utilization of health
services such as antenatal care, child health,
immunization, family planning…etc

14. Types of health behaviors…
3) Illness behaviors
The action of people that take before consulting health
care workers, including recognition of early symptoms ,
taking home remedies (self-medication), consulting family
and healers are called illness behaviors.
It is recognition of early symptoms and prompt self-referral
for treatment before the disease becomes serious
 Any activity undertaken by an individual who perceives
himself to be ill, to define the state of health, and to
discover a suitable remedy

15. Type health behavior
Becoming aware of symptoms
Consulting others in family
Illness behavior Self-medication (self- referral)
Decision to go for treatment (either to traditional healer or health facility)
Doctors –patient consultation
Following advice and taking prescribed drugs.
Compliance
Behavior Returning for follow up
Fig 2.2: stages in illness behavior

16. Type health behavior
4. Compliance behaviors
 A behavior following a course of prescribed drugs
5. Rehabilitation behaviors
 A type of behavior that prevent further disabilities after a serious
illness.
Eg. -Fracture of hands/ legs needs to exercise
- counseling after lung cancer surgery to exercise or quite
smoking
6. Community action
 Action undertaken by the individuals and groups to change and
improve their surrounding to meet special needs.
E.g. - Community participation in installation of improved water
supply,
- building of latrines

17. What are factors that affect human behavior?

18. Factors Determining (Affecting) Human
Behavior
Human behavior is influenced by a huge range of factors.
Lawrence Green identified three categories of factors
affecting individual or collective behavior.
 Describes the PRECEDE framework, an acronym
that stands for Predisposing, Reinforcing,
Enabling factors in Educational Diagnosis and
Evaluation.
 Each of which has a different type of influence on
behavior:

19. Behaviors
Predisposing
factors
Enabling
factors
Reinforcing
factors
Cultures
/norms
19
Knowledge, Attitude,
Perception, Beliefs, Values,
Confidence/Self-efficacy,
Existing skills,, Behavioral
intention , etc.
Availability,
Affordability,
Accessibility,
resources to
accomplish the
behaviors
Peer pressure, Influential
people, Perceived social
pressures/significant
others/discouragement/en
couragement
Factors Determine (Affecting) Human Behavior

20. 1. Predisposing Factors
 Are antecedents or prior to behavior that provide the
rationale or motivation for the behavior to occur.
E.g. Knowledge, Perception, Belief , Attitude, Values,
Confidence/self-efficacy, Outcome efficacy, Behavioral
intention, etc.
 And existing personal skills that facilitate or hinder motivation for
change.
 They are generally referred to cognitive variables because they are
inside the mind and have to do with knowing or believing
 They are also called psycho-social because they are socially influenced
 E.g. For an individual to use condom, he has to have knowledge
about condom and develop positive attitude towards utilization of
condom.

21. Group work presentation
Knowledge
Belief
Attitudes
Values
Describe each

22. Knowledge
 Knowledge (cognition) is a mental process that includes
thinking, remembering, perceiving of everything in the
universe.
It is the storage of information or experience in the brain,
and the means of acquiring knowledge by the brain is by
perception.
We also gain knowledge through information provided by
teachers, parents, friends, books, newspapers, etc…
Perception is giving meaning and interpretation of data and
information received by the five sense organs
Knowledge = perception + storage of information
E.g. knowledge about methods of prevention of HIV.

23. Belief
 Belief is ‘trust’ or ‘confidence’ or something regarded
by a person as truth. It also refers to the conviction
/assurance/ of a phenomenon or object is true or real.
Beliefs deal with a people understands of themselves
and their environment. People usually do not know
whether what they believe is true or false.
They 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.

24. Belief
Beliefs are different with respect to every country and
community.
For instance,, in one country a pregnant woman eating
egg is regarded by the people as willing to
accommodate a difficult delivery believing that the egg
makes the baby extremely big headed.
Clashing with this, in another country there is a belief
that a pregnant woman must eat egg to bear a strong
and healthy baby.

25. Attitudes
 Attitude as “a tendency of mind or of a relatively constant
feeling towards a certain category of objects, people, or
situation.” Or
 Attitude is a relatively constant feelings, or set of beliefs directed
towards an object, person or situation. They are evaluative
feelings and reflect our likes and dislikes.
In different terms
 attitudes as a collection of beliefs that always includes an
evaluative aspect.
 attitude as a learned predisposition to respond in a consistently
favorable or unfavorable manner with respect to a given object.

26. Attitudes
 With in the above context of the definition of attitude, social
psychologists and psychologists brought four important
concepts that determine what attitude is. These concepts are:
Attitude is:
Affect for or against
Evaluation of
Like or dislike
Positive ness or negative ness toward a psychological
object.
 They often come from our experiences or from
those of people close to us. They either attract us
to things, or make wary of them.

27. Attitude------- Case
• E.g. w/o Almaz had fever and visited the nearby health
center. The staff on duty that day was very busy and
shouted at her, “Do you want us to waste our time for a
mild fever? Come back when we are less busy.” She did
not like being shouted at.
From this case:
1, what type of attitude developed towards the health staff ?
2, what is her judgement for the next time when she is sick?
 This experience gave her bad attitude toward the health
staff. This bad attitude could discourage her from
attending the health center next time she is sick.

28. Attitudes-------
Attitude is used for a person’s judgement of a
behaviour as good or bad
This judgement will depend on beliefs held about the
consequences of performing the behaviour
– For example, a mother may believe that breast
feeding is good for the health of her child and at the
same time makes her look old-fashioned.
Overall, if a person believes that performing the
behaviour will lead to good outcomes, then the
attitude will be favourable and vies versa.

29. Values
 Values are broad ideas and widely held assumptions
regarding what are desirable, correct and good that
most members of a society share.
Every individual places or gives a relative worth to
every thing around. This worth or preference or
judgment is known as value.
It is defined as the regard that something is held to be
important or worth; and prized by an individuals or
community

30. Value----
• Values provide us with criteria and conception by which we
evaluate people, objects and events as their relative worth,
merit, beauty or morality.
 A person values might be reflected in the way he or she
completes the following statement: ‘the things that are
important to me are...’
 Examples of characteristics that can be valued by the
communities include:
• Being a good mother -having many children/cattle
• Being approved by friends -masculinity and sexual prowess
• Being attractive to opposite sex -academically success
• Being a man of God -success in foot ball events
• being ‘modern’ -being healthy

31. Values---
However, A person may have his/her own values, but
usually values are parts of a culture and shared at a
community or national level.
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
Values have contextual application.
– They are the basis for justifying one’s actions in moral or
ethical terms.
– They are standards most important to us.

32. Values
 Example: A married woman is more respected than a
non-married one in the Ethiopian context. Marriage is
highly valued and respected by many communities in
developing countries like Ethiopia. It is considered as
one of the standards for the quality of life.
• In short, values are beliefs and standards upon which a
man acts by preference.
• They are learned (not inherited) and are much like
selective perception. For example – nice book has no
value for illiterates

33. B. Enabling factors
Enabling factors are those skills, resources, barriers
that can help or hinder the desired behavioral
changes as well as environmental changes.
Enabling factors are those antecedents to behavior that
facilitate a motivation to be realized.
Or these are characteristics of the environment
that facilitates healthy behavior and any skill
or resource required to attain the behavior.
They help individuals to choose, decide and adopt
behaviors and may be barriers and assets to needed
changes.

34. Enabling…
This category of factors include:
The health-care environment
-availability and accessibility
Eg presence of FP service
-affordability
New skills/ Presence of health related skills /
– deciding to practice a behavior
Eg how to use condom, how to prepare ORS
Resources. E.g.. Facilities, money, time, labor services,
skills, transportation, materials and the distribution and
their location.

35. Enabling…
Other environmental factors such as community and /or
governmental laws, policy, rules, regulations, priority
and commitment can be a barrier or a facilitator of the
behavior change to be occurred
Example (1): strong enforcement of the local ordinances
and government prohibiting the sells of cigarettes may
lead to unavailability of cigarettes in his/her immediate
environment or making exceedingly costly as well as the
existing social norms or customs prohibiting smoking are
enabling factors which discourage smoking (the
behavior).

36. Enabling…
 Example for; Enabling factors for a mother to give oral
dehydration solution to her child with diarrhea could
be: time, containers, salt and sugar and skill how to
prepare and administer it.
 Example : enabling factors for a latrine construction
would be money, essential components such as slabs
and necessary construction skills.
 Example for FP program, the enabling factors would be
availability of contraceptives, accessible FP services and
the necessary skills for using a particular method.

37. Enabling factors
 In general, it is believed that enabling factors should be
available for an individual or community to perform intended
behavior.
Behavioral intention Behavioral change
Enabling factors
(Time, money and materials, skills, accessibility to health
services)
 Behavioral intention is willingness/ readiness to perform a
certain behavior provided that enabling factors are readily
available.

38. C. Reinforcing factors
 Reinforcing factors are those factors subsequent to a
behavior that provide the continuing reward or
incentives for the behavior to be persistent and
repeated.
These factors come subsequent to the behavior. They
are important for persistence or repetition of the
behavior. .
Are those consequences of actions that determine
whether the actor receives positive or negative
feedback and is supported socially or by significant
others after it occur.

39. Reinforcing factors…
Significant others
 Can also be called relevant others or influential others. These are
people who are significant (determine or influence) the behavior
of others to encourage or discourage to do something.
 We often listen to what he or she says and tries to do what he or
she does.
 Among these important people are elders, friends, peers, parents,
grand parents, village leaders, religious leaders and people with a
lot of experience and skills (teachers, health workers, etc.).
Examples
The woman does not adopt FP because her husband
disapproves.
The young man who starts smoking because his friends
encourage him to do so.

40. Reinforcing factors
 The most important reinforcing factors for a behaviour to occur or
avoid include; Family, Community leaders, Decision makers,
Peers, teacher and Health providers etc-----
Class activity
 Example: should a patient have a chronic-illness such as diabetes;
there will be follow-ups that need repeated visits (maybe lifelong
in some cases). These repeated visits are important for the
patient to reduce sufferings, minimize complications, and prolong
life. The behavior of a patient is also important for a health care
provider. Because, the activities and outcomes of the care
provided to the patient depend on the cooperation and the
partnership developed between the patient and the health care
provider
Question,
-what is the intended behavior?
-Who is the reinforcer for behaviour should be subsequent ?

41. 41
Predisposing
Factors
Reinforcing
Factors
Enabling
Factors
Create Intention to Act
Realizes the
Intentions
Encourage Behaviors
to Persist
Summary of Factors Affect Human Behaviors
Remember: Any given behavior can be explained as a
function of the collective influence of these three factors
Sustainable Behavior

42. Theoretical Sequence to Address Determinants
of Behaviors
• Knowledge
, Attitude,
Beliefs,
• Values
Predisposing
Factors
• Availability,
affordability,
accessibility &
others
resources
Enabling
Factors
• Peer
influence
& social
pressure
Reinforcing
Factors
Behaviors
42
In practice simultaneously

43. • Approaches to Change
Determinants
of Behaviors
• Direct communication with target
individuals-educational approaches
Predisposing
Factors
• Organization change, avail services,
accessibility, advocacy, resource
mobilization
Enabling Factors
• In direct communication with the
social environments , influential
peoples
Reinforcing
Factors
43
Educational Approach to Behavior Change

44. Role of human behaviour in prevention of
disease
Class activity
1. What is prevention?
2. What are Levels of prevention of disease
Primary prevention - explain its
- main aims for each
Secondary prevention - give example for each
Tertiary prevention

45. Role of human behaviour in prevention of disease
 Prevention is defined as the planning for and the
measures taken to prevent the onset of a disease or
other health problem before the occurrence of
undesirable health events.
 There are three distinct levels of prevention: primary,
secondary, tertiary prevention
Healthy person early signs disease death
Primary HE Secondary HE Tertiary HE
Levels of prevention of disease

46. Role of human behaviour in prevention of disease
1, Primary prevention
 All activities carried out to keep healthy people healthy
and prevent them getting disease. Or preventing healthy
people from becoming sick.
 In order to carried out effective primary prevention , we
must know who is most “at risk” of getting diseases.
 The main objective of primary preventions are promoting
health, preventing exposure and preventing diseases
 Promoting health: consists of general non-specific
intervention that enhance health like improvement of
socioeconomic status, provision of adequate food, housing
and education

47. Role of human behaviour in prevention of disease
 Prevention of exposure: avoidance of factors which may
cause of disease if an individual is exposed to them.
Fg. Provision of safe and adequate water, vector control, etc
 Prevention of disease: prevention of disease development
after the individual has became exposed to the disease
cause factors.
Eg immunization can be takes as good example
 Reduce incidence
– persuade individuals to adopt behaviors believed
to reduce the risk of disease
– Adopt a healthy life style
– persuade individuals to utilize preventive health
service appropriate with healthy behavior

48. Role of human behaviour in prevention of disease
2, Secondary prevention
 It is important to ensure that the community can recognize
early signs of disease and go for treatment before the
disease become serious.
 Concerned to prevent the development of existing disease,
minimize its severity, reverse its progress;
 Reduce prevalence.
– Persuade individuals to utilize screening service appropriately;
learn appropriate self care; seek early diagnosis and treatment
– persuade individuals to comply with medical treatment and
recommendations
 The aim of Secondary prevention is
-to stop or slow the progression of disease and
-to prevent or limit permanent damage

49. Tertiary prevention
 Concerned to prevent deterioration, relapse and complications,
promote rehabilitation; help to adjust to terminal conditions
 Tertiary prevention seeks to limit disability or complication arising
from an irreversible condition.
 Tertiary prevention overlaps with secondary prevention and
includes behaviours that are involved in rehabilitation and
treatment
 The main objectives: -A/ treatments to prevent further disability or
death. -B/new training and special education to help pts to return to
some useful work and life in the community

50. Role of Behaviors in Disease Prevention
• Promotive behaviors
Preventive behaviors
Utilizations behaviors
Community actions
Primary Prevention
• Illness behaviors
Compliance behaviors
Secondary Prevention
• Rehabilitation behaviors
Tertiary Prevention
50
 HE plays significant role:-Preventive Behaviors,
Promotive Behaviors , Utilization Behaviors.

51. Unit Summary
• Any given behavior can be explained as a
function of the collective influence of these
three factors.
• The notion of collective causation, or
contributing causes, is particularly important
because behavior is multifaceted
phenomenon