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.

1. Health and Human Behaviors
By Samuel Dessu (Assis. Professor)
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2. Outline
Behaviors
Definitions and concepts
Types of behaviors
Determinants of human behaviors
Predisposing factors –psychosocial factors
Enabling factors
Reinforcing factors
Role of behaviors in disease prevention
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3. Leaning outcome
 At the end of this session, you will be able to;
 Define what behaviors mean?
 Identify types of health behavior
 Analyzes the relation ship between behavior and disease
burden in contemporary world
 Describe factors affect human behaviors
 Discuss the role of human behaviors in disease
prevention
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4. 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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5. Behaviors ….
Example:
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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6. Components of Behavior
 Basically human behavior has 3 domains;
A) Cognitive domain (Information)
 Encodes, stores, retrieves, processes information;
 purpose is manipulation of information
Eg. knowledge, awareness
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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7. Behavior….
Note:
1. 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.
2. The same words ( behavior=action= practice)
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8. Behavior and health
Determinants of health
 Broadly, health is determined by two major categories
of determinants or factors.
 These are Behaviors and environmental determinants.
 Behaviors are those daily actions which are under the
possibility of the control of the person/individual/ where
as environmental determinants are those factors
which are not easily under the control of the person.
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9. Determinant of Health…
 .
Life style/Behavior
Environment
Health
F.g.1. Relationships of Behaviors/life style & environment as a
cause of health

10. Behavior and health…
Types of behaviors:
Well/healthy behavior (behavioral immunogens) can
promote health
Eg. Physical exercise, BF, seeking treatment, ………..
Ill/unhealthy behavior can harm health
Smoking, chat chewing, excessive alcohol
consumption, unsafe sex, sedentary life style etc.
These are called behavioral pathogens and are leading
risk factors for preventable death and disease
worldwide
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11. Behavior and health…
 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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12. Human behavior and disease burden
 The world is experiencing 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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13. 13
The behavior-health link becomes clear when examining
the 10 leading risk factors for preventable death and
disease worldwide.

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15. 15
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.

16. 16
Risk factors translate into disease, disability, and
death—collectively referred as the ―burden of
disease‖.
Addressing risky behaviors rather than specific
diseases is cost-effective because one risk factor
can result in several diseases.

17. Types of healthy behaviours important for health
promotion
Promotive behaviors
Preventive behaviors
Utilization behaviors
Illness behaviors
Compliance behaviors
Rehabilitation behaviors
Community action
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18. Types of healthy behaviours important for health
promotion...
1) Promotive behaviors
Physical exercise , use of latrine, Child-spacing , proper
disposal of dirty water, Good nutrition, clean storage of
food, Breast-feeding, tooth cleaning, reduction/cessation
of unhealthy practices such as cigarette smoking, and
excessive alcohol consumption
2) Preventive behaviors
Taking anti-malaria drugs , immunization, using mosquito
bed nets
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19. Types...
3) Utilization behaviours – utilization of health services.
Eg. ANC service, Immunization services, Child-health service
Screening programs, FP service
4) Illness behaviours - recognition of symptoms and prompt
self-referral.
 It is what people do when they feel ill.
 aimed to seek remedy
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20. 4) Compliance (adherence) – following
course of prescribed medicines
5) Rehabilitation behaviours – what people
need to do after an illness/surgery to recover
 A type of behavior that prevent further
disabilities after a serious illness
6) Community action - actions by
communities to change their surroundings
include community participation in health
decision-making
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21. Factors determine human behavior
 Human behavior is influenced by a huge range of factors.
 Lawrence Green identified three categories of factors
affecting individual or collective behavior.These are;
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22. Factors determine human behaviors
Behaviors
Predisposing
factors
Enabling
factors
Reinforcing
factors
Cultures/n
orms
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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/enc
ouragement

23. 1. Predisposing factors
 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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24. Predisposing…
 These include,
Knowledge
Attitude
Beliefs
Values
Confidence/self-efficacy (perceived)
Motivation
Previous experience (existing skills) that may form ‗perceived
self-efficacy‘, but not the actual one (competence).
note: Perception predispose; competence enables
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25. Knowledgeorawareness
 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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26. Knowledge ….
 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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27. Knowledge …
 Therefore, one of the main task in health education is
helping the learner to become knowledgeable about
some health topic.
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28. 28
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
Perception

29. Skills
 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
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30. Attitude
• 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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31. Characteristics of attitude
1) Predisposition- exposure related to an attitudinal
object. No exposure, no attitude
2) Evaluation-can be evaluated by intensity or
judgment.
 The most unique characteristic of attitude that differs it
from other concepts like motives, drive, traits.
e.g. Favorable or unfavorable
3. Has directions- +ve or -ve, good or bad.
Negative ……………… positive
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32. Attitude….
4) Changeability-can be changed, not static.
5) Stability or consistency
 Stability=related to time/same response/set of
responses in the presences of object over time
 Consistency= sameness of attitude/ same response/set
of responses in the presences of object
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33. Linkbetween knowledge(K)andAttitude(A)
Knowledge
Feeling/sense
of like or
dislike
Attitude
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34. Attitude measurement
 Is a concept/latent variable that can be measured/inferred.
 Self-reported (verbal) attitudes - asked direct questions about
their feelings, opinion or via observation for overt/covert
behaviors.
 The Likert Scale –is of one the mostly commonly used scale.
 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. Condom use increase sexual pleasure.
1. S.disagree 2. disagree 3. undecided 4. agree 5.S.agree
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35. Belief
 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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36. Beliefs…
 And also,Attitudes and beliefs are confusing terms
 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
 Overall, if a person believes that performing the
behavior will lead to mainly good outcomes, then the
attitude will be favorable and vies versa.
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37. Belief…
 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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38. Difficulty index of changing beliefs
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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39. Typesofbeliefs
 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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40.  Harmful belief: is a belief which damage health.
 Helpful beliefs: is a belief which preserves health.
 Neutral beliefs: is a belief which neither damages nor
preserves health.
 What do you if you are unsure???……..Nothing
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41. Relationship between beliefs and attitudes
Attitude Beliefs
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42. BeliefsVs attitude ….
 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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43. Beliefs Vs attitude ….
 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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44. Value
 The relative worthy/preference/judgment individual
gives every thing around is known as value.
 value is something held to be important or worth; and
prized by an individuals or community.
 The degree of importance given to something (dictionary)
 E.g. The value of my children’s happiness is second only to
that of my wife
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45. Examples of characteristics that can be valued by the
communities
 Being a good mother
 having many children/cattle
 Being approved by friends
 masculinity and sexual prowess
 Being attractive to opposite sex
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Value exert strong and
enduring influence on
behaviors.
It provides general
guides to behaviors.

46. Examples…
 Having beautiful girl friend
 academically success
 Being a man of God /Allah, success in foot ball events , being
‘modern’
 being healthy
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47. 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.
What are e.g. of disadvantegious value?
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48. Value conflict and value clarification
 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.
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49. Cont…
 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
 Role plays/dramas are used to clarify values.
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50. Relationship between attitude and value
 Values are more permanent and resistant to
change than attitudes and beliefs and they
determine attitude.
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51. Difficult index; Relationship between attitude and value
Knowledge Beliefs Attitude Value
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< <
<
Values are more permanent and resistant to change than
attitudes and beliefs and they determine attitude.
In terms of difficulty of changing:

52. 2. Enabling factors
 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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53. Enabling ….
 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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54. They include,
 Availability, accessibility and affordability of health care
 New skills (competence), the non-existing skills
 Resources. Eg.Time, money, transportation etc.
 Actual skills in practice represent enabling factors.
 A lack of skills, usually because of education, differs from a
poor ―perceived self-efficacy‖ in that it represents a real
deficit, not just a lack of confidence.
 Or Perceptions of skill predispose; competence enables.
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55. example
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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56. 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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57. Enabling …
 In behavior change communication be sure that
enabling resources are readily available in the
community of interest.
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58. 3.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.
 positive or negative feedback and is support
socially or by significant others after it occur.
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59. 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.
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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60. Religious
leaders
I want to use FP, but…
Grand
parents
Friends
Husband
Traditional
healers
The influence of social pressure (circle of influence)
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61. 61
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

62. 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
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In practice simultaneously

63. Educational approaches to behavior change
• 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
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64. 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
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65. Behavior change approaches
1.The persuasion approach
the deliberate attempt to influence the other person
to do what we want them to do. ‗directive‘/
forcefully/coercion.
Convincing on an option
2. The informed decision making approach.
 Give information, address barriers to perform
behavior
Develop confidence to perform the behavior
Empower them to take actions
PCII HE 65

66. Further reading materials
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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67. Thank you!
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