determinants of behavior , undertanding of health and illness behaviour
- 1. © John Hubley & June Copeman 2008 Understanding Health & Illness Behavior Dr Ensaf S. Abdel Gawwad Dr. Azza Mehanna
- 2. Human Biology (Genetics) Environment Health Services Lifestyle (Human behaviour) Health Field Model
- 3. Objective of the lecture • What causes us to behave the way we do?
- 4. The impact of health-related behaviors on health and illness An impressive body of research has provided convincing evidence for the pivotal role of behavior in well-being, and morbidity and mortality, as well as health care costs (Schroeder, 2007).
- 5. The impact of health-related behaviors on health and illness some estimates indicate that nearly 3/4 of all health care costs are attributable to chronic diseases resulting from health behaviors such as tobacco use and exposure, poor diet, and physical inactivity (Woolf, 2008).
- 6. Behaviour and mortality • Lifestyle behaviors account for some 40% of mortality in industrialized countries and have been implicated in up to 2/3 of all cancers (Kushi et al., 2006).
- 7. Behaviour and mortality • 90% of all lung cancer mortality is attributable to cigarette smoking, which is also linked to other illnesses such as cancers of the bladder, pancreas, mouth, and oesophagus and coronary heart disease. • Bowel cancer is linked to behaviours such as a diet high in total fat, high in meat and low in fibre.
- 8. Lifestyle and health • Smokers, on average, reduce their life expectancy by five years and individuals who lead a sedentary (i.e. Non active) lifestyle by two to three years (Bennett and Murphy, 1997).
- 9. Holy Four • Four behaviours in particular are associated with disease: smoking, alcohol misuse, poor nutrition and lower levels of exercise; these are called the “holy four”. • Conversely, rarely eating between meals, sleeping for seven to eight hours each night, and eating breakfast nearly every day have been associated with good health and longevity (Breslow and Enstrom 1980). • Recently high-risk sexual activity has been added to the risk factor list.
- 10. Holy Four • Research has shown that adherence to five key lifestyle behaviors (eliminating tobacco exposure, body mass index (BMI) < 25, engaging in 30 minutes of physical activity or more per day, consuming alcohol in moderation, and eating a healthy diet) reduced coronary events by 62% over 16 years in a cohort of 42,000 US adult men (Chiuve et al,2006).
- 11. Behavior • A word used to describe specific acts that a person carries out. • Any observable response from a person to a stimulus. • Any overt action with a measurable frequency, intensity and duration. • The terms : actions and practices are functionally equivalent.
- 12. Following Ajzen and Fishbein (1980), behaviours can be defined in terms of four components: • Action, target, time and context (TACT). • The action component is a necessary part of the definition of any behaviour. The target component is usually necessary, though not always. Behavior
- 13. • Time and context are optional; they enable the definition of behaviour to be as specific as required. • For example, consider the definition: ‘eat breakfast tomorrow’. Here, ‘eat’ is the action, ‘breakfast’ is the target. Behavior
- 14. Alternative targets would be ‘a bowl of cereal’ or ‘lunch’) and ‘tomorrow’ is the time component. No context is specified in this example. Behavior
- 15. • As an illustration of the importance of context, consider the following definitions: 1. using a condom the next time I have sex 2. using a condom the next time I have sex with my regular partner 3. using a condom the next time I have sex with a new sexual partner. Behavior
- 16. Different kinds of behaviour • Lifestyle : a collection of behaviors that make up a person’s way of life e.g. patterns of eating, exercise, etc. • One-time behaviour : a behaviour that a person is likely to do only a few times in their life e.g. take their child for immunization.
- 17. Different kinds of behaviour • Tradition : التقاليد behavior passed down over time by sections of society e.g. circumcision. • Community action: - actions by individuals and groups to change and improve their surroundings to meet special needs.
- 18. Different kinds of behaviour • Utilization behaviour: - utilization of health services such as antenatal care, child health, immunization, family planning…etc • Compliance behaviours: - following a course of prescribed drugs such as for tuberculosis. • Rehabilitation behaviours: - what people need to do after a serious illness to prevent further disability.
- 19. Concerns of health behavior research: Health behavior research is concerned about explaining between-individual variation in particular health behaviours. For example: • Why do some people engage in regular physical activity while others do not? • Why do people differ in the frequency with which they engage in physical activity?
- 20. Concerns of health behavior research (cont.): • Why do some women accept an invitation to go for breast screening while other women do not? • Why do some adolescents try smoking while others remain non-smokers?
- 21. Concerns of health behavior research (cont.): It is also concerned about studying determinants of within-individual variation: • why does an individual’s behaviour vary over time or across different settings? For example, why does a woman attend for her first breast screen but not for subsequent screens? • Why does a smoker smoke more on some days or in some situations than in others?
- 22. Concerns of health behavior research • Another concern is the extent to which health behaviours cluster together. For example: • Do smokers have generally less healthy lifestyles than non-smokers? • Are people who attend for one kind of screening test more likely to attend for another kind of screening test?
- 24. • Cognitive determinants of health behavior. • They are assumed to be most proximal to the behaviour. • Factors that exert their effects prior to a behavior occurring, by increasing or decreasing a person or population's motivation to undertake that particular behavior. Predisposing factors Knowledge Attitudes Beliefs Values Perceptions Needs Self-efficacy, Intentions, Existing skills Predisposing Factors
- 25. • All of these can be seen as targets for change in health promotion or other public health interventions. • Such motivational factors subject to change through direct communication or education Predisposing factors Knowledge Attitudes Beliefs Values Perceptions Needs Self-efficacy, Intentions, Existing skills Predisposing Factors
- 26. Awareness: Awareness refers to becoming conscious about an action, idea, object, person or situation (being mindful). Example: A health educator screening a film on avian flu in a community in which no one knows about that disease. Predisposing factors Awareness & Knowledge
- 27. Predisposing factors Awareness & Knowledge Knowledge: • It is intellectual acqaintenance of facts. • It is learning of facts and gaining of insights. • It often comes from experience. We also gain knowledge through information provided by teachers, parents, friends, books, newspapers • Is usually a necessary but not always a sufficient cause of behavior change.
- 28. Predisposing factors Beliefs • Convictions from within that something is real or true. • Might be beneficial, harmful, neutral.
- 29. Predisposing factors Beliefs • A belief can come from different sources, including: a person’s own experiences or experiments (direct experience). the acceptance of cultural and societal norms (e.g. religion) what other people experience (indirect experience)or say (e.g.education or mentoring).
- 30. Predisposing factors Beliefs • Beliefs that are transmitted through generations, and deeply rooted in culture are difficult to change.
- 31. Predisposing factors Beliefs Statements of belief about health include such comments as "I don't believe that exercising daily will make me feel any better."
- 32. Predisposing factors Values. • Values are generally long-term standards or principles that are used to judge the worth of an idea or action. • A value is a measure of the worth or importance a person attaches to something. • characteristics that are valued or cherished (usually abstract). • Values are considered to be more entrenched and thus less open to change than beliefs or attitudes.
- 33. Predisposing factors Values. • Of interest is the fact that people often hold conflicting values. • For example, a teenage male may place a high value on living a long life; at the same time, he may engage in risky driving activities, such as speeding and driving without a seat belt, because he values the sense of power and freedom he gains through such activities. • Health promotion programs often seek to help people see the conflicts in their values or between their values and their behavior = values clarification (small group discussion).
- 34. Predisposing factors Attitudes • Attitude is a relatively constant feeling towards something or someone. • Mental predisposition toward a particular behavioral reaction. • An overall feeling of like or dislike towards someone or something. • It always has an evaluative dimension. • Attitudes can always be categorized as positive or negative.
- 36. Predisposing factors • Values: what is important to you • Beliefs: what you believe is true • Attitude: the way you express your values and beliefs---feelings, thoughts, words, and actions.
- 38. Predisposing factors • Value: education • Belief: everyone should have a university education • Attitude: get angry when people are not studying.
- 39. Predisposing factors • Value: Health • Belief: everyone should eat healthy food. • Attitude: advice people to eat healthy food.
- 40. Predisposing Factors That Are Not Amenable to Change. • other factors such as genetic, sociodemographic, and personality characteristics as also playing a role in predisposing to health-related behavior. However, because most of these are not amenable to change through health education, they are treated as a special subcategory of predisposing factors.
- 41. • The impact of these factors, however, on behavioral change often depends on their support from enabling and reinforcing factors. Predisposing factors Knowledge Attitudes Beliefs Values Perceptions Needs Self-efficacy, Intentions, Existing skills Predisposing Factors
- 42. Enabling factors • Enabling factors are resources, and skills that facilitate a behavior's occurrence. – can be positive or negative Enabling factors Resources Availability Accessibility Skills Abilities
- 43. Enabling factors SKILLS • They are the tasks required for a desired behavior to occur. • Any skill that still need to be developed is considered to be enabling factors.
- 44. Enabling factors Skills Examples: • Breast self-examination: Women who have never been shown how to perform breast self-examination may feel that they would do it wrong and may therefore not try at all. • Preparing healthy diet: women may not know how to decrease the fat content of their diet or to increase the amount of vegetables they eat so as to reduce their risk of cancer and heart disease.
- 45. Enabling factors Skills • Advocacy: women who receive training in advocacy may be effective in securing funding for comprehensive breast cancer screening programs for low-income recipients.
- 46. Enabling factors Resources HEALTH CARE RESOURCES • These include such things as health care providers, hospitals, public health programs and classes, clinics for those who are sick, and programs for healthy people who are trying to maintain or improve their health. • The relative availability, accessibility, and affordability of these resources may either enable or hinder undertaking a particular behavior.
- 47. Enabling factors Resources • Other important conditions and resources include policy initiatives, the availability of healthful products and alternatives to unhealthful behaviors, and the existence and enforcement of legislation.
- 48. DETERMINATS OF BEHAVIOR Predisposing factors Reinforcing factors Enabling factors • Reinforcing factors: – Presence or absence of support, encouragement or discouragement from those around you Social pressure Social norms: Family, Peer, Teachers, Employee, Mass media…
- 49. Health Overt behavior patterns, actions, and habits that relate to health maintenance, to health restoration, and to health improvement.” What is Health Behavior???
- 50. Categories of health behaviour • A distinction is often made between positive and negative health behaviours. • Examples of positive, ‘healthy’, ‘healthful’ or ‘healthenhancing’ health behaviours are taking regular exercise, going for annual health checks and eating at least five portions of fruit and vegetables a day.
- 51. Categories of health behaviour • Negative, ‘unhealthy’, ‘risky’, ‘health- compromising’ or ‘health-impairing’health behaviours would include, for example smoking, drinking heavily, driving too fast and eating a diet high in saturated fat.
- 52. Other categories of health behavior: Preventive health behavior Illness behavior Sick-role behavior
- 53. Preventive health behavior : Behaviors carried out by healthy people to keep themselves healthy. • These actions include developing and maintaining a healthy lifestyle, self-protective behavior such as wearing a helmet when riding a bicycle, using seat belts, or wearing a condom during sexual activity. • Behaviors aiming at prevention. Three categories of health behavior:
- 54. Illness behavior is any activity undertaken by individuals who perceive themselves to be ill for the purpose of defining their state of health, and discovering a suitable remedy. • Behaviors in response to symptoms. Three categories of health behavior:
- 55. Different types of illness behavior • Turn to medical care system for help. • Turn to self-help strategies. • Dismiss the symptoms.
- 56. Sick-role behavior involves any activity undertaken by those who are ill for the purpose of getting well. It includes receiving treatment from medical providers, generally involves a whole range of dependent behaviors, and leads to some degree of exemption from one's usual responsibilities. • Behaviors in response to diagnosed disease. Three categories of health behavior:
- 57. Primary prevention involves actions to keep disease from occurring (such as immunizations). Levels of prevention Secondary prevention involves actions to detect the presence of disease in its early stages when it is easier to treat. These actions include: Accessing professional health services, Medical examinations, Medical testing. Tertiary prevention involves actions to reduce the severity of a disease that has already occurred, to minimize its complications, or to promote recovery (such as managing diabetes, cardiac rehabilitation, or alcohol and other drug rehabilitation).
- 58. Levels of prevention healthy onset of advanced disability person symptoms symptoms death (reversible) (not reversible ) Primary Secondary Tertiary prevention prevention prevention rehabilitation
- 59. Health Education • Health education has been defined in many ways by different authors and experts. • Lawrence Green defined it as “a combination of learning experiences designed to facilitate voluntary actions conducive to health.” • The terms “combination, designed, facilitate and voluntary action” have significant implications in this definition. • Combination: emphasizes the importance of matching the multiple determinants of behavior with multiple learning experiences or educational interventions. • Designed: distinguishes health education from incidental learning experiences as systematically planned activity. • Facilitate: means create favorable conditions for action. • Voluntary action : means behavioral measures are undertaken by an individual, group or community to achieve an intended health effect without the use of force, i.e., with full understanding and acceptance of purposes.
- 60. Aims of health education Aims • Motivating people to adopt health-promoting behaviors by providing appropriate knowledge and helping to develop positive attitude. • Helping people to make decisions about their health and acquire the necessary confidence and skills to put their decisions into practice
- 61. Health Promotion • Most people use the term health education and health promotion interchangeably. • However, health promotion is defined as a combination of educational and environmental supports for actions and conditions of living conducive to health.
- 62. Health Education/Health Promotion Health Education Health Promotion Health Promotion
- 63. THANK YOU
Editor's Notes
- #2: Of considerable influence was the publication in 1973 of the report New perspective on the health of the Canadians by the then Prime Minister of Canada Marc Lalonde. Central to this report was the Health Field Model. This argued that - far from being determined by health services - health was determined by human biology or genetic endowment, environment and human behaviour – See Figure 1.3. The term life style entered the discourse as a key determinant of health.
- #16: Decision-based behaviour – where a person goes through a conscious decision-making process before deciding to perform (or not to perform the behaviour) – e.g. a person’s decision to start taking regular exercise. One-time behaviour – a behaviour that a person is likely to do only a few times in their life e.g. take their child for immunization, install a smoke alarm in their house, have a vasectomy. Routine behaviour or habit– an action that people do regularly - usually without a conscious decision such as washing hands after going to the toilet. Addictive behaviour – when there is some reinforcement of the behaviour through a biological or psychological adaptation leading to dependency on the substance e.g. smoking, drugs, alcohol. Custom – also called a behavioural norm – a behaviour shared by a group of people which forms part of the culture of the community e.g. the diets of ethnic minorities, body piercing among young people. Tradition – behaviour passed down over time by sections of society e.g. circumcision, avoidance of certain foods. Lifestyle – a collection of behaviours that make up a person’s way of life e.g. patterns of eating, exercise, leisure, clothing etc.
- #17: Decision-based behaviour – where a person goes through a conscious decision-making process before deciding to perform (or not to perform the behaviour) – e.g. a person’s decision to start taking regular exercise. One-time behaviour – a behaviour that a person is likely to do only a few times in their life e.g. take their child for immunization, install a smoke alarm in their house, have a vasectomy. Routine behaviour or habit– an action that people do regularly - usually without a conscious decision such as washing hands after going to the toilet. Addictive behaviour – when there is some reinforcement of the behaviour through a biological or psychological adaptation leading to dependency on the substance e.g. smoking, drugs, alcohol. Custom – also called a behavioural norm – a behaviour shared by a group of people which forms part of the culture of the community e.g. the diets of ethnic minorities, body piercing among young people. Tradition – behaviour passed down over time by sections of society e.g. circumcision, avoidance of certain foods. Lifestyle – a collection of behaviours that make up a person’s way of life e.g. patterns of eating, exercise, leisure, clothing etc.
- #18: Decision-based behaviour – where a person goes through a conscious decision-making process before deciding to perform (or not to perform the behaviour) – e.g. a person’s decision to start taking regular exercise. One-time behaviour – Routine behaviour or habit– an action that people do regularly - usually without a conscious decision such as washing hands after going to the toilet. Addictive behaviour – when there is some reinforcement of the behaviour through a biological or psychological adaptation leading to dependency on the substance e.g. smoking, drugs, alcohol. Custom – also called a behavioural norm – a behaviour shared by a group of people which forms part of the culture of the community e.g. the diets of ethnic minorities, body piercing among young people. Tradition – behaviour passed down over time by sections of society e.g. circumcision, avoidance of certain foods. Lifestyle – a collection of behaviours that make up a person’s way of life e.g. patterns of eating, exercise, leisure, clothing etc.
- #58: More effective to prevent people becoming ill than to treat afterwards