understanding human behaviour
TRANSCRIPT
Understanding human behaviour
Health promotion
Why do people do what they do?
• Concerns about health behavior is huge
• A lot of campaign is heard every day
• Behavioral change is expected
• Instead, resistance to behavioural change is a challenge
• Even if there is change in some, sustenance is a problem
• Why?
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The complex Social-Ecological Web
• Factors that affect behaviour are many and complex
• Until the late 1970s/early 80s, health education
programs were individualistic
• Focused primarily on the knowledge, attitudes, and
motivations of individuals
• The impact of social, cultural and economic factors
was not considered
• Recent health promotion approach considers the
multiplicity of influences
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Ecological model
• Based from biology, ecology implies that:
– A system of interactions between organisms
and an environment
– The complex relationships between organisms
and environment
– The dependent relationships between
members/ components of the system, where if
one part of the system is disturbed, other
parts will be affected
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Ecological model
• Ecological model asserts that no one factor
influences peoples’ behaviour;
• Instead, it is the complex interaction between an
environment and individuals
“Behaviour does not stand in a vacuum”
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Diagram of linkage and connections among people, environment and
behaviour
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Ecological model cont...
• Individual factors
– Awareness, knowledge, attitude, motivation,
perception
– Biophysical characteristics (genetics,
systematic vulnerabilities)
– Developmental stage
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Ecological model cont...
• Social environment:
– Social factors
• Level of social support,
• Cultural beliefs
• Peer pressure etc.
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Ecological model cont...• Socio-economic and structural factors
– Poverty
– Education,
– Access to health care and preventive services
– Social stressors such as neighbourhood
violence
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Ecological model cont...
• Political factors
– Policies and funding for health promotion
programs
– Health insurance (policies, costs, availability)
– Regulations that impact health risk
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Ecological model cont...
• Environmental factors
– Presence of an environmental risk (air and water
pollution)
– Disaster
– Conditions for the spread of an infectious disease
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Why do we need to study human behaviour?
1. Most health issues could not be addressed by treatment
alone
2. Health is determined by ordinary human actions and
behaviours
3. These behaviours are modifiable through public health efforts
• However, most health education programs failed because
they neglected to understand factors that influence actions
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Cont...
• A proper understanding of the influences in human
behaviour avoid the pitfalls of victim-blaming
• This can be achieved by separating the influences:
– that are under the control of the individual – from those that requires action from external forces
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What is behaviour and how can we affect it?
Behaviour is an action or practice to change it we
need to define the behaviour, see into intention
and social pressure and have empathy
1.Empathy-understanding other people’s perspective
• we often complain because the community ignores
our advice to follow healthy behaviours.
• precautions to maintain health that make sense to
us, are rejected by community
• we look at actions from our own point of view as
health workers
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Cont....
– Example: emphasising national priorities in family
planning • Growing population, over usage of available
resources People are rational for the actions they take
A useful approach ‘value expectancy theory ‘
suggested that “people will only perform a
given behaviour if they themselves see that it
will provide some benefits”04/11/23 15M.Molla, SPH
Cont....2. Defining behaviour
• A starting point to understand people’s decision about
adopting a behaviour is defining the behaviour in detail
• Undefined behaviours may be general:
– Eg. Sanitation, hygiene
– Latrine use, washing hands after visiting toilets etc..
are specific behaviours which can be targeted
individually
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Cont...
3. Behavioural intentions and enabling
factors
• People may intend to do a certain
health behaviour but still not do so
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Cont...
• This may be because of the influence of enabling factors
• Lack of facilities
• Lack of time
• Lack of skill
• Lack of money
• Lack of information
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Cont...4. Social pressure:
• Is a direct influence or a belief that individuals hold towards what significant others/ salient referents think about their action
• Failure of most health education programs is that they are directed towards individuals
• Ignore the influence of other people
• Only few people do what they believe on04/11/23 19M.Molla, SPH
Cont..
• Influential people changes during the life time of a
person:
• As a child parents
• At early adolescence older friends
• Young person peer pressure
• Pressure from others could be positive or negative
Eg. Women’s decision of FP husband’s pressure
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Culture and behaviour
• Most people agree that culture has an important
role in determining behaviour
• It is common to hear terms such as cultural
practices, cultural beliefs, cultural values, and
cultural norms.
• Culture is a misunderstood term and actually
consists of three overlapping features:
– Shared characteristics
– Traditions and
– Belief systems04/11/23 21M.Molla, SPH
Shared characteristics
• Is a behaviour, value or belief which can be shared by
a group of people, a whole community, a society or
even a nation
• The term sub-culture can be also applied to a group
such as teenagers, solders, factory workers when we
consider their special characteristics
• Other words could be customs or norms i.e.,
something that is normal or common for the group
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Traditions
• Practices which has been maintained for a long
time and passed down from parents to children
• This is called the process of socialization
• Tradition is a result of primary socialization from
parent to children (first 5 years of a child)– Language– Habits,– Values beliefs and rules of behaviour are learnt– This happens by the child following instructions
by parents/ or observation of actions of adults
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Belief systems• While some behaviours
exist on their own, others
are part of a wider
system of beliefs such as
religion or traditional
medicine system• Eg. One person’s
avoidance of pork as a matter of dislike, others may not eat pork because, a person may be a Jew or a Muslim
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Cont..• Beliefs deal with peoples understanding of themselves and
their environment.
• Beliefs about the different possible outcomes from
performing an action are important in understanding
behaviour
• Knowing how a belief is formed helps to change the
behaviour
• Example : if a Pt. had a bad experience in health facility use,
then his belief towards health services will be negative
• If a belief is part of a wider belief system then it is difficult
to change. Eg. Religion
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Attitude• 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
• 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 mainly good outcomes, then the attitude will be favourable and vies versa.
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Values• Values are characteristics to be hold important
and prized by an individual or community
• Values are qualities at an abstract level such as
bravery and intelligence
• A persons value may be reflected as follows: “the
things that are important to me are....”
– Being a good, mother
– Having many children
– Owning a large number of cattle
– Having the respect of my community
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Values
• A person may have his/her own values, but
• Values are usually part of the culture and shared
at a community or national level
• Health is one aspect of values but community
related values may be more important
• In health education one has to bring important
health values this is called value- clarification
and usually carried out in small group
discussions04/11/23 28M.Molla, SPH
Health an ancient concept rooted in culture
• Many different traditional health systems are
practiced throughout the world
• Traditional healers are widely respected by many
• In the past, they were criticized and called
‘quacks’ and ‘witch doctors’
• Now, their role is recognized as important and
integrated in the primary health care in many
countries
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Health an ancient concept....
• To understand the health system in the community
certain questions should be raised about:
– Concept of health and illness
– Coping with illness “Telel” from butajira
– Beliefs about health , disease prevention and
treatment
– General beliefs concerning health and illness
behaviours-
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Traditional health systems
• There are many traditional health systems:
• Some of these includes
• The Hindu Ayurvedic medicine, the Chinese Yin/Yang
system and homeopathic medicine
• These are complex medical ‘systems’ with written
books, training colleges and registration procedures
for recognition
• Others are small scale, informal and passed on through
oral traditions and healers taking apprentices to study
under them
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Traditional health systems
• Traditional medical systems can be grouped in to two:
• The first group the ‘personalistic’ systems of medicine
where the blame of for illness is put on supernatural
forces, witchcraft, spirits or the ‘evil eye’ .
• The second group are the ‘naturalistic’ based on natural
expectations including theories of body, actions of herbs
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Types of traditional medicine system Supernatural / personalistic
Natural
Illness explained Active purposeful intervention of another person or supernatural agent, e.g. Through witchcraft, evil eye, spirits
Illness is explained in terms of concepts of disease and health. E.g. Lack of balance of body hot /cold
Extent to which same explanation for illness also applies for other misfortunes
Illness is only a special case of a wider misfortune
Limited only to disease only, not other disasters or misfortunes
Levels of causation Thinking about causes on different levels-not just cause of illness but who has caused it
Single level of cause, do not ask questions such as who caused it
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Types of traditional medicine system
Supernatural Natural
Diagnosis Powerful witch doctors or spiritualists needed to identify who has caused the illness. Treatment less important
Patient seeks aid for curers for relief of symptoms and not find what has happened
Nature of curers Curers are needed who have supernatural or magical divining power
Curers tend to be ‘ doctors’ in that they have learnt their skills through observation and practice and not through divine intervention
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Different ways in which culture can influence health
Lifecycle: family structure, role of women and
children, socialization, roles surrounding birth,
growing up, sex and marriage, family formation,
work , growing up old, death
Patterns of living and consumption: clothing,
housing, child rearing, food production consumption
and storage hygiene practices and sanitation
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Different ways in which culture can influence health....cont
Health and illness behaviours: ideas about
mental illness and handicap; care of sick people;
traditional medicine systems; patterns of help
seeking; use of doctors and traditional healers;
concepts about biological working of the body;
growth, conception; pregnancy, birth
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Different ways in which culture can influence health cont...
• Patterns of communication: language: verbal and
non verbal; taboos on public discussion of sensitive
items; oral traditions
• Religion and world view:
– Ideas about the meaning of life and death; rituals
surrounding important life events; ideas about
the possibility and desirability of change
• ;
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Different ways in which culture can influence health cont...
• Patterns of social and political organization:
– Political structures; community leadership and
authority; division and social inequalities
• Economic pattern/types of employment:
– Ideas about wealth and income; ownership of
land; use of money and barter; saving and
credit arrangements
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Principles of health education
• HE is pervasive
• HE is important for people from all walks of life
as applicable to changing conditions
• Can be institutional or a self learning process
• It is an educational and learning process
• HE should be need based
Principles of health education
• Educational diagnosis is necessary to assess the
need and the use appropriate method
• HE should be relevant and problem oriented
• Introduce new ideas with natural ease and
caution not to affect the culture
Principles of health education
• The Health Educator:
– should be aware of the predictors of health behaviour
– should have knowledge and skills of behavioural
sciences
• to understand health problems and their solutions
from a scientific and logical point of view
• the point of departure should be what people know
Principles of health education
• Freely discuss on the health problems and solutions
• There should be a free flow of communication (two way)
• The health educator has to make him self acceptable
– Practice what he/she professes
• Introduce small changes in graded fashion
Principles of health education
• Pumping all information at once is dangerous
• The client should have an opportunity for:
– Identification of problems
– Planning
– Implementation
– And evaluation
• This is best in community education and
participation
Principles of health education
• Use terms/languages that can be easily understood
• Drastic change of behaviour is dangerous.
– It may bring cultural conflict and resentment
particularly if the behaviour is in contrary to the
existing cultures
– Therefore, it should start from the existing culture
and gradually try at change of habit and practices
Some terms related to behaviour
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Some terms related to behaviour
• Awareness: This is the lowest level of cognition
• Perception: interpretation of the meaning given to sensory information
• Knowledge: is storage of information in the brain
• Attitude: the positive or negative predisposition of an individual towards a behaviour
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Terms related to behaviour cont..
Motivation
• It is a combination of forces which initiate, direct and sustain behaviour towards goal
• Two forces: – Intrinsic (psychological or internal factors)
factors
– Extrinsic (environmental) factors
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Terms related to behaviour cont..
Decision making:
• It is a process of commuting oneself to a particular course
of action or behaviour to achieve a particular goal.
• Based with reference to the final judgement a person has
to make a change of behaviour or adoption of new
practice.
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Terms related to behaviour cont..
Society:
Society arises out of community.
– Unlike community, which refers to the
structure, location and size of the population,
– society refers to the human relationship,
– behavioural patterns,
– cultural traits,
– institution, etc.,
– in the community 49M.Molla, SPH