Health Education and Promotion Module PDF

Health Education and Promotion Module:Behaviour change theories By Dr Olubunmi Adeyemi MB;BS, MPH, FWACP  Objectives of the Module Appreciate the role of health education and promotion in health maintenance and disease prevention U...

Health Education and Promotion Module:Behaviour change theories By Dr Olubunmi Adeyemi MB;BS, MPH, FWACP  Objectives of the Module Appreciate the role of health education and promotion in health maintenance and disease prevention Understand the theories and principles of health education as well as health promotion and communication for healthy behavioral change Understand the behaviour change theories Describe how beliefs and values influence healthy behaviour  Behaviour change theories Objectives of the topic: To understand behaviour change approaches To identify the various behavior change theories To understand and appropriate the various behaviour change theories  Outline Introduction to health promotion Health Promotion and Disease Prevention Theories and Models Behavioural change approach Common theories of Behavioural Change/ Health behavior Factors influencing behavioural change Conclusion  What is Health Promotion? Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. Public health is a multi-disciplinary field that aims to : 1) Prevent disease and death, 2) Promote a better quality of life, and 3) Create environmental conditions in which people can be healthy by intervening at the institutional, community, and societal level.  Health Promotion behaviors Health behaviour refers to activities people undertake to: Prevent diseases e.g. Behavioural change Communication; Government policies, Health education, immunization. Early detection of asymptomatic diseases through screening tests; mass vaccination, mass administration of chemotherapy. Public health practitioners depends upon their ability to accurately identify and define public health problems, assess the fundamental causes of these problems, determine populations most at-risk, develop and implement theory- and evidence-based interventions, evaluate and refine those interventions to ensure that they are achieving their desired outcomes without unwanted negative consequences. Thus, Public health practitioners must know how to apply the basic principles, theories, research findings, and methods of the social and behavioral sciences to inform their efforts.  Behaviour change approach Behavior change refers to any transformation or modification of human behavior. Refers to efforts put in place to change people's personal habits and attitudes, to prevent disease It may imply a broad range of activities and strategies which focus on the following: Individuals; having healthy diets and avoiding harmful health practices e.g. smoking or drug abuse Community; adoption of healthy cultural practices Environment; avoidance of open dumping of refuse and open defecation Behavioral scientists have devoted considerable effort to the development and evaluation of models and theories designed to understand and/or influence health behavior.  Behaviour change approach…2 Behavior change programs are activities that help a person or a community to reflect upon their risk behaviors and change them to reduce their risk and vulnerability Behavior change programs tend to focus on a few behavioral change theories The behavioural change model is a preventive approach and focuses on lifestyle behaviours that impact on health. These are interventions targeted at the level of individual, interpersonal and community  Health Promotion and Disease Prevention Theories and Models A thorough understanding of theories used in public health, which are mainly derived from the social and behavioral sciences is important to PH practitioners. Theories are plausible explanatory propositions devised to link possible causes to their effects. While models are schematic representations of reality or of one's view of a possible world, constructed to improve one's understanding about the world and/or to make predictions. There are several theories and models that support the practice of health promotion and disease prevention. The choice of theories or model depends on the situation; type of program planning to understand and explain health behavior and guide to the identification, development, including implementation of interventions.  Health Promotion and Disease Prevention Theories and Models... Public health theory refers to: Articulation of the framework of beliefs and knowledge which enable us to explain a specific phenomenon. When identifying a theory or model to guide health promotion or disease prevention programs, it is important to consider a range of factors, such as the specific health problem being addressed, the population(s) being served, and the contexts within which the program is being implemented. It helps to explain why individuals and communities behave the way they do, and so guide the educator in planning effective health promotion and disease prevention programs One of the major problems for public health practitioners is that theories are not articulated in everyday language but are made up of concepts and constructs which are often difficult to understand.  Behaviour change approach models It seeks to persuade individuals to adopt healthy lifestyle behaviours, use preventive health services, take responsibility for their own health. The main models of health include: Personal Behaviour Model (Health Model) Self-empowerment model. Collective action model. Relapse prevention model Behavioural theories also known as behavioral psychology, is a theory of learning which states all behaviors are learned through interaction with the environment through a process called conditioning.  Common theories of Behavioural Change/ Health behavior Ecological Models. Transtheoretical Model/Stages of Change Theory of Reasoned Action/Planned Behavior. Social Cognitive theory/ Learning theories Self-regulation theory Self-determination theory Protection motivation theory The Health Belief Model Health action process approach Behaviorist learning theory Diffusion of innovation theory  Dimensions of behavior Behavior has at least six dimensions, namely: Frequency or rate Duration Latency Topography Locus Force  Self-Efficacy/ Empowerment Model Self-efficacy implies the ability to take control of your life and be the master of your own destiny This refers to individual impression of their own ability to perform a demanding or challenging task. This is premised on: Belief in the ability to strive to achieve your set out targets and goal. Individual’s prior success in the task or related task Individual’s psychological and physiological state  Considerations to implementation Use of peer model e.g. Peer education on HIV/AIDS, sensible students Drugs policy Give the right, desirable and adequate health information Teach specific strategies that would enhance behavioural change Identify and capitalize on existing interests Encourage voluntary adoption of healthy lifestyle Establish effective communication with feedback mechanism  Ecological Model Ecological models highlights people’s interactions with their physical and sociocultural environments. It recognizes the influence of physical and socio-cultural environments on person’s health behavior.. It is a model that assist in providing a complete perspective on range of factors that influence health and well-being; affect specific health behaviors, including the social determinants of health. It recognize multiple levels of influence on health behaviors, including: Intrapersonal/individual factors: which influence behavior such as knowledge, attitudes, beliefs, and personality.  Ecological Model--2 Interpersonal factors: such as interactions with other people, which can provide social support or create barriers to interpersonal growth that promotes healthy behavior. Institutional and organizational factors: including the rules, regulations, policies, and informal structures that constrain or promote healthy behaviors. Community factors: such as formal or informal social norms that exist among individuals, groups, or organizations, can limit or enhance healthy behaviors. Public policy factors and laws: including local, state, and federal policies and laws that regulate or support health actions and practices for disease prevention including early detection,  Examples of Ecological Models Project HEART (Health Education Awareness Research Team) used an ecological model to design a health promotion and disease prevention program to address cardiovascular disease risk factors. using a community health worker (CHW) promotora model to provide services. CDC's Colorectal Cancer Control Program (CRCCP) was designed to address multiple factors of influence on colorectal cancer prevention, using ecological model components. Rural networks and coalitions often acknowledge multiple factors of influence and may be designed using theoretical components of ecological models.  Stages of Change Model (Transtheoretical Model) The Stages of Change Model, also called the Transtheoretical Model, explains an individual's readiness to change their behavior. This model views behavior change as a progression through a series of six stages or levels. In adopting healthy behaviours or elimination unhealthy ones, people progress through stages, which are: Pre-contemplation: There is no intention of taking action. Contemplation: There are intentions to take action and a plan to do so in the near future. Preparation: There is intention to take action and some steps have been taken. Action: Behavior has been changed for a short period of time. Maintenance: Behavior has been changed and continues to be maintained for the long- term. Termination: There is no desire to return to prior negative behaviors.  Considerations for Implementation It describes how an individual or organization integrates new behaviors, goals, and programs at various levels. At each stage, different intervention strategies will help individuals progress to the next stage and through the model. Individuals within a population will likely vary in their readiness to change Movement through this model is cyclical – individuals may progress to the next stage or regress to a previous stage. It may be an appropriate model for health promotion and disease prevention programs related to worksite wellness, tobacco use, weight management, medication compliance, addiction, and physical activity, among other health topics.  Theory of Reasoned Action/ Theory of Planned Behavior The Theory of Reasoned Action and the Theory of Planned Behavior are two closely related theories. This theory believes that achieving and maintaining behavior change requires intent to adopt a positive behavior or drop a negative one as well as the perception of social norms about the behavior. It assumes that individuals perceived and considered the behavioural consequences before performing the particular behaviour Such behaviour could be perceived as either positive or negative Consideration is given to how the society or community perceive such behaviour The intent to change one’s behaviour depends on the individual attitude and social pressure  Theory of Reasoned Action/ Theory of Planned Behavior…2 It suggests that a person's health behavior is determined by their intention to perform a behavior. It involves: A person's behavioral intention (intention to perform a behavior) which is also predicted by Person's attitude toward the behavior (personal evaluation of the behavior) Subjective norms regarding the behavior (what people believe about the behaviour. Subjective norms are the result of social and environmental surroundings and Person's perceived behavioural control (that one can exercise control over performing the behavior). Generally, positive attitude and positive subjective norms result in greater perceived control and increase the likelihood of intentions governing changes in behavior.  Theory of Planned Behavior Theory of planned behavior emphasizes the role of intention in behaviour In this case, incidence of actual performance is proportional to the amount of control the individual possesses over the behaviour and the strength of the individual’s intention.  Considerations for Implementation The Theory of Reasoned Action/Planned Behavior provide useful information for predicting health behaviors and for planning and implementing health promotion and disease prevention programs. Subjective norms can be used to describe the behaviors of healthcare providers, patients, care providers, and others in the community. These theories have been used to guide asthma counseling and treatment compliant, tobacco use interventions, and anti-drug media campaigns, among others. Example: Cervical cancer prevention program-The program components include strategies to increase knowledge and modify attitudes, beliefs, and behaviors, using the Theory of Planned Behavior as a guide.  Social Cognitive theory (SCT) This theory focuses on how people learn from individuals experiences, the actions of others, and their interaction with their environment itself. It recognizes that health behavior change is the result of reciprocal relationships among the environment , personal factors, and attribute of the behavior itself. Social Cognitive Theory (SCT) describes the influence of individual experiences, the actions of others, and environmental factors on individual health behaviors. SCT provides opportunities for social support through instilling expectations, self- efficacy, and using observational learning and other reinforcements to achieve behavior change. All the determinants interact to influence how we evaluate, interprete, organize and apply information  Key components of the SCT related to individual behavior change include: Self-efficacy: The confidence in one’s ability to take action and overcome barriers. (i.e. belief that an individual has control over and is able to execute a behavior. This is the most important personal factor in cognitive theory Behavioral capability/ learning: Understanding and having the skill to perform a behavior. Expectations: Determining the outcomes of behavior change. Expectancies: Assigning a value to the outcomes of behavior change. Self-control: Regulating and monitoring individual behavior. Observational learning: Watching and observing outcomes of others performing or modeling the desired behavior. Reinforcements: Promoting incentives and rewards that encourage behavior change.  Social cognitive theory cont’d In Social Cognitive Theory, people learn by observing others e.g. role model Focuses on the reciprocal interactions of factors identified to determine behavioural change Determinants are: Environmental: learning influences individual personal characteristics Personal: beliefs, expectations, values, culture, emotional makeup, genetic influence Behavioural element : what we do or say Examples: Using of skill-building exercises to increase independence and develop healthy behaviors among people. A community-based intervention designed to reduce the risk of HIV and other sexually transmitted diseases adopts the use of mentor mothers to provide information and risk reduction materials to the target population.  Considerations for Implementation Behaviour change results from interaction between person and environment Providing information and training about actions is essential Model positive outcome (s) of behaviour Using persuasion, support encouragement to promote healthy choice behaviour Identifying and emulating credible role models Providing rewards for healthy lifestyle Correcting negative behaviour that could deter positive change  Diffusion of Innovation Theory Diffusion of innovation theory places emphasis on innovations as an agent of behavioural change People and organization or societies adopt new ideas, products or behaviours at different rates and the rate of adoption is affected by some predictable factors, which are: The innovation self Communication channels Time (time it takes the message to get across) Social system (all kinds of components which construct the society e.g. religion, institutions, group of people, etc.)  Other theories Media theories Mass media can focus attention on issues, generating public awareness and momentum for change. Research on agenda setting has shown that the amount of media coverage of a given issue correlates strongly with public perception about its importance. Social movement theories Social movements refer to collective citizen actions to promote social changes in policies, laws, social norms, and values. Social movements promote legislative and policy changes to advance their causes and build coalitions with policy makers. They seek to influence the legislative process through mobilisation, financial and voting support for allies.  Other theories Cont’d Social network and social support theory This theory is characterized by web of social relationships that surround and influence individuals. The structural characteristics of networks refer to: The degree of similarity among members; resource exchange; emotional closeness; formal roles; knowledge and interaction among members; and power and influence among members. The functions of social networks refer to social trust, influence, support and criticism, emotional bonds, and aid and assistance. The types of social support can be emotional, informational, instrumental, and self- assessment.  Other theories Cont’d Theory of social norms The theory of social norms is based on the rules that a group uses to discriminate between appropriate and inappropriate values, beliefs, attitudes, and behaviours Social norms may be explicit or implicit, and failure to conform can result in social sanctions and/or social exclusion. Collective norms operate at the level of the social system (social network, community, entire society) and represent a collective code of conduct. Theories of complexity Complexity theorists argue that individuals are part of complex systems characterized by multiple interacting agents. They conclude that human behaviour is non-linear and unpredictable because of the number and diversity of agents and variables in the system  Importance of Behaviour change theory It aims to understand the environment and interpersonal influences (such as peers) in order to change behavior, which can be more effective than a focus on the individual to change behavior. Peer influences and normative beliefs are especially important when addressing behaviors in youth. Behavior change is complicated and complex because it requires a person to disrupt a current habit while simultaneously fostering a new, possibly unfamiliar, set of actions. The evidence shows that different patterns of behaviour are deeply embedded in people's social and material circumstances, and their cultural context. Interventions to change behaviour have enormous potential to alter current patterns of disease. This process takes time, usually longer than we prefer.  Drivers to successful behavior change Three key drivers of behaviour change are : Motivation Capability, which are internal conditions, and Opportunity, which is an external condition. These are all interlinked and can influence each other Examples of behavior changes Tobacco use, alcoholism, multiple sex partners, substance use, reckless driving, obesity, or unprotected sexual intercourse amongst others. Behavior modification can contribute to the success of self-control, and health- enhancing behaviors. Steps towards Lasting Behavioral Change Observing your own actions and their effects Analyzing what you observe Strategizing an action plan Taking action  Approaches to Behaviour Change Adoptive/adaptive leadership (Policy levels) New emergent roles (individual levels-life style changes and development of healthy habits) Talent and engagement strategy (community level)  Factors Influencing Behavioural Change Behavioural change is influenced by the following: Educational background Socio-economic factors Environmental factors Age of individual Gender Customs and traditions Cultural background Family Religion Thank you for listening