Lectures on Human Behaviour, Disease and Illness PDF

Defining Concepts: Human Behaviour, Disease and Illness Afoi B. Barry Dept. of Nursing, Bingham University Karu Outline Introduction Innate and learned Objectives Behaviour Defining Reflex Behaviour Behaviour Defining Human Principles of...

Defining Concepts: Human Behaviour, Disease and Illness Afoi B. Barry Dept. of Nursing, Bingham University Karu Outline Introduction Innate and learned Objectives Behaviour Defining Reflex Behaviour Behaviour Defining Human Principles of Behaviour Behaviour Features of Human Stimulus and Response Behaviour Conclusion INTRODUCTION This unit hopes to systematically analyze the term “behaviour” and specifically, “human behaviour” Some may argue why bother defining behaviour since it appears very obvious and simple. However, this assumption may be wrong, especially in trying to assess the underlying factors influencing behaviour.  Objectives At the end of this unit, you should be able to: Define behaviour‘ in a more general term Discuss principles of behaviour Define human behaviour Identify features of human behaviour Identify distinctions between human and animal behaviour.  Definition of Behaviour This generally refers to the actions or reactions of a person or animal or plant in response to external or internal stimuli. Behaviour is also viewed as an external change or activity exhibited by an organism. Or a manner in which something functions or operates. Behaviour can also be viewed as the way a person, animal, plant or chemical behaves or functions in a particular situation behaviour patterns are observable and measureable Principles of Behaviour Stimulus and Response Innate and Learned Behaviour Reflex Behaviour  Stimulus and Response A stimulus is any phenomenon that directly influences the activity or growth of a living organism. Phenomenon, means any observable fact or event, Stimuli can be of so many varieties e.g. chemicals, heat, light, pressure, and gravity and any environmental change. In some cases an internal environment can act as a stimulus.  Stimulus and Response Cont’d All creatures, are capable of automatic responses to stimuli e.g. when an animal reaches the age of courtship and mating it responds automatically to changes in its body. When a person inhales dust, pepper, or something he or she is allergic to, a sneeze follows. The person may suppress the sneeze but the body still responds automatically by initiating a sneeze. Innate and Learned Behaviour In general, behaviour can be categorized as either innate (inborn) or learned, but the distinction is frequently unclear. In many cases it is safe to say that behaviour present at birth is innate, but this does not mean that behaviour that manifests later in life is learned. Behaviour is considered innate when it is present and complete without any experience. Innate &Learned Behaviour Cont’d Behaviour is considered innate when it is present and complete without any experience e.g. at about four weeks, human babies smile spontaneously at a pleasing stimulus. Lower animals that lack a well-developed nervous system rely on innate behaviour. Higher animals, on the other hand, use both innate and learned behaviour. A fish is born knowing how to swim, whereas a human or a giraffe must learn how to walk.  Reflex Behaviour An excellent example of an innate animal behaviour, and one in which humans also take part, is the reflex. A reflex is a simple, inborn, automatic response to a stimulus by a part of an organism‘s body. The simplest model of reflex action involves a receptor and sensory neuron and an effector organ. Such a mechanism is at work by reflex e.g. salivating in the presence of food.  Reflex Behaviour Cont’d More complex reflexes require processing inter-neurons between the sensory and motor neurons as well as specialized receptors. These neurons send signals across the body, or to various parts of the body, as, for example, when food in the mouth stimulates the salivary glands to produce saliva or when a hand is pulled away rapidly from a hot object.  Reflex Behaviour Cont’d Reflexes help animals respond quickly to a stimulus, thus protecting them from harm. In contrast, learned behaviour results from experience and enables animals to adjust to new situations. If an animal exhibits a behaviour at birth, it is a near certainty that it is innate and not learned. Sometimes later in life, a behaviour may appear to be learned when, in fact, it is a form of innate behaviour that has undergone improvement as the organism matures.  Reflex Behaviour Cont’d For example, chickens become more adept at pecking as they get older, but this does not mean that pecking is a learned behaviour; on the contrary, it is innate. The improvement in pecking aim is not the result of learning and correction of errors but rather is due to a natural maturing of muscles and eyes and the coordination between them.  Definition of Human Behaviour Human Behaviour could be broadly defined as manner of acting or controlling oneself It could be viewed as an observable demonstration of capability, skill, or characteristics. Human behaviour could also be viewed as a definitive expression of capability, in that it is a set of actions that presumably, can be observed, taught, learned and measured Definition of Human Behaviour Cont’d These definitions therefore portray human behaviour as observable demonstration of skills and characteristics as well as definitive expression of such characteristics. This then indicates that human behaviour is not mechanistic but rather definitive, controlled and flexible. What then are the features of human behaviour. Features of Human Behaviour Verbal Voluntary Nonverbal Involuntary Conscious Normal Unconscious Abnormal Overt Covert  Verbal This means that human behaviour requires a language to express feelings and emotions. Lower animals also use a form of language to express feelings and emotions but human language appears to be more conscious and definitive. Verbal expression also stimulates good doctor/patient relationship and helps in better diagnosis of illnesses. Nonverbal This means human behaviour which is independent of a formal language. This type of behaviour can sometimes be observed through body languages and facial gesture.  Conscious This refers to a state of being aware of a stimulus or event. For example, a hungry or sick person is very likely to be aware of the state, which in turn triggers behaviours necessary for that particular stimulus. It is thus expected that an individual eats when hungry or visits the health professional when sick.  Unconscious This is an opposite of consciousness. Here a person is unaware of a stimulus or event. Interestingly, certain body languages that people exhibit could be categorized here. For example, an anxious person may be unaware to the fact that he or she is exhibiting certain behaviours like: tapping the foot, biting the fingers, sweating, etc. Also, a complete state of unconsciousness is best described while sleeping, if not rudely woken by a loud sound. Overt This form of human behaviour is open, observable and possibly measured. Good examples are a; child crying when in need or a sick person engaging in certain health habits (eating healthy, exercising), to feel better.  Covert Here, behaviour is closed, hidden and not readily observable. Certain cultural practices could trigger this type of behavioural pattern. A very interesting example is the belief that men are generally not supposed to cry because they are the stronger sex. They are expected to be brave and bear grief like men, though they may cry in the safety of their homes. Here, behaviour is covert because such emotions are not readily observed.  Voluntary Here, behaviour is performed willingly and controlled, and not forced. The adage that you can take a horse to the stream but you cannot force it to drink also applies to human behaviour. For example, a student must be willing to learn, and when forced could lead to school drop-out or exam malpractices. Involuntary This refers to actions or behaviour, performed suddenly without an ability to be controlled. For example, a sudden sharp pain could trigger a corresponding uncontrollable response like jerking or screaming. Normal Normal behaviour refers to typical, expected or ordinary activities that generally conform to a given norm and dictate of a society. For example, it is normal for a child to wet the bed or generally behave like a child but such behaviour could be frowned at when they are exhibited by an adult. Abnormal Abnormal behaviour refers to those activities that are different from the usual or expected. Thus, they are seen to be a deviation from the norm. CONCLUSION We have come to appreciate other technical aspects of behaviour and human behaviour, which appear simple and complex at the same time. The concepts introduced in this unit, such as stimulus and response, innate and learned behaviour etc. are not very difficult to apply in our activities of daily living. Try applying them and you will realize that they are much simpler than they appear. Defining Concepts: Human Behaviour, Disease and Illness Conceptualizing Health and Disease. INTRODUCTION: knowingly or unknowingly, we have different concepts of health that guide our behaviours. This unit, looks at different concepts of health and disease. OBJECTIVES At the end of this unit, you should be able to: Summarize the WHO perspective of health. Distinguish between holistic, positive and negative concepts of health Define Disease Determine Syndrome and Disease Determine transmission of Disease Ascertain social significance of Disease What is Health The Constitution of WHO, in conformity with the Charter of the United Nations declares that health is basic to the happiness, harmonious relations and security of all people: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. What is Health Cont’d The highest attainable standard of health is a fundamental human right without distinction of race, religion, political affiliation, economic and social isolation. The health of all people is fundamental to the attainment of peace and security. It is the responsibility of government to protect and provide the peoples health needs and social measures. What is Health Cont’d Unequal development in different countries in promotion of health, control of disease, especially communicable disease, is a common danger. The Healthy development of the child is essential and of basic importance to a healthy generation. What is Health Cont’d The informed opinion and active cooperation of the public are of utmost importance in the improvement of the health of the people. Components of health Is your health good, average or poor? The answers could be extracted from these three dimensions of health. A holistic dimension A positive dimension A negative dimension A Holistic Dimension of Health A Holistic Concept of health is the belief that being healthy means being without any physical disorders or diseases and being emotionally comfortable. E.g. a person with anxiety or low self- esteem, malaria or chickenpox or a wide range of unpleasant feelings is likely to label himself/herself ill according to this concept. Advantages of Holistic Dimension of Health It tends to make people sensitive about their health. They notice when something does not feel right within them and pay more attention to their bodies more quickly than other people. It can spur people to eat healthy and live healthy. Disadvantages of Holistic Dimension of Health It can lead to oversensitivity to signs and symptoms of illness. Oversensitivity can lead people to believe that they are ill when they are not. It can lead to unnecessary worry and result in people wasting their health care provider’s time.  A Positive Dimension of Health Is the belief that being healthy is a state achieved only by continuous effort. People with this belief take active steps to maintain their health e.g. choice of food, exercise and other activities they believe will keep them well. Such people feel responsible for their own health. They take credit for the continued healthy state and blame themselves if they develop symptoms. According to this view, people who do not take action to maintain their own health cannot be healthy even if there is nothing wrong with them (Cockerham, 2003).  Advantages of Positive Dimension of Health These people tend to take plenty of exercise, avoid smoking and excessive intake of alcohol, and eat a balanced diet. When ill, they adopt attitudes and behaviours that contribute to getting better. They believe they can recover and so tend to do better than those who believe that they are doomed to die. People with positive dimensions to health tend to be active rather than passive in relation to their own health Disadvantage of Positive Dimensions of Health One disadvantage of this concept is that, by taking responsibility for their own health, people might blame themselves for their illnesses and feel guilty when they become ill. A Negative Dimension Of Health A negative dimension of health is the view that being healthy is the absence of illness e.g. not having any symptoms of disease, pain or distress. People with this view are likely to believe that good health is normal and are likely to take it for granted. Advantage of Negative Dimension of Health A person with this perspective may be less anxious about his/health. Disadvantage of Negative Dimension of Health A person with negative health concept believes that being healthy is by chance, while those with positive concepts take active steps to stay well. He/she may think less of healthy habits as well as measures to live healthy. He/she may engage in self medication because good health is taken for granted.  Defining Disease Pathology is the study of diseases. Nosology is the subject of systematic classification of diseases Medicine is the broader body of knowledge about human diseases & their treatments. When we think of physical infirmities that we have had, we most often think in terms of what is wrong with our bodies biologically e.g. chicken pox, flu, diabetes, hypertension etc. Defining Disease Cont’d Sometimes the term “disease” is used broadly to include injuries, disabilities, disorders, syndromes, infections, symptoms, deviant behaviours, and atypical variations of structure and function, while in other contexts these may be considered distinguishable categories. Defining Disease Cont’d The term disease is also, often used metaphorically for disordered, dysfunctional, or distressing conditions of other things, as in disease of society. Disease thus alters the normal functioning of the body and creates a lot of anxiety for the sick person. It is also a universal phenomenon, constitutes a threat to survival and disrupts socio-economic life of people.  Defining Disease Cont’d Definition 1 A disease is a change away from a normal state of health to an abnormal state in which health is diminished Definition 2 It is an abnormality of the body or mind that causes discomfort, dysfunction, distress, or death to the person afflicted or those in contact with the person. Defining Disease Cont’d Definition 3 Cole (1970), defined disease as specific kinds of biological reactions to some kind of injury or change affecting the internal environment of the body. Definition 4 In biology, disease refers to any abnormal condition of an organism that impairs function.  Syndromes and Disease Medical usage sometimes distinguishes a disease, which has a known specific cause or causes (called its etiology), from a syndrome, which is a collection of signs or symptoms that occur together. many conditions have been identified, yet continue to be referred to as “syndromes” https://en.wikipedia.org/wiki/List_of_syndromes. Furthermore, numerous conditions of unknown etiology are referred to as diseases in many contexts (Taylor, 2006).  Transmission of Disease Influenza is are contagious/infectious diseases transmitted by a variety of mechanisms, e.g. aerosols produced by coughs and sneezes, insects bites or other vectors, contaminated water or food. Other diseases, such as cancer and heart disease are not considered to be due to infection, although micro-organisms may play a role, and cannot be spread from person to person.  Social Significance of Disease The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognitions of diseases of post-traumatic stress (PTSD), also known as “Soldier‘s heart”, “shell shock”, and “combat fatigue” https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967 Social Significance of Disease Cont’d Repetitive motion injury or Repetitive stress injury (RSI); and Gulf War syndrome has had a number of positive and negative effects on the financial and other responsibilities of governments, corporations and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread (Taylor. 2006).  Social Significance of Disease Cont’d A condition may be considered to be a disease in some cultures or eras but not in others. Oppositional-defiant disorder, attention- deficit hyperactivity disorder, and, increasingly, obesity are conditions considered to be diseases in the United States and Canada today, but were not so- considered decades ago and are not so- considered in some other countries.  Social Significance of Disease Cont’d Also, malaria, HIV/AIDS, childhood diseases like polio etc, seem to be top priority in the sub Saharan African countries. Lepers are also a group who were historically shunned and the term “leper” still evokes social stigma. Fear of disease can still be a widespread social phenomenon, though not all diseases evoke extreme social stigma. You may read this report https://www.pmnewsnigeria.com/2019/10/17/49-of-children-under-five-not-growing- well-in-nigeria-unicef/ CONCLUSION The fact that there are different perceptual dimensions of health does not mean that your attitude to health necessarily belongs to just one of them. You will probably find that you apply one concept in some situations and others on different occasions. Conceptualizing Illness Outline Defining Illness Perspectives of Illness Illness as subjective sensation of illness Illness as observable symptom of disease Illness as disorder or malfunction How concepts of Illness overlap How concepts of illness do not overlap Distinction between disease and illness Illness Dynamics Major Components of Illness Dynamics OBJECTIVES At the end of this unit, you should be able to: Provide an in-dept definition of illness. Determine perspectives of illness Determine how concepts of illness overlap Determine how concepts of illness do not overlap Distinguish between disease and illness Illustrate components of illness dynamics INTRODUCTION All of us have had experiences of getting sick and feelings of discomfort associated with it. Illness is certainly a universal human experience, irrespective of age, gender, religious belief or socio-cultural differences.  Definition of Illness Illness has several definitions. Some definitions cover up to the 18th century—to mean either wickedness, depravity, immorality, or unpleasantness. In simple terms the word "ill" is a contracted form of evil. Another definition, from the 19th century- meaning the state of being ill. Definition of Illness Cont’d Definition 1: Bishop (1994) defined Illness as the experience of suffering and discomfort, which may or may not be related to objective physical pathology. Definition 2: Barondness (1979); Jennings, (1986), defined illness as an experience of discomfort and suffering. These follow the 18th century definitions. Definition of Illness Cont’d Definition 3: Illness is also defined as a state or condition of suffering as the result of a disease or sickness. Definition 4: Illness is also the individual‘s perception and labeling of a set of physical and emotional experiences. Definition of Illness Cont’d Definition 5: a person‘s perception of their health, regardless of whether they in fact have a disease (Weiss and Lonnquist, 2005) These are 19th century definitions, suggesting cognition on illness perception and scientific view of illness (Cockerham, 2003).  Perspectives of Illness The perspectives of illness are: Illness as subjective sensation Illness as a set of symptoms or disease Illness as a disorder or a malfunction of a body tissue, organ or system  Illness as the Subjective Sensation A subjective sensation of illness means feeling ill. People might feel ill when they have some disease symptoms; or when no symptoms are present. By this definition, illness exists when people decide that they feel ill or describe themselves as being ill. Peoples anxiety or sensitive towards their health likely make them think they are ill even when symptoms are mild or absent.  Illness As Observable Symptoms Of Disease Disease refers to a diagnosable problem which may be physiological (a physical disorder) or psychiatric (a mental disorder). This view of illness is objective (evidence based). Also, when people become ill they usually develop symptoms. After developing symptoms, people think of themselves as ill and decide to take action  Illness As Observable Symptoms Of Disease Cont’d People might think of themselves as ill but a doctor or a hospital consultant may or may not be unable to detect any disorder. Sometimes, people might have a disease but not notice any symptoms, or might notice symptoms but not think of themselves as ill. E.g. a person with cold might ignore it and carry on as normal. There are different opinions about what is meant by being healthy or being ill (Bishop, 1994). Illness As A Disorder Or Malfunction The term disorder‘ refers to some malfunction of a body tissue, organ or system. This concept is based on the idea that body systems can go wrong. This definition is the one that the writer of a medical textbook is likely to have in mind (Cockerham, 2003). How Concepts of Illness Overlap Telling the difference between the three concepts of illness may be difficult because they sometimes overlap. Illness as subjective sensation can overlap with illness as having symptoms of disease. Symptoms of illness (e.g. pain and tiredness) are themselves subjective sensations. This overlap is most noticeable with mental disorders.  How Concepts of Illness Overlap Cont’d Unlike physical illnesses, mental disorders often have no symptoms that are detectable through observation, blood tests, scans, etc. A person suffering from depression is likely to have no observable symptoms apart from complaining of overwhelming feelings of misery and helplessness. In this case, illness as a subjective sensation is the same as illness as disease symptoms.  How Concepts of Illness Overlap Cont’d In other situations it is easier to tell the difference. A person with a skin rash (observable disease symptom) might not think of himself or herself as ill (subjective sensation) The concept of illness as disease symptoms can also overlap with illness as a disorder or malfunction. This is usually the case when the symptoms correspond very closely to the malfunction. For example, a person with a lung disorder such as pneumonia will experience difficulty in breathing. When Concepts of Illness Do Not Overlap However, in other situations these concepts of illness can be distinct. A person could experience symptoms, such as sneezing and a runny nose that are not caused by malfunction of any body tissue, organ or system. Rather, those symptoms are the result of ineffective functioning of the immune system to overcome a cold virus. In this case, illness as disease symptoms is distinct from illness as disorder or malfunction.  When Concepts of Illness Do Not Overlap A contrasting example is that a person can have a serious malfunction of body tissue (tumour growing on the spleen, abdomen and brain) but not feel ill until the tumour is pressing on surrounding tissue that has more sense organs This is because there are few sense organs in these parts of the body. So the sufferer might remain healthy with no sign of illness until it gets critical When Concepts of Illness Do Not Overlap Cont’d Another situation in which illness as symptoms of disease and illness as malfunction do not overlap is when the symptoms could be the result of a range of malfunctions. A person feels constantly tired and out of breath. A blood test reveals that the person is anaemic.  When Concepts of Illness Do Not Overlap cont’d The symptoms of tiredness, shortness of breath and anaemia do not arise from any particular disorder or malfunction. The anaemia could be caused by a disorder of the bone marrow, internal bleeding or dietary deficiency. Only further tests and investigations could reveal a specific disorder or malfunction. When Concepts of Illness Do Not Overlap Cont’d However, in most people who are seriously ill, these three aspects of illness occur together. People will think of themselves as ill, they will notice symptoms (e.g. partial paralysis) and they will have an organ malfunction (e.g. a stroke or bleed into the brain). Distinction between Illness and Disease Professor Marshall Marinker, a general practitioner, suggested over twenty years ago a helpful way of distinguishing between disease and illness. He characterizes these "two modes of unhealth as follows.  Distinction between Illness and Disease Cont’d Disease is a pathological process, most often physical. Disease can be thought of as the presence of pathology, which can occur with or without subjective feelings of being unwell or social recognition of that state. The quality which identifies disease is some deviation from a biological norm.. Distinction between Illness and Disease Cont’d There is an objectivity about disease which doctors are able to see, touch, measure, and smell.  Distinction between Illness and Disease Cont’d Illness is a feeling, an experience of un- wellness which is entirely personal, interior to the person or the patient. Thus, it is a subjective state of un-wellness, with certain individual differences in coping mechanisms. Often it accompanies disease, but the disease may be undeclared, as in the early stages of cancer. Sometimes illness exists without finding any disease.  Distinction between Illness and Disease Cont’d A person without any disease may feel unhealthy and believe he/she is ill. Another person may subjectively feel healthy and believe not to be ill even though he/she may have a disease such as dangerously high blood pressure, Alternatively, a person may have a disease and not feel ill. E.g. Hypertension is called the silent killer, it can exist for a long time without being detected Distinction between Illness and Disease Cont’d Many cancers can also exist and develop for weeks, months or even years without being detected (Weiss and Lonnquist, 2005).  Illness Dynamics The relationship among one‘s biological status i.e. genetic constitution and physical pathology, emotional makeup, and the supports and stresses of a social matrix (confluence of biologic, psychologic, and social aspects), represents the patient‘s understanding of a specific disease during a particular period of life.  Illness Dynamics Illness dynamics incline one to assess all illness-related information comprehensively covering values, wishes, needs, and fears, which causes the patient to perceive, assess, and defend against the loss of health in a highly subjective manner. This may significantly affect the patient‘s ability to cope with the disease positively or negatively. Major Components of Illness Dynamics Biological Psychological Social Biological Nature, severity, and time course of disease Affected organ, system, body part, or body function Baseline physiological functioning and physical resilience Genetic endowment  Psychological Maturity of ego functioning and object relationships Personality type Stage in the lifecycle Interpersonal aspects of the therapeutic relationship (e.g. counter-transferance of healthcare providers) Previous psychiatric history Effect of past history on attitudes toward treatment (e.g., postoperative complications) Social Dynamics of family relationships Family attitudes toward illness Level of interpersonal functioning (e.g., educational and occupational achievements, ability to form and maintain friendships) Cultural attitudes  CONCLUSION Illness definition is indeed not as easy as it appears because of its dynamic nature. In its subjective nature, illness is influenced not only by the person‘s biological state but also by cultural and social factors, situational variables, stress, personality, and concepts the person holds about the nature of disease. Thus illness represents a true interaction between physical, social and psychological milieu. CONCEPTUALIZING HEALTH BEHAVIOUR Outline Defining Health Behaviour Health Promotion: An Overview Dimensions of Health Behaviour What are Health Habits Complexities of Health Behaviour Conclusion Objectives Define health behaviour Illustrate an overview of health promotion Identify dimensions of health behaviour Explain and identify health habits Describe the complexities of health behaviour INTRODUCTION This course started by defining behaviour, human behaviour, diseases, health and illness. It discussed other health and illness related variables like illness and the mind-body relationship, acute versus chronic illness, and also scrutinized cultural and socio-demographic factors of health and illness. INTRODUCTION Cont’d The fact that social and cultural factors provide the context for the experience of health and illness is well established, but how then do we notice symptoms and perceive ourselves to be ill or healthy. A clear and in-depth definition of health behaviour as well as illness behaviour is been provided in previous lectures. INTRODUCTION Cont’d This is because we cannot conceptualize illness behaviour without first looking at health behaviour. A deviation in health behaviour could lead to illness and thus, illness behaviour. All the topics discussed in previous units and modules served as basic introductions to health and illness behaviours. INTRODUCTION Cont’d Remember that the term health is defined as a state of complete physical, mental and social well-being and not merely the absence of disease or/and infirmity. However, health is a broad term that includes both health and illness behaviours. Defining Health Behaviour Health behaviour is a broad term that includes: 1. Health Behaviour and 2. Illness behaviour Definition 1: Health behaviours are behaviours considered to be related to primary prevention of disease. Defining Health Behaviour Cont’d Definition 2: Health behaviour is any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting or maintaining health, whether or not such behaviour is objectively effective towards that end.  Defining Health Behaviour Cont’d Definition 3: The combination of knowledge, practices, and attitudes that together contribute to motivate the actions we take regarding health. Definition 4: Health behaviours are behaviours undertaken by people to enhance or maintain their health (Stone, 1979). Poor health behaviours are important because they are implicated in illness and may easily become poor health habits. Defining Health Behaviour Cont’d Definition 5: Health behaviours are behaviours that a person engages in, while still healthy for the purpose of preventing disease (Kasl and Cobb, 1966). These include a wide range of behaviour from stopping smoking, losing weight, exercising regularly and eating right.  Defining Health Behaviour Cont’d Definition 6: Health behaviour is an activity undertaken by a person believing himself/herself to be healthy, for the purpose of preventing disease or detecting it in an asymptomatic stage (for example, following a healthy diet). This is regarded as primary prevention of disease. Secondary prevention of disease is more closely related to the control of a disease that an individual has or that is incipient in the individual.  Defining Health Behaviour Cont’d Secondary prevention is most closely tied to illness behavior. Illness behaviour in this case is any activity undertaken by a person, who feels ill and discover a suitable remedy e.g. Visiting your health care provider. Tertiary prevention is generally seen as directed towards reducing the impact and progression of symptomatic disease in the individual  Defining Health Behaviour Cont’d This type of prevention is highly related to the concept of sick-role behaviour. Sick role behaviour is any activity undertaken for the purpose of getting well, by those who consider themselves ill e.g. taking prescribed medication or resting. It generally includes receiving treatment from appropriate therapists, involves a whole range of dependent behaviours, and leads to some degree of neglect of the person‘s usual duties.  Health Promotion: An Overview Health promotion is a general philosophy that has at its core the idea that good health, or wellness, is a personal and collective achievement. For the individual, it involves developing a programme of good health habits early in life and carrying them through adulthood and old age. For Health care providers, health promotion involves teaching people how best to achieve healthy lifestyle and helping people at risk for particular health problems learn behaviours to offset or monitor those risks (Maddux, et al, 1988). Health Promotion: An Overview Cont’d For the psychologist, health promotion involves the development of interventions to help people practice good health habits and change poor ones. For the community and the nation, health promotion involves a general emphasis on good health, the availability of information to help people develop and maintain healthy life styles, and the availability of resources and facilities that can help people change poor health habits. Health Promotion: An Overview Cont’d The mass media can contribute to health promotion by educating people about health risks posed by certain behaviours such as smoking, excessive alcohol consumption, unprotected sexual habits and sharing of sharp objects. Health Promotion: An Overview Cont’d The legislation can also contribute to health promotion by mandating certain activities that may reduce risk, such as the use of seat belts when driving, prohibition of drunk driving, mandatory immunization of children etc (Taylor, 2006)  Dimensions of Health Behaviour There is no consensus about the traits that constitute a genuinely healthy body. Ware (1986), identified 6 primary dimensions of health behaviours used by many researchers Physical Functioning Mental Health Social Well being Role Functioning General Health Perception Symptoms  Dimensions of Health Behaviour Cont’d 1. Physical Functioning: focuses on physical limitations regarding ability to take care of self, being mobile and participating in physical activities, ability to perform everyday activity; and number of days confined in bed. 2. Mental Health: focuses on feelings of anxiety and depression, psychological well-being and control of emotions and behaviour. 3. Social Well being: focuses on visiting or speaking on the telephone with friends, family and a number of close friends and acquaintances.  Dimensions of Health Behaviour Cont’d 4. Role Functioning: focuses on freedom and limitations in discharging usual role activities such as work or school 5. General Health Perception: focuses on self-assessment of current health status and amount of pain being experienced. 6. Symptoms: focuses on reports of physical and psychophysiological symptoms. (Weiss and Lonnquist, 2005).  What Are Health Habits? Health habits are health-related behaviour that are firmly established and often performed automatically, without awareness. These habits usually develop in childhood and begin to stabilize around age 11 or 12 (Cohen, Brownell and Felix, 1990). Wearing a seat belt, brushing one‘s teeth, and eating a healthy diet are examples of these kinds of behaviours.  What Are Health Habits? Cont’d Although, a health habit may have developed initially because it was reinforced by positive outcomes, such as parental approval, it eventually becomes independent of the reinforced process and is maintained by the environmental factors with which it is customarily associated. As such, it can be highly resistant to change. Consequently, it is important to establish good health habits and eliminate poor ones (Taylor, 2006).  What Are Health Habits? Cont’d A dramatic illustration of the importance of good health habits in maintaining good health is provided by a classic study of people living in California, conducted by Belloc and Beslow (1972). These scientists began by defining seven important good health habit: sleeping 7 to 8 hours at night, not smoking, eating breakfast each day, having not more that one to two alcohol drinks each day, getting regular exercise, not eating between meals, and being not more that 10% overweight. What Are Health Habits? Cont’d They then asked each of nearly 7,000 country residents to indicate which of these behaviours they practiced. Residents were also asked to indicate how many illnesses they had had, which illnesses they had, how much energy they had and how disabled they had been (for example, how many days of work they had missed on the previous six to twelve months period). What Are Health Habits Cont’d The researchers found that the more good health habit people practiced, the fewer illnesses they had, the better they felt, and the less disabled they had been. A follow-up of these individuals nine and half years later found that mortality rate were dramatically lower for both men and women practising the seven health habits. What Are Health Habits Cont’d Specifically, men following these health habits had a mortality rate only 28%, than that of men following zero to three of the health habits (78%), and women following the seven health habits had a mortality rate of 43% than that of women following zero to three of the health habits, (57%) (Breslow and Enstrom, 1980) Complexities of Health Behaviour Although, healthy and unhealthy lifestyles are commonly discussed as if a person either does or does not practice good health behaviour, research on health behaviours has shown that the practice of one health behaviour is often only weakly related to the practice of others (Kirscht, 1983, Mechanic, 1979). Why is this?  Complexities of Health Behaviour Cont’d The major reasons seem to be that health behaviours differ on a number of dimensions and may be influenced by different factors. For one thing, some health habits require that a person actively engage in positive activities, whereas others require the avoidance of harmful ones. A person may initiate good habits e.g. exercising and eating right, same person may have difficulty in avoiding the temptation to smoke and excessive use of alcohol. Complexities of Health Behaviour Cont’d In addition, some health habits such as brushing ones teeth, eating right and exercising, can be performed by the individual without professional assistance, whereas others, such as receiving regular check-ups or immunization, require medical supervision. Complexities of Health Behaviour Cont’d Health behaviours also differ considerably in their complexity. Some, like immunization or check-ups, are relatively simple and are performed only occasionally, many health behaviours, however, are repeated and are embedded in important habit patterns. For example, obtaining health benefits from exercise requires that the person exercise on a regular basis. Complexities of Health Behaviour Cont’d Positive habits like brushing one‘s teeth, and negative habits such as smoking and overeating, are closely related to the person‘s daily routines and general habits patterns. Beyond this, complex, long-term habits may become integrated together as a part of the person‘s overall life-style (Kirscht, 1983).  CONCLUSION Health behaviour is perceived as any activity undertaken by an individual, regardless of actual or perceived health status, for the purpose of promoting, protecting or maintaining health. Health promotion as well as complexities of health behaviours, dimensions of health behaviour and health habits could aid healthy living. CHANGING PATTERNS OF HEALTH AND ILLNESS CHANGING PATTERNS OF HEALTH AND ILLNESS Changing Patterns of illness and Disease Metamorphosis Environment, Health and Diseases Lifestyle, Health and Diseases Health/Illness and the Advent of New Technology Health/Illness and Health Research Changing patterns of Health/Illness and Epidemiology OBJECTIVES Analyze the changing patterns of illness and metamorphosis of disease Discuss the influence of lifestyle on the changing patterns of health/illness Identify environmental influences on health/illness Identify the role of technological advancement on disease detection Explain changing patterns of illness and health research Scrutinize the role of epidemiology on changing patterns of health/illness  INTRODUCTION Illness and health experience cuts across age, sex, religion, social, cultural, race, etc. We are able to appreciate the great metamorphosis that has been experienced in illness causation and origins, as well as in different health seeking habits. Before now, the human race reported less complicated illnesses, which are also mainly acute in nature and thus less complicated treatment regimes, but the narratives have since changed. INTRODUCTION Cont’d Most illnesses reported now are chronic and often times very complicated. What triggered these changes in illness patterns. changes in technology and lifestyle reflect directly to these observations. Patterns of disease have changed substantially in the past 100 years.  INTRODUCTION Cont’d Observations have shown that until the 20th Century, the major causes of illness and death were acute disorders, especially tuberculosis, influenza, pneumonia, cholera, etc. Presently, it could be observed that chronic diseases like cancer, diabetes, HIV/AIDS, heart diseases, etc. are major causes of illness. There has been an increase in what have been called the preventable‘ disorders, including the lung cancer, cardiovascular diseases, alcohol, drug abuse and vehicular accidents (Matarazzo, 1985). INTRODUCTION Cont’d Also, since 1900, life expectancy for both men and women has greatly improved in the western world and more recently in the developing world. This change is made possible by breakthroughs in treating and preventing infectious diseases such as polio, influenza, smallpox, rubella (Matarazzo, 1985).  INTRODUCTION Cont’d With the elimination of these diseases through vaccination, new diseases become more prominent and now account for more deaths. Cancer deaths, for example, have tripled, even among children, heart diseases, cancer and HIV/AIDS have become major killers. People may live with such chronic diseases, for many years. These changes affect illness behaviours and health seeking habits and decisions for treatment significantly.  Environment, Health and Disease Health hazzards in the environment, such as polluted water, air, toxic chemicals, refuse dumps, etc. have the potential to kill, injure and sicken individuals, and significantly influence the entire communities. Air pollution contributes substantially to respiratory ailments; toxic compounds have been shown to lead to cancer, chronic degenerative diseases, reproductive and developmental impairment, neurological problems and diseases of immune system (Bishop, 1994).  Lifestyle, Health and Disease Diseases like cancer, diabetes, HIV/AIDS, etc. that formed major causes of death and illness nowadays are in some respect, diseases caused by lifestyle and behaviour. Diet, smoking, stress, substance use & abuse are all behavioural factors that are associated with development of today‘s feared illnesses. At the turn of the century, 580 deaths in every 100,000 U.S. citizens were due to influenza, pneumonia, diptheria, tuberculosis, and gastro-intestinal infections. (Califona,1989).  Lifestyle, Health and Disease Cont’d Today, these diseases account for only 30 deaths per 100,000 citizens. This rapid decline in deaths from infectious agents, he argues, has been accompanied by increased numbers of deaths from diseases caused or facilitated by preventable behavioural factors such as smoking.  Health/Illness and Advent of New Technology Worthy of note is the fact that new technologies now make it possible to detect, prevent, and even identify genes that contribute to many disorders e.g. breast cancer, diabetes, etc. have been uncovered. Equipment for proper diagnosis of diseases like HIV/AIDS have improved the life-span of individuals. Health/Illness and Advent of New Technology Cont’d Such complex and innovative technologies have also aided the production of drugs needed to tackle several debilitating diseases. Thus, we could assert that the advent of new technologies have really paved way for more informed health seeking behaviour.  Health/Illness and Health Research Helping people to make informed and appropriate decisions appears to be at the forefront of health research. Research has revealed diseases and lifestyles that could lead to some diseases. Thus people could learn to change their diet and stick to their resolution. Research has indeed given us feedback on healthy living.  Changing Patterns of Health/Illness and Epidemiology Changing pattern of illness could also be analyzed from the point of view of epidemiology. Epidemiology is the study of frequency, distribution and causes of infectious and noninfectious diseases in a population, based on an investigation of the physical and social environment. Changing Patterns of Health/Illness and Epidemiology Cont’d Epidemiologists not only study who has what kind of cancer, but address questions such as why some cancers are more prevalent in certain areas than others, likewise HIV/AIDS and other communicable and non-communicable diseases. CONCLUSION It is indeed very obvious that there are many variables associated with changing patterns of health and illness. Suffice to note that variables such as lifestyle, health researches, new technology, disease metamorphosis, epidemiological variables all combine to form coherent understanding in this regard. Please note that the variables presented here are just few of the many factors that influence such observable changing patterns of health and illness. Please, feel free to come up with more. THEORETICAL APPROACHES TO HEALTH AND ILLNESS BEHAVIOUR Outline Expectancy-Value Model Social Learning Model Fishbein‘s Theory of Reasoned Action The Health Belief Model Attribution Model The Health Perception Approach Social Network/Social Support Theories Naturalistic Viewpoint Conclusion  OBJECTIVES At the end of this unit, you should be able to: Describe Expectancy-Value Model as well as its 3 main approaches Discuss the role of Attribution Model of health and illness perception Determine the influence of Health Perception Model on illness and health seeking behaviours. Discuss the social network/social support theory Describe the views of Naturalistic Model of illness perception and causation.  INTRODUCTION All theories of health and illness serve to create a context of meaning within which the patient can make sense of his or her bodily experience. A meaningful context for illness usually reflects core perceptual, social, and expectancy values. The following are models that would broaden our conception of health and illness behaviour.  Expectancy-Value Model Many models of health and illness behaviour are based upon an expectance- value approach to motivation. This asserts that individuals are motivated to maximize gains and minimize losses. Behavioural choice and persistence are a function of the expected success of the behaviour in attaining a goal and the value of the goal. Expectancy-Value Model Cont’d Three models based on expectancy- Value Model approach are: Social Learning Theory Fishbein’s Theory of Reasoned Action The Health Belief Model  Social Learning Theory Rotters‘s Social Learning Theory posits that: the potential for behaviour to occur in any specific situation is a function of the expectancy that the behaviour will lead to a particular reinforcement in that situation and the value of that outcome‘ (Rotter, 1954). A sick person is likely to take a day or two off from work if he or she expects to be pampered by worried relatives and vice versa.  Social Learning Theory Cont’d One generalized expectancy is “locus of control” which is the generalized expectancy that whether one‘s own behaviour or forces external to oneself, controls reinforcement. Starting with Rotter‘s Scale, measuring generalized expectancies on one dimension (Rotter, 1966), locus of control has been expanded to include three orthogonal dimensions viz:  Social Learning Theory Cont’d 1. internal 2. Powerful and 3. Chance. (Levenson, 1973). Locus of control can be measured as a general expectancy or an expectancy specific to a particular situation. Strickland (1978) therefore suggests that in a novel or ambiguous situation an individual‘s behaviour is predictable from generalized expectancies.  Social Learning Theory Cont’d The concept of health as a value has been neglected in health research. It is frequently assumed that the value placed on health is uniformly high. The most common method of measuring health is based on Rockeach‘s terminal value ranking test (1973), respondents were asked to assess the value of health relative to items such as: a comfortable life, world peace, happiness and health.  Fishbein’s Theory of Reasoned Action This theory is based on the assumption that most human behaviour is under voluntary control and hence is largely guided by intention. Intention is determined by both the individual‘s attitude towards performing the behaviour and their subjective norms, i.e. their. perception of the degree to which significant others think performing the behaviour is important (Fishbein and Ajzen, 1975). Fishbein’s Theory of Reasoned Action Cont’d The attitude component is the product of the beliefs (expectations) that performing a specific behaviour will lead to a certain consequence, and the individual‘s valuation of that consequence (i.e., how good or bad such an outcome would be). The subjective normative component of the model also incorporates an expectancy and value component. Fishbein’s Theory of Reasoned Action Cont’d It is the product of the expectation that important others will consider the performance of the behaviour important and the value of that person‘s approval. This theory thus considers both the individual‘s attitude towards a behaviour as well as the influence of social environment as important predictors of behavioural intention Fishbein’s Theory of Reasoned Action Cont’d The relative contribution of the two components of the model will in part depend on the behaviour in question. For example, a pregnant woman is likely to go through the pain and rigors of pregnancy because of the value and the joy that a new baby brings. The Health Belief Model The Health Belief Model (HBM), unlike the previous theories was developed to explain and predict behaviour in health context (Becker, 1974). While originally developed to predict preventive health behaviours, the model has also been used to predict behaviour of both acute and chronically ill patients. The Health Belief Model Cont’d The likelihood of an individual undertaking a particular action is seen as a function of the individual‘s perception of: Their susceptibility to the illness The seriousness of the illness The potential benefit and costs involved in undertaking the particular action The Health Belief Model Cont’d Cues to action, which may be internal (such as the perception of a symptom) or external (such as health education message) will determine whether behaviour is performed. The precise way in which the variable combine to predict behaviour is unclear. Stone (1990) suggests that the HBM makes relative rather than quantitative predictions.  Attribution Model Attribution Model is concerned with the way people explain events (Kelly and Michela, 1980). It deals with causes that individuals infer from outcomes that occurred in the past. By contrast, Social Learning Theory deals with expectancies about the future. The distinction between attribution of causes of past events and perceived control over a future situation has been made by Brickman et al. (1983). Attribution Model Cont’d They treat judgement about the cause of a problem as separate from judgement about solutions to the problem. Hence in a health-related context, attributions concerning the origin of an illness will not necessarily be the same as attributions concerning its treatment or course.  The Health Perception Approach This view is based on the notion that illness related to behaviours result from a series of decisions based on how patients view their current health situations (Garrity and Lawson, 1989). A patient‘s understanding of his or her clinical status is seen as equally important as actual physical status in determining behavioural health outcomes such as return to work and resumption of activities. The Health Perception Approach Cont’d Patient‘s mood and behaviour concerning their illness are seen as resulting from what they believe about how severe their disorder is, and, within the limits of the patient‘s actual physical disability, recovery is bound to health perceptions.  Social Networks/Social Support Theories Health educators today recognize the importance of the social environment and advocate changes in the social ecology which supports individual change to better health and a higher quality of life. Long-term behavior change depends on the level of participation and ownership felt by those being served within the community.  Social Networks/Social Support Theories Cont’d Social networks can be kin (extended family) or non-kin (church or work groups, friends or neighbours who regularly socialize in clubs and sporting teams). Social networks have certain types of characteristics: (1) Structural, such as size (number of people) and density (extent to which members really know one another); Social Networks/Social Support Theories Cont’d (2) Interactional, which include reciprocity (mutual sharing), durability (length of time in relationship), intensity (frequency of interactions between members), and dispersion (ease with which members can contact each other) (3) Functional, such as providing social support, connections to social contacts and resources, and maintenance of social identity.  Social Networks/Social Support Theories Cont’d Social support also refers to the varying types of aid that are given to members of a social network. Research indicates that there are four kinds of supportive behaviors or acts: (1) Emotional support - listening, showing trust and concern; (2) Instrumental support - offering real aid in the form of labor, money, time.  Social Networks/Social Support Theories Cont’d (3) Informational support - providing advice, suggestions, directives, referrals. (4) Appraisal support -affirming each other and giving feedback. This social support is given and received through the individual's social network. However, it is important to remember that "some or all network ties may or may not be supportive."  Naturalistic Model Naturalistic theories of disease causation tend to view health as a state of harmony between a human being and his or her environment; when this balance is upset, illness will result. When the body is in balance with the natural environment, a state of health prevails. When that balance is disturbed, illness results. People invoke both types of causation in explaining an episode of illness, treatment may entail two corresponding types of therapy.  CONCLUSION As we have seen, theories about health and illness deal with ideas people use to maintain a healthy state. Such ideas spanned from perceptual, social and expectancy values. Expectancy-Value Approach looked at motivation and health/illness behaviour. The Social Learning perspective is of the notion that the potential for illness or health behaviour is a function of expectancy that the behaviour will lead to a particular reinforcement.  CONCLUSION Cont’d The Feishbein‘s Theory of Reason Action is also based on the assumption that most human behaviour in health/illness is under voluntary control and hence largely guided by intentions. The Health Belief Model, its approaches and principles are based on how individuals predict and behave in health context. Also, attribution theory is concerned with how individuals explain events..  CONCLUSION Cont’d Health Perception Approach view, health/illness related behaviour is a series of decisions based on how patients view their current health status’ While the naturalistic model saw illness as resulting from imbalance between the nature and the body. Lastly, the social support view, looked at the varying types of aid that are given to members of a social network FOUNDING FATHERS OF SOCIOLOGY Outline Introduction Objective Auguste Comte and Positivism Herbert Spencer and Social Darwinism Karl Marx and Class Conflict Emile Durkheim and Social Integration Max Weber and Protestant Ethics Talcott Parsons and C. Wright Mills: Theory vs Reforms Conclusion Objectives At the end of this unit, you should be able to: List the founding fathers of sociology Identify their specific contributions to sociology Describe the latest shift in emphasis among founding fathers of sociology.  INTRODUCTION Several persons became founding fathers by their great contributions to the origin and development of Sociology. It is noteworthy that each of these great Sociologists contributed by adopting a central theme, phrase or concept which became a focal point at the birth of Sociology. From the adoption of the name ‘Sociology’ through its peculiar imagination to theoretical formulation, forerunners and founding fathers have emerged. Auguste Comte and Positivism The idea of applying the scientific method to the social world is known as “positivism”, apparently was first proposed by Auguste Comte (1798-1857). With the French Revolution still fresh in his mind, Comte left the small town in which he had grown up and moved to Paris. The change he experienced, combined with those France underwent in the revolution, led Comte to become interested in what holds society together.  Auguste Comte and Positivism Cont’d What creates social order, he wondered, instead of anarchy or chaos? And then, once society does become set on a particular course, what causes it to change? As he considered these questions, Comte concluded that the right way to answer them was to apply the scientific method to social life. Just as this method had revealed the law of gravity, so too, it would uncover the laws that underlie society. Auguste Comte and Positivism Cont’d Comte called this new science “sociology” – the study of society. From the Greek “logos” (study of) and the Latin “socius” (comparison or being with others). Comte stressed that this new science (Sociology) not only would discover social principles but also would apply them to social reforms, to making society a better place to live.  Auguste Comte and Positivism Cont’d To Comte, applying the scientific method to social life meant practicing what might be called “armchair philosophy” drawing conclusions from informal observation of social life.  Auguste Comte and Positivism Cont’d Since Comte insists that we must observe and classify human activities in order to uncover society’s fundamental laws, and because he developed this idea and coined the term ‘sociology’. Comte is often credited as being the founder of Sociology. Herbert Spencer and Social Darwinism Herbert Spencer (1820-1903), a native of England, is sometimes called the second founder of sociology. Unlike Comte, Spencer stood firmly against social reform. In fact, he was convinced that no one should intervene in the evolution of society. Spencer was convinced that  Herbert Spencer and Social Darwinism Cont’d Thus overtime, societies steadily improve. Interfering with this natural process is discouraged. The fittest members will produce a more advanced society unless misguided people get in the way and let the less fit survive. Spencer called this principle “the survival of the fittest”. Herbert Spencer and Social Darwinism Cont’d Although Spencer coined this phrase; it usually is attributed to his contemporary, Charles Darwin, who proposed that organisms evolve over time as they adapt to their environment. Because they were so similar to Darwin ideas, Spencer‟s view of the evolution of societies became known as “social Darwinism”. Herbert Spencer and Social Darwinism Cont’d Like Comte, Spencer was more of a social philosopher than a sociologist. Also like Comte, Spencer did not conduct scientific studies, but simply developed ideas about society. Karl Marx and Class Conflict Cont’d The influence of Karl Marx (1818-1883) on world history has been so great. Marx, who came to England after being exiled from his native Germany for proposing revolution, believed that the engine of human history is “class conflict”. Karl Marx and Class Conflict Cont’d He said that the bourgeoisie (the controlling class of capitalists, those who own the means to produce wealth – capital, land, factories and machines) are locked in conflict with the proletariat (the exploited class, the mass of workers who do not own the means of production). Karl Marx and Class Conflict Cont’d This bitter struggle can end only when members of the working class unite in revolution and throw off their chain of bondage. The result will be a classless society, one free of exploitation, in which everyone will work according to their abilities and receive according to their needs Marxism is not the same as communism. Karl Marx and Class Conflict Cont’d Although Marx supported revolution as the only way that the workers could gain control of society, he did not develop the political system called communism.  Emile Durkheim and Social Integration Cont’d The primary professional goal of Emile Durkheim (1858-1917), who grew up in France, was to get sociology recognized as a separate academic discipline. Up to this time, sociology was viewed as part of history and economics. Durkheim achieved this goal when he received the first academic appointment in sociology, at the University of Bordeaux in 1887.  Emile Durkheim and Social Integration Cont’d Durkheim had another goal to show how social forces affect people‟s behaviour. To accomplish this, he conducted rigorous research. Comparing the suicide rate of several European countries (1897/1966) and (found that each country’s suicide rate was different and that each remained remarkably stable year after year.  Emile Durkheim and Social Integration Cont’d He also found that different groups within a country had different suicide rates which remained stable from year to year. From this, Durkheim drew the insightful conclusion that suicide is not simply a matter of individuals deciding to take their lives for personal reasons. That social factors underlie suicide and so keeps those rates fairly constant year after year. Emile Durkheim and Social Integration Cont’d Durkheim identified social integration, the degree to which people are tied to their social group, as a key social factor in suicide. He concluded that people with weaker social ties are more likely to commit suicide.  Emile Durkheim and Social Integration Cont’d The central principle in Durkheim’s study of suicide was that human behaviour cannot be understood simply in individualistic terms. We must examine the social forces that affect people’s lives. If we look at human behaviour (such as suicide) only in individualistic terms, we miss its social basis. Emile Durkheim and Social Integration Cont’d Like Comte, Durkheim also proposed that sociologists intervene in society to improve it. He suggested that new social groups be created. The family and these groups would meet people’s need for a sense of belonging.  Max Weber and the Protestant Ethic Cont’d Max Weber (1864-1920), a German sociologist and a contemporary of Durkheim, also held professorship in the new academic discipline of sociology. With Durkheim and Max, Weber is one of the most influential Sociologists. Weber disagreed with Marx’s1s claim that economics is the central force in social change. According to Weber, that role belongs to religion.  Max Weber and the Protestant Ethic Cont’d Weber (1904) theorized that Roman Catholic belief system encouraged them to hold on to traditional ways of life, while the Protestant belief system encouraged its members to embrace change. Protestantism, he said, undermined people’s spiritual security. Roman Catholics believed that because they were church members, they were on their road to heaven.  Max Weber and the Protestant Ethic Cont’d But Protestants who did not share this belief, turned to outside “signs” that they were in God’s will financial success became the major sign that God was on their side. Consequently, Protestants began to live frugal lives, saving their money and investing the surplus in order to make more. This according to Weber brought about the birth of capitalism  Max Weber and the Protestant Ethic Cont’d Weber called this self-denying approach to life the “Protestant ethic” and termed the readiness to invest capital in order to make more money “the spirit of capitalism”. Testing his theory, Weber compared the extent of capitalism in Roman Catholic and Protestant countries. In line with this theory, he found that capitalism was more likely to flourish in Protestant countries.  Talcott Parsons and C. Wright Mills: Theory versus Reform During the 1940s, the emphasis shifted from social reforms to social theory. Talcott Parsons (1902-1979), for example, developed abstract models of society that greatly influenced a generation of sociologists. Parsons’s detailed models of how the parts of society harmoniously work together did nothing to stimulate social activism. Talcott Parsons and C. Wright Mills: Theory versus Reform Cont’d C. Wright Mills (1916-1962) developed the theoretical abstractions of this period and in 1956, he urged sociologists to get back to social reform. He saw the coalescing of interests on the part of a group he called “the power elite” i.e. the top leaders of business, politics, and the military, as an imminent threat to freedom. Talcott Parsons and C. Wright Mills: Theory versus Reform Cont’d Shortly after Mills’ death, fueled by the Vietnam War, the United States entered a turbulent era of the 1960s and 1970s. Interest in social activism was sparked, and Mills’ idea became popular among a new generation of sociologists. Talcott Parsons and C. Wright Mills: Theory versus Reform Cont’d The apparent contradiction of these two aims i.e. “analyzing society versus working toward its reform” creates a tension in sociology that is still evident today. Some sociologists believe their role is to analyze some aspects of society and publish their findings in sociology journals. Others say this is not enough that sociologists have an obligation to make society a better place in which to live. CONCLUSION From its inception, Sociology has developed approaches to the scientific and/or systematic study of the society. Its contributions to the understanding of the social forces within the society as contained in the works of the founding fathers cannot be over-emphazised. The development within the discipline of sociology in contemporary time is a product of the effort of the founding fathers ATTITUDE CHANGE AND SPECIFIC HEALTH BEHAVIOUR PROBLEMS ATTITUDE CHANGE AND SPECIFIC HEALTH BEHAVIOUR PROBLEMS 1 Preventive Health Behaviour 2 Attitude Change and Health Promotion 3 Addressing Specific Health Behaviour Problems Preventive Health Behaviour Introduction Objectives Understanding Preventive Health Behaviour Determinants of Preventive Health Behaviour Major Trends in Preventive Health Behaviour Conclusion OBJECTIVES At the end of this unit, you should be able to: Describe preventive health behaviour. Identify the determinants of preventive health behaviour. Illustrate the major trends in preventive health behaviours. Understanding Preventive Health Behaviour Preventive health behavior generally follows from a belief that certain health behavior will benefit health. An obvious example is quitting smoking to reduce the chances of early morbidity and mortality or exercising for stronger cadiovascular muscles and good health. There is no one theory or concept that explains why people perform certain behaviors. Many theories have been developed to describe, understand, explain, and influence health-related behavior. Understanding Preventive Health Behaviour Cont’d Although these theories contribute substantially to our understanding of individual behavior, they are often limited because the broader social and environmental context in which an individual lives is not taken into account. It is becoming increasingly recognized that individual unhealthful behaviors reflect the social, cultural, and environmental contexts within which they occur. Determinants of Preventive Health Behaviour Although individual actions contribute to a person's health behavior, preventive health behavior is not totally volitional. Socio-cultural and environmental aspects of a person's life influence preventive health behavior, and these factors can have minimal to great effect in determining whether a preventive health behavior is performed. Determinants of Preventive Health Behaviour Cont’d Some preventive health-related behaviors occur for reasons unrelated to health. Cultural traditions, attitudes, and beliefs can play an important role in the ways in which people behave. In Mediterranean countries, the traditional diet has been found to be an important preventive diet. The traditional meal is often cooked in olive oil, which may help in preventing heart disease. Determinants of Preventive Health Behaviour Cont’d Social, economic, and cultural determinants of behaviors are closely linked. For many years it was unfashionable for women to smoke cigarettes. In the decades since this taboo was removed, there have been substantial gender-related changes in the overall burden of smoking-related diseases. Determinants of Preventive Health Behaviour Cont’d Between 1981 and 1996 the per-person mortality burden of smoking-related diseases such as lung cancer and chronic obstructive pulmonary disease decreased by 15 percent and 16 percent, respectively, for males, but increased by 62 percent and 70 percent for females. Currently, 24.2 percent of adult men and 20.9 percent of adult women smoke cigarettes, according to the Centers for Disease Control and Prevention (CDC). Determinants of Preventive Health Behaviour Cont’d Preventive health-related behaviors are also undertaken specifically to improve or enhance health. These types of behavior include both primary prevention and early detection. Primary prevention behaviors aim to prevent the incidence of disease (the number of new cases occurring within a given time frame). Determinants of Preventive Health Behaviour Cont’d Exercise to improve aerobic fitness and prevent cardiovascular disease is an example of a primary preventive behavior. People who increase their levels of physical activity have been found to have reduced levels of risk factors such as high blood pressure, high blood cholesterol, and excess body fat. Early detection (or secondary prevention) behaviors aim to prevent early forms of disease from progressing. Determinants of Preventive Health Behaviour Cont’d This involves people who have already developed preclinical disease or risk factors for disease but in whom the disease has not yet become clinically apparent. Behaviors such as having a breast screen (mammogram) or a pap test for cervical cancer are intended to detect disease early so it can be treated promptly (Westbeng and Janson, 1996). Determinants of Preventive Health Behaviour Cont’d Some preventive health-related behaviors may, or may not, improve health outcomes. It is becoming increasingly common for people to use a range of complementary and alternative medicines to improve their health. The 1995 Australian National Health Survey estimated that almost 26 percent of the population used vitamin or mineral supplements, and over 9 percent used herbal or natural medications. Determinants of Preventive Health Behaviour Cont’d Females used these therapies more than males. These behaviors are undertaken with the hope of improving health without clear evidence that the practice has beneficial effects for individuals or populations. Major Trends in Preventive Health Behaviour Despite the general good health of people in developed and developing countries, there is still considerable scope for improvement in preventive health behaviors. Unfortunately, the last years of the twentieth century and early twenty first century saw only modest improvements in this area. The number of people using seat belts has improved due to several sensitization programmes. Major Trends in Preventive Health Behaviour Cont’d This period also saw a reduction in the number of people reporting driving while over the blood alcohol limit and a reduction in alcohol-related motor vehicle deaths. Also, economic hardship in some countries may have stopped many from drinking excessively. Major Trends in Preventive Health Behaviour Cont’d In African countries, society frowns at women that smokes so cases of lung cancer is not very common among this group, though, the younger generation appears to be smoking more than the older ones. Although there is a strong association between dietary behavior and many chronic illnesses, there has been little change in terms of people following dietary guidelines or eating fresh fruits and vegetables. Obesity has continued to increase, with no real change in physical activity. CONCLUSION It is clear that individual preventive behaviors such as eating healthy, exercising regularly, moderation in the use of alcohol and the avoidance of tobacco and tobacco products can contribute greatly to a person's health. However, preventive health behavior is but one element within a complex range of influences on health. Biological, social, environmental, and economic factors also play a role. Together these influence the health outcomes for individuals as well as for populations. ATTITUDE CHANGE AND HEALTH PROMOTION Introduction Fear Appeal Objectives Mass Media Appeal Principles used to Self help Groups promote attitude Health Promotion in change and positive the schools health behaviour Health Promotion in Information Appeals the work place Persuasion Health Promotion in Key factors in the communities Persuasion Conclusion OBJECTIVES At the end of this unit, you should be able to: Identify and discuss the principles used to promote attitude change and positive health behaviour. Discuss the goals of health promotion in schools, workplaces and communities. Principles Used to Promote Attitude Change and Positive Health Behaviour How can we go about promoting these attitude changes? This question has been the focus of great deal of research among health professionals. Beginning in the 1950‘s, many studies have examined in great detail how people respond to persuation attempts and the process involved. From these researches have come principles that can be used to promote attitudes and beliefs conducive to good health behaviour (Bishop, 1994). The following are some of the principles identified: Information Appeals Promoting good health behaviour requires that people be aware of the connections between behaviour and health and know what is involved in healthy behaviour. For example, motivating people to eat a balanced and healthy diet or engage in more physical exercise demands that they be aware of the role of diet and exercise in health and realize their importance. So, a necessary step in changing health behaviour is providing people with information to guide their actions. Information Appeals Cont’d This is a simple enough proposition, but there is more to information appeal than simply providing the information. Bringing about changes in behaviour through information appeals involves at least five different processes. (McGiure, 1969). They are: Audience attention comprehension. Yielding Retention Action  Information Appeals Cont’d We need to get the audience attention: This is no mean feat, considering the amount of information that people are constantly bombarded with. Once a message is received, the next step is comprehension. For a message to be comprehensive, it must be presented in terms that are understandable to the audience and that fit their conceptions of health and illness. Information Appeals Cont’d Assuming the message is understood by the audience, the third step in persuasion is yielding, that is, accepting the position advocated by the message. For information to have a long-term effect there must also be message retention, and finally, action in which the person‘s behaviour changes to become healthier. Persuasion How can we facilitate these processes and increase the likelihood that health information will be effective in changing health behaviour? Studies of persuasion have identified key factors in persuasion. They are:  Key Factors in Persuasion Cont’d First, the effectiveness of a message often depends on who presents it. It is clearly advantageous for a message to be delivered by a communicator who is perceived as an expert or trustworthy. For health messages, physicians and other health professionals are ideal communicators, especially when they are well known and prestigious. Also, traditional rulers, religious heads, non-governmental organizations, parents, etc. could also act as communicators of health messages, especially in the area of HIV/AIDS and safe sex. Key Factors in Persuasion Cont’d Secondly, messages are more likely to be accepted when they are presented by communicators who are attractive (Chaiken, 1979), confident in their delivery and perceived as similar to the audience. For example, information on female genital mutilation or Vesco Vaginal Fistula is more likely to be accepted when presented by a female health worker or the head of an NGO working in that area than the opposite Fear Appeal One of the more common approaches to attitude change is to try to motivate change in behaviour through the use of fear. The idea is that people will be more likely to accept a message and change their behaviours if their fears and apprehension are appealed to. Such an approach is particularly relevant to health behaviour since the objective of changing health behaviour is to avoid future disease and disability. Fear Appeal Thus the message often has a built-in component of fear (Bishop, 1994). For example, recent efforts aimed at encouraging ‗safe sex‘ are designed to convince people to change their sexual behaviour so as to avoid the threat of AIDS. Given the fear of AIDS, such messages are implicitly, if not explicitly, designed to motivate behaviour change through arousing fear. Similarly, efforts to persuade people to stop smoking are often based on appealing to their fear of cancer and heart diseases. Mass Media Appeal Another means of influencing people‘s attitudes and health behaviour that would seem promising is through the mass media. In modern technological societies, there are few people who are not touched in one way or another by television, radio, newspaper and other mass media. Overall, the primary value of mass media appeals lies in their cumulative effects. Mass Media Appeal Cont’d Although, individual media messages and campaigns may have relatively weak effects, the summation of multiple messages over time can be quite impressive. A good example is the daily and consistent campaign against HIV/AIDS infection, thus reducing the statistics of HIV/AIDS in most countries. Self-Help Groups The discussion above considers programmes that rely on professionals to assist in bringing about behaviour change. What about programmes in which people with problem health behaviours help themselves and others with similar problems. Interest in self-help groups for a variety of problems, including chronic ailments like HIV/AIDS, Cancer, Alcoholism, weight problems, physical deformities, etc, have dramatically increased in recent years. Self-Help Groups All these groups are based on the idea that no one is better able to help another with a problem than someone who has experienced or is experiencing the problem first hand. Further, by helping others, the helper is also helped. This is what Alan Gartner and Frank Riessman (1984), called the helper therapy principle‘. Groups play a critical role of providing its members with support, reinforcement, sanction and feedback. Thus, it enhances the power of the individual members to deal with the problem. Health Promotion in the Schools By their nature, schools provide an ideal setting for promoting positive health behaviour. Childhood is the time when many lifelong behaviour patterns are being formed, and the amount of time children spend in the classroom makes school settings attractive as an intervention site. Thus many have called for comprehensive health education in schools because it is believed that such programmes would help children understand personal and societal health issues. Health Promotion in the Schools Cont’d It will also increase their competency to make informed decisions about health behaviours that effect health. Health Promotion in the Work Place Whereas schools provide a seemingly ideal location for promoting health in children, the work place has considerable potentials for encouraging good health habits in adults. Working adults spend a great deal of time at their places of work. Thus, the work place has a large captive audience that can potentially be influenced to adopt positive health habits. From an employee‘s point of view, there are some economic and humanitarian reasons for promoting healthy living.  Health Promotion in the Work Place Cont’d It is evident that the annual cost of treating preventable diseases runs into millions of Naira or Dollars, including the direct cost of disease treatment and indirect costs from lost productivity, absenteeism, and employee turnover. Recent years have witnessed a veritable explosion of health promotion programmes in the work place. Programmes range in size from few lectures on health topics such as stress management, nutrition, exercise, to extensive programmes involving large, well-staffed exercise and health facilities. Health Promotion in the Communities Several of the approaches already described have been aimed at specific segments of the population such as school children and adult employees, what about health promotion programmes that target entire communities? Might there be advantages to developing programmes that can be applied across the board to everyone living in a particular area? The answer is clearly yes. Stephen Weiss (1984) points out several advantages for community- based prevention programmes. Health Promotion in the Communities Cont’d Such programmes use prevention methods that apply to the environments in which people live. One problem with programmes limited to the clinic, schools or work place is that person‘s behaviour might be effectively changed in that setting, but the change may not generalize to other environments. Because members of the target population all live in the same community, community- based programmes enhance opportunities for information exchange and social support among programme participants. Health Promotion in the Communities Cont’d Further, because of their scale, community- based programmes can minimize the per capital cost. Health Promotion in the Communities Cont’d By their nature, community based interventions are complex undertakings. To be comprehensive and effective, such programme typically involves multi channels such as mass media campaigns, work place programmes, health education programmes in the schools, physician appeals and face-to- face counseling (Puska, 1984)  CONCLUSION Does changing attitudes change health behaviour? Studies of persuasion demonstrate convincingly that people‘s attitudes can be changed through information and fear appeals. Although this is encouraging and provides us with an important first step, it is only a first step. For attitude change to promote good health, the changes must not be only in attitude, but in behaviour also. Thus, our interest in attitude change is predicated on the assumption that changes in attitudes will be reflected in people‘s behaviour. Addressing Specific Health Behaviour Problems Objectives Causes of HIV/AIDS Alcohol Abuse Sexual Contact Causes of Alcohol Exposure to Infected Abuse Body Fluid Obesity Mother-to-child Causes of Obesity Transmission HIV/AIDS Conclusion Objectives At the end of this unit, you should be able to: Describe alcohol abuse and its health implications Identify causes of alcohol abuse Describe obesity and its causes Discuss in detail, the symptoms and causes of HIV/AIDS INTRODUCTION So far, we have considered the processes that determine people‘s health behaviour and some of the basic techniques available for influencing those behaviours. We are now ready to take up applications of these principles to specific health problems. The unit thus considers alcohol abuse, obesity, and HIV/AIDS which forms one of the main products of risky sexual behaviours. These 3 specific health problems form just a small sample of the very many health behaviour problems.  Alcohol Abuse Data on consumption of alcoholic beverages indicate that the use and abuse of alcohol is widespread throughout the world. Alcohol consumption differs significantly between countries, but all countries have at least some individuals who drink to excess. Along with tobacco, alcohol consumption is a major source of disease and death. Alcohol Abuse Cont’d Although some evidence indicates that the consumption of moderate amounts of alcohol may, in fact, be beneficial to one‘s health, the extended heavy drinking of alcohol and the consumption of alcohol under certain circumstances can produce serious health effects, including cirrhosis of the liver, gastrointestinal problems, lung disease, and neurological problems Alcohol Abuse Cont’d Among the latter is the Wermick-Korsakoff Syndrome, a psychotic condition characterized by severe memory deficits and confusion, as well as visual and movement difficulties. One of the most heart wrenching effects of alcohol use is the Fetal Alcohol Symdrome (FAS), in which the consumption of alcohol by a woman during pregnancy can lead to serious health problems of the child, including growth deficiencies, central nervous system difficulties, facial abnormalities and mental retardation (Benzer, 1987). Alcohol Abuse Cont’d In addition to the direct medical complications of alcohol use, the consumption of alcohol also has many indirect effects. For example, a good number of traffic accidents, suicides and homicides could be attributed to alcohol related habits. Also, the abuse of alcohol could cost a country a huge amount of money, as indirect cost of treatment, crime and vehicular accidents.  What causes Alcoholism? Alcoholism generally refers to alcohol consumption that is compulsive, addictive or habitual and results in serious threat to a person‘s health and well- being. What is it that leads to alcoholism and why are some people able to consume alcohol in moderate quantities while others become alcoholics? The causes of alcoholism have been widely debated for a long time. Probably the most popular theory is that alcoholism is a disease (Gitlow, 1973, Jellinek, 1960). What causes Alcoholism? Cont’d According to this model, the alcoholic sometimes differ from others who consume alcohol. Although most people can control their drinking, the alcoholic cannot. After a drink or two, an alcoholic experiences a physiological addictive response triggered by the alcohol consumed, which leads to an irresistible craving for more alcohol. The person is then unable to stop drinking until intoxication occurs or the person runs out of alcohol drinks. What causes Alcoholism? Cont’d Despite its popularity, the disease model was seriously criticized by several alcoholism researchers (Marlatt, 1979, Peele, 1984). Among the criticisms are that the disease model does not address why people drink or adequately describe the process by which a person becomes an alcoholic. Further, it does not explain how it is that many problem drinkers cease their problem drinking without treatment or account for alcoholics who learn to drink in a controlled manner (Peele, 1984). What causes Alcoholism? Cont’d Whereas the disease model seeks the causes of alcoholism in the biological makeup of the person, the social learning model looks to the social environment. According to this model, alcoholism is a learned addictive behaviour that can be unlearned. Several studies have also provided evidence that drinking patterns are related to the person‘s social environment. For example, parent drinking and drinking by peers are significantly related to onset of drinking habit in adolescents (Monti, Abrams, Kadden and Cooney, 1989). What causes Alcoholism? Cont’d In addition, the amount that a person drinks in a particular situation can be significantly influenced by the drinking behaviour of a model (parents, friends). Beyond this, there is also evidence that the likelihood of becoming an alcoholic is increased if the person has a history of deviant behaviour and lacks the social skills for dealing with distressed situation (Zucker and Golberg, 1986). Obesity Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, is increased to a point where it is associated with certain health conditions or increased mortality. Obesity is both an individual and clinical condition and is increasingly viewed as a serious public health problem. Obesity Cont’d Excessive body weight has been shown to predispose to various diseases, particularly cardiovascular diseases, diabetes mellitus type 2, sleep apnea, and osteoarthritis Obesity, especially central obesity (male-type or waist-predominant obesity), is an important risk factor for the "metabolic syndrome" ("syndrome X"), the clustering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. Obesity Cont’d These are diabetes mellitus type 2, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia). An inflammatory state is present, which — together with the above — has been implicated in the high prevalence of atherosclerosis (fatty lumps in the arterial wall), and a prothrombotic state may further worsen cardiovascular risk (Powdemaker, 1997). Obesity Cont’d Apart from the metabolic syndrome, obesity is also correlated (in population studies) with a variety of other complications. For many of these complaints, it has not been clearly established to what extent they are caused directly by obesity itself, or have some other cause (such as limited exercise) that causes obesity as well. Most confidence in a direct cause is given to the mechanical complications in the following list: Obesity Cont’d Cardiovascular: congestive heart failure, enlarged heart and its associated arrhythmias and dizziness, cor pulmonale, varicose veins, and pulmonary embolism. Endocrine: polycystic ovarian syndrome (PCOS), menstrual disorders, and infertility. Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasis (gallstones), hernia, and colorectal cancer. Obesity Cont’d Renal and genitourinary: erectile dysfunction, (Esposito et al, 2004), urinaryincontinence, chronic renal failure, (Ejerblad, et al, 2006), hypogonadism (male), breast cancer (female), uterine cancer (female), stillbirth. Integument (skin and appendages): stretch marks, acanthosis nigricans, lymphedema, cellulitis, carbuncles, intertrigo Obesity Cont’d Musculoskeletal: hyperuricemia (which predisposes to gout), immobility, osteoarthritis, low back pain Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia (Whitmer et al, 2005). Respiratory: dyspnea, obstructive sleep apnea, hypoventilation syndrome, pickwickian syndrome, asthma. Psychological: Depression, low self esteem, body dysmorphic disorder, social stigmatization Obesity Cont’d While being severely obese has many health ramifications, those who are somewhat overweight face little increased mortality or morbidity. Some studies suggest that the somewhat "overweight" tend to live longer than those at their "ideal" weight (Giugliano, Di Palo, Giugliano, Marfella, D‘Andrea, D‘Armiento and Giugliano, 2004). Obesity Cont’d This may in part be attributable to lower mortality rates in diseases where death is either caused or contributed to by significant weight loss due to the greater risk of being underweight experienced by those in the ideal category. Another factor which may confound mortality data is smoking, since obese individuals are less likely to smoke (Giugliano, Di Palo, Giugliano, Marfella, D‘Andrea, D‘Armiento and Giugliano, 2004). Causes of Obesity Overeating In its simplest conception, obesity is only made possible when the lifetime energy intake exceeds lifetime energy expenditure by more than it does for individuals of "normal weight". When food energy intake exceeds energy expenditure, fat cells (and to a lesser extent muscle and liver cells) throughout the body take in the energy and store it as fat. Additional factors that cause obesity Factors that have been suggested to contribute to the development of obesity include: Genetic factors and some genetic disorders (e.g., Prader-Willi syndrome) Underlying illness (e.g., hypothyroidism) Eating disorders (e.g., binge eating disorder) Certain medications (e.g., atypical antipsychotics, some fertility medication) Additional factors that cause obesity Cont’d Sedentary lifestyle A high glycemic diet (i.e., a diet that consists of meals that give high postprandial blood sugar) Weight cycling, caused by repeated attempts to lose weight by dieting. As with many medical conditions, the caloric imbalance