Understanding human behaviour

Understanding human behaviour

Health promotion

Why do people do what they do?

• Concerns about health behavior is huge

• A lot of campaign is heard every day

• Behavioral change is expected

• Instead, resistance to behavioural change is a challenge

• Even if there is change in some, sustenance is a problem

• Why?

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The complex Social-Ecological Web

• Factors that affect behaviour are many and complex

• Until the late 1970s/early 80s, health education

programs were individualistic

• Focused primarily on the knowledge, attitudes, and

motivations of individuals

• The impact of social, cultural and economic factors

was not considered

• Recent health promotion approach considers the

multiplicity of influences


Ecological model

• Based from biology, ecology implies that:

– A system of interactions between organisms

and an environment

– The complex relationships between organisms

and environment

– The dependent relationships between

members/ components of the system, where if

one part of the system is disturbed, other

parts will be affected


Ecological model

• Ecological model asserts that no one factor

influences peoples’ behaviour;

• Instead, it is the complex interaction between an

environment and individuals

“Behaviour does not stand in a vacuum”


Diagram of linkage and connections among people, environment and

behaviour

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Ecological model cont...

• Individual factors

– Awareness, knowledge, attitude, motivation,

perception

– Biophysical characteristics (genetics,

systematic vulnerabilities)

– Developmental stage



• Social environment:

– Social factors

• Level of social support,

• Cultural beliefs

• Peer pressure etc.

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Ecological model cont...• Socio-economic and structural factors

– Poverty

– Education,

– Access to health care and preventive services

– Social stressors such as neighbourhood

violence

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• Political factors

– Policies and funding for health promotion

programs

– Health insurance (policies, costs, availability)

– Regulations that impact health risk

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• Environmental factors

– Presence of an environmental risk (air and water

pollution)

– Disaster

– Conditions for the spread of an infectious disease

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Why do we need to study human behaviour?

1. Most health issues could not be addressed by treatment

alone

2. Health is determined by ordinary human actions and

behaviours

3. These behaviours are modifiable through public health efforts

• However, most health education programs failed because

they neglected to understand factors that influence actions

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Cont...

• A proper understanding of the influences in human

behaviour avoid the pitfalls of victim-blaming

• This can be achieved by separating the influences:

– that are under the control of the individual – from those that requires action from external forces

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What is behaviour and how can we affect it?

Behaviour is an action or practice to change it we

need to define the behaviour, see into intention

and social pressure and have empathy

1.Empathy-understanding other people’s perspective

• we often complain because the community ignores

our advice to follow healthy behaviours.

• precautions to maintain health that make sense to

us, are rejected by community

• we look at actions from our own point of view as

health workers

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Cont....

– Example: emphasising national priorities in family

planning • Growing population, over usage of available

resources People are rational for the actions they take

A useful approach ‘value expectancy theory ‘

suggested that “people will only perform a

given behaviour if they themselves see that it

will provide some benefits”04/11/23 15M.Molla, SPH

Cont....2. Defining behaviour

• A starting point to understand people’s decision about

adopting a behaviour is defining the behaviour in detail

• Undefined behaviours may be general:

– Eg. Sanitation, hygiene

– Latrine use, washing hands after visiting toilets etc..

are specific behaviours which can be targeted

individually

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Cont...

3. Behavioural intentions and enabling

factors

• People may intend to do a certain

health behaviour but still not do so

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Cont...

• This may be because of the influence of enabling factors

• Lack of facilities

• Lack of time

• Lack of skill

• Lack of money

• Lack of information

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Cont...4. Social pressure:

• Is a direct influence or a belief that individuals hold towards what significant others/ salient referents think about their action

• Failure of most health education programs is that they are directed towards individuals

• Ignore the influence of other people

• Only few people do what they believe on04/11/23 19M.Molla, SPH

Cont..

• Influential people changes during the life time of a

person:

• As a child parents

• At early adolescence older friends

• Young person peer pressure

• Pressure from others could be positive or negative

Eg. Women’s decision of FP husband’s pressure

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Culture and behaviour

• Most people agree that culture has an important

role in determining behaviour

• It is common to hear terms such as cultural

practices, cultural beliefs, cultural values, and

cultural norms.

• Culture is a misunderstood term and actually

consists of three overlapping features:

– Shared characteristics

– Traditions and

– Belief systems04/11/23 21M.Molla, SPH

Shared characteristics

• Is a behaviour, value or belief which can be shared by

a group of people, a whole community, a society or

even a nation

• The term sub-culture can be also applied to a group

such as teenagers, solders, factory workers when we

consider their special characteristics

• Other words could be customs or norms i.e.,

something that is normal or common for the group

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Traditions

• Practices which has been maintained for a long

time and passed down from parents to children

• This is called the process of socialization

• Tradition is a result of primary socialization from

parent to children (first 5 years of a child)– Language– Habits,– Values beliefs and rules of behaviour are learnt– This happens by the child following instructions

by parents/ or observation of actions of adults

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Belief systems• While some behaviours

exist on their own, others

are part of a wider

system of beliefs such as

religion or traditional

medicine system• Eg. One person’s

avoidance of pork as a matter of dislike, others may not eat pork because, a person may be a Jew or a Muslim

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Cont..• Beliefs deal with peoples understanding of themselves and

their environment.

• Beliefs about the different possible outcomes from

performing an action are important in understanding

behaviour

• Knowing how a belief is formed helps to change the

behaviour

• Example : if a Pt. had a bad experience in health facility use,

then his belief towards health services will be negative

• If a belief is part of a wider belief system then it is difficult

to change. Eg. Religion

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Attitude• Attitudes and beliefs are confusing terms

• Attitude is used for a person’s judgement of a

behaviour as good or bad

• This judgement will depend on beliefs held about

the consequences of performing the behaviour

• For example, a mother may believe that breast

feeding is good for the health of her child and at

the same time makes her look old-fashioned. • Overall, if a person believes that performing the

behaviour will lead to mainly good outcomes, then the attitude will be favourable and vies versa.

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Values• Values are characteristics to be hold important

and prized by an individual or community

• Values are qualities at an abstract level such as

bravery and intelligence

• A persons value may be reflected as follows: “the

things that are important to me are....”

– Being a good, mother

– Having many children

– Owning a large number of cattle

– Having the respect of my community

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Values

• A person may have his/her own values, but

• Values are usually part of the culture and shared

at a community or national level

• Health is one aspect of values but community

related values may be more important

• In health education one has to bring important

health values this is called value- clarification

and usually carried out in small group

discussions04/11/23 28M.Molla, SPH

Health an ancient concept rooted in culture

• Many different traditional health systems are

practiced throughout the world

• Traditional healers are widely respected by many

• In the past, they were criticized and called

‘quacks’ and ‘witch doctors’

• Now, their role is recognized as important and

integrated in the primary health care in many

countries

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Health an ancient concept....

• To understand the health system in the community

certain questions should be raised about:

– Concept of health and illness

– Coping with illness “Telel” from butajira

– Beliefs about health , disease prevention and

treatment

– General beliefs concerning health and illness

behaviours-

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Traditional health systems

• There are many traditional health systems:

• Some of these includes

• The Hindu Ayurvedic medicine, the Chinese Yin/Yang

system and homeopathic medicine

• These are complex medical ‘systems’ with written

books, training colleges and registration procedures

for recognition

• Others are small scale, informal and passed on through

oral traditions and healers taking apprentices to study

under them

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Traditional health systems

• Traditional medical systems can be grouped in to two:

• The first group the ‘personalistic’ systems of medicine

where the blame of for illness is put on supernatural

forces, witchcraft, spirits or the ‘evil eye’ .

• The second group are the ‘naturalistic’ based on natural

expectations including theories of body, actions of herbs

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Types of traditional medicine system Supernatural / personalistic

Natural

Illness explained Active purposeful intervention of another person or supernatural agent, e.g. Through witchcraft, evil eye, spirits

Illness is explained in terms of concepts of disease and health. E.g. Lack of balance of body hot /cold

Extent to which same explanation for illness also applies for other misfortunes

Illness is only a special case of a wider misfortune

Limited only to disease only, not other disasters or misfortunes

Levels of causation Thinking about causes on different levels-not just cause of illness but who has caused it

Single level of cause, do not ask questions such as who caused it

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Types of traditional medicine system

Supernatural Natural

Diagnosis Powerful witch doctors or spiritualists needed to identify who has caused the illness. Treatment less important

Patient seeks aid for curers for relief of symptoms and not find what has happened

Nature of curers Curers are needed who have supernatural or magical divining power

Curers tend to be ‘ doctors’ in that they have learnt their skills through observation and practice and not through divine intervention

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Different ways in which culture can influence health

Lifecycle: family structure, role of women and

children, socialization, roles surrounding birth,

growing up, sex and marriage, family formation,

work , growing up old, death

Patterns of living and consumption: clothing,

housing, child rearing, food production consumption

and storage hygiene practices and sanitation

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Different ways in which culture can influence health....cont

Health and illness behaviours: ideas about

mental illness and handicap; care of sick people;

traditional medicine systems; patterns of help

seeking; use of doctors and traditional healers;

concepts about biological working of the body;

growth, conception; pregnancy, birth

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Different ways in which culture can influence health cont...

• Patterns of communication: language: verbal and

non verbal; taboos on public discussion of sensitive

items; oral traditions

• Religion and world view:

– Ideas about the meaning of life and death; rituals

surrounding important life events; ideas about

the possibility and desirability of change

• ;

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Different ways in which culture can influence health cont...

• Patterns of social and political organization:

– Political structures; community leadership and

authority; division and social inequalities

• Economic pattern/types of employment:

– Ideas about wealth and income; ownership of

land; use of money and barter; saving and

credit arrangements

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Principles of health education

• HE is pervasive

• HE is important for people from all walks of life

as applicable to changing conditions

• Can be institutional or a self learning process

• It is an educational and learning process

• HE should be need based


• Educational diagnosis is necessary to assess the

need and the use appropriate method

• HE should be relevant and problem oriented

• Introduce new ideas with natural ease and

caution not to affect the culture


• The Health Educator:

– should be aware of the predictors of health behaviour

– should have knowledge and skills of behavioural

sciences

• to understand health problems and their solutions

from a scientific and logical point of view

• the point of departure should be what people know


• Freely discuss on the health problems and solutions

• There should be a free flow of communication (two way)

• The health educator has to make him self acceptable

– Practice what he/she professes

• Introduce small changes in graded fashion


• Pumping all information at once is dangerous

• The client should have an opportunity for:

– Identification of problems

– Planning

– Implementation

– And evaluation

• This is best in community education and

participation


• Use terms/languages that can be easily understood

• Drastic change of behaviour is dangerous.

– It may bring cultural conflict and resentment

particularly if the behaviour is in contrary to the

existing cultures

– Therefore, it should start from the existing culture

and gradually try at change of habit and practices

Some terms related to behaviour

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Some terms related to behaviour

• Awareness: This is the lowest level of cognition

• Perception: interpretation of the meaning given to sensory information

• Knowledge: is storage of information in the brain

• Attitude: the positive or negative predisposition of an individual towards a behaviour

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Terms related to behaviour cont..

Motivation

• It is a combination of forces which initiate, direct and sustain behaviour towards goal

• Two forces: – Intrinsic (psychological or internal factors)

factors

– Extrinsic (environmental) factors

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Decision making:

• It is a process of commuting oneself to a particular course

of action or behaviour to achieve a particular goal.

• Based with reference to the final judgement a person has

to make a change of behaviour or adoption of new

practice.

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Society:

Society arises out of community.

– Unlike community, which refers to the

structure, location and size of the population,

– society refers to the human relationship,

– behavioural patterns,

– cultural traits,

– institution, etc.,

– in the community 49M.Molla, SPH

Health & Medicine

Understanding human behaviour