HEALTH AND HUMAN BEHAVIOUR best power point..pdf

It includes main contents of health education! #Health #Education.
It contains main components of behavior ecological models and more usefull knowledge!

1. HEALTH AND HUMAN BEHAVIOUR
By :-Mohammed W.(MPH)
Email: [email protected]
[email protected]
5/19/2025 By :- Mohammed W.(MPH) 1

2. Learning Objectives
❖Define behavior and related terms
❖List components of behavior
❖Identify Factors affecting human behaviors
❖Ecological model
❖Educational Approaches to Behavioral Changes
❖Discuss why people resist to change behavior
5/19/2025 By :- Mohammed W.(MPH) 2

3. Defining behavior
Behavior:
❖ Is an action that has a specific frequency, duration, and purpose,
whether conscious or unconscious
❖Human behavior is caused by genetic and environmental factors
❖The various voluntary movements undertaken by the body in response
to motives and decision
❖Health education is an instrument to shape/modify behavior.
❖It also helps to encourage and support healthy behavior
5/19/2025 By :- Mohammed W.(MPH) 3

4. Defining behavior….
Example:
•To say a person has smoking behavior
• Action – he/she must smoke cigarette
•Duration –is it for a week/month?
•Frequency- how many times a day?
•Purpose –is he/she doing consciously or not
5/19/2025 By :- Mohammed W.(MPH) 4

5. Defining behavior….
❖People stay healthy or become ill, often as a result of their
own action or behavior.
❖The following are examples of how people’s
actions/behaviors can affect their health:
➢Using mosquito nets and IRS helps to keep mosquito away
➢Feeding children with bottle put them at risk of diarrhea
➢Defecating in an open field will lead to parasitic infection
➢Unsafe sex predisposes people to unwanted pregnancy,
HIV/AIDS and other STDs
5/19/2025 By :- Mohammed W.(MPH) 5

6. Health behaviour:
Def. 1
•Any activity undertaken by an individual for the purpose of
promoting, protecting or maintaining health, whether or not
such behavior is objectively effective towards that end
Def. 2
•An action taken by a person to maintain, attain, or regain
good health and to prevent illness
❑ Health behavior reflects a person's health beliefs
5/19/2025 By :- Mohammed W.(MPH) 6

7. Health behaviour….
The study of health behaviour is based upon two assumptions:
1. The recognition of high proportion of mortality and
morbidity is caused due to a particular pattern of behaviour
and these behaviour patterns are Modifiable
2. The recognition of individuals as major contributors of
their health .
5/19/2025 By :- Mohammed W.(MPH) 7

8. Health behaviour….
Research on health behaviour is based on two main aims:
❖To gain more general understanding of the reason why
individuals perform a variety of behaviours
❖To design interventions to improve such health
compromising behaviours
5/19/2025 By :- Mohammed W.(MPH) 8

9. Components of Behavior
•Basically our behavior has 3 domains
A) Cognitive domain- “stored information” . when ever you change a person’s
knowledge you are changing his/her cognitive domain.
•Knowledge
•Perception
•Thinking
B) Affective domain-cognition +feeling (connation)
•Attitude
•Beliefs,
•Value
C) Psychomotor domain
•Psycho-mind
Motor – action
•Practice/action/behavior- often when our knowledge and attitude are
expressed in terms of action
5/19/2025 By :- Mohammed W.(MPH) 9

10. Types Of Health Behavior
Preventive Health Behavior
◦action taken when a person wants to avoid
being ill or having a problem e.g. a mother
takes her child for immunization
Illness Behavior
◦action taken when a person recognizes signs
or symptoms that suggest a pending illness
e.g. a mother gives her child cough
medicine after hearing her wheeze
5/19/2025 Mohammed w. (Bsc,MPH) 10

11. Types Of Health Behavior…
•Health-related behavior
•Those actions that a person does that may have
health implications, but are not undertaken with a
specific health objective in mind
Sick-role Behavior
◦Action taken once an individual has been
diagnosed (either self or medical diagnosis) e.g.
an employee takes a vacation because he is ill,
he takes treatment and obeys his doctor’s
advice.
5/19/2025 Mohammed w. (Bsc,MPH) 11

12. •A number of studies have looked at the relationship
b/n the performance of a range of health behaviours
and a variety of health outcomes.
For example:
•A study conducted on six life styles i.e., avoid
smoking, moderate alcohol intake, sleeping seven to
eight hrs at night, regular exercising, eating breakfast
regularly, and maintaining a desirable body weight
Were together associated with lower morbidity and
long-term survival
125/19/2025 Mohammed w. (Bsc,MPH)

13. Factors affecting human behavior
1. Knowledge or cognition
•Knowledge often comes from experience/information from
teachers and parents, friends, books, etc.
•Knowledge on prevention of HIV/malaria/
2. Attitudes (feelings)
•It is the degree to which the person has a favorable or
unfavorable evaluation of the behavior in question.
•Attitudes can be considered as a collection of beliefs that
always include an evaluative aspect
•E.g.
•Smoking
•Sport
•Condom
5/19/2025 By :- Mohammed W.(MPH) 13

14. Factors affecting human behavior…
3. Beliefs
•A belief is a conviction that a phenomenon or object is true
or real
•There are many traditional beliefs on causation, cure and
prevention of diseases since the ancient times, which
continue to be perpetuated generation through generations
5/19/2025 By :- Mohammed W.(MPH) 14

15. Factors affecting human behavior…
4. Values (preference)
•Every individual places or gives a relative worth to
everything around
• This worth or preference or judgement or weight is known
as value
5/19/2025 By :- Mohammed W.(MPH) 15

16. Factors affecting human behavior…
5. Culture
•The normal forms of behavior, beliefs, values and use of
resources form a pattern or way of life.
6. Skills
•Skills refer to a person’s ability to perform the tasks that
constitute a health related behavior.
7. Lifestyle:
•Consciously chosen, personal behavior of individuals.
8. Social Norms:
•The influence of social pressure that is perceived by the individual
(normative beliefs) to perform or not perform a certain behavior
•Is a type of social behaviour that is valued by the society as
appropriate and benefiting
5/19/2025 By :- Mohammed W.(MPH) 16

17. Factors affecting human behavior…
Perceived Behavioral Control:
•The individual’s belief concerning how easy or difficult
performing the behavior will be.
Subjective norm
•People who are important to us greatly influence our behavior.
Examples: parents, elders, friends, experienced people, highly
educated people, teachers, etc.
Resources:
•facilities, money, time, labor services, skills, materials and their
distribution and their location affect behavior. Example:
availability and accessibility of family planning services.
5/19/2025 By :- Mohammed W.(MPH) 17

18. Factors affecting behavior can be classified into 3 major
categories
1. Predisposing factors
•These factors provide the rationale or motivation for the
behavior
- Knowledge, beliefs, attitudes, values
2. Enabling factors
•Antecedent (Precursor) to behavior that enable a motivation
to be realized
- Availability \ accessibility of health resources
- Community or government laws, priority and
commitment to health
- Health related skills
5/19/2025 By :- Mohammed W.(MPH) 18

19. Factors affecting human behavior…
3 - Reinforcing factors
•Factors subsequent to behavior that provides the
continuing reward or incentive for the behavior and
contributes to its persistence or repetition
Examples - Family, peers, teachers, employers, health
providers, community leaders, decision-makers may consider
as reinforcing factors.
5/19/2025 By :- Mohammed W.(MPH) 19

20. Class Discussion
• Why is people still practice unhealthy
habits? Why people Resist to change to
Health Behavior??
5/19/2025 By :- Mohammed W.(MPH) 20

21. Barriers to Healthy Behaviors
1. Individual Barriers:
•Behaviors are often learned when very young, so that one
acquires habits without knowing or questioning their rationale
•Lack of concern
•Immediate rewards and punishments are much more effective
than delayed ones
•The tendency of most people to believe that they are less likely to
become ill than others
5/19/2025 By :- Mohammed W.(MPH) 21

22. •The health threats posed by the so called risky habits seem
remote compared to the immediate pleasures,
relief/gratification they get
•Inconvenience and effort involved in adopting more
healthful preventive behaviors
•People feel secure doing what is familiar; they feel insecure
doing something new
•Economic status
5/19/2025 By :- Mohammed W.(MPH) 22

23. 2. Family Barriers
•Health habits are often acquired from parents and
others who model health-compromising behaviors
•People may fear disapproval and rejection if they change to a
new behavior
•People find it hard to admit that their parents and other
respected people and traditions are wrong
•Doing what everyone else does, at the same time and place,
provides one with the opportunity for social interaction
235/19/2025 By :- Mohammed W.(MPH)

24. 3. Health System Barriers
•Medicine tends to focus on treatment rather
than prevention
•Accessibility and availability of service
•Quality of care
245/19/2025 By :- Mohammed W.(MPH)

25. 4. Environmental Barriers
❖Access to _____ (health care, exercise facilities, if
easy access to grocery stores)
❖ Some environments promote health-
compromising behaviors
❖e.g., alcohol promotion
255/19/2025 By :- Mohammed W.(MPH)

26. What influence Health??
26
Ecological Approach to Health behavior
• This approach Expands responsibility for health
beyond the individual to the community
,environment and policy level Calls for community
leadership to improve health.
5/19/2025 By :- Mohammed W.(MPH)

27. An Ecological Model of Health Behavior
27
Individual
Biological
Psychological
Skills
Social/Cultural
Physical Environment
Policy Context
5/19/2025 By :- Mohammed W.(MPH)

28. An Alternative: Ecological Models
28
Multi-level intervention approaches says
•First, create environments & policies that make
healthy choices easy
•Then, educate & motivate people to make those
choices
5/19/2025 By :- Mohammed W.(MPH)

29. An Ecological Framework Depicting the Multiple Influences of health
29
Individual
Factors
(personal)
Social
Environment
(networks)
Macro-level
Environments
(sectors)
Physical
Environments
(settings)
Home
Worksites
School,
Afterschool
Child-care
Restaurants &
fast food outlets
Supermarkets
Convenience &
corner stores
Access
Availability
Barriers
Opportunity
Cognitions (e.g.
attitudes, preferences,
knowledge, values)
Skills and behaviors
Lifestyle
Biological (e.g. genes,
gender, age)
Demographics (e.g.
income, race/ethnicity)
Outcome expectations
Motivations
Self-efficacy
Behavioral capability
Societal and cultural
norms and values
Food and beverage
industry
Food marketing and media
Food and agriculture
policies
Economic systems
Food production &
distribution systems
Government & political
structures and policies
Food assistance programs
Health care systems
Land use and
transportation
Practices
Legislative,
regulatory, or
policy actions
Family
Friends
Peers
Role modeling
Social support
Social norms
5/19/2025 By :- Mohammed W.(MPH)

30. Reading Assignment
•Educational Approaches to Behavioral
Changes
5/19/2025 By :- Mohammed W.(MPH) 30

31. M oha mmedwa g ris@su. edu. et
wa g rismw@g ma il. com
Theory and Models Used in
Health Education and Health
Promotion Practice
Mohammed W.(MPH)
Email: [email protected]
[email protected]
315/19/2025 By :-Mohammed W.( MPH)

32. Objectives
At the end of this chapter, you will be able to;
1.Define the meanings of theory and model
2.Explore the roles/functions of theories
3.Discuss the major theories and models in Health
education
4.Practice the application of theories and models in
Health education and health promotion to change
behavior
325/19/2025 By :-Mohammed W.( MPH)

33. What is Theory?
▪A theory is a set of interrelated concepts, definitions,
and propositions that present a systematic view of
events or situations by specifying relations among
variables, in order to explain and predict the events or
situations
▪Asystematicexplanationfortheobservedfactsandla
wsthatrelatetoaparticularaspectoflife
(Babbie,1989)
5/19/2025 By :-Mohammed W.( MPH) 33

34. 5/19/2025 By :-Mohammed W.( MPH) 34

35. • Concepts are the building blocks of theory, the primary
elements of theory
• Concepts can vary in the extent to which they have meaning
or can be understood outside the context of a specific theory
•Construct is the term used for a concept developed or
adopted for use in a particular theory. Thus, it has a very
specific and technical meaning
•Key concepts of a given theory are its Construct
5/19/2025 By :-Mohammed W.( MPH) 35

36. •Variables are the empirical counterparts or
operational forms of constructs
•They specify how a construct is to be measured in a
specific situation
•Variables should be matched to constructs when
identifying what should be assessed in the evaluation
of a theory-driven program
5/19/2025 By :-Mohammed W.( MPH) 36

37. •Models are generalized, hypothetical descriptions, often
based on an analogy, used to analyze or explain something
- It provides the vehicle for applying the theories
- Repeatedly tested theory is Model
•It does not attempt to explain the processes underlying
learning, but only to represent them
5/19/2025 By :-Mohammed W.( MPH) 37

38. Theory
Explanatory theory Change theory
385/19/2025 By :-Mohammed W.( MPH)

39. Explanatory theory / theory of a problem
•It helps to describe and identify why a
problem exists, it explain the reasons
•Predict behaviors under defined conditions
and guide the search for modifiable factors
like knowledge, attitudes, self-efficacy, social
support, and lack of resources
•Examples of explanatory theories include
❑ Health Belief Model,
❑ Theory of Planned Behaviour, ........
395/19/2025 By :-Mohammed W.( MPH)

40. Change Theory /theory of action
•Guides the development of health interventions
• It spells out concepts that can be translated into program
messages and strategies, and offers a basis for program
evaluation
•Change theory helps program planners to be explicit about their
assumptions for why a program will work
• Examples:
- Diffusion of Innovations,
- Precede Proceed Model

405/19/2025 By :-Mohammed W.( MPH)

41. Explanatory Theory and Change Theory in the Process of Program
Planning and Evaluation
41
Q. What theory can do for us?
5/19/2025 By :-Mohammed W.( MPH)

42. What theory can do for us
•Guide the search for reasons WHY people are not
following public health and medical advice
•Help in pinpoint WHAT you need to know before
developing or organizing an intervention
•Provide insight into HOW you shape program
strategies to reach people and organizations
•Help us to implement effectively
5/19/2025 By :-Mohammed W.( MPH) 42

43. •Identify WHAT should be monitored, measured, and/or
compared in the program evaluation (Glanz, Lewis, and
Rimer, 1996; Glanz, Rimer, and Lewis, 2002)
•A number of systematic reviews have shown that using
theory in crafting interventions can lead to more
powerful effects than interventions developed without
theory (Ammerman etal. 2002; Legler etal, 2002)
5/19/2025 By :-Mohammed W.( MPH) 43

44. What theory can NOT do for us
• Can't guarantee success
• Can’t predict with 100% accuracy because
•Dealing with human & social behaviors
445/19/2025 By :-Mohammed W.( MPH)

45. Generally,
•Theories are by their nature abstract; they do not have a
specified content or topic area
• Like an empty cup, they have a shape and boundaries
but nothing concrete inside
•They only come alive in public health and health
behavior when they are filled with practical topics,
goals, and problems
5/19/2025 By :-Mohammed W.( MPH) 45

46. •No one theory can address all variables that contribute to
a person’s behavior, and not all theories are applicable to
all situations
•No one theory will be right in all cases!
•The choice of a suitable theory should begin with
identifying the problem, goal, and units of practice (van
Ryn and Heaney, 1992; Sussman and Sussman, 2001)
5/19/2025 By :-Mohammed W.( MPH) 46

47. • But elements of different theories may be combined
to create a program tailored for a specific issue and
target population
•Combination of theories are becoming the norm in
health behavior change interventions
5/19/2025 By :-Mohammed W.( MPH) 47

48. Theory Research
Practice
485/19/2025 By :-Mohammed W.( MPH)

49. Theories and Applications
Behavior is viewed as being affected by, and affecting,
multiple levels of influence. They are:
(1) Intrapersonal, or individual factors;
(2) Interpersonal factors;
(3) Institutional, or organizational factors;
(4) Community factors; and
(5) Public policy factors (McLeroy et al., 1988)
495/19/2025 By :-Mohammed W.( MPH)

50. An Ecological Perspective: Levels of Influence
Concept Definition
•Intrapersonal Factors Individual characteristics that influence
behavior, such as knowledge, attitudes, beliefs,
and personality traits
•Interpersonal Factors Interpersonal processes, and primary groups
including family, friends, peers, that provide
social identity, support, and role definition
•Institutional Factors Rules, regulations, policies, and informal structures, which
may constrain or promote recommended behaviors
•Community Factors Social networks and norms, or standards, which
exist as formal or informal among individuals,
groups, and organizations
•Public Policy Local, state, federal policies and laws that regulate or
support healthy actions and practices for disease
prevention, early detection, control, and management
5/19/2025 50 By :-Mohammed W.( MPH)

51. For example,
A woman might delay getting a recommended cancer
screening test (a mammogram) because she is afraid of
finding out she has cancer. This is an individual-level
factor. However, her inaction might also be influenced
by her doctor's not recommending mammography, the
difficulty of scheduling an appointment because there is
only a part-time radiologist at the clinic, and her inability
to pay the high fee. These interpersonal, organizational,
and policy factors also influence behavior.
5/19/2025 By :-Mohammed W.( MPH) 51

52. Dominant theories and models in health
education/promotion
Individual (Intrapersonal) Health Behavior
Models/Theories
•Health Belief Model (e.g., Becker, Hochbaum,
Janz)
•Theory of Planned Behavior and Reasoned action
(Ajzen & Fishbein)
•Stages of Change Model (Transtheoretical Model)
(Prochaska & DiClemente)
525/19/2025 By :-Mohammed W.( MPH)

53. Community level model/theory
•Theories at the community level explore how social systems
function
•They offer strategies that work across settings such as
schools, work sites, health care organizations, and
communities
•Diffusion of innovations (Rogers and Shoemaker)
•Social Learning Theory or Social Cognitive Theory
(Rotter and Bandura)
535/19/2025 By :-Mohammed W.( MPH)

54. Programme level/ Program Planning Models
•PRECEDE-PROCEED Model (Green &
Kreuter)
•Social marketing theory
545/19/2025 By :-Mohammed W.( MPH)

55. Reference
1.KAREN GLANZ etal. Health Behavior and Health
Education, Theory, Research, and Practice. 4th edition.
USA: Jossey-Bass publisher , 2008.
2.Theory at a Glance a guide for health promotion practice.
2
nd
edition.
5/19/2025 By :-Mohammed W.( MPH) 55

56. Theories at intra-
personal level
Health Belief Model (HBM)
Mohammed W.(MPH)
Email: [email protected]
[email protected]
5/19/2025 By :- Mohammed W.(MPH) 56

57. Objectives
•Discuss the origins of the Health Belief Model (HBM)
•Present the key components of the HBM
• Describe the measurement of HBM constructs
• Give examples or applications of the HBM in public health
intervention
5/19/2025 By :- Mohammed W.(MPH) 57

58. •The HBM was developed initially in the 1950s by social
psychologists in the U.S. Public Health Service to explain
the widespread failure of people to participate in programs to
prevent and detect disease (Hochbaum, 1958; Rosenstock, 1960, 1974)
•Research was initiated to explain failure of large number of
eligible adults to participate in tuberculosis screening
programs provided at no charge in a mobile X-ray units
conveniently located in various neighborhoods
585/19/2025 By :- Mohammed W.(MPH)

59. •HBM is a psychological model that attempts to explain and
predict health behaviours by focusing on the attitudes and
beliefs of individuals
•It predict why people will not take action to prevent, to
screen for, or to control illness conditions
595/19/2025 By :- Mohammed W.(MPH)

60. HBM is based on the understanding that a person will take a
health-related action if that person:
1.Feels that a negative health condition can be avoided,
2.Has a positive expectation that by taking a recommended action,
he/she will avoid a negative health condition, and
3.Believes that he/she can successfully take a recommended health
action
605/19/2025 By :- Mohammed W.(MPH)

61. The key constructs of the HBM :
❑Perceived Threat: Consists of two parts: perceived
susceptibility and perceived severity of a health condition
1. Perceived Susceptibility: One's subjective perception of
the risk of contracting a health condition (Could the
problem affect me?)
2. Perceived Severity: Feelings concerning the seriousness of
contracting an illness or of leaving it untreated (including
evaluations of both medical and clinical consequences and
possible social consequences), how bad is it?
615/19/2025 By :- Mohammed W.(MPH)

62. 3.Perceived Benefits: The believed effectiveness of strategies
designed to reduce the threat of illness
e.g. - Taking a pain killer (perceived as very effective)
- Eating fiber to reduce risk of colonic ca (perceived as
less )
625/19/2025 By :- Mohammed W.(MPH)

63. 4. Perceived Barriers: The potential negative aspect of a
particular health actions, including physical,
psychological, and financial demands
•Perceived benefits and perceived barriers must be
considered together in a cost benefits analysis, i.e. when
the benefits of the behavior outweigh the costs (barrier),
in the mind of a given patient, then the likelihood of
action is increased
5/19/2025 By :- Mohammed W.(MPH) 63

64. 5. Cues to action: is an added concept which activates that
readiness to take an action and stimulates overt behavior
•Cues to Action: Events, either bodily (e.g., physical
symptoms of a health condition) or environmental (e.g.,
media publicity) or reminder that motivate people to take
action
5/19/2025 By :- Mohammed W.(MPH) 64

65. 6. Self-efficacy: a concept recently added to the HBM
•Refers to one’s ability and confidence to successfully
perform an action
•Self-efficacy is defined as “the conviction that one can
successfully execute the behavior required to produce the
outcomes” (Bandura, 1997)
5/19/2025 By :- Mohammed W.(MPH) 65

66. •An individual's behavior is determined by whether the
individual;
a. Believes that he or she is susceptible to a particular health
problem
b. Regards this problem as serious-sufficiently to arouse
certain fear or threat to life
5/19/2025 By :- Mohammed W.(MPH) 66

67. c.Believe that a course of action available to them would be
beneficial in reducing either their susceptibility to or
severity of the condition
d. At the same time inexpensive and convenient
e. Receives an appropriate cue to take health promoting action
and have self efficacy
5/19/2025 By :- Mohammed W.(MPH) 67

68. Example;
•Women will be more likely to adhere to screening
mammography recommendations;
✓If they feel susceptible to breast cancer
✓Think breast cancer is a severe disease
✓ Perceive barriers to screening as lower than perceived
benefits
✓Have higher self-efficacy for obtaining mammograms
and
✓ Receive a cue to action
5/19/2025 By :- Mohammed W.(MPH) 68

69. 695/19/2025 By :- Mohammed W.(MPH)

70. 5/19/2025 70By :- Mohammed W.(MPH)

71. Table from “Theory at a Glance: A Guide for Health Promotion Practice" (1997)
Concept Definition Application
Perceived SusceptibilityOne's opinion of chances of getting
a condition
Define population(s) at risk, risk levels;
personalize risk based on a person's features
or behavior; heighten perceived
susceptibility if too low.
Perceived Severity One's opinion of how serious a
condition and its consequences are
Specify consequences of the risk and the
condition
Perceived Benefits One's belief in the efficacy of the
advised action to reduce risk or
seriousness of impact
Define action to take; how, where, when;
clarify the positive effects to be expected.
Describe evidence of effectiveness.
Perceived Barriers One's opinion of the tangible and
psychological costs of the advised
action
Identify and reduce barriers through
reassurance, incentives, assistance.
Cues to Action Strategies to activate "readiness"Provide how-to information, promote
awareness, reminders.
Self-Efficacy Confidence in one's ability to take
action
Provide training, guidance in performing
action.
715/19/2025 By :- Mohammed W.(MPH)

72. Class Discussion
•Explain risky sexual behaviors and its intervention with
HBM
5/19/2025 By :- Mohammed W.(MPH) 72

73. •Association of HBM Constructs with Risky Sexual
Behaviors;
•A function of;
• perceived risk of contracting the disease
• perceived severity of the disease
• perceptions of benefits and barriers to specific AIDS-
protective behaviors
5/19/2025 By :- Mohammed W.(MPH) 73

74. •for individuals who exhibit high-risk behaviors, perceived
susceptibility is necessary before commitment to changing
these risky behaviors can occur
• For individuals who do not believe they are at risk, the
benefits or barriers to an action are irrelevant
•Self-efficacy has been studied in relation to HIV-protective
behaviors
5/19/2025 By :- Mohammed W.(MPH) 74

75. Susceptibility measures asking the question,

•“If you do not practice safer sex, how likely are you to
become infected with the AIDS virus?” or
•“How likely are you to become infected with the AIDS
virus?”
•Perceptions of AIDS severity address the perceived costs of
being HIV-positive
5/19/2025 By :- Mohammed W.(MPH) 75

76. •Perceived benefit was motivated by the perceived value of
condoms to avoid pregnancy, as well as avoidance of
HIV/AIDS
•Barriers such as reduction of sensation and pleasure were
associated with condom use
•Self-efficacy was a significant predictor of sexual behaviors
that included increased condom use, decreased number of
sex partners, and decreased number of sexual encounters
5/19/2025 By :- Mohammed W.(MPH) 76

77. Concept
Condom Use Education Example STI Screening or HIV Testing
1. Perceived
Susceptibility
Youth believe they can get STIs or
HIV or create a pregnancy.
Youth believe they may have been
exposed to STIs or HIV.
2. Perceived SeverityYouth believe that the consequences
of getting STIs or HIV or creating a
pregnancy are significant enough to
try to avoid.
Youth believe theconsequences of
having STIs or HIV without knowledge
or treatment is significant enough to try
to avoid.
3. Perceived BenefitsYouth believe that the
recommended action of using
condoms would protect them from
getting STIs or HIV or creating a
pregnancy.
Youth believe that the recommended
action of getting tested for STIs and HIV
would benefit them — possibly by
allowing them to get early treatment or
preventing them from infecting others.
2. This is an example from two sexual health actions.
5/19/2025 By :- Mohammed W.(MPH) 77

78. 4. Perceived Barriers Youth identify their personal barriers to
using condoms (i.e., condoms limit the
feeling or they are too embarrassed to
talk to their partner about it) and explore
ways to eliminate or reduce these barriers
(i.e., teach them to put lubricant inside
the condom to increase sensation for the
male and have them practice condom
communication skills to decrease their
embarrassment level).
Youth identify their personal barriers to getting
tested (i.e., getting to the clinic or being seen at
the clinic by someone they know) and explore
ways to eliminate or reduce these barriers (i.e.,
brainstorm transportation and disguise options).
5. Cues to Action Youth receive reminder cues for action in
the form ofincentives (such as pencils
with the printed message "no glove, no
love") or reminder messages (such as
messages in the school newsletter).
Youth receive reminder cues for action in the
form of incentives (such as a key chain that
says, "Got sex? Get tested!") or reminder
messages (such as posters that say, "25% of
sexually active teens contract an STI. Are you
one of them? Find out now").
6. Self-Efficacy Youth receive training in using a condom
correctly. Youth confident in using a
condom correctly in all circumstances.
Youth receive guidance (such as information on
where to get tested) or training (such as practice
in making an appointment).
5/19/2025 By :- Mohammed W.(MPH) 78

79. Scope and Application
•The Health Belief Model has been applied to a broad range
of health behaviors and subject populations
Three broad areas can be identified:
1) Preventive health behaviors, which include health-
promoting (e.g. diet, exercise) and health-risk (e.g. smoking)
behaviors as well as vaccination and contraceptive practices
5/19/2025 By :- Mohammed W.(MPH) 79

80. 2) Sick role behaviors, which refer to compliance with
recommended medical regimens, usually following
professional diagnosis of illness
3) Clinic use, which includes physician visits for a
variety of reasons
5/19/2025 By :- Mohammed W.(MPH) 80

81. Evidence for the model’s performance,
Reviews of HBM studies (Janz & Becker, 1984)
•Perceived barriers were the most powerful single predictor
across all studies and behaviors
•Perceived susceptibility was a stronger predictor of
preventive health behavior
• Perceived benefits was a stronger predictor of sick-role
behavior
•Perceived severity was the least powerful predictor;
however, this dimension was strongly related to sick-role
behavior
5/19/2025 By :- Mohammed W.(MPH) 81

82. Critiques of HBM by proponents of other behavior change models
❖HBM includes all possible variables: More a comprehensive checklist
than a theory
❖HBM relegates social and environmental factors to secondary status
❖Does not recognize role of social norms/influences
5/19/2025 By :- Mohammed W.(MPH) 82

83. ❖Many “health behaviors” performed for non-health reasons
e.g. weight loss to look better
❖Assumes a clear perception of the link between the behavior
and the health outcome
- That link may not be there,
-There may be multiple benefits of the behavior
5/19/2025 By :- Mohammed W.(MPH) 83

84. Summary
For behavior change to succeed,
➢People must feel threatened by their current behavioral
patterns (perceived susceptibility and severity)
➢Believe that change of a specific kind will result in a valued
outcome at an acceptable cost (perceived benefits)
➢They also must feel themselves competent (self-efficacy) to
overcome perceived barriers to take action
➢They need to get a cue to action
845/19/2025 By :- Mohammed W.(MPH)

85. Theory of Reasoned Action and Theory
of planned behaviour
Mohammed W.(MPH)
Email: [email protected]
[email protected]
5/19/2025 by:- Mohammed W. ( MPH) 85

86. Introductions
•Originators of model: "Theory of Reasoned Action"
and "Theory of Planned Behavior.“ were Martin
Fishbein and IcekAjzen
•The Theory of Reasoned Action (TRA) was developed
in 1967. Revised 1970s,1980 and 1988
865/19/2025 by:- Mohammed W. ( MPH)

87. Circumstances that led to the model development:
• TRA/TPB originated in the field of social psychology
• As early as 1862 psychologists developed theories
suggested that "attitudes could explain human actions”
•This ideas remained relatively intact until the early 1960s
when many social scientists began to review attitudes and
behavior predictors
•In 1935, Gordon W. Allport theorized that the attitude-
behavior was not uni-dimensional
5/19/2025 by:- Mohammed W. ( MPH) 87

88. •In the 1950’s, this point of view that attitude is multi-
dimensional became universal
•Rosenberg and Hovland in 1960 theorized that a person’s
attitude toward an object is filtered by their affect, cognition
and behavior
•After reviewing all the studies they developed, Theory of
Reasoned Action,
•looks at behavioral intentions rather than attitudes as the
main predictors of behaviors
885/19/2025 by:- Mohammed W. ( MPH)

89. TRA
•TRA can be used to predict, explain, and
influence human behavior
•It was designed to explain all human behavior
under volitional control,he/she can decide at
will to perform or not to perform the behavior
895/19/2025 by:- Mohammed W. ( MPH)

90. •TRA asserts that the most important determinant of behavior
is behavioral intention
•Influenced by;
•Attitude toward performing the behavior
•Subjective norm associated with the behavior
905/19/2025 by:- Mohammed W. ( MPH)

91. Theory of reasoned action
91
Behavior
Intentions
Attitudes
Subjective
norms
5/19/2025 by:- Mohammed W. ( MPH)

92. 1. Attitudes toward a specific action:
•Is determined by the individual’s beliefs about
outcomes/behavior (behavioral beliefs), weighted by
evaluations of those outcomes
925/19/2025 by:- Mohammed W. ( MPH)

93. Eg.
Behavioral Beliefs:
If I exercise, my heart will be healthier
If I exercise, I will take time from my family
Outcome evaluation:
It is important to me that I have a strong heart
It is important to me that if I spent mach time with my family
935/19/2025 by:- Mohammed W. ( MPH)

94. ❖An attitude toward a behavior can be predicted
by the product of the outcome evaluation and
belief strength
❖Implications of this approach:
❖ Two people may have the same set of beliefs
about a behavior but a totally different attitude
because of different outcome evaluations or
belief strengths
945/19/2025 by:- Mohammed W. ( MPH)

95. 2. Subjective norm: It is a degree to which the person feels
social pressure to perform or not to perform the behavior
•Is determined by a person’s normative beliefs and
motivation to comply
•Normative beliefs: A perception about the expectation of
significant others

955/19/2025 by:- Mohammed W. ( MPH)

96. •Normative beliefs
My mother want me to exercise
My friends want me to go gym with them
•Motivation to comply
I care about what my mother want me to do
I don’t care what my friends want to do
965/19/2025 by:- Mohammed W. ( MPH)

97. •For each referent, we have a specific level of motivation to
comply with their wishes for us
•A person’s subjective norm is a function of their normative
beliefs for salient referents, and motivation to comply with
these different referents
975/19/2025 by:- Mohammed W. ( MPH)

98. 985/19/2025 by:- Mohammed W. ( MPH)

99. Theory of Planned Behavior
•To improve the predictive power TRA
•To predict and understand motivational influences on
behavior that is not under the individual's volitional control
•TPB examines the relations between an individual’s
beliefs, attitudes, intentions, behaviour, and
perceived control over that behaviour
995/19/2025 by:- Mohammed W. ( MPH)

100. ➢ Perceived Behavioral Control: an individual's
perceived ease or difficulty of performing the particular
behavior
➢It is determined by the total set of accessible control
beliefs
➢ The concept of perceived behavioral control is
conceptually related to self-efficacy
1005/19/2025 by:- Mohammed W. ( MPH)

101. •Control beliefs: the individual perception about the degree
of person control over the behavior
Eg.
•I don’t think I can make to go to the gym when I am stressed
with lot of work

•I think I can make to go gym even if I have a lot of work
1015/19/2025 by:- Mohammed W. ( MPH)

102. Core assumption
•To predict whether a person intends to do something, we
need to know:
• Whether the person is in favour of doing it
(‘attitude’)
• How much the person feels social pressure to do it
(‘subjective norm’)
• Whether the person feels in control of the action in
question (‘perceived behavioural control’)
1025/19/2025 by:- Mohammed W. ( MPH)

103. General Rule

Strong
Intentions
Strong
Attitude
Strong
Subjective
Norm
Strong
Perceived
Behavioral
Control
More likely to perform the Behavior
5/19/2025 by:- Mohammed W. ( MPH) 103

104. 1045/19/2025 by:- Mohammed W. ( MPH)

105. Class Discussion
•Apply TPB to explain addictive
1055/19/2025 by:- Mohammed W. ( MPH)

106. Limitations of TPB
•Factors such as personality and demographic variables are
not taken into consideration

•There is much ambiguity regarding how to define
perceived behavioral control and this creates measurement
problems
•Assumption is made that perceived behavioral control
predicts actual behavioral control. This may not always be
the case
5/19/2025 by:- Mohammed W. ( MPH) 106

107. •TPB only works when some aspect of the behavior is not
under volitional control
•The longer the time interval between behavioral intent and
behavior, less likely the behavior will occur
• Unconscious motives are not considered
1075/19/2025 by:- Mohammed W. ( MPH)

108. Scope and Application of TPB
- Provide useful information for the development of
communication strategies.
- In evaluation studies,disease prevention behavior, birth
control behavior, consumption prediction
Eg. Researches on whether to wear a seat belt, whether to
check oneself for disease and whether to use condoms when
having sex
1085/19/2025 by:- Mohammed W. ( MPH)

109. Example Behavior/Cessation
Attitude toward the Behavior:
"You know what? I think, smoking is dangerous for my
health."
•Subjective Norms: "I wonder my wife like me to quit
smoking."
•Perceived Behavioral Control: "I can quit smoking, even if
I’m hooked on cigarettes!"
•Intention: I want to quit smoking right now!"
•Behavior: "As you can see, I am not smoking anymore.
Instead of taking a cigarette, when I get the craving, I crumble
paper now."
5/19/2025 by:- Mohammed W. ( MPH) 109

110. M oha mmedwa g ris@su. edu. et
wa g rismw@g ma il. com
Trans Theoretical Model
of Behavior Change
Mohammed W.(MPH)
Email: [email protected]
[email protected]
110BY: Mohammed W. (MPH)

111. •Called as stages of change model or model of intentional
change
•Introduced by Prochaska and DiClemente in 1984
•This model describes individuals’ readiness to change or
attempt to change toward healthy behaviors
•It describes how people modify a problem behavior or
acquire a positive behavior
Trans Theoretical Model(TTM)
111BY: Mohammed W. (MPH)

112. Core constructs
1.Stages of change
2.Process of change
3. Decisional balance:"reflects the individual’s relative
weighing of the pros and cons of changing“
4. Self-efficacy
•The situation-specific confidence people have that they can
cope with high risk situations without relapsing to their
unhealthy or high risk habit"
112BY: Mohammed W. (MPH)

113. 5. Temptation: reflects the converse of self-efficacy
• Temptation reflects the intensity of urges to engage in a
specific habit when in the midst of difficult situations"
•Generally, It is a model that focuses on the decision making
of the individual
•It uses to change chronic behavior
113BY: Mohammed W. (MPH)

114. Stages of change
•TTM see change as a process involving progress through
a series of five stages
1.Pre-contemplation
2.Contemplation
3.Preparation
4.Action
5.Maintenance
114BY: Mohammed W. (MPH)

115. Pre contemplation
▪Is the stage in which people are not
intending to take action in the foreseeable
future
▪Person does not thinking about changing
behavior
115BY: Mohammed W. (MPH)

116. Contemplation
•People are aware that a problem exists
•Thinking about changing behavior in the near future
( next six month)
•They have no commitment to undertake action
•people ‘stuck’ in this stage for long periods of time
116BY: Mohammed W. (MPH)

117. Preparation
•People are intending to take action in the
immediate future
•Person prepares to under take the desired
change
•These individuals have a plan of action, such
as
•Consulting a counselor/ health education
•Talking to their physician
•Buying a self-help book
117BY: Mohammed W. (MPH)

118. Action
•People have made specific overt modifications in their life-
styles within the past six months
•Individuals actually modify their behavior, experiences, or
environment
•Since action is observable, behavior change often has been
equated with action
•The action stage is also the stage where vigilance against
relapse is critical

118BY: Mohammed W. (MPH)

119. Maintenance
•Continuation of behavior change
•People work to prevent relapse & strengthen the gains
attained in the action stage
•They are less tempted to relapse and increasingly more
confident that they can continue their change
119BY: Mohammed W. (MPH)

120. Termination
•Zero temptation and total self efficacy
•It is an ideal
120BY: Mohammed W. (MPH)

121. •Evidence suggest that behavior change occurs in stages or
steps movement through these stages is neither unitary or
linear but, rather involving cyclical pattern

•People appear to move through an orderly sequence of
change
•Although some people move more rapidly then others; some
may get “stuck” at one stage for a long time
121BY: Mohammed W. (MPH)

122. 122BY: Mohammed W. (MPH)

123. Precontemplation
Contemplation
Preparation
Action
Maintenance
Relapse
123BY: Mohammed W. (MPH)

124. 124BY: Mohammed W. (MPH)

125. Q. What is the advantage of knowing the stage of
change in health promotion activities?
125BY: Mohammed W. (MPH)

126. 126BY: Mohammed W. (MPH)

127. How Change Occurs
•Processes of Change: are the covert and overt activities that
people use to progress through the stages
•It provide important guides for intervention programs, since
the processes are independent variables that people need to
apply, or be engaged in, to move from stage to stage
•Ten processes have received the most empirical support in
research to date
127BY: Mohammed W. (MPH)

128. 10 process with in the 5 stages
128BY: Mohammed W. (MPH)

129. 129BY: Mohammed W. (MPH)

130. •Which process of change is/are important
element in the transitions between different
stages of changes?
130BY: Mohammed W. (MPH)

131. ➢ For movement from pre contemplation to
contemplation, the processes of "consciousness
raising," "dramatic relief," and "environmental
reevaluation" are emphasized
➢Between contemplation and preparation, "self-
reevaluation" is emphasized
131BY: Mohammed W. (MPH)

132. ➢ Between preparation and action, "self-liberation" is
emphasized
➢Between action and maintenance, "reinforcement
management", "helping relationship," "counter
conditioning," and "stimulus control" are emphasized
➢Interventions to change behavior must be "stage-matched,"
that is, "matched to each individual’s stage of change"
132BY: Mohammed W. (MPH)

133. 133BY: Mohammed W. (MPH)

134. Strengths of TTM
•See change as a process involving progress
through a series of five stages
•Applied to a wide variety of problem behaviors
•Implies that different intervention approaches
are needed for people at different stages of
change
134BY: Mohammed W. (MPH)

135. Limitations
•It focuses on the individual without assessing the role that
structural and environmental issues may have on a person's
ability to enact behavior change
•Presents a descriptive rather than a causative explanation of
behavior, the relationship between stages is not always clear
•Each of the stages may not be suitable for characterizing
every population
135BY: Mohammed W. (MPH)

136. BY: Mohammed W. (MPH) 136

137. Questions
•Are you interested in trying to quit smoking? (Pre-
contemplation)
•Are you thinking about quitting smoking soon?
(Contemplation)
•Are you ready to plan how you will quit smoking?
(Preparation)
•Are you in the process of quitting smoking? (Action)
•Are you trying to stay smoke-free? (Maintenance)
137BY: Mohammed W. (MPH)

138. M oha mmedwa g ris@su. edu. et
wa g rismw@g ma il. com
Health Education
Planning Model
model of framework
Mohammed W.(MPH)
Email: [email protected]
[email protected]
1385/19/2025 By :-Mohammed W. (MPH)

139. Objectives of the session
•Discuss the components of PRECEDE-PROCEED
model
•Discuss the role of PRECEDE-PROCEED model in
health promotion planning
•Explain the diagnostic phases of the model & their
applications
1395/19/2025 By :-Mohammed W. (MPH)

140. Introduction
•Planning – planning is about drawing sound and feasible
goal to solve practical problem at hand
•Purpose of the program planning: - is to devise a program
that is appropriate to the health problem & identified target
group, with in the resource limit, & which will have the best
chance of bringing about desired change
5/19/2025 By :-Mohammed W. (MPH) 140

141. •Health promoters use theories & models to design,
implement & evaluate health behavior change programs.
•PRECEDE – PROCEED Model is one of the best models
which is used to develop comprehensive program planning
•PRECEDE-PROCEED is a planning model
5/19/2025 By :-Mohammed W. (MPH) 141

142. •Designed by Lawrence Green and Marshall Kreuter for
health education and health promotion programs(1970)
•Its overriding principle is that most enduring health
behavior change is voluntary in nature
•It should be reflected in a systematic planning process which
seeks to empower individuals with understanding,
motivation, and engagement in community affairs to
improve their quality of life
5/19/2025 By :-Mohammed W. (MPH) 142

143. •PRECEDE – This is the beginning of the assessment or
diagnostic stage of the process
•is an acronym for Predisposing, Reinforcing, Enabling,
Causes in, Educational Diagnosis and Evaluation
•PROCEED- is the evaluation portion of the process
•Is an acronym for Policy, Regulatory, Organizational
Constructs in Educational and Environmental Development
1435/19/2025 By :-Mohammed W. (MPH)

144. •Unlike other theories, it does not attempt to predict or
explain the relationship among factors influencing some
behavior out comes
• Rather, it provide a framework for applying other theories to
identify most appropriate intervention strategies
•Mainly used to design service programs
1445/19/2025 By :-Mohammed W. (MPH)

145. •Framework for developing policy & initiating
implementation & evaluation process
•The fundamental principle is on target audience
participation
•Two main proposition:
•Health & health risks are caused by multiple factors
•Efforts to effect behavior, environmental & social
changes must be multidimensional
1455/19/2025 By :-Mohammed W. (MPH)

146. DESCRIPTION OF THE MODEL
PRECEDE - the first 5 phases are diagnostic which
identifies objectives & provide the object for
implementation & evaluation phases
•Phase 1 - Social Diagnosis
•Phase 2 - Epidemiological Diagnosis
•Phase 3 - Behavioral & Environmental Diagnosis
•Phase 4 - Education & Organizational Diagnosis
•Phase 5 - Administrative & Policy Diagnosis
1465/19/2025 By :-Mohammed W. (MPH)

147. PROCEED - the second 4 phases
•Phase 6 - Implementation
•Phase 7 - Process Evaluation
•Phase 8 - Impact Evaluation
•Phase 9 - Outcome Evaluation
1475/19/2025 By :-Mohammed W. (MPH)

148. PRECEDE/PROCEED FRAMEWORK
Phase 1 - Social Diagnosis/Assessment
-Seeks to subjectively define the quality of life (problems &
priorities) of priority population
-Need assessment
-The outcome of Phase 1 is the community's subjective
evaluation of which health issues or concerns have a
negative impact on their quality of life
1485/19/2025 By :-Mohammed W. (MPH)

149. •Therefore, health promotion activities should address
unsatisfied needs and barriers to happiness
•This may not always be possible, since community
members may identify non-health issues
• Also, the identified issue may be found to be less
important by later assessment. Nonetheless, finding out
what concerns the community is the place to start
1495/19/2025 By :-Mohammed W. (MPH)

150. Methods used for social diagnosis
▪ Community Forums/discussion
▪ Focus Groups
▪ Surveys
▪ Interviews
1505/19/2025 By :-Mohammed W. (MPH)

151. Phase 2 - Epidemiological Diagnosis
• This phase helps determine health issues associated with
the quality of life
• Determine which of the subjective matters identified in
Phase 1 can be objectively confirmed as serious health
issues
1515/19/2025 By :-Mohammed W. (MPH)

152. Examples of Epidemiological Data:
• Vital statistics
• Prevalence
• Incidences
•Morbidity
• Mortality
1525/19/2025 By :-Mohammed W. (MPH)

153. Epidemiological assessment serves three functions:
1.To confirm the top priority identified in Phase 1 or if this is
not possible, to re-rank those concerns based on objective
indicators of health status;
2. To be able to justify your program's Phase 1 rank; and,
3. To help allocate resources
1535/19/2025 By :-Mohammed W. (MPH)

154. Phase 3 - Behavioral and Environmental
Diagnosis/Assessment
•Behavioral assessment: identifies what behaviors cause or
are strongly related to the problem you identified in Phase 1
and 2
•Environmental assessment uses the same process as the
behavioral assessment to identify environmental risk factors
1545/19/2025 By :-Mohammed W. (MPH)

155. •Once identified, it becomes necessary to select which
behavioral risk factor and, probably, which environmental
risk factor to address. This is again a matter of setting
priorities

•Identifying the most important and most changeable factor
as a way of setting priorities
1555/19/2025 By :-Mohammed W. (MPH)

156. More Important Less Important
More Changeable High Priority
Quadrant I
Low Priority Except for
Political Reasons
Quadrant III
Less Changeable Priority for Innovations
Assessment Crucial
Quadrant II
No Program
Quadrant IV
1565/19/2025 By :-Mohammed W. (MPH)

157. Phase 4 - Educational Diagnosis
This phase assesses the causes of health behaviors which
were identified in Phase 3

Three kinds of causes are identified - predisposing factors,
enabling factors, and reinforcing factors
1575/19/2025 By :-Mohammed W. (MPH)

158. Phase 5 - Administrative and Policy Diagnosis
•Assessment of resources, budget development and allocation
•Development of an implementation timetable, organization
or personnel within programs, and coordination of the
program with all other departments, and institutional
organizations and the community
1585/19/2025 By :-Mohammed W. (MPH)

159. Diagnostic element of the PRECEDE/PROCEED Model
Planning step Function
1. Social assessment Assess People view of their own need
And quality of life
2. Epidemiological assessment Document which health problem is most
important for which group of community
3. Behavioural and environmental assessment Identify factors that contribute to the health
problem interest
4. Educational and ecological assessment Identify predisposing , enabling and reinforcing
factors that must be in place to initiate and
sustain change
5. Administrative and policy assessment Identify police, resource and circumstance in
the programme context that may help or
hinder implementation
1595/19/2025 By :-Mohammed W. (MPH)

160. Phase 6 - Implementation of the Program: Design
intervention and assess availability of resources and
implement program
Phase 7 - Process Evaluation is used to evaluate the process
by which the program is being implemented
Phase 8 - Impact Evaluation measures the program
effectiveness in terms of intermediate objectives and changes
in predisposing, enabling, and reinforcing factors
1605/19/2025 By :-Mohammed W. (MPH)

161. Phase 9 - Outcome Evaluation
•Measures change in terms of overall objectives and changes
in health and social benefits or the quality of life
•It takes a very long time to get results and it may take
years before an actual change in the quality of life is seen
1615/19/2025 By :-Mohammed W. (MPH)

162. 1625/19/2025 By :-Mohammed W. (MPH)

163. Surveillance, Planning and Evaluating for Policy and Action:
PRECEDE-PROCEED MODEL*
Quality of
life
Phase 1
Social
assessment
Health
Phase 2
Epidemiological
assessment
Health
education
Policy
regulation
organization
Public
Health
Phase 5
Administrative &
policy assessment
Output Longer-term
health outcome
Short-term
social impact
Short-term
impact
ProcessInput Long-term
social impact
Phase 6
Implementation
Phase 7
Process evaluation
Phase 8
Impact evaluation
Phase 9
Outcome evaluation
Predisposing
Reinforcing
Enabling
Phase 4
Educational &
ecological
assessment
Behavior
Environment
Phase 3
Behavioral &
environmental
assessment
*Green & Kreuter, Health Promotion Planning, 3rd ed., 1999. 1635/19/2025 By :-Mohammed W. (MPH)

164. Summary
The model provide common ground for planners &
community
✓Social Diagnoses →assess community perceived needs
✓Epidemiology, Behavioral, Educational Diagnoses → assess
actual needs
✓Administrative & Policy diagnoses →identifies parameters
in which intervention can operate
1645/19/2025 By :-Mohammed W. (MPH)

165. Discussion
Q. What do you think is the advantage of this framework than
the traditional planning methods?
Q. What do you think is/are the limitations of this framework?
5/19/2025 By :-Mohammed W. (MPH) 165

166. Limitations
▪Heavily data driven
▪Resource intensive
▪Time taking
5/19/2025 By :-Mohammed W. (MPH) 166

167. Example
•The Effect of an Intervention Based on the PRECEDE-
PROCEED Model on Preventive Behaviors of Domestic
Violence Among Iranian High School girls
5/19/2025 By :-Mohammed W. (MPH) 167

168. Objectives
•This study was conducted to evaluate the effect of an intervention
based on PRECEDE-PROCEED Model on preventive behaviors of
domestic violence among Iranian high school girls.
Patients and Methods
•An interventional study was completed during 2010-2011 in 10 high
schools in the district 17 of Tehran municipality with 510 female
students. We used the components of the PRECEDE-PROCEED
Model for planning, implementation and evaluation of the program.
Based on the results of need assessment, an appropriate environmental
and educational intervention was implemented in the intervention
group. Changes in predisposing, reinforcing, enabling factors and
especially preventive behaviors immediately and two months after the
intervention activities were assessed by questionnaires based on
PRECEDE-PROCEED Model.
5/19/2025 By :-Mohammed W. (MPH) 168

169. Results
•The intervention had significantly positive effect on
predisposing, enabling and reinforcing factors immediately
and two months after the intervention (P < 0.05). Repeated
measures Analysis of variance showed a significant positive
increase in preventive behaviors score in the intervention
group from baseline to two months
Conclusions
•The PRECEDE-PROCEED Model can be applied as a
conceptual framework for identifying the relevant
behavioral and environmental risk factors associated with
domestic violence. Development and implementation the
skills-based education using this model can lead to the
promotion of preventive behaviors of domestic violence
and reduction in domestic violence cases
5/19/2025 By :-Mohammed W. (MPH) 169

170. •Thank You
5/19/2025 By :- Mohammed W.(MPH) 170