Understanding Behaviour and behavioural change

understanding behaviour

1. Understanding Behavior Factors that influence behavior

2. Problem…? Or Solution ? Focus on behavior!

3. Cover those tanks and get rid of unnecessary containers ! Why won’t those illiterate people DO what they’re supposed to do???

4. Why is Sharukh in the hospital? Because he has a bad infection in his leg. But why does he have an infection? Because he has a cut on his leg and it got infected. But why does he have a cut on his leg? Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on. But why was he playing in a junk yard? Because his neighborhood is kind of run down. A lot of kids play there and there is no one to supervise them. But why does he live in that neighborhood? Because his parents can't afford a nicer place to live. But why can't his parents afford a nicer place to live? Because his Dad is unemployed and his Mom is sick. But why is his Dad unemployed? Because he doesn't have much education and he can't find a job. But why ...?”

5. Definitions of Theory

6. Initial theory of change framework concerning the effect of promotional approaches intended to improve handwashing and sanitation behavioural factors (short-term outcomes), handwashing and sanitation behaviour change (intermediate outcomes) and reduce morbidity and mortality longer-term outcomes)

7. The Stress Response and Development of Allostatic Load. (see note below)

8. Potential Targets for Organizational Change Interventions . SOURCE: Modified and reproduced by special permission of the Publisher, Cnsulting Psychologists Press, Inc., Palo Alto, CA 94303 from Handbook of Industrial & Organizational Psychology, 2nd ed., vol. 3, by Marvin D. Dunnette and Leatta M. Hough (Eds.).

9. Beyond Dialogue: Moving Toward Convergence

10. Expert (sender) sending messages to non-expert (receiver) A Generation Ago . . . . Monologue: The “Medical Era”

11. Moving from monologue to dialogue The 70s: “Field Era”

12. • Need to reach people beyond the clinics • Derived from extension agent approach in agriculture • Field work supported by IEC materials, films and audio visuals • Mass media impact on behavior considered modest due to limited reach • Large volume IEC • SMCR(E) (sender-message- channel, receiver - as dominant communication model The 70s: “Field Era”

13. Moving from dialogue to mutual adjustment and convergence The 90s to Present: “Strategic Era”

14. A predictive model : Influence of ideational elements on behavior Knowledge Attitudes Self-Image Perceived Risk Self-Efficacy Norms Emotion Social Influence Personal Advocacy BEHAVIOR Implies simultaneous effect of all influences.

15. Individual Family/home Community Institutions Policy/Regulation ¡Focus on behaviors! A Comprehensive Behavior Change Approach

16. Kasl and Cobb define three categories of health behavior : 1. Preventive health behavior : any activity undertaken by an individual who believes himself (or herself) to be healthy, for the purpose of preventing or detecting illness in an asymptomatic state. 2 . Illness behavior : any activity undertaken by an individual who perceives himself to be ill, to define the state of health, and to discover a suitable remedy ( Kasl and Cobb, 1966a). 3. Sick-role behavior : any activity undertaken by an individual who considers himself to be ill, for the purpose of getting well. It includes receiving treatment from medical providers, generally involves a whole range of dependent behaviors, and leads to some degree of exemption from one’s usual responsibilities ( Kasl and Cobb, 1966b).

17. Human behaviours important for better health Community action - actions by communities to change their surrounds includes community participation in health decision-making Health behaviours – actions people undertaken to be healthy Utilization behaviours – utilisation of health servies Illness behaviours - recognition of symptoms and prompt self-referral Compliance (adherance) – following course of prescribed medicines Rehabilitation behaviours – what people need to do after an illness/surgery to recover

18. Some important behaviors for the promotion of health Adoption of health promoting behaviors- breastfeeding, weaning, oral rehydration, latrines, hygiene practices, tooth brushing. Reduction of health damaging behaviors- smoking, alcohol consumption, accidents. Utilization of health services- antenatal care, immunization, screening programs, Recognition of early symptoms and prompt referral service for treatment- Kalazar Following of drug regimes- tuberculosis Actions to promote rehabilitation Improving surroundings

19. Specificity needed to define behavior Specifying not only what the behavior is but who is to carry it out and when. E.g.- Vaguely stated ideas- (Sanitation), hygiene. Precise- Type of latrine and construction materials. Hygiene includes, washing of hands, food preparation, clean storage of water and disposal of feaces.

20. Defining the Behavior It is important to carefully define the precise behavior/actions you are wanting to influence. Exercise: Produce a list of the specific behaviors that might be promoted for the following topics: family planning smoking, immunization

21. Types of behaviours Decision-based behaviours – where a person goes through a conscious decision-making process before deciding to perform (or not to perform the behaviour) One-time behaviour – a behaviour that a person is expected to do only a few times in their life. (also usually a decision-based behaviour). Routine behaviour – something people do regularly - usually without a conscious decision (a behaviour might start as decision-based and then become a routine as it is integrated into their pattern of life ) Addictive behaviour – when there is some physiological reinforcement of the behaviour through a biological adaptation in the person who becomes dependent on regular use of the substance.

22. Criteria to describe the behavior- How often should it be performed? Daily, every few days, occasionally, only once. How complicated is to carry it out? Simple, requires learning new skills. How easily does it fit in with the existing practice? Totally incompatible, some compatibility, fits in with the existing practice. How much does it cost, either in time, money or resources to carry out the behavior. Will beneficial effects be observed in the short time? (within a few weeks, months, years) Does the behavior fit in with need of the community? How much impact will the behavior have on health? (great, some, little)

23. BASNEF MODEL ACRONYM FOR- Beliefs, Attitudes, Subjective norms and Enabling Factors. BASNEF MODEL draws on the PRECEDE MODEL and Theory of Reasoned Action.

24. Step- two FACTORS INFLUENCING BEHAVIOR AND BEHAVIOR CHANGE INTENTION NO ENVIRONMENTAL CONSTRAINTS SKILL NECESSARY TO PERFORM THE BEHAVIOR ADVANTAGES OUTWEIGH THE DISADVANTAGES PERCIEVES SOCIAL PRESSURE TO PERFORM THE BEHAVIOR BEHAVIOR IS PERSISTENT WITH THEIR SELF IMAGE EMOTIONAL REACTION TO PERFORM THE BEHAVIOR IS POSITIVE THAN NEGATIVE HAS THE PERCIEVED SELF EFFICACY TO PERFORM THE BEHAVIOR. REF- Fishbein , M. et al. “Factors influencing behaviour and behaviour change.” Final report prepared for NIMH theorists workshop. Washington, D.C., 1991.

25. Thank you