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1. Health and Human Behavior

2. Objectives
At the end of the session, the students will be able to:
• Define human behavior and other related terms
• Explain determinants of health
• Identify factors determining human health behavior
• Understand approaches of behavior change.
• Identify types of human health behaviors

3. What is health?
Health is a very abstract concept to conceptualize and
measure and it is too difficult to put in words. It is a
broad concept and its definition also differs among
social classes, cultures, and religion and ethnic groups.
 However, World Health Organization defines health
as: “A state of complete physical, mental, and social
well-being not merely the absence of disease or
infirmity”.

4. Determinant of Health
The major causes of death in developing countries, including Ethiopia
are communicable diseases, such as TB, HIV/AIDS, Malaria, &
diarrheal diseases.
 In addition, the magnitude and severity of malnutrition in which it
accompanied these diseases play as a vicious cycle and devour
many lives and lead many sufferings.
 However, in most cases these diseases and associated health
problems can be prevented or can be controlled through
appropriated health behaviors change and health behaviors
modifications.

5. Determinant of Health…
Broadly, health is determined by two major categories of
determinants or factors. These are behaviors and
environmental determinants.
Behaviors are those daily actions which are under the
possibility of the control of the person/individual/ where
as environmental determinants or factors are those
factors which are not easily under the control of the
person.

6. Determinant of Health…
• .
Life style/Behavior
Environment
Health
F.g.1. Relationships of Behaviors/life style & environment as a
cause of health

7. Determinant of Health…
As it has been seen in the above figure, behavior affects
health and environment; as well as environment affects
health and behaviors.
On the other side of the coin, behavioral and environmental
factors/determinants are also responsible as a causes for
diseases, illnesses, sickness, disability, handicaps and
premature deaths

8. Determinant of Health…
Generally,
An important justification for health education and
health promotion comes from the fact that health is
determined, not by medical services and drugs, but by
ordinary human actions and behaviors.
Many health education programs have failed because
they put too much emphasis on individual behavior and
neglected to understand the cultural, social, economic
and political factors that influence his/her behaviors or
actions.

9. Determinant of Health…
However, a proper understanding of the influences outside
the individual’s control will avoid the pitfall of victim-
blaming.
These outside influences could include advertising health-
damaging products such as cigarettes, government policies
such as promoting tobacco cultivation or location of health
services, poverty and unemployment.

10. Behaviour
• Behaviour is an action that has a specific frequency, duration
and purpose whether conscious or unconscious. It is what we
“do” and how we “act”.
• People stay healthy or become ill, often as a result of their own
action or behaviour
The following are examples of how people’s actions can affect
their health:
 Using mosquito nets and insect sprays helps to keep mosquito
away.
 Feeding children with bottle put them at risk of diarrhoea.
 Defecating in an open field will lead to parasitic infection.
 Unsafe sex predisposes people to unwanted pregnancy,
HIV/AIDS and other STDs

11. Behaviour…continued
• In health education ,it is very important to be
able to identify the practices that cause, cure,
or prevent a problem.
• The words actions, practices and behaviours
are different words of the same thing.

12. Behaviour…continued
• Human behaviour is among the major determinants
of health of individuals, families or communities.
• Healthy behaviours contribute to the overall health
of individuals and communities and unhealthy
behaviours adversely affect the quality of life people
at different levels.
• Most health issues cannot be dealt with by treatment
alone.
• The promotion of health and prevention of diseases
will usually involve some changes in life styles or
human behaviour.

13. Behaviour…continued
Examples of behaviours promoting health and preventing
diseases:
Healthy behaviours: - actions that healthy people
undertake to keep themselves or others healthy and prevent
disease. Good nutrition, breast feeding, reduction of health
damaging behaviours like smoking are examples of healthy
behaviours
Utilization behaviour: - utilization of health services such
as antenatal care, child health, immunization, family
planning…etc

14. Behaviour…continued
• Illness behaviour: - recognition of early symptoms and
prompt self referral for treatment.
• Compliance behaviours: - following a course of
prescribed drugs such as for tuberculosis.
• Rehabilitation behaviours: - what people need to do
after a serious illness to prevent further disability.
• Community action: - actions by individuals and groups
to change and improve their surroundings to meet special
needs.

15. Factors affecting human behavior
As it has been seen from the previous figure (Fig.1) there
are two major categories of human health
determinants/factors.
Among these determinants, behaviors are one category in
which it again can be subdivided in to three categories as
of the following figure according to Lawrence Green.

16. Factors affecting human behavior…
• .
Predisposing factors
Reinforcing factors
Enabling factors
Behavior
Environment
Health
F.g.1.2 Relationships of Predisposing, Reinforcing, & Enabling factors as
determinants of behaviors and environment for health or hindrance of health

17. Factors affecting human behavior…
There are three categories of factors affecting
(determining) individual or collective behavior, each of
which has a different type of influence on behavior:
A. predisposing factors
B. Enabling factors
C. Reinforcing factors

18. A. predisposing factors
Are antecedents or prior to behavior that provide the
rationale or creation of motivation for the behavior to occur.
This type of factor include:
• Knowledge -Confidence/self-efficacy
• Perception - Outcome efficacy
• Belief -Behavioral intention
• Value -Attitude
• and existing personal skills that facilitate or hinder
motivation for change.

19. Predisposing factors …
E.g. an adolescent knows the untoward consequences of
smoking and may have a negative attitude towards
smoking and believe that it is harmful (predisposing
factors) which causes him/her not to smoke (the
behavior).
In general, predisposing factors are factors at individual
levels rather than environmental (social environment and
other environmental) factors.

20. B. Enabling factors
Enabling factors are those skills, resources, barriers that
can help or hinder the desired behavioral changes as well
as environmental changes.
Enabling factors are those antecedents to behavior that
facilitate a motivation to be realized.
They help individuals to choose, decide and adopt
behaviors and may be barriers and assets to needed
changes.
This category of factors include:

21. Enabling…
The health-care environment
-availability
-accessibility
-affordability
New skills
Resources. E.g.. Facilities, money, time, labor services,
skills, transportation, materials and the distribution and
their location.

22. Enabling…
Other environmental factors such as community and /or
governmental laws, policy, rules, regulations, priority
and commitment can be a barrier or a facilitator of the
behavior change to be occurred
Example (1) : strong enforcement of the local ordinances
and government prohibiting the sells of cigarettes may
lead to unavailability of cigarettes in his/her immediate
environment or making exceedingly costly as well as the
existing social norms or customs prohibiting smoking are
enabling factors which discourage smoking (the
behavior).

23. Enabling…
On the other hand if social norms allowed or welcomed
smoking behaviors and the government policy, rules and
regulations don’t address the issue then the enabling
factors are good for smokers and initiates smoking but
dangers health of the citizens.
Example 2. Enabling factors for a mother to give oral
dehydration solution to her child with diarrhea could be:
time, containers, salt and sugar and skill how to prepare
and administer it.

24. Enabling…
Example (3): enabling factors for a latrine construction
would be money, essential components such as slabs and
necessary construction skills.
Example (4) for FP program, the enabling factors would be
availability of contraceptives, accessible FP services and
the necessary skills for using a particular method.

25. Enabling…
NB. When the public make the effort to follow your health
education you should ensure that the required services
(enabling factors) such as screening facilities, medicines,
vaccines, building materials, etc. are actually available.

26. C. Reinforcing factors
Reinforcing factors are those factors subsequent to a
behavior that provide the continuing reward or incentives
for the behavior to be persistent and repeated.
Are those consequences of actions that determine
whether the actor receives positive or negative feedback
and is supported socially or by significant others after it
occur.

27. Reinforcing factors…
Significant others
Can also be called relevant others or influential others.
These are people who are significant (determine or
influence) the behavior of others to encourage or
discourage to do something.
We often listen to what he or she says and tries to do
what he or she does.

28. Reinforcing factors…
Among these important people are elders, friends, peers,
parents, grand parents, village leaders, religious leaders
and people with a lot of experience and skills (teachers,
health workers, etc.).
Examples
The woman does not adopt FP because her husband
disapproves.
The young man who starts smoking because his
friends encourage him to do so.

29. Reinforcing factors…
• Mother/father Friends
• Husband/wife
l employer
political leaders
Brothers/sisters chiefs
• Parent-in-low religious leaders
• Grand parents traditional healers
• Health workers
Fig 2.1. The influence of social pressure (circle of influence)
• Source: Dr. John Hubley. Communicating health. 2nd ed. Copy
right John Hubley 1993. VIKAS publishing agency
Man

30. Changes of Behavior
Our behavior changes all the time, some are natural while
others are planned changes.
 Natural changes: When changes occur because of
natural events in the community around us, we often
change with out thinking much about it.
• Example, Mr. X, usually drink Coca-cola whenever he
feel extreme thirst, but he may change his behavior and
drink Pepsi-cola if no Coca-cola is available in the
cafeteria.

31. Changes of Behavior
Planned changes: When changes occur deliberately
and/or planned.
Example Mr. K, chews a big bundle of chat each day. But
now he is experiencing sevior constipation and loss of
appetite. Consequently, he decides to quit chat chewing.
Then he plans to decrease progressively by consuming
half a bundle of the previous day.

32. Behavior change approaches
The persuasion approach:-the deliberate attempt to
influence the other person to do what we want them to
do. (Often called the ‘directive’ approach or, when done
forcefully, coercion).
Such approach is used in situations where there is serious
treat such as epidemics and natural disasters, and the
actions needed are clear-cut.

33. Behavior change approaches…
The informed decision making approach:- giving
people information, problem-solving and decision-making
skills to make decision but leaving the actual choice to
the person (‘open’ or ‘non-judgmental’ approach).
Such approach is used with groups who have been
disadvantaged or oppressed by promoting awareness-
‘conscious-raising’ and ‘building confidence’ that they
have the power to make their appropriate decisions and
control their own lives called empowerment.

34. Types of health behaviors
Health behaviors- are actions that healthy people undertake to
keep themselves or others healthy and prevent disease.
It includes not only observable, overt actions but also the
mental events and feeling states that can be reported and
measured
It can also defined as: “Those personal attributes such as
beliefs, expectations, motives, values, perceptions, and other
cognitive elements; personality characteristics, including
affective and emotional states and traits; and overt behavior
patterns, actions, and habits that relate to health maintenance,
to health restoration, and to health improvement”-

35. Types of health behaviors…continued
Broadly health behaviors can be classified as follows:-
1) Promotive behaviors:-such as Physical exercise, use of
latrine, Child-spacing, proper disposal of dirty water, Good
nutrition, clean storage of food, Breast-feeding and
reduction/cessation of unhealthy practices such as cigarette
smoking, breast- feeding and excessive alcohol consumption

36. Types of health behaviors…continued
2) Preventive behaviors
 taking anti-malaria drugs
 immunization
 using mosquito bed nets
3) Utilization behaviors
Is concerned with utilization of health services such as:
ANC services
Immunization services
Child-health services
Screening programs
FP service

37. Types of health behaviors…continued
4) At risk behaviors:
It refers to the activities undertaken by an individuals,
who believes himself to be health but at a greater risk of
developing a specific health condition, for the purpose of
preventing that condition or detecting it in an
asymptomatic state.
For example, HIV/AIDS testing

38. Types of health behaviors…continued
5) Illness behaviors
The action people take before consulting health care
workers, including recognition of symptoms, taking
home remedies (self-medication), consulting family and
healers are called illness behaviors.
It is recognition of early symptoms and prompt self-
referral for treatment before the disease becomes
serious

39. Types of health behaviors…continued
6) Compliance behaviors
A behavior following a course of prescribed drugs
(taking too much drug or too less or no drug because of
severity and short recovery). Best example is TB –
prolonged drug use.
7) Rehabilitation behaviors
A type of behavior that prevent further disabilities after a
serious illness.
E.g. counseling after lung cancer surgery to exercise or quit
smoking

40. Types of health behaviors…continued
8) Community action
Action undertaken by the individuals and groups to
change or improve their surrounding to meet special
needs.
For example community participation in:
Installation of improved water supply
Building of latrines and upgrading the unimproved

41. Types of health behaviors…continued
9. Self-Care Behavior: Activity undertaken by an
individual, who considers himself or herself to be ill,
for the purpose of getting well.
It includes minimal reliance on appropriate therapies,
involves few dependent behaviors, and leads to little
neglect of one’s usual duties.

42. Types of health behaviors…continued
10. Wellness Behavior: Activity undertaken by an
individual, who believes himself to be healthy for the
purpose of attaining an even greater level of health.
11. Mutual-Aid Behavior: Activity in which people
support each other in relation to their common health
problems or aspirations

43. Types of health behaviors…continued
13. Family Planning Behavior: Activity undertaken by an
individual or couple to influence the occurrence or
normal continuation of the pregnancy
14. Parenting Health Behavior: Wellness, prevention, at risk,
illness, self-care, or sick role actions performed by an
individual for the purpose of ensuring, maintaining, or
improving the health of a conceptus or child for whom the
individual has responsibility

44. Types of health behaviors…continued
15. Health related social Action: Activity undertaken by an
individual singularly or in concert with others (i.e.,
collectively through organizational, legal, or economic
means, to influence the provision of medical services, the
effect of the environment, the effect of various products, or
the effect of social regulations that influence the health of
population

45. THANK YOU