Community medicine

1. BEHAVIORAL
SCIENCE
Dr. Dalia El-Shafei
Lecturer, Community medicine
department, Zagazig university

2. How to understand humanHow to understand human
behaviorbehavior

4. HEALTH
PROBLEM
 May take many different components,
therefore it may be viewed in the form of.

5. HEALTH BELIEF
MODEL

6. HBM can explain:

7. BACKGROUND
Theorists:
(1950’s) Group of social psychologists
Trying to explain why people were not
participating in disease detection
programs. (TB Screening)
Theorists:
(1950’s) Group of social psychologists
Trying to explain why people were not
participating in disease detection
programs. (TB Screening)

10. PERCEIVED
SUSCEPTIBILITY
Subjective belief that a person may acquire
a disease or enter a harmful state as a
result of a particular disease.

11. PERCEIVED
SEVERITY
Belief in the extent of harm that can result
from the acquired disease or harmful state
of a particular behavior.
SEVERE
(death)

12. PERCEIVED
BENEFITS
Belief in the advantages of the methods
suggested for reducing the risk or
seriousness of the disease of harmful state
from a particular behavior.

13. PERCEIVED
BARRIERS
 Concern that the new behavior will take
too much time.
 Their belief could be actual or imagined.

14. SELF-EFFICACY
Confidence in a
persons ability to
purse a behavior

15. CUES TO ACTION
To cause a force that would make
a person feel the need to take
action.
 Advice from a doctor, or friends or
propaganda

18. 1ry Prevention example for HBM
Should I get the H1N1
vaccination?

19. CONSTRUCTS &
APPLICATIONS
 Perceived
susceptibility
 How likely is it I
will get swine flu?
Perceived
severity
Perceived
benefits
How bad would it
be if I did?
What do I gain by
getting the shot?

20. CONSTRUCTS &
APPLICATIONS
 PerceivedPerceived
BarriersBarriers
 Is it available-Is it available-
what’s the cost?what’s the cost?
Cues to
Action
Self
Efficacy
Posters, Emails,Posters, Emails,
commercialscommercials
I am confident II am confident I
can be healthycan be healthy

21. HBM IN HEART
CONDITION
Chest pain sometimes affect performance
(Perception) of risk & its seriousness
Middle aged male with stressful life
Changing risky behavior
Demographic & social variables
Motivating health behavior

22. Perception of benefits
Realize they adopt a healthy behavior (enjoy life,
carry work & not get ill)
Perception of barriers
A friend or a doctor warned him that he is at
increasing risk to become ill
Cues for Action
Work commitments reduce time for sports
social events & fast food eating

23. STAGES OF CHANGING
HEALTH BEHAVIORExit
Maintain
safe life
Pre
contemplation

26. PRE CONTEMPLATION STAGE
Person has no
awareness or no
motivation for the
need to change
habits or lifestyle

27. CONTEMPLATION STAGE
People enter this
stage when they are
thinking about
change or have
enough motivation
to enter the cycle.

28. COMMITMENT “PREPARATION”
STAGE
Willing to make
serious decision to
change.

29. ACTION STAGE
Actively begin
to change.

30. MAINTENANCE STAGE
People struggle to
maintain change.

31. RELAPSE STAGE
Early exit from the cycle due to
false belief of satisfaction.

32. EXIT STAGE
People are settled
into changed
behavior & can exit
the cycle from the
revolving door

34. ILLNESS
BEHAVIOR

35. ILLNESS BEHAVIOR
DEFINITION:
How the patient
ThinkThink...... Feel & ReactFeel & React
when he develop any symptom

38. CLINICAL TIP OF THE ICEBERG
PHENOMENON
Only MinorityMinority of
the patients visit their
physicians
MajorityMajority of
the patients are in
the community
The Tip of The Iceberg

40.  I am a patientI am a patient
 I am weakI am weak
 I need helpI need help
It is not easy to show your
weakness
Why patients may deny their Illness?

41. Symptoms (Biological ProblemBiological Problem)
is notnot the only reason for
patient seeking medical help.

42. The Real Reason for Patient attendance
Idea
Concerns
Expectation
Effect
Feelings
IllnessDisease
++Physical
Symptoms

43. Comprehensive Approach
Idea
Concerns
Expectation
Effect
Feelings
Illness frameworkDisease framework
++
(McWhinney 1984

44. DOCTOR’ BEHAVIOR
Pts feel frustrated
doctor behalf badly against minor complaints
Pts feel doctors uninterested
Both types of feelings influence
subsequent consulting behavior &
medical ttt adherence & health.

45. PRESENTATION OF
SYMPTOMS
Experiencing symptoms may be presented as:
1.Perceiving any change or deviation of body
functions.
2.Interpretation of ill health symptom.
3.Explore seriousness through
Severity.
Familiarity of symptoms.
Duration of frequency.
4.Evaluation of symptoms that require further
action (illness behavior).

46. VARIABLES INFLUENCE ILLNESS
BEHAVIOR
 Visibility of symptoms & signs.
 Extent to perceive as serious.
 Extent to disrupt normal life.
 Persistence & frequency.
 Personal tolerance.
 Available knowledge & cultural assumptions
towards symptoms.
 Needs to denial or compete with illness.
 Interpretation of symptoms (stigma).
 Understanding of health providers.
 Availability of suitable health service.

47. PATIENT
COMPLIANCE

48. A CHRONIC PROBLEM!!A CHRONIC PROBLEM!!
Hippocrates once wrote
that patients often lied
about taking their
medicine.
Adherence to medication
was a big problem then,
and still is today.
Hippocrates of Cos
(ca. 460 BC – ca. 370 BC)
Greek: πποκράτηςἹ

49.  Patient compliance describes the degree to which
a patient correctly follows medical advice.
 Most commonly, it refers to medication or drug
compliance, but it can also apply to other
situations such as medical device use, self care,
self-directed exercises, or therapy sessions
PATIENT COMPLIANCE
(ADHERENCE OR CAPACITANCE)

50. PATIENT’S COMPLIANCE
 Adherence to the advice of health care
professionals [includes]:
1. Preventive health behavior.
2. Keeping medical appointments
3. Self care actions.
4. Taking medications as directed.

52. PATIENT’S
INCOMPLIANCE
Almost 50% of prescribed medications
have health impacts.
Doctors may be effective with only with
55-60% of pts.
Pts may become ill due to non
adherence.
10-25% of hospital admission
due to non adherence

53. CATEGORIES OF
MEDICATION NON-
ADHERENCE
PRIMARY
NO PRESCRIPTION
SECONDARY
 INTENTIONAL
UNINTENTIONAL
53
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54. 10/22/1554

55. OBSTACLES TO PATIENT
COMPLIANCE
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esso

56. FACTORS ASSOCIATED
WITH ADHERENCE
 First:
Pts has to understand what they are really
asked to do.
 Second:
Pts must remember what they are told.
 Third:
Pts must be satisfied with the doctor &
consultation.

57. COMPLIANCE
AIDS