An analysis of application of behavioral science in practice of medicine

1. Behavioral Science in Medicine
Col Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), MBBS
Armed Forces Medical Institute (AFMI)

2. Behavior
-The way in which one acts or conducts oneself, especially towards
others is Behavior.
-Behavior can be defined as the way in which an individual behaves
or acts. It is the way an individual conducts herself/himself.
1. Behavior is everything a person does.
2. Behaviors that can be observed
• Behaviors that can be heard/seen
• Behaviors that can be measured

5. Eight parameters of behavior are:
B = Behavior
I= Identity of the individual who is behaving
W- Want
K= Knowledge (Cognition)
K-H= Know-How
P= Performance
A= Achievement
PC= Personal Characteristics
S= Significance.

6. Causes of Individual Behavior
• Inherited characteristics
• Learned characteristics

7. Learned characteristic

8. Perception is a way of regarding, understanding, or interpreting
something; a mental impression.

9. Perception
A drowning person is asking for help; and the gentleman has perceived his call for help as
asking for soap. This is how our behavior is influenced by variations in our perception of
situations.

10. Personality
Personality is the combination of characteristics or qualities that
form an individual's distinctive character.
Type-A personality seeks challenges and Type-B personality seeks status quo.

14. Attitude
Attitude is a settled way of thinking or feeling about someone or
something, typically one that is reflected in a person's behavior.

15. Values
-Values are the moral principles and beliefs or accepted standards
of a person or social group.
-Values are a person's or society’s beliefs about good behavior and
what things are important.

16. Mechanism of Behavior
ActionBehavior
Behavior
Intention
Personal
Attitude
Norms
Beliefs
Direct
Observation
Information from
various sources.
eg TV
infer basing on
information
Belief about an
object or person
Belief about
some performing
Belief about some
performing with
knowledge of
‘approval’/
‘disapproval’ of
people, or things
Our actions are determined by our behavior. Behavior is influenced by attitude and norms;
which again depend on our beliefs, learnt through observation, information from various
sources, including education and inferences drawn from any information interacting with
past experiences. Similarly ,behavior can be changed by providing appropriate education

17. Suppose you have a patient sitting in front of you. She is a 58-year-
old woman who works a lot and reports a high level of daily stress.
She is hypertensive, smoker for more than 30 years, is overweight
and has not been exercising regularly. She came to see you because
of low back pain and poor sleep. As a healthcare professional, you
want to help her.

18. One major goal is to address the risk factors for cardiovascular
disease, but you will also want to alleviate her current acute
conditions. At this stage, you can simply follow the guidelines and
give her advice on the benefits of exercise, weight loss, healthy
eating and decreased sodium intake, inform her about
atherosclerotic cardiovascular disease risks and prescribe
medication on an evidence basis.

19. But will these recommendations really work? Do you take the
patient through all of these topics, select a few, or let her direct the
conversation? Will she adhere to your recommendations? And how
can you know? What are the applicable incentives and penalties for
complying or not with these guidelines? Are there other variables
that should be included in this equation?

20. Behavioral sciences provide a starting point for
healthcare professionals to address the questions
raised above and improve health care delivery.

21. Behavioral Science
Behavioral science is a branch of social science that derives its
concepts from observation of the behavior of living organisms.
Broadly defined, behavioral science is the study of human habits,
actions, and intentions.
Combining knowledge of sociology, psychology and anthropology
with strong observation, research, and communication skills, a
behavioral scientist works with communities and individuals
examining behavior and decision-making.

22. Behavioral science has three domains:
1. Psychology
2. Sociology
3. Anthropology

23. Psychology
-Psychology is the scientific study of the human mind
and its functions.
-Psychology is the scientific study of the mind and
behavior.
-Psychology is focused to individual person.

24. Sociology
Sociology is the study of the development, structure,
and functioning of human society. It is focused to a
group of people belonging to a society.
Sociology is the scientific study of society, including
patterns of social relationships, social interaction, and
culture.

25. Anthropology
Anthropology is the study of what makes us human.
Anthropology is the study of people throughout the world, their
evolutionary history, how they behave, adapt to different
environments, communicate and socialize with one another.
The study of anthropology is concerned both with the biological
features that make us human (such as physiology, genetic
makeup, nutritional history and evolution) and with social
aspects (such as language, culture, politics, family and religion).

26. Components of Behavioral Science
• Is a discipline
• Emphasizes human mental process
• Gives a ‘I’ feeling
• Individual demands empirical evidence
Psychology
• Is a discipline
• Emphasizes human society
• Gives a ‘we’ feeling
• Society demands empirical evidence that
links sociological ideas to live experience
Sociology
• Is a discipline
• Emphasizes human society, & association
in the past
• Empirical evidence that links with
documents, tools, fossil…
Anthropology

27. Topic domains for the behaviour science in
medical teaching:
1. Mind body interaction
2. Patient behavior
3. Physician role and behavior
4. Physician patient interaction
5. Social and cultural issues in health care
6. Health policy and economics

28. Relevance and importance of Behavioral Science to
Health & Medicine
Relevance is demonstrated in the:
-Aetiology of illness,
-Presentation of illnesses,
-Delivery of health care,
-Aspects of social and psychological treatment.

29. -Behavioral and social factors are important in planning
for health care with assessment and treatment of both
physical and psychiatric disorder.
-Cultural factors play a role in the behavior of the patient
and treatment.
-Psychological tests help in the psychiatric diagnosis.

30. -Systematic study of psycho-social phenomena (including problems)
in health and disease
-Understanding problems of psycho-social exclusion and
marginalization in care services (e.g., sex workers, poor, people
living with HIV/AIDS & STDs)
-Investigating and understanding psycho-social crises related to
health and disease (e.g., disease outbreak)
-Explaining social responses to poverty, exclusion, marginalization,
prejudice and discrimination which influences healthcare services

31. -Justice through medicine in crime, delinquency, social arbitration
-Development of systems of medical knowledge and medical care
-Integration of alternative medical systems in culturally diverse
environments
-Address the issues of healthcare provider - patient relationship

32. Categories of Behavioral Sciences
Decision Sciences: Decision sciences deals with the decision
processes . It concentrate mainly on Psychology.
Communication Sciences: Communication Sciences deals with
communication strategies used by human. Communication does
not mean 'speech‘ rather communication implies human
interaction and relationship.
It concentrate mainly on Sociology and Anthropology.

33. Concepts of
Psychology
Concepts of
Anthropology
Concepts of
Sociology
Decision
process
Communication
strategies
The scope of behavioral science encompasses linking the concepts
of psychology, sociology and anthropology with decision process and
communication strategies.
Scope

34. •Health behavior is a behavior that affects health:
–Health impairing habits, which is called "behavioral pathogens"
(for example smoking, eating a high fat diet)
–Health protective behaviors, which is defined as "behavioral
immunogens" (e.g. attending a health check).
•Illness behavior is a behavior aimed at seeking a remedy (e.g.
going to the doctor).
•Sick role behavior is an activity aimed at getting well (e.g. taking
prescribed medication or resting). In other words, sick role is
behavior and obligations expected from a sick person.
Health related Behaviors

35. -Illness behavior is described as the state when the
individual feels ill and behaves in a particular way
-Illness is a psychological concept:
– It has different meanings for different people
– It’s based upon an individual’s personal evaluation of
his/her bodily state and ability to function
Illness Behavior

36. Disease versus ill/illness behavior:
 Disease is physical malfunctioning of the body.
 Illness is subjective perception of whether one is
sick or not. It is possible to have a disease and not
feel ill, e.g., undetected diabetes. Also possible
to feel ill without any detectable disease, e.g.,
hypochondriasis.

37. Sick Role
• The sick role – any activity undertaken for the
purpose of getting well by those who consider
themselves ill
• This is a social role
• A patient who enters the sick role has both rights and
obligations
• There are positives and negatives to the sick role.

38. Sick Role Behavior
There are four aspects of sick role behavior:
•The sick person is not at fault for being sick
•The sick person is excused from usual (everyday)
responsibilities
•The sick person must get well as soon as possible
•The sick person must seek professional help

39. Behavior causing ill-health

42. Behavior related to Chronic Illness

43. Five key health-related behaviors for chronic disease prevention
are:
-Never smoking,
-Getting regular physical activity,
-Consuming no alcohol or only moderate amounts,
-Maintaining a normal body weight, and
-Obtaining daily sufficient sleep.

44. How to change a behavior

45. In the past, ‘Fat TV’ without remote control, ensured slim owner. With change of technology,
‘Slim TV’ with remote control has gifted a fat owner. Technology also changes behavior.

46. The Health Belief Model (HBM) is a psychological health behavior
change model developed to explain and predict health-related
behaviors, particularly in regard to the uptake of health services.
The health belief model suggests that people's beliefs about
health problems, perceived benefits of action and barriers to
action, and self-efficacy explain engagement (or lack of
engagement) in health-promoting behavior. A stimulus, or cue to
action, must also be present in order to trigger the health-
promoting behavior.
Health Belief Model (HBM)

49. Yellow marked boxes are the target for educational intervention, to ensure healthy practices.

50. Components of HBM
-Perceived susceptibility: This refers to a person's subjective
perception of the risk of acquiring an illness or disease.
-Perceived severity: This refers to a person's feelings on the
seriousness of contracting an illness or disease. There is wide
variation in a person's feelings of severity, and often a person
considers the medical consequences (e.g., death, disability) and
social consequences (e.g., family life, social relationships) when
evaluating the severity.
-Perceived benefits: The course of action a person takes in
preventing (or curing) illness or disease relies on consideration and
evaluation of both perceived susceptibility and perceived benefit,
such that the person would accept the recommended health action
if it was perceived as beneficial.

51. -Perceived barriers: This refers to a person's feelings on the
obstacles to performing a recommended health action. There is
wide variation in a person's feelings of barriers, or impediments,
which lead to a cost/benefit analysis. The person weighs the
effectiveness of the actions against the perceptions that it may be
expensive, dangerous (e.g., side effects), unpleasant (e.g., painful),
time-consuming, or inconvenient.
-Cue to action: This is the stimulus needed to trigger the decision-
making process to accept a recommended health action. These cues
can be internal (e.g., chest pains, wheezing, etc.) or external (e.g.,
advice from others, illness of family member, newspaper article,
etc.).
-Self-efficacy: This refers to the level of a person's confidence in his
or her ability to successfully perform a behavior.

53. Conclusion
• Mere focus on medicine and clinical domain of
healthcare are not sufficient to ensure health.
• Combination of knowledge of medicine and
skill in behavioral science are complimentary
for effective healthcare services.
• Focus on behavioral changes for compliance
to treatment, healthy practices and healthy
life-style are the challenges against prevailing
Chronic Diseases.