Green Behav Dx 04

Green-Behav-Dx-04

BEHAVIORAL & ENVIRONMENTAL DIAGNOSIS Behavioral Dx: - systematic analysis of the behavioral links to the goals/problems that were identified in epid / social Dx Environmental Dx: paralel analysis of factors in the social and physical environment, that could be causally linked to the behavior that was identified.  WHY AN EMPHASIS ON BEHAVIOR? BEHAVIOR INFLUENCE HEALTH IN THREE WAYS: 1 DIRECT & 2 INDIRECT

THE

PHYSICAL & SOCIAL ENV. CAUSES

BEHAV. CAUSES

HEALTH HEALTH-CARE ENV. CAUSES

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Green-Behav-Dx-04

DECREASING PERSON’S YEARS OF POTENTIAL LIFE --- ROUGHLY ESTIMATED: BEHAVIORAL / LIFESTYLE : ENVIRONMENT, GENETIC, BIOLOGICAL = 50%

 THE FIVE STEPS IN BEHAVIORAL DX 1. SEPARATING BEHAVIORAL AND NON BEHAVIORAL CAUSES OF THE PROBLEM LEADING CAUSES OF DEATH

RISK FACTORS : - BEHAVIORAL - BIOLOGICAL - ENVIRONMENTAL - SOCIAL

NonBehavioral Gender Age Family history Diabetes

Behavioral Smoking High fat diet Heavy Alcohol consumption Sedentary life style

Related to Behav. Hypertension High Cholest.Serum Stress Obesity

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Green-Behav-Dx-04

2. DEVELOPING AN INVENTORY OF BEHAVIOR INVENTORY OF BEHAVIORS ASSOCIATED WITH REDUCTION OF MORTALITY FROM CARDIOVASCULAR DISEASE. PREVENTIVE BEHAVIORS 1.Maintain/ attain desirable weight 2.Stop smoking / don’t start 3.Stop heavy drinking 4.Continue / begin regular exercise 5. Reduced consumption of foods high in saturated fats 6.Avoid excessive, constant stress and/or do relaxation exercise 7.Participate in high blood pressure and cholesterol screening programs TREATMENT BEHAVIORS 1.Make informed decisions regarding medication & surgery 2.Keep scheduled appointment with health providers 3.Take medications as prescribed 4.Maintained / reduced weight as prescribed 5. stop smoking, 6.Cut down alcohol consumption as prescribed 7.Continue/begin regular exercise as prescribed 3

Green-Behav-Dx-04

3. RATING BEHAVIORS IN TERMS OF IMPORTANT THE IMPORTANCE OF A BEHAVIOR IS INDICATED: a. Occurs frequently b. Clearly linked to the health problem MEASURE OF DISEASE ASSOCIATION: Incidence of the problem In those exposed to the rsik factor Relative risk = -----------------------------------------------Incidence of the problem in Those not exposed to the risk factor RELATIVE RISK FOR CORONARY HEART DISEASE RSIK FACTORS IN MIDDLE-AGED MEN

RISK FACTORS

RELATIVE RISK

Smoking Hypertension Elevated serum cholesterol

2.0 2.4 2 – 3 (depend on level of elevation) 2.5 2.1 1.9

Diabetes Obesity Physical activity

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Green-Behav-Dx-04

RATING THE RELATIVE IMPORTANCE OF BEHAVIORS ASSOCIATED WITH CARDIOVASC. DISEASE

IMPORTANT -Smoking -Eating high-fat foods

Basis for rating behavior -very strong risk ratio, High prevalence -Strong rsik ratio, Very high prevalence

-Lack of exercise -High stress LESS IMPORTANT

All unrelated to the desired outcome: primary prevention Not monitoring blood pressure Not adhering to medic.prescription Not keeping medical appointments Making uninformed decision about treatment

4. RATING BEHAVIORS IN TERMS OF CHANGEABILITY Relative Changeability based on perceived attributes of selected preventive health behaviors HEALTH a b c d e f g BEHAVIOR 5

Green-Behav-Dx-04

a.RELEVANCE b.SOCIAL APPROVAL c.ADVANTAGES d.COMPLEXITY e.COMPATIBILITY with values, experiences & needs f.DIVISIBILITY or TRIALABILITY g.OBSERVABILITY CODE: + (POSITIVE), 0 (NEUTRAL), - (NEGATIVE) Rating the Changeability of behaviors associated with Cardiovascular disease Changeability MOST CHANGEABLE -Smoking prevention LESS CHANGEABLE -Eating foods with high fatty Acid content -overeating -exercise

Basis for rating behavior Recent trends & new Research These practices are deeply rooted in culture, soc.relationship and lifestyle. Previous Attempts to change them have had limited success.

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Green-Behav-Dx-04

More changeable

More less Important Important High priority for Low priority except Program focus to demonstrate change for political purposes (quadrant 3) (quadrant 1)

Priority for No program Less innovative program; Changeable evaluation crucial (quadrant 2)

(quadrant 4)

Matrix of health behav.in CVD prevention in youth. _____________________________________________ More less Important Important Smoking Medical treatment More Related behaviors changeable (quadrant 3) (quadrant 1) Eating foods with High fatty-acid Less Content Changeable Overeating Lack of exercise

Not relaxing

(quadrant 4) (quadrant 2)

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Green-Behav-Dx-04

SETTING BEHAVIORAL OBJECTIVES - WHO? The people expected to change - WHAT? The action or change in behavior / health practice to be achieved - HOW MUCH? The extent of the condition to be achieved - WHEN? The time which the change is expected to occur SMART in behavioral term -



Specific Measurable Attainable / appropriate Realistic Time bound

WHY EMPHASIS ON ENVIRONMENT?

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