Modul 7 - Behavioral Diagnosis

BEHAVIORAL DIAGNOSIS: ASSESSING HEALTH ACTIONS Module 7

HEALTH PROMOTION & EDUCATION (DEMA 3253) DIPLOMA IN ENVIRONMENTAL HEALTH VICTORIA INTERNATIONAL COLLEGE PREPARED BY: MR KHAIRUL NIZAM MOHD ISA

PRECEDE FRAMEWORK Phase 6 Administrative diagnosis

Direct communication: public, patients

Phase 4-5 Educational diagnosis

Phase 3 Behavioral diagnosis

Predisposing factors: knowledge, attitudes, values, perceptions

Phase 1-2 Epidemiological & social diagnosis

Nonhealth factors Quality of life

Nonbehavioral causes Health education components of health program

Indirect communication: staff development, training, supervision, consultation, feedback

Enabling factors: Availability of resources, accessibility, referrals, skills Reinforcing factors: Attitudes and behavior of health and other personnel, peers, parents, employers, ect.

Behavioral causes Behavioral indicators: utilization, preventive actions, consumption patterns, compliance, selfcare Dimensions: Earliness, frequency, quality, range, persistence

Health problems

Vital indicators: Morbidity, Mortality, fertility, disability Dimensions: incidence, prevalence, distribution, intensity, duration

Subjectively defined problems of individuals or communities Social indicators: illegitimacy, population, welfare, unemployment, absenteeism, alienation, hostility, discrimination, votes, riots, crime, crowding

BEHAVIOR • Behavioral problems refers to the behaviors believed to cause health problems for the people for whom the educational intervention is intended. • After considerable analysis, target behaviors are selected and the approach to changing them stated in term of behavioral objectives. • Behavioral objectives are the means by which program objectives and programs goals are achieved.

BEHAVIOR • Health problems have both behavioral and non-behavioral causes. • Non-behavioral cause are personal and environmental factors that can contribute to health problem but that are not controlled by behavior of the target population. • Non-behavioral causes include: ▫ ▫ ▫ ▫ ▫ ▫

Genetic Climate Work place Residence Environmental (air, water, soil, roads, fluoridation, food, ect.) Technological (adequacy of medical care, facilities)

BEHAVIOR

Nonbehavioral causes

Nonhealth factors Quality of life

Behavioral causes

Health problems

BEHAVIOR • Behavioral causes can be influenced by certain non-behavioral causes, especially through collective action. • Eg. Communities, neighborhoods, or special interest groups can organize, vote, boycott, lobby, or support and prevent certain environmental and technology changes. • Thus, behavior can influence health in 3 ways: ▫ Direct ▫ Indirect (2 ways) Environmental causes

1 2

Behavioral causes 3

Health Technological causes

5 BASIC STEPS IN BEHAVIORAL DIAGNOSIS • Step 1: Differentiating between behavioral and non-behavioral causes of health problem • Step 2 : Developing an inventory of behaviors • Step 3 : Rating behaviors in terms of importance • Step 4 : Rating behaviors in term of changeability • Step 5 : Choosing behavioral targets

Step 1: Differentiating between behavioral and non-behavioral causes of health problem • Differentiate between the behavioral and non-behavioral causes of health problem by listing the known risk factors for that problems/diseases. • eg. Risk factors for cardiovascular diseases Smoking Gender Inactive life-style Stress High serum cholesterol High blood pressure

Heavy alcohol consumption Diabetes Obesity Age Family history of diseases High fatty-acid intake

Step 2 : Developing an inventory of behaviors • Once the behavioral and non-behavioral factors have been listed, the list of behavioral factors should be refined. • Procedure: a) Identify the behavioral associated with preventing the health problem and state them in term of actions to be taken. b) Identify the treatment procedures of the health problem in sequential order. What are the steps that people have to go through to comply with a recommended method of prevention treatment.

Inventory of behaviors • Develop a flow chart of causation or transition from beginning to end of a behavioral process or event. • Eg. The behavior of involve in recycling campaign: ▫ Taking care  willing to separate/sort trash  send to recycling center • It can be sabotaged at many points along the way, for example, when they mix up organic wastes and glasses. • This level makes it possible to isolate concrete behavioral events from non-behavioral factors in such a way as to ensure that intervention-education and administrative- are highly targeted.

Inventory of behaviors Preventive behaviors 1. Maintain or attain desirable weight 2. Stop smoking or don’t start 3. Stop heavy or abusive drinking or don’t start 4. Continue or begin regular exercise 5. Avoid excessive, constant stress and/ or do relaxation exercise 6. Participate in high blood pressure screening programs Treatment behaviors 1. Make informed decisions regarding medication, surgery and so forth 2. Take prescribed medication 3. Maintain or attain desirable weight 4. Stop smoking 5. Stop heavy or abusive drinking or don’t start 6. Continue or begin regular exercise 7. Avoid excessive, constant stress and/ or do relaxation exercise

Step 3 : Rating behaviors in terms of importance • Reduce the extensive list of behavior to a manageable length by establishing which behaviors are the most important. • Steps: ▫ Available data are linked to the behavior and health problems ▫ Put them in sequence and rationality

• Behavior can be considered important if a strong theoretical cases available causally related to a health problem. • The stronger the rationale, the greater the probability that the behavior selected for intervention program.

Rating behaviors Important Smoking Eating foods with high fatty-acid content Over eating Lack of exercise Not relaxing

Basis for rating behavior Very strong association; high incidence Strong association; high incidence Moderate association; high incidence Moderate association; high incidence Moderate association; high incidence

Not (less) important Not monitoring blood pressure Not adhering to medical regimen Making uniformed decision about treatment matters

Basis for rating behavior Not related to the desired outcome of the program: primary prevention

Step 4 : Rating behaviors in term of changeability • Guideline to determine the potential for behavior changeability: ▫ Probably when behaviors are still in the development stages or have only recently been establish ▫ When behaviors are still only superficially tied to established cultural patterns or life-styles ▫ Have been successfully changed in other programs

• Behavior have low changeability when they: ▫ Have long been established ▫ Are deeply rooted in culture patterns or life-style ▫ Have not been changed in previous attempts

Step 5 : Choosing behavioral targets • Time to select the behavior that will be focus of the educational intervention. • To facilitate the selection, the results of the importance and changeability ratings are arranged in a simple matrix table.

Changeable

Important

Not (less) important

1. High priority for program

3. Low priority except to demonstrate change for “political” purposes

2. Priority for innovative Not (less) Changeable program: evaluation crucial

4. No program

Choosing behavioral targets Changeable

Important

Not (less) important

1. High priority for program

3. Low priority except to demonstrate change for “political” purposes

2. Priority for innovative Not (less) Changeable program: evaluation crucial

4. No program

• Depending on the program objectives, the priority behaviors will be more likely come from quadrants 1 and 2. • Behavior in quadrant 3 likely accepted when there is a political need to document change. Eg. Drive over limit among bus express drivers – installation of black box in buses.

Choosing behavioral targets • Matrix of health behavior in preventing cardiovascular diseases Important Changeable

1. None

2. Smoking Eating food with high Not (less) Changeable fatty-acid content Overeating Lack of exercise Not relaxing

Not (less) important 3. None 4. None

Stating behavioral objectives • This is the final step after the target health behavior has been identified. • The behavioral objective should answer these questions: ▫ Who – the people expected to change ▫ What – the action or change in behavior or health practice to be achieved ▫ How much – the extent of the condition to be achieved ▫ When – the time in which the change is expected to occur eg. Who – residents aged 15-25 in BTP What – the reduction in the incidence of cigarette smoking How much – 20% decline in smoking prevalence When – the time of the proposed follow-up evaluation, 2 years after the program is initiated. Young adults aged 15-25 years in BTP will show a 20% reduction in incidence of cigarette smoking within 2 years of program implementation.

Thank you