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BEHAVIOR CHANGE

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Title: BEHAVIOR CHANGE


1
BEHAVIOR CHANGE
HEALTH BELIEF MODEL
(HBM)
First comprehensive explanation of the dynamics
of health behavior.
The HBM emphasizes the importance of perception
in the decision making process. More important
than objective truth is the expectation that a
particular belief evokes about a certain course
of behavior.
2
Modifying Factors
Likelihood of Action
Individual perceptions
Demographic Variables
Sociopsychological Variables
Likelihood of taking recommended
preventive health action
Perceived Susceptibility Severity Benefits/Action
Barriers

PERCEIVED THREAT
CUES TO ACTION
Information Reminders
Persuasive Communication
Experience
3
STAGES OF BEHAVIORAL CHANGE
Precontemplation- is the stage during which
the individual is not seriously thinking about
changing. Lack of awareness of a health
problem. Contemplation-when the person starts to
think seriously about changing in the near term,
with means about six months.
4
Preparation- this stage denotes that the
individual intends to take action in near
future, has made small preliminary behavior
changes. Shares idea with others. Action-is the
six month period following the actual behavior
change and maintenance extends from this point
until termination. Try the new behavior, in
cases the action stage is experimentation.
5
Maintenance- continued change on the part of
the individual, the phase when individual
establishes the new pattern of behavior and seeks
attitudinal and environmental support that tends
to support.
6
Three basic forms of program evaluation Process
Evaluation How well is the intervention
addressing the objectives? To what extent
program failure was due to inappropriate/poorly
conducted learning activities. Impact
Evaluation To what extent were the objectives
achieved? The impact the program has on the
learner in terms of knowledge, attitudes
and skills.
7
Outcome Evaluation Were the program goals
achieved? In health education programs the goals
are concerned with health behaviors and health
status.
8
Phases 1-2 Epidemiological Social
Factors
Phase 3 Behavior Diagnosis
Phase 6
Phases 4-5 Educational Diagnosis
Administrative Diagnosis
Predisposing Factors KNOWLEDGE ATTITUDES VALUES P
ERCEPTIONS
Nonhealth Factors
Nonbehavioral Causes
Health Education and Health Programs
Quality of Life
Enabling Factors Availability of Resources Access
ibility Referrals Skills
Behavioral Causes
Health Problems
Subjectively defined problems of individuals or
communities Social Indicators Illegitimacy Welfare
Population Unemployment Absenteeism Crowding
Vital Indicators Morbidity Mortality
Fertility Disability Dimensions Incidence/Preva
lence Intensity/Duration Distribution
Reinforcing Factors Attitudes Behavior Peers Pare
nts Employers
9
Phase 1 Social Diagnosis
THE
PRECEDE-PROCEED MODEL
Phase 5 Administrative and policy
diagnosis
Phase 3
Phase 4 Educational and
Organizational
Phase 2 Epidemiological Diagnosis
Behavioral and Environmental Diagnosis
PRECEDE
Predisposing Factors
Health Promotion
Behavior and Lifestyle
Quality of Life
Health Education
Health
Reinforcing Factors
Environment
Policy Regulation Organization
Enabling Factors
Phase 6 Implementation
Phase 9 Outcome Evaluation
Phase 7 Process Evaluation
Phase 8 Impact Evaluation
PROCEED
10
MEDIATORS are factors that are casually
associated with the target behavior. Mediators
are important objectives because altering them
appropriately, all other things being equal,
leads to a behavior change in the expected and
desired direction. Human behavior is complex and
influenced simultaneously by many variables, it
is difficult to be certain what particular
variable is the mediator. Research and theory in
health promotion often provides a good idea.
Mediators are best identified and specified by
direct needs assessment and research.
11
Mediators KNOWLEDGE PERCEPTIONS ATTITUDES VALUES
SKILLS EXPERIENCES REINFORCEMENT BELIEFS
12
Percursors are factors associated with behavior,
but which cannot be altered by usual
intervention methods because they occurred in the
past, are biological (ie genetics or natural
ability) Examples of other precursors include
socioeconomic status, race, age, personality, and
previous experiences.
13
Efficacy studies ask the question, Does the
intervention effect behavior change under
optimal conditions? Self-efficacy is individual
judgements of their capabilities to organize and
execute courses of action required to attain
designated types of performances. Self-efficacy
is surprisingly good predictor of behavior,
Observation and research support the common
belief that people tend to do things that they
believe will lead to valued outcome.
14
Effectiveness studies ask the question, Under
usual circumstances, to what extent does the
intervention effect behavior change?
15
ASSESSMENT TECHNIQUES NEEDS OF TARGET
POPULATION
NOMINAL GROUP PROCESS FOCUS GROUP ROUND
ROBIN COMMUNITY FORUM
16
Diagnostic Evaluation forms a part of the
needs assessment process. It is commonly applied
to individuals or groups to determine what they
most need in the way of knowledge, attitude
change, behavioral change or skill
development. Preferred Health Promotion
Needs Assessment Term Feedback on knowledge,
attitudes, risk behaviors, health status, and
perceived needs of the target population and of
the status of available health promotion programs.
17
Formative Evaluation is carried out partway
through a program or intervention process to
identify any needed mid-course
adjustments. Formative Evaluation Process
Evaluation Feedback on programs implementation,
site response, participant response, practitioner
response, and personnel competency. Review of
programs external features in terms of training
level of the instructors books, pamphlets,
films, curriculum and etc. HOW WELL
IS THE PROGRAM BEING
IMPLEMENTED?
18
Process Evaluation information is obtained
from records and documents routinely generated by
the program, observations of class sessions,
interviews and surveys of staff members and
participants, and expert reviews of materials and
plans versa program objectives. Process
Evaluation is Divided into Three
Levels INDIVIDUAL ORGANIZATIONS GOVERNMENTS
19
Summative Evaluation takes place after
the program is completed in order to determine
whether the program should be continued or to
identify needed modifications prior to the
programs next use. Summative Evaluation Impact
Outcome Impact
20
Impact Evaluation Feedback on knowledge,
attitudes, beliefs and behavior of participants
programs and policies of organizations and
governments.
The purpose of impact evaluation is to assess
changes in knowledge, attitudes, beliefs, values,
skills, behaviors, and practices as a result of
the intervention. Individual Did the
participants knowledge, beliefs, and attitudes
about alcohol consumption change as a result of
the program?
21
Outcome Evaluation Feedback on health status,
morbidity and mortality. Outcome evaluation
measures improvements in health or social
factors as a result of the intervention Level
INDIVIDUAL ONLY Epidemiology facts are
important in outcome evaluation. Have the
morbidity rates related to consumption of alcohol
decreased?
22
PROGRAMS
PROCESS
INSTRUCTORS CONTENT METHODS TIME
ALLOTMENTS MATERIALS

BEHAVIOR
KNOWLEDGE ATTITUDE CHANGE HABIT CHANGE SKILL
DEVELOPMENT
IMPACT
The Evaluation Process
OUTCOME
HEALTH
MORTALITY MORBIDITY DISABILITY QUALITY OF LIFE

23
CHOOSING A RESEARCH DESIGN Research design
specifies When, Whom interventions will be
applied and when, whom measurements are
taken. Health Education Practitioner will
ask ONE GROUP PRETEST AND POSTTEST DESIGN Did
the program meet its objectives? Did the program
DO Something Else ? Attitudes, Behavior
(Impact, Outcomes) RD
24
THREE MAJOR TYPES OF RESEARCH DESIGNS
Experimental Design random assignment to
experimental and control groups with measurement
of both groups. Random assignment is used to make
the two groups as equivalent as possible. Other
Types of ED Posttest Only Control Group Pretest
Posttest Control Group
25
Quasiexperimental Design, or nonequivalent compari
son group designs, they have two groups without
random assignment of subjects to the groups.
Therefore, it is important to select a comparison
group that is as similar to the intervention
group as possible. Educational programs usually
does not allow intact classes to be divided.
AGAIN No Random Assignment Most health classes
school and worksite use a quasi design!
26
NONEXPERIMENTAL DESIGN This type of RD design
has only one group. Measures are taken
before(pretest) and after the intervention
(posttest). NO CONTROL GROUP Types of
Nonexperimental designs One Shot Case Study
Design One Group Pretest/Posttest Design Intact
Group Comparison Control groups aid in control
validity factors ie history, maturation.
27
Internal Validity is the assurance that the
program caused the change that was measured and
not outside factors. Rival explanations must be
ruled out. Threats to internal validity are
instrumentation, selection, and participant
attrition.
28
Instrument validity is compromised when
changes occurs in the way measures are taken
pretest/posttest or when participants become more
skilled at the measurements. Lack of
equivalence of the treatment and
comparison groups define the selection threat to
validity. ie treatment group volunteers
comparison group nonvolunteers
29
Attrition is the loss of subjects during an
intervention. Usually those who are
unsuccessful in the program drop out, so the
intervention appears more effective than it
actually is. Other threats history,
maturation Experimental designs when random
assignment into experiment and control groups,
provide the strongest evidence of program effect.
Weaknesses attrition and instrumentation
differences.
30
Quasiexperimental designs this type of study
rules out threats of maturation, history and
testing, differences between the groups such as
a volunteer bias are serious concern. Nonexperime
ntal designs without random assignment or a
control group , offer little control over threats
to validity.
31
Validity Three main forms
Content Validity (FACE VALIDITY) this is
typically used in the construction of new scales
and measures in health education. Experts are
asked to examine the instrument to see whether
it measures all relevant areas of the concept.
32
CRITERION VALIDITY is concerned with how well
the measure correlates with another measure of
the same phenomenon, usually existing
validated instruments, physiological measures, or
observations. TWO TYPES OF CRITERION VALIDITY
ARE Concurrent validity two measures taken at
the same time idea relates performance on one
test with performance on another well reputed
test.
33
Predictive Validity if the measure of interest
is correlated with a future measure of the same
phenomenon. Can be established by relating a
test to some actual behavior of which the test is
supposed to be predictive.
34
Construct Validity flows from the theoretical
frameworks of health education. It measures
whether a given instrument measures a specific
concept or related to other concept as predicted
from a particular theory.
35
EXTERNAL VALIDITY is the assurance that the
results of the evaluation can be generalized to
other people and settings. The key to external
validity lies in how similar the people and
setting are to those on which the experiment was
conducted.
36
RANDOMIZATION means that each person in
the population of potential participants has
equal chance of being selected or
assigned. RANDOM SELECTION is the best way to
achieve external validity, because the subjects
are likely to be representative of the population
from which they are selected. RANDOM ASSIGNMENT
of subjects to experimental and control groups is
the best way to achieve internal validity.
37
RELIABILITY is the extent to which an
instrument measures what it is measuring
consistently, that it will produce the same score
if applied to an object two or more times.
38
INTEROBSERVER RELIABILITY is the extent to
which two or more observers agree on their
measures of the same subject at the same
time. INTRAOBSERVER RELIABILITY is the
extent to which the same observer is consistent
in measures of the same subject at different
times.
39
TEST-RETEST RELIABILITY also termed
stability, is the extent to which an instrument,
such as a knowledge test or health beliefs
scale, provides the same score at two different
times.
INTERNAL CONSISTENCY measures the extent to
which component items in an instrument are
similar or measure the same concept.
For example When a knowledge test is
internally consistent, persons who do well on the
total score also tend to do better on each test
item throughout the test than the subjects who do
poorly.
40
MULTIPLE-FORM RELIABILITY is the extent to which
two equivalent forms of the instrument provide
comparable results when administered to the same
subjects at the same time. SPLIT-HALF
RELIABILITY is similar conceptually to
multiple-forms it is obtained by randomly
assigning items within an instrument to two sets
of scores and examining the correlation between
them. (ie. Odd number Even number).
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