Technical Models for Health Promotion

Why conventional Hygiene Education does not change behavior?

Fallacy 1 Universal hygiene messages can be given Based on the belief that knowledge of the planners and educators is always superior to the people

Fallacy 2 Telling people what to do solves the problem

Fallacy 3 When people know about health risks they take action

Fallacy 4 Any improvements are equally useful

People adapt their lifestyle to local circumstances and develop their insights and knowledge over years of trial and error

Practices which are most cost-effective in prevention of faecal-oral diseases 1. Preventing faeces from gaining access to the environment; 2. Handwashing, after defecation and before touching food; 3. Maintaining drinking water free from faecal contamination.

Technical Models of Health Promotion Environmental Approaches Ecological Model Social Marketing Model Political Economy Model Precede-Proceed Framework Social Responsibility Model Life Cycle Models Stages of Change Innovation Diffusion Theory Health, Attitude, Belief, and Behavior Change Approaches Health Belief Model Theory of Reasoned Action Theory of Planned Behavior Prospect Theory Social Learning Theories Health Action Model

Socio-ecological Model

Socio-ecological Model The socio-ecological model recognizes the interwoven relationship that exists between the individual and their environment. Individual behavior is determined to a large extent by social environment, e.g. community norms and values, regulations, and policies. Barriers to healthy behaviors shared among the community as a whole. Lowering these barriers makes behavior change more achievable and sustainable. The most effective approach - a combination of the efforts at all levels--individual, interpersonal, organizational, community, and public policy.

Stages of Change Precontemplation (i.e. considering the change) Contemplation of change (i.e. starting to think about initiating change) Contemplation without action Preparation (i.e. seriously thinking about the change within a given time period (e.g. the next 6 months) or taking early steps to change) Action (i.e. making change in or stopping the target behavior within a 6-month period) Maintenance of change (i.e. maintaining the target behavior change for more than 6 months) In some cases, relapse

Diffusion of innovations model Innovator (2.5%): need for novelty and need to be different Early Adopter (13.5%): recognize the value of adoption from contact with innovators Early Majority (34%): need to imitate or match up with others with a certain amount of deliberateness Late Majority (34%): need to join the bandwagon when they see that the early majority has legitimated the change Laggard (16%): need to respect traditions

Health Belief Model Perceived susceptibility: the subjective perception of risk of developing a particular health condition. Perceived severity: feelings about the seriousness of the consequences of developing a specific health problem. Perceived benefits: beliefs about the effectiveness of various actions that might reduce susceptibility and severity (the latter two taken together are labeled “threat’). Perceived barriers: potential negative aspects of taking specific actions. Self-efficacy: belief that s/he will be able to do it. Cues to action: bodily or environmental events that trigger action.

Theory of Reasoned Action Theory of Planned Behavior

Social Cognitive Theory Self-efficacy: a judgment of one’s capability to accomplish a certain level of performance. Outcome expectation: a judgment of the likely consequence such behavior will produce. Outcome expectancies: the value placed on the consequences of the behavior. Emotional coping responses: strategies used to deal with emotional stimuli including psychological defenses (denial, repression), cognitive techniques such as problem restructuring, and stress management. Enactive learning: learning from the consequences of one’s actions (versus observational learning). Rule learning: generating and regulating behavioral patterns, most often achieved through vicarious processes and capabilities (versus direct experience). Self-regulatory capability: much of behavior is motivated and regulated by internal standards and self-evaluative reactions to their own actions.

When learning, people remember 20% of what they hear, 40% of what they hear and see, and 80% of what they discover for themselves. - Hope and Timmel 1984:103)

Social Learning Models Social learning theory is derived from the work of Gabriel Tarde (1843-1904) which proposed that social learning occurred through four main stages of limitation: close contact, imitation of superiors, understanding of concepts, role model behaviour

Integrated Model of Communication for Social Change (IMCSC) An iterative process where ‘community dialogue’ and “collective action” work together to produce social change in a community that improves the health and welfare of all its members. COMMUNITY DIALOGUE COLLECTIVE ACTION SOCIETAL IMPACT CATALYST INFORMATION EQUITY SOCIAL CAPITAL

Community Dialogue

CLICS STAGE 2 STAGE 3 STAGE 4

Major factors which stimulate people to change behavior Facilitation, Practical understanding, Influence from others, Capacity to change