Psychological Basis of Health Education (CHS 384) INSTRUCTOR: NORAH ALSADHAN, MPH Lecture-1- September/15/2013

The Scope of Health Education and Health Behavior Health education and health promotion are recognized increasingly as ways to meet public health objectives and improve the success of public health and medical interventions around the world. Health educators work in a variety of settings including schools, worksites, governmental organizations, medical settings, communities,…etc

The art of health behavior and health education is rapidly evolving. The most frequent causes of death globally are chronic diseases including heart disease, cancer, lung disease, and diabetes. Recently there has been a dramatic increase in public, private, and professional interest in preventing disability and death through changes in lifestyle and participation in screening programs. This interest is stimulated by the epidemiological transition from infectious to chronic disease, the aging of the population, and the rapidly escalating health care costs. The Scope of Health Education and Health Behavior

Definitions of Health Education “Health education is concerned not only with individuals and their families, but also with the institutions and social conditions that impede or facilitate individuals toward achieving optimum health” William Griffiths(1972) “Health education attempts to close the gap between what is known about optimum health practice and that which is actually practiced”

“Health Education is aimed at bringing about behavioral changes in individuals, groups, and larger populations from behaviors that are presumed to be detrimental to health, to behaviors that are conducive to present and future health”. Simonds (1976) “Any combination of learning experiences designed to facilitate voluntary adaptation of behavior conducive to health” Green (1980) Definitions of Health Education

Health education includes not only instructional activities and other strategies to change individual health behavior but also organizational efforts, policy directives, economic supports, environmental activities, mass media, and community-level programs. Health Education covers the continuum from disease prevention and promotion of optimal health to the detection of illness to treatment, rehabilitation, and long- term care Definitions of Health Education

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Health Promotion Health Promotion is define as “ any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health” (Green and Kreuter, 1991)

Definitions of Health Behavior The central concern of health education is health behavior. Health behavior refers to “the actions of individuals, groups, and organizations, as well as their determinants, correlates, and consequences, including social change, policy development and implementation, improved coping skills, and enhanced quality of life. (Pakerson and others,1993) “Those personal attributes such as beliefs, expectations, motives, values, perceptions, and other cognitive elements; personality characteristics, including affective and emotional states and traits; and overt behavior patterns, actions, and habits that relate to health maintenance, to health restoration, and to health improvements” (Gochman, 1982,1997)

Categories of health Behavior Preventive health behavior : any activity undertaken by an individual who believes himself or (herself) to be healthy, for the purpose of preventing or detecting illness in an asymptomatic state. Illness behavior: any activity undertaken by an individual who perceives himself to be ill, to define the state of health, and to discover a suitable remedy Sick-role behavior: any activity undertaken by an individual who considers himself to be ill, for the purpose of getting well. It includes receiving treatment from medical providers, generally involves a whole range of dependent behavior and leads to some degree of exemption from one’s usual responsibilities.

Using theory in crafting interventions can lead to more powerful effects than interventions developed without theory.

Theory and Practice Theory and practice are a continuum along which the skilled professional should move with ease. The best theory is informed by practice and the best practice should be grounded in theory. Theory and practice build on each other. The task of health behavior and health education is both to understand health behavior and to transform knowledge about behavior into effective strategies for health enhancement. Health educators usually work in situations where sources are limited, thus, it is essential that they reach evidence-informed judgments about the interventions.

Theory Is a set of interrelated concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables, in order to explain and predict the event or situation. Theories explain behavior and suggest ways to achieve behavior change A theory must have these qualities: Generalizability Testability Abstract: no specified content or topic area.

Theories guide the search for Why? What? How? Theory

Concepts Major components of a theory Building blocks

Constructs A concept that has been developed or adopted for use in a particular theory. A construct can only be understood in the context of its parent theory A construct must be measurable in order to qualify as a construct Example: self-efficacy

Variables The empirical counterparts of constructs They specify how a construct is to be measured in a specific situation Example: creating a questionnaire to measure depression so you can assign a score to an individual.

How do variables affect each other Correlative: Depression and cancer Causative: Smoking and heart disease Coincident: Being left-handed and developing diabetes.

Mediating: A process that intervene between input and output in a system Example: social support mediates between stress and disease Moderating : A variable that affects the direction or strength of the relation between the independent and dependent variable Example: lifestyle factors moderate the effect of race on hypertension. How do variables affect each other

Types of theory Explanatory theories: Describe problems Identify source of problems Search for modifiable factors Examples: Health belief Model Theory of planned behavior

Types of theory Change theories Intervention design Evaluation strategies Provide explicit assumption for why a program will work Help determine why a program didn’t work Examples: Community organization Diffusion of innovations

Model Most health behavior is too complex to be explained by a single theory Models are constructed from theories and empirical findings PRECEDE-PROCEED Social Marketing Ecological planning model

Applying theory Begins with identifying a problem Population affected Units of analysis or change Types of behavior to be addressed One time intervention( mammography) Lifestyle Change (regular exercise) Cessation (smoking) Adoption (flossing)