1. HUMAN BEHAVIOUR AND HEALTH PROMOTION LINKAGE

2. PHASES BETWEEN KNOWLEDGE & BEHAVIOUR Source: Adapted from Fishbein & Ajzen 1975.)

3. BEHAVIOUR: DEFINITION Behaviour is …...

4. BEHAVIOUR 1. HEALTH-DIRECTED 2. HEALTH-RELATED

5. TYPES OF HEALTH-RELATED BAHAVIOUR 1. PREVENTIVE HEALTH BEHAVIOUR 2. ILLNESS BEHAVIOUR 3. SICK-ROLE BEHAVIOUR

6. BEHAVIOURAL THEORIES AND MODELS

7. HEALTH BELIEF MODEL “Two major factors influence the likelihood that a person will adopt a recommended preventive health action First they must feel personally threatened by disease I.e. they must feel personally susceptible to a disease with serious or severe consequences Second they must believe that the benefits of taking the preventive action outweigh the perceived barriers to (and/or cost of) preventive action”

8. HEALTH BELIEF MODEL (Visual)

9. HEALTH BELIEF MODEL (Detailed)

10. Modified Health Belief Model as Applied to HIV/AIDS Programme

11. THEORY OF REASONED ACTION “…there is one primary determinant of behaviour, namely the person’s intention to perform it. This intention is itself viewed as a function of two determinants. - person’s attitude toward performing the behaviour (based on his/her beliefs about the consequences of performing the behaviour, i.e. his or her beliefs about the costs and benefits of performing the behaviour) and - the person’s perception of social (or normative) pressure exerted upon him or her to perform the behaviour.” Source : Fishbein and Ajzen [1975], Ajzen and Fishbein [1980] Fishbein, Middlestadt and Hitchcock [1991], page 4 in Developinh Effective Behaviour Change Interventions, Fishbein M, Univ. of Illinois.

12. THEORY OF REASONED ACTION

13. Theory of Reasoned Action and Personal Behaviour applied to HIV/AIDS programme action (Adapted to key focus areas)

14. SOCIAL COGNITIVE THEORY “Two major factors influencing the likelihood that one will take preventive action: First, like the Health Belief Model, a person believe that the benefits of performing the behaviour outweigh the costs (i.e. a person should have more positive than negative outcome expectancies) Second, and perhaps most important, the person must have a sense of personal agency, or self-efficacy with respect to performing the preventive behaviour … must believe that he or she has the skills and abilities necessary for performing the behaviour under a variety of circumstances”. Source: Fishbein summarising Bandura [1986, 1989, 1991, page 3 in Developing Effective Behaviour Change Interventions, Fishbein M, Univ of Illinois.

15. SOCIAL LEARING THEORY OR SOCIAL COGNITIVE THEORY

16. Stages of changing health behaviour (Adapted from Neesham C, 1993 and Prochaska J & DiClemente C, 1984) Pre-contemplation Not interested in changing ‘risky’ lifestyle Exit: Maintaining ‘safer’ lifestyle Action: Making changes Maintenance: Maintaining change Relapse: Relapsing back Contemplating: Thinking about change Commitment: Ready to change

17. Stages of Change as applied to HIV/AIDS Programme Precontemplation Young man has heard about AIDS but doesn’t think it is relevant to his life. Contemplation Young man believes that he and his friends are at risk and thinks that he should do something. Decision/ Determination Young man is ready & plans to use condoms so goes to a shop to buy them. Maintenance Wearing condoms has become a habit and young man regularly buys them. Action Young man buys and uses condoms.

18. STAGES OF CHANGE MODEL

19. THE BEHAVIOUR CHANGE SPIRAL

20. The Behaviour Change Spiral in the context of the Enabling Environment

21. DIFFUSION MODEL

22. DIFFUSION OF INNOVATION PROCESS Cummulative number or % of adopters Time Innovators Early adopters Early majority Late majority Late adopters Source: Green & MCAlister 1984.

23. DIFFUSION OF INNOVATION Time Relapse between awareness, interest, trial and adoption Time Percentage of population 25 50 75 100 A BC E FG STAGES Awareness Interest Trial Adoption Late adopters Early adopters Source: Green & MCAlister 1984.

24. STEPS TO BEHAVIOUR CHANGE Knowledge 1. Recalls family planning messages. 2. Understands what family planning means. 3. Can name family planning method(s) and/or source of supply. Approval 4. Responds favorable to family planning messages. 5. Discusses family planning with personal networks (family, friends). 6. Thinks family, friends, and community approve of family planning. 7. Approves of family planning. As developed by Population Communication Services for communication programmes appropriate for family planning and reproductive health.

25. Intention 8. Recognise that family planning can meet a personal need. 9. Intends to consult a provider. 10. Intends to practice family planning at some time. Practice 11. Goes to a provider of information/supplies/services. 12. Chooses a method and begins family planning use. 13. Continues family planning use. Advocacy 14. Experiences and acknowledges personal benefits of family planning. 15. Advocates practice to others. 16. Supports programmes in the community.

26. VARIABLES UNDERLYING BEHAVIOURAL PERFORMANCE Generally speaking it appears that in order for a person to perform a given behaviour one or more of the following must be true: 1. The person must have formed a strong positive intention (or made a commitment) to perform the behaviour; 2. There are no environment constraints that make it impossible to perform the bahviour; 3. The person has the skills necessary to perform that behaviour;

27. 4. The person believes that the advantages (benefits, anticipated positive outcomes); 5. The person perceives more social (normative) pressure to perform the behaviour than to not perform the behviour; 6. The person perceives that performance of the behaviour is more consistent than inconsistent with his or her self image, or that it’s performance does not violate personal standards that activate negative self-actions; 7. The persons emotional reaction to performing the behaviour is more positive than negative; and 8. The person perceives that he or she has the capabilities to perform the behaviour under a number of different circumstances…”

28. Audiences along a Behaviour Continuum: Possible Communication Strategies

29. Health-related behaviour change: the examples of exercise for women

30. PRECEDE-PROCEED PHASES

31. PRECEDE/PROCEED MODEL (Behavioural Domains)

32. CONCEPTUAL MODEL OF COMMUNITY EMPOWERMENT (Perceived Control) Multiple levels of perceived control Individual Organistaional Community Demographic characteristic: Race, gender, income, education Attitudes about effectiveness Participation in action Event to which local group attempts to influence public policy Participatory events in organisation (activity level and leadership)

33. MASLOW’S HIERARCHY OF NEEDS Basic physiological needs - hunger, thirst and related needs Safety needs - to feel secure and safe, out of danger Belongingness and love needs - to affiliate with others, be accepted and being Esteem needs - to achieve, be competent, and gain approval and recognition Self-actualization needs - to find self-fulfilment and realise one’s own potential