2. 11 BEHAVIOUR CONCEPT AT MEDICAL SCIENCES INTEGRATION OF BEHAVIORAL SCIENCES TO MEDICINE A. BASAK CINAR

3. HELLO ! MY NAME IS A. BASAK CINAR IF YOU WOULD LIKE TO KNOW MORE ABOUT ME, PLEASE CLICK ON MY PICTURE.” “I am mainly interested at Behavioural Sciences at Medicine. I have studied about “ Communication Pathways at Medicine, mainly at Oral Health Care” and “Oral Health Psychology” in common and at children specifically.”

4. This presentation is introduction to “Integration of Behavioral Sciences to Medicine” I health concept and its relation to behaviour behaviours as dynamic patterns that can be transferred from one type to another how to change negative health behaviours to positive ones, and communication process holistic approach: integration of behavioural sciences to medicine

6. “ Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” ( http://www.who.int/about/definition/en /) SO CAN NOT BE REFERRED TO NEGATIVELY AS THE ABSENCE OF DISEASE, ILLNESS, AND SICKNESS. RELIANCE ON A NEGATIVE DEFINITION OF HEALTH WILL PROVIDE LITTLE INFORMATION ABOUT THE HEALTH OF 80-90 PERCENT OF THE POPULATIONS. (Ann Bowling,1997)

7. DEPENDS ON MEDICAL AND NON-MEDICAL FACTORS AMONG THOSE ONE FACTOR INTEGRATING AND AFFECTING EACH BEHAVIOR RESTORE, MAINTAIN, IMPROVE (+) HEALTH

8. NON-MEDICAL DETERMINANTS OF HEALTH Better Worse neutral state of health Health behaviours Living-working conditions Personal resources Environmental factors Health Behaviour

9. X axis Y axis (0,0) not brushing nonbrushing Y axis brushing X axis Figure 1: example for change at behavioural patterns on axial platform

10. ? BEHAVIOUR ? SYSTEM OR UNIQUE & ALONEBEHAVIOUR If human beings are thought to be as open systems, most important factor keeping the continuity/aliveness of the system is behavioural models that are formed, as outcome of individual needs, expectations, wishes. Cognitive and emotional structure affect the forming, organisation, activation, continuity and improvement of those models and also set up the differentiation among individuals.

11. BEHAVIOR B Directed to decrease inharmonity. Target goal is attractor. BEHAVIOR A Directed to increase inharmonity. Target goal is compeller. BEHAVIORAL SYSTEM “self”& self regulation Self Centred Behavioural System Figure 2: Behavioural System located around “self” centre

12. The concept of a postmodern self, states that the self is actually made up of many different selves, not just one stable self. It is multiple, adaptable and socially constructed. Then for example a woman might have family self (mother, wife, daughter,…), social relationship-self ( worker, friend, …), patient self. So self refers to the composite of ideas, feelings, and attitudes people have about themselves. (Morreale, Spitzberg, & Barge, 2002) (Morreale, Spitzberg, & Barge, 2002)

13. PLATENARY SELF health Child’s opinion about teeth brushing habits of his/her mother Child’s opinion about his/her own brushing, intend to brush or not Thoughts about the frequency of brushing Feelings; dislike, like brushing

14. ? HOW TO?? X axis emotional factors Y axis, cognitive factors ?

15. How to succeed communication with patient in most effective and efficient way, to achieve the most valuable outcome at health care service; patient with improved health and satisfaction that will lead patient’s compliance to health regimens at the long term. EMOTIONAL FACTORS (FEELINGS, EXPECTATIONS...) COGNITIVE FACTORS (KNOWLEDGE, THOUGHTS,...) SOCIAL RELATION SELF FAMILY SELF PATIENT SELF ETC. ? EMOTIONAL FACTORS (FEELINGS, EXPECTATIONS...) COGNITIVE FACTORS (KNOWLEDGE, THOUGHTS,...) SOCIAL RELATION SELF FAMILY SELF PATIENT ETC. DOCTOR SELF

16. PATIENT PSYCHOLOGY ( DIAGNOSIS ) INVESTIGATING DIFFERENT COMMUNICATION METHOD ALTERNATIVES EVALUATION CHOOSING THE SUITABLE COMMUNICATION MODEL ARRANGING COMMUNICATION MODEL ACCORDING TO PATIENT,DESIGNING TREATMENT PLAN ON THE FRAME OF THIS MODEL COMMUNICATION BEFORE, DURING AND AFTER TREATMENT AND FOLLOWING UP THE REACTIONS OF PATIENT IMPROVING POSITIVE AND LEAVING OUT THE NEGATIVE COMMUNICATIVE PATTERNS WHICH ARE DETERMINED BY PATIENT’S BEHAVIORAL FEEDBACK ANALYSING THE PROBLEMS AT NEGATIVE FEEDBACK CONTINOUS COMMUNICATION AND IMPROVEMENT OF POSITIVE HEALTH BEHAVIOURS FOLLOW UP PLANNING ACTING C ONTROL

17. As patient’s compliance to health regimens mostly determines the success of treatment, rehabilitation, preventive measures, he/she should be taken into consideration as a system with biological-physiological subgroups and psychological processes. Behaviour B (e.g NONsmoking) Behaviour A (e.g smoking) Figure 3

18. nurse doctor patien t Figure 4: Interaction between patient, doctor, nurse

19. Thus will bring out control over the bright futures of tomorrow ….and many questions starting with how….. How to analyse this subgroups- subsystems - among the perspective of system concept. How to find out effective communicative pathways How to define non-medical parameters relevant to health How to improve the quality of lives, remembering that only healthy individuals can take the responsibility of their own lives and the society they are living in. Responsibility will bring out endeavour and willingness to develop the quality at every single area in society.

20. Even in a simple system composed of patient, doctor, nurse answers are not so easy and with one choice. First step might be to remember prevention, treatment, rehabilitation should not be based on only medical parameters.Most effective solution may lay down on the concept of integration of Behavioural Sciences to Medical Sciences. Behavioural Sciences :“INDIVIDUAL’S BEHAVIOUR WITH ITS REASONS, GOALS; CHARACTERISTICS OF BEHAVIORAL PROCESSES; AND ITS RELEVANCE TO OTHER SCIENCES ARE STUDIED” THE MAIN SCIENCES THAT FORM BEHAVIORAL SCIENCES : PSYCHOLOGY SOCIOLOGY SOCIAL PSYCHOLOGY ANTHROPOLOGY

21. Provision of health services is a process and generally patient is the most common/identified input and outcome of this system. Patient with medical or non medical problems will enter system and then leave it as satisfied or dissatisfied.This mood will turn back to system by feedback as input. Patient maintained or improved his/her (+) health, is positive feedback whereas patient with the previous health or worser health conditions are negative for the system. So how to, at least maintain, the restored (+) health state. If the process chain between input and output is the key determinant, so then it might be better to define this process.

22. Patient with special needs and expectations; visiting health services Patient with positive health outcomes, satisfied and accepted the offered new health behaviour; leaving the health services FEEDBACK D.S B.S M.S P.S & S.S. Interaction of sciences that forms the prevention, treatment and rehabilitation processes (transformation period) Open systems have two main components, those are input and output (reference) (reference) input output System composed of many subsystems Transformation process ???????

23. A patient with deep caries and pain Input Treatment Black box; no any other interaction Communicative Patterns based on Behavioural Sciences Marketing (2.level subsystem of behavioural sciences) e.g.affective and convincing communicative patterns... Treatment and maintenance/improvement of positive oral health care, development of oral care behaviour:::::long term success Psychology e.g:Patient’s beliefs, thoughts, feelings, attitudes towards oral health care Sociology e.g. social norms, beliefs affecting the patient’s attitudes, thoughts, living conditions, social realities, environmental factors …………. Social Psychology e.g. how affected from friends, modelling from family outcome White box TRANSFORMATIONPTRANSFORMATIONP Figure 5

24. planing treatment Follow-up communication control Communication; active process at every stage of health care service. Communicative patterns can not be standardised for all patients because all patients have different needs, feelings, attitudes, expectations

25. KNOWLEDGE SKILLS MOTIVATION KNOWLEDGE SKILLS MOTIVATION KNOWLEDGE SKILLS MOTIVATION RECEIVING MESSAGE CONSTRUCTING MEANING RESPONDING TO MESSAGE knowledge motivation skills DOCTOR PERCEPTIONPERCEPTION PATIENT Figure 6: Communication between doctor and patient

26. MEDICAL SCIENCES ARE MAINLY FOCUSED ON “HEALTH” OF INDIVIDUALS NONE OF OPEN SYSTEMS CAN LIVE WITHOUT INTERACTION WITH NEIGHBOURHOOD SYSTEMS INDIVIDUALS ARE OPEN SYSTEMS ON CONTINOUS INTERACTION WITH EXTERNAL & INTERNAL ENVIRONMENT. MEDICAL SCIENCES ARE ON INTERACTION WITH THE SYSTEMS AFFECTING INDIVIDUALS SO ONLY ONE WAY; MEDICAL TREATMENT; CAN NOT BE SO EFFECTIVE AT LONG TERM. HOLISTIC APPROACH; INTEGRATION OF BEHAVIORAL SCIENCES AND MEDICINE MIGHT BE A KEY FOR A SOCIETY WITH HEALTHY INDIVIDULAS HEALTHY INDIVIDUALS ARE EMPOWERED FUTURE OF A SOCIETY

28. THANKS FOR READING PLEASE REMEMBER THAT I WILL BE GLAD TO HEAR ABOUT YOUR VALUABLE COMMENTS basak.cinar@helsinki.fi