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BEHAVIOR CHANGE

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

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BEHAVIOR CHANGE

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  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. Phase 3 Behavior Diagnosis Phases 1-2 Epidemiological & Social Factors Phase 6 Phases 4-5 Educational Diagnosis Administrative Diagnosis Predisposing Factors: KNOWLEDGE ATTITUDES VALUES PERCEPTIONS Nonhealth Factors Health Education and Health Programs Nonbehavioral Causes Quality of Life Enabling Factors: Availability of Resources Accessibility 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/Prevalence Intensity/Duration Distribution Reinforcing Factors: Attitudes Behavior Peers Parents Employers

  9. Phase 1 Social Diagnosis THE PRECEDE-PROCEED MODEL Phase 5 Administrative and policy diagnosis Phase 4 Educational and Organizational Phase 3 Phase 2 Epidemiological Diagnosis Behavioral and Environmental Diagnosis PRECEDE Predisposing Factors Health Promotion Behavior and Lifestyle Health Education Quality of Life Reinforcing Factors Health Environment Policy Regulation Organization Enabling Factors Phase 9 Outcome Evaluation Phase 6 Implementation 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 program’s 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 program’s 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 comparison 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. Nonexperimental 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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