[MUSIC] Today we are beginning the intrapersonal, or individual level of health behavior. First we will look at the general outline of the section. And then we will spend time on understanding how people at the community level view health and illness. We will be trying in this section to review models and theories of health behavior, in order to help us understand why people do what they do. And also help us work together with people to design health education programs to enhance their health behavior. There are different types of theories and models that we will be using during this module. And in actual health education program planning, these are often used in combination. There are explanatory models, theory-based models, process models, and planning models. Explanatory models provide the insiders view of the world. It can be individual, what an individual perceives and believes. Or they can be collective in community. Explanatory models consist of what people in a given setting or culture believe, think about, perceive, about the nature, cause, prevention, and response to an event. In our particular case the events we're concerned about are health and illness events. Explanatory models are not simply a discrete set of ideas about a specific disease. As we mentioned in module one, there is an important distinction between disease and illness, and people's illness perceptions integrate into their perceptions about religion, the world, economy, and social relations. Explanatory models take cognizance of the broader beliefs about how the body works and what factors influence a person's fate in life. Theoretical models, or theoretical constructs, look at factors that determine behavior, are associated with and or influence behavior. The first that we'll look at is a symbol force field theory that looks at factors that drive and restrain a given behavior. After this we will look at the different concepts that influence behaviors, specific factors, or variables. Such as self-efficacy, locus of control, outcome expectations, beliefs, intentions, etc. And see how these different concepts can work together to help us understand in a given community, or with a given person or patient why that person behaves the way they do. These theoretical constructs can help us form hypothesis that can be researched and tested. Such that A, an antecedent factor, such as knowledge or attitude is associated with or influences B, a particular health behavior. With this information we can plan programs that target specific antecedents. A third type of model is a process or stage model. This recognizes, as we gave in our example of the steps involved with filtering water to prevent Guinea-worm, that behavior is not a monolithic concept to be turned off and on like a light switch. Actually what people think of as a single behavior, filtering water is usually a combination of steps. And people progress through the steps according to their readiness to change. People must be aware, that a change is needed. They must have thought about or considered what the alternatives are, and what the implications are for a given behavioral choice. They need a chance to try the new behavior, evaluate that, and then if it is found to yield results that they like, then they may incorporate that into their normal habits. Process and stages are also called the transtheoretical model. And it's important to consider each stage together with the theoretical models. What variables, such as knowledge, skills, attitudes, help propel a person to the next stage of change? What lack of factors may inhibit a person from trying a new behavior or maintaining a new behavior? So therefore, process models and theoretical models can be used together to understand health behavior. Finally, we have planning models, or planning frameworks that combine the concepts from theoretical models in order to diagnose why people behave the way they do. And help identify appropriate interventions. These models help us also to choose health education strategies that are linked with the antecedent factors. And also help us evaluate whether interventions have been successful in one, modifying the intercede factors. And two, resulting in the health behaviors that are desired. The various theories and models that we'll be looking at are not very useful in an abstract sense. They have to guide us in collecting information from the community that will help us understand why people behave the way they do. So, remember from a previous lecture, we showed the slides from CDC's behavior risk factor surveillance. And the question arose, well people ate vegetables or they didn't, they got vaccines or they didn't. The question of course is why? So what the various models will do that we will be discussing in this section is to help us answer those questions of why. The important question comes, how do we do that? And hopefully during your time at Hopkins, you will take some methodology courses. Courses in survey methods, how to design questionnaires. To ask people about the information, not only do they use a bed net or have they used a bed net. What are their opinions opinions about the bed nets? Do they think the bed nets are effective? We want to, we can gather information through in depth surveys of key informants who are important people when we're talking about local disease prevention. We may want to talk to some indigenous healers. We may want to talk to some of the health workers and find out from their experience what's happening. We want to talk to women leaders in the community. Another data gathering method is focus group discussion, getting people together with similar characteristics. Bringing together male youth, or female youth, talking about their experience in terms of sexual coercion, and violence. Or their perceptions of sexually transmitted diseases. This will give us ideas in fact, that can help us develop better questionnaires. Because the focus groups, if we let people talk in their own words, we can find out how they define and name and express different local diseases and conditions. And we can incorporate those into our questionnaires and surveys. Other qualitative methods are things like pile sorts. Where people can sort out different symptoms of diseases and try to figure out what are the local names for those. Participant observation, where you're actually in the community attending festivals, sitting in the clinic, going to the farm with people, walking around the market. Keeping your eyes open to see what people do in terms of nutrition and food. What they do in terms of treating illnesses. How they talk about and define the problems they have in their own community. And of course we can review a number of documents and text. These texts may be in the form of clinic records. They may be in the form of minutes for community meetings, or the text maybe not written text. They may be oral or verbal histories, things like proverbs and stories that have been passed down from generations. So these are different ways that we can gather information to help us construct our various models and theories that will help us understand why people behave the way they do.
