Behavioral science

BEHAVIORAL SCIENCE

Dr. Dalia El-ShafeiLecturer, Community medicine department, Zagazig university

How to understand human How to understand human behaviorbehavior

HEALTH PROBLEMMay take many different components,

therefore it may be viewed in the form of.

HEALTH BELIEF MODEL

HBM can explain:

BACKGROUND

Theorists:(1950’s) Group of social psychologists

Trying to explain why people were not participating in disease detection programs. (TB Screening)

PERCEIVED SUSCEPTIBILITY

Subjective belief that a person may acquire a disease or enter a harmful

state as a result of a particular disease.

PERCEIVED SEVERITY

Belief in the extent of harm that can result from the acquired disease or

harmful state of a particular behavior.

SEVERE(death)

PERCEIVED BENEFITS

Belief in the advantages of the methods suggested for reducing the risk or seriousness of the disease of

harmful state from a particular behavior.

PERCEIVED BARRIERS

Concern that the new behavior will take too much time.

Their belief could be actual or imagined.

SELF-EFFICACY

Confidence in a persons ability to purse a behavior

CUES TO ACTIONTo cause a force that would

make a person feel the need to take action.

Advice from a doctor, or friends or propaganda

1ry Prevention example for HBM

Should I get the H1N1 vaccination?

CONSTRUCTS & APPLICATIONS

Perceived susceptibility

How likely is it I will get swine flu?

Perceived severity

Perceived benefits

How bad would it be if I did?

What do I gain by getting the shot?

CONSTRUCTS & APPLICATIONS

Perceived Perceived BarriersBarriers

Is it available- Is it available- what’s the what’s the cost?cost?

Cues to Action

Self Efficacy

Posters, Posters, Emails, Emails, commercialscommercialsI am confident I I am confident I can be healthycan be healthy

HBM IN HEART CONDITION

Chest pain sometimes affect performance

(Perception) of risk & its seriousness

Middle aged male with stressful life

Changing risky behavior

Demographic & social variables

Motivating health behavior

Perception of benefits

Realize they adopt a healthy behavior (enjoy life, carry work & not get ill)

Perception of barriers

A friend or a doctor warned him that he is at increasing risk to become ill

Cues for Action

Work commitments reduce time for sports social events & fast food eating

STAGES OF CHANGING HEALTH BEHAVIOR Exit

Maintain safe life

Pre contemplatio

n

PRE CONTEMPLATION STAGE

Person has no awareness or no motivation for

the need to change habits or

lifestyle

CONTEMPLATION STAGE

People enter this stage when they are thinking about change or have enough motivation to enter the cycle.

COMMITMENT “PREPARATION” STAGE

Willing to make serious decision to

change.

ACTION STAGE

Actively begin to change.

MAINTENANCE STAGE

People struggle to maintain change.

RELAPSE STAGE

Early exit from the cycle due to false belief of satisfaction.

EXIT STAGE

People are settled into changed behavior & can exit the cycle from the revolving door

ILLNESS BEHAVIOR

ILLNESS BEHAVIORDEFINITION:

How the patient ThinkThink... ... Feel & React Feel & React

when he develop any symptom

CLINICAL TIP OF THE ICEBERG PHENOMENON

Only MinorityMinority of the patients visit their physicians

MajorityMajority of the patients are in the community

The Tip of The Iceberg

I am a patientI am a patient I am weakI am weak I need helpI need help

It is not easy to show your weakness

Why patients may deny their Illness?

Symptoms (Biological ProblemBiological Problem) is notnot the only reason for

patient seeking medical help.

The Real Reason for Patient attendance

IdeaConcerns

ExpectationEffect

Feelings

IllnessDisease

++Physical Symptoms

Comprehensive Approach

IdeaConcerns

ExpectationEffect

Feelings

Illness frameworkDisease framework

++

(McWhinney 1984

DOCTOR’ BEHAVIOR

Pts feel frustrated

doctor behalf badly against minor complaints

Pts feel doctors uninterested

Both types of feelings influence subsequent consulting behavior

& medical ttt adherence &

health.

PRESENTATION OF SYMPTOMS

Experiencing symptoms may be presented as:

1.Perceiving any change or deviation of body functions.2.Interpretation of ill health symptom.3.Explore seriousness through Severity.Familiarity of symptoms.Duration of frequency.4.Evaluation of symptoms that require further action (illness behavior).

VARIABLES INFLUENCE ILLNESS BEHAVIOR

Visibility of symptoms & signs.Extent to perceive as serious.Extent to disrupt normal life.

Persistence & frequency.Personal tolerance.

Available knowledge & cultural assumptions towards symptoms.

Needs to denial or compete with illness. Interpretation of symptoms (stigma).

Understanding of health providers.Availability of suitable health service.

PATIENT COMPLIANC

E

A CHRONIC PROBLEM!!A CHRONIC PROBLEM!!

Hippocrates once wrote that patients often lied about taking their medicine.

Adherence to medication was a big problem then,

and still is today. Hippocrates of Cos

(ca. 460 BC – ca. 370 BC) Greek: Ἱπποκράτης

Patient compliance describes the degree to which a patient correctly follows medical

advice.

Most commonly, it refers to medication or drug compliance, but it can also apply to other

situations such as medical device use, self care, self-directed exercises, or therapy

sessions

PATIENT COMPLIANCE (ADHERENCE OR CAPACITANCE)

PATIENT’S COMPLIANCEAdherence to the advice of health

care professionals [includes]:

1.Preventive health behavior.2.Keeping medical appointments

3.Self care actions.4.Taking medications as directed.

PATIENT’S INCOMPLIANCE

Almost 50% of prescribed medications have health impacts.

Doctors may be effective with only with 55-60% of pts.

Pts may become ill due to non adherence.

10-25% of hospital admission due to non

adherence

CATEGORIES OF MEDICATION NON-

ADHERENCE

PRIMARY NO PRESCRIPTION

SECONDARY INTENTIONAL

UNINTENTIONAL

53

Kiran

Sharma

, Assistant

Professor

05/01/2354

OBSTACLES TO PATIENT COMPLIANCE

Kiran

Sharma

, Assistant

Professor

FACTORS ASSOCIATED WITH ADHERENCE

First: Pts has to understand what they are really

asked to do.

Second: Pts must remember what they are told.

Third: Pts must be satisfied with the doctor &

consultation.

COMPLIANCE AIDS