Modul 8 - Education Diagnosis

EDUCATIONAL DIAGNOSIS: ASSESSING CAUSES OF

HEALTH BEHAVIORModule 8

HEALTH PROMOTION & EDUCATION (DEMA 3253)DIPLOMA IN ENVIRONMENTAL HEALTHVICTORIA INTERNATIONAL COLLEGE

PREPARED BY: MR KHAIRUL NIZAM MOHD ISA

PRECEDE FRAMEWORK

Health education components of health program

Predisposing factors: knowledge, attitudes, values, perceptions

Enabling factors: Availability of resources, accessibility, referrals, skills

Reinforcing factors: Attitudes and behavior of health and other personnel, peers, parents, employers, ect.

Nonbehavioral causes

Behavioral causes

Behavioral indicators: utilization, preventive actions, consumption patterns, compliance, self-care

Indirect communication: staff development, training, supervision, consultation, feedback

Direct communication: public, patients Nonhealth factors

Health problems

Vital indicators: Morbidity, Mortality, fertility, disability

Dimensions: incidence, prevalence, distribution, intensity, duration

Quality of life

Subjectively defined problems of individuals or communities

Social indicators: illegitimacy, population, welfare, unemployment, absenteeism, alienation, hostility, discrimination, votes, riots, crime, crowding

Dimensions: Earliness, frequency, quality, range, persistence

Phase 6Administrative diagnosis

Phase 4-5Educational diagnosis

Phase 3Behavioral diagnosis

Phase 1-2Epidemiological & social diagnosis

EDUCATION DIAGNOSIS

• The educational diagnosis is an importance part of determining how best to initiate the process of behavior change.

• 3 factors causing health behavior:▫Predisposing – precursor to behavior that provide the

rationale or motivation for the behavior▫Enabling – precursor to behavior that allow a motivation or

aspiration to be realized▫Reinforcing – provide the continuing reward, incentive or

punishment for behavior and contribute to its persistence or extinction

Predisposing factors: Knowledge Beliefs Attitudes Values Selected demographic variables

Enabling factors: Availability of resources Accessibility of health resources Community/government priority and commitment to health Health related skills

Reinforcing factors: Family Peers Teachers Employers Health provider

Specific behavioral problem

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Contributing influenceSecondary effectsApproximate order in which the action usually occur#

PREDISPOSING FACTORS

• Predisposing factors include:▫Knowledge▫Attitude▫ Beliefs▫Values▫ Perception

• Knowledge▫ An increase in knowledge does not always cause behaviour to change.▫ But can influence a positive associate between behaviour and health

effects.▫ Health knowledge is necessary but not sufficient factor in changing health

behaviour.▫ Only can motivate them.

PREDISPOSING FACTORS

• Belief▫Belief is a conviction that a phenomenon or object is true or

real. ▫Faith, trust and truth are words used to express or simply

belief.▫Example of belief statements:

“I don’t believe that medication can work.” “Exercise won’t make any difference.” “It sure isn’t going to work for me.”

PREDISPOSING FACTORS

▫Model of belief pattern1. The person must believe that his or her health is in jeopardy.2. The person must perceive the potential seriousness of the condition

in term of pain or discomfort, time loss from work, economic difficulties and so forth.

3. On assessing the circumstances, the person must believe that benefits stemming from the healthy behavior outweigh the costs and are indeed possible and within his or her grasp.

4. There must be a cue to action or precipitating force that makes the person feel the need to take action.

PREDISPOSING FACTORS

• Value▫ Personal values are inseparably linked to choices of behavior.▫Values of life and health and desire must be considered to get a

better life.▫Helping people to sort through conflicts in their health-related

value is an important health education technique.

• Attitude▫A tendency of mid or relatively constant feeling toward a certain

category or objects, persons and situations.▫Attitude can always be assessed in terms of good and bad or

positive or negative.

PREDISPOSING FACTORS

• Technique to examine and understanding the attitude:▫ Examine the concept toward the attitude. eg.

Concept: cigarette smokingGood : __ . x_ . __ . __. __ : BadPretty : __ . __ . x_ . __ . __ : UglyHappy : x_ . __ . __ . __ . __ : Sad

ENABLING FACTORS• Enabling factors are the skills and resources necessary to

perform a health behaviour.• The factors include:▫ Resources – health care facilities, personnel, schools, out reach

clinics▫Accessibility of various resources▫ Cost, distance, available transportation, open hours for use.▫ Personal health skills (ability to perform the tasks that constitute

the desirable behaviour).

• Examine the resources, accessibility and skill possess by the target population before start educational program.

• Failure to consider the these may lead to serious practical problems.

REINFORCING FACTORS• Reinforcing factors are those that determine whether health

actions are supported.• Examples of reinforcing factors are:

Family fellow patientsPeers supervisorsCo-workers teachersNurses

• Sources of reinforcement depending on the objectives ad type of program. For example:▫ High school education programs: peers, teachers, school administrators

and parents▫ Occupational health education programs: co-workers, supervisors,

family

REINFORCING FACTORS

• Assessing the reinforcing factors is important to make sure that the program participants have maximum opportunities for supportive feedback during the behaviour change process.

SPECIFYIG AND SELECTING FACTORS DETERMINING BEHAVIOUR

• Three basic steps:1. Identifying and sorting factors into three categories2. Setting priorities among categories3. Establishing priorities within the categories

Identifying and sorting factors into three categories▫ Informal methods

Assign a team to brainstorming the potential barriers to behavioral change.

▫ Formal methods Use survey questionnaires or records

SPECIFYIG AND SELECTING FACTORS DETERMINING BEHAVIOUR

Setting priorities among categories▫ Classify the factors causing behaviors into positive or negative.▫ Example: Involve in waste recycling

Predisposing factorsPositive

Attitude, belief, value:Willing to use dustbin

NegativeAttitude, belief, value:Not important to take care on environment, feel that government should take that responsible

Enabling factorsPositive

Dustbin available in each house, apartment. Municipal provide recycling bins.

NegativeThe bins not accessible The bins are damaged

Reinforcing factorsPositive

Encourage by family, teachersNegative

Family, teachers, peers not taking part

SPECIFYIG AND SELECTING FACTORS DETERMINING BEHAVIOUR

• The enabling factors that provide the services will have to come first.

• Reinforcement factors cannot come into play until behaviour have been evidenced.

• While, the predisposing factors would be translated into interventions first.

• Some enabling factors may have to be developed over a long period of time by means of community organizations, legislation, policy and government.

SPECIFYIG AND SELECTING FACTORS DETERMINING BEHAVIOUR

Establishing priorities within the categories• Within the 3 categories of behavioral causes factors can be translated for

intervention using the same criteria as used in selection of initial behaviors : Importance and changeability.

• Importance• How widespread or frequent the factors• If the factor identified is very widespread or occur often, it should

qualify for priority consideration.• How compelling or urgent the factors• Immediate consequence for people at high risk need to pay attention

first

SPECIFYIG AND SELECTING FACTORS DETERMINING BEHAVIOUR

• Changeability• Individual pass through stage level of changeability• Awareness interest trail decision adoption

• Use these 2 criteria to rank the various cause of health behavior in order of priority and to focus the health education program that can totally give a good impact to the target population.

Thank you