Why conventional
health education does
not change behavior?
Fallacy 1
Behavior Change Messages can be given
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Based on the belief that knowledge of the planners
and educators is always superior to the people
Fallacy 2
Telling people what to do solves the problem
Fallacy 3
When people know about health risks they take action
Fallacy 4
Any improvements are equally useful
People adapt their lifestyle to local
circumstances and develop their
insights and knowledge over years of
trial and error
Technical Models of Health
Promotion
 Environmental Approaches
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Ecological Model
Social Marketing Model
Political Economy Model
Precede-Proceed Framework
Social Responsibility Model
 Life Cycle Models
 Stages of Change
 Innovation Diffusion Theory
 Health, Attitude, Belief, and Behavior Change Approaches
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Health Belief Model
Theory of Reasoned Action
Theory of Planned Behavior
Prospect Theory
Social Learning Theories
 Health Action Model
Socio-ecological Model
Socio-ecological Model
 The socio-ecological model recognizes the interwoven
relationship that exists between the individual and their
environment.
 Individual behavior is determined to a large extent by
social environment, e.g. community norms and values,
regulations, and policies.
 Barriers to healthy behaviors shared among the community
as a whole. Lowering these barriers makes behavior change
more achievable and sustainable.
 The most effective approach - a combination of the efforts
at all levels--individual, interpersonal, organizational,
community, and public policy.
Stages of Change
 Precontemplation (i.e. considering the change)
 Contemplation of change (i.e. starting to think about
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initiating change)
Contemplation without action
Preparation (i.e. seriously thinking about the change
within a given time period (e.g. the next 6 months) or
taking early steps to change)
Action (i.e. making change in or stopping the target
behavior within a 6-month period)
Maintenance of change (i.e. maintaining the target
behavior change for more than 6 months)
In some cases, relapse
Diffusion of innovations model
 Innovator (2.5%): need for novelty and need to be
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different
Early Adopter (13.5%): recognize the value of adoption
from contact with innovators
Early Majority (34%): need to imitate or match up with
others with a certain amount of deliberateness
Late Majority (34%): need to join the bandwagon
when they see that the early majority has legitimated
the change
Laggard (16%): need to respect traditions
Health Belief Model
 Perceived susceptibility: the subjective perception of risk of
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developing a particular health condition.
Perceived severity: feelings about the seriousness of the
consequences of developing a specific health problem.
Perceived benefits: beliefs about the effectiveness of
various actions that might reduce susceptibility and
severity (the latter two taken together are labeled “threat’).
Perceived barriers: potential negative aspects of taking
specific actions.
Self-efficacy: belief that s/he will be able to do it.
Cues to action: bodily or environmental events that trigger
action.
 Theory of Reasoned Action
 Theory of Planned Behavior
Social Cognitive Theory
 Self-efficacy: a judgment of one’s capability to accomplish a certain
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level of performance.
Outcome expectation: a judgment of the likely consequence such
behavior will produce.
Outcome expectancies: the value placed on the consequences of the
behavior.
Emotional coping responses: strategies used to deal with emotional
stimuli including psychological defenses (denial, repression), cognitive
techniques such as problem restructuring, and stress management.
Enactive learning: learning from the consequences of one’s actions
(versus observational learning).
Rule learning: generating and regulating behavioral patterns, most
often achieved through vicarious processes and capabilities (versus
direct experience).
Self-regulatory capability: much of behavior is motivated and regulated
by internal standards and self-evaluative reactions to their own actions.
When learning, people
remember 20% of what they
hear, 40% of what they hear
and see, and 80% of what
they discover for themselves.
- Hope and Timmel 1984:103)
Social Learning Models
Social learning theory is derived from the work of
Gabriel Tarde (1843-1904) which proposed that social
learning occurred through four main stages of
limitation:
 close contact,
 imitation of superiors,
 understanding of concepts,
 role model behaviour
Integrated Model of Communication for Social
Change (IMCSC)
An iterative process where ‘community dialogue’ and
“collective action” work together to produce social change in a
community that improves the health and welfare of all its
members.
INFORMATION EQUITY
CATALYST
COMMUNITY
DIALOGUE
COLLECTIVE
ACTION
SOCIAL CAPITAL
SOCIETAL
IMPACT
Community Dialogue
CLICS
STAGE 2
STAGE 3
STAGE 4
Major factors which stimulate
people to change behavior
 Facilitation,
 Practical understanding,
 Influence from others,
 Capacity to change