Health Promotion And Health Education

DR NATASHA K (MBBS, MPH, PHD FELLOW)ASST PROF BUHSDRNATASHA1976@GMAIL.COM

Lecture 7, CHANGE PROCESS, ATTITUDE

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What is Attitude?Attitude may be defined as a tendency to react to a person, object or event in a particular way. Knowing the attitude of their patients, doctors can be aware how to handle their patients or change the attitude of their patients in a positive direction.

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Components of AttitudePersons’ attitude towards some object, event, person, situation, policy or action has three distinct components:

Cognitive component : consists of the beliefs, concepts or ideas of the individual about the object

Feeling component : refers to the emotions related to the object.

Action tendency component : The action tendency component of an attitude includes all the behavioral preparedness associated with the attitude.

Cont…Example: If a mother has a positive cognition and positive

feeling regarding ‘breastfeeding her child’, she would behaviorally develop readiness to do it. If on the other hand, a mother has some form of negative cognition and negative feeling on the same issue, she would be behaviorally ready not to do it, will avoid doing it, and will find excuse not to do it, even if she is under pressure from doctors, husband, mother or any close person to her.

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Dissociation between Cognition and Emotion

Only providing information, education and knowledge regarding any community issue, like ‘safe drinking of tube well water’ is not going to produce change in practice regarding drinking water choice, unless the community’s level of emotion regarding this issue is raised up to the positive and effective level.Any health campaign only emphasizing behavioral change through education without adding positive emotion, will fail to produce its desired impact, almost always.

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Change of AttitudeThe attitude of an individual is not a static phenomenon. There are several factors which will help change attitudes, while there are factors which might resist such change. The major factors in this regard are:

The personality of the individual The group affiliation or approval in which the individual lives

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Depend upon the individual’s intelligence and perception about the welfare of others

Upon the capacity of the individual either to accept or to reject depending upon the benefit or gain of the new ideas to be adopted

Upon the needs and lifestyle of the individual concerned

What is Social Change?Society changes over large blocks of time. Whether this change is for the better or for the worse is a matter of discussion among economists and other social scientists. Every country, specially the developing countries, are interested in quickening the changes in many development fields.

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Therefore, they have planned time bound plans like 5 years plans, with definite targets to be achieved. In order to achieve this target changes in the society is required. There are several categories of change agents in the welfare Departments (health, Agriculture, Education, Adult Education Cottage Industries etc.) to bring about this change in a planned manner.

What is Change process? A Change Process is a set of procedures that help teams to control change effectively. It's not that you have to prevent change from happening; it's how you manage change once it occurs that really matters. The Change Process allows to record change requests, and review and approve those requests, before implementing them.

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Peoples health related attitudes and practices have their roots in century old customs, beliefs, habits, style of living etc. Unhealthy practices give rise to many health problems. So, such practices have to be changed to improve health. It is not an easy task to bring change and develop sustained healthful behavior.

Ways to bringing change

Herbert C. Callaman has identified three different ways of bringing change:

1. Change by compliance or force2. Change by identification3. Change by internalization

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Cont…A. Change by compliance or force

It is unwilling change brought by force, enforcement of law, fear, incentive, punishment, etc. Such kind of coercive change does not last long to occur sustained positive result. This kind of change does not involve individual’s knowledge and self decision.

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Cont…

B. Change by identificationThis kind of change occurs among some people who want to maintain their prestige and status. They adopt change for their recognition in the community.

e.g. A rich family may maintain a sanitary latrine to keep their prestige in the community. Some other families may even imitate them and build latrines again to keep their prestige before others.

This kind of change also does not base on knowledge and attitude development. Such change also will not be sustained satisfactorily.

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Cont…

C. Change by internalization

This kind of change is brought about by people’s voluntary or conscious efforts. It based on the development of appropriate knowledge and attitude which help in making thoughtful decision.Several mental stages undergo in a stepwise process to occur change in behavior which is adopted for satisfactory period of time.

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Stages of Change Process/Planned Change

E.M. Roger’s and Lewin Kurt are two important workers who have studied the change process.

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E.M. Roger’s ModelRogers put forward the theory of diffusion and adoption of ideas. Roger was a pioneering scientist who did research in the field of diffusion and adoption process in accepting a new idea or innovation (New idea).Diffusion: Diffusion is the process whereby information about the new idea or innovation is disseminated (dispatched) to the people i.e. Transfer of knowledge from one person to other.

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E.M. Roger’s Model of adoption suggests five sequential stages as follows:

a) Awareness stageb) Interest stagec) Evaluation staged) Trial stagee) Adoption stage

Cont…A. Awareness stageThe individual knows about the new idea but lacks information.

B. Interest stageThe individual becomes interested and collects more information about it.

C. Evaluation – Application - Decision stageThe individual makes mental application of the new idea to his present and future situation and makes a decision to try it or not to try it.

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D. Trial stageThe individual uses the new practices on a small scale. In some cases this may not be possible.

E. Adoption stageIf the trial is to his liking than the individual will practice it on a full scale and it will become a part o his life.Each individual takes his own time to pass through these stages.

Field Theory of Change by Lewin Kurt

He used the example of an Ice-block freezing-Moving-Refreezing as shown in the figure below:

 (1)Freezing (2) Moving (3)Refreezing

 

Old position New position

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Cont…..A man who has to change his practices must:-

Be dissatisfied with his old practice (freezing) He must move towards the new practice (Moving) action He will follow the new practice and this will become a part

of his life by (Refreezing) repetition and permanency. Roger was a pioneering scientist who did research in the field of diffusion and adoption process in accepting a new idea or innovation (New idea).

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Five Phases Unfreezing to Refreezing Theory of Change by Lewin Kurt

Freezed phase: it is not included in change process in this theory as change has not started yet

a) The unfreezing phageb) The problem-diagnosis phagec) The goal-setting phaged) The new behavior changee) The refreezing phage

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Cond…A. The unfreezing phageUnfreezing phase is a state of readiness for change in individual's basic attitudes and behavior. When people become ready to consider the changes to be for themselves they are said to be undergoing a process of unfreezing.

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“MOVING TO A NEW LEVEL”

Problem Dx

20B. The problem-diagnosis phageAt this stage the individual’s identity supporting as well as opposing forces for change, and analyze them in terms of how and where changes can be introduced. That is what we call problem diagnosis.

Cond…C. The goal-setting phage

Once the problem is understood the individuals are then able to establish specific goals for desired change in behavior.

D. The new behavior changeAfter the goals are specified the individuals try new behavior as trial and see the consequences. The behavior should base on alternative course of action.

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Goal setting

New behaviour

Cond…E. The refreezing phageThe individual after experiencing optional behavior as trial will be able to identify and decide for a beneficial change. At this stage the individual/s will be well motivated to act for the expected change. It will manifest on-going behavior or sustained change. In this case individual/s can be said to have undergone the refreezing phase.

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Resistance to Change

Definition of Resistance:Resistance has many components. It can not be

considered as a single entity. Some of the major feature of resistance are as follows:a) Threat to the established social structureb) Threat to vested interestc) Threat to the individual himselfd) Late adopters

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Resistance to Change1. Threat to the established social structure. In each community there are traditional and established ways which are accepted by the people as important. When innovations are against these norms it poses a threat to the community (Late marriage-society requires early marriage).

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2. Threat to vested interest. In the community there are individuals for gaining money or power from certain practices. When innovations reduce these practices, then the vested interest practice are threatened (Family Planning, Doctor-malaria, Temple-small pox vaccination)

Cont…3. Threat to the individual himself. Many health innovations are unpleasant, painful and difficult go perform. Many of these are therefore posing personal threats. (vasectomy importance loss of health, surgery- expensive, Immunization- distance and loss of time.)

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4. Characteristics of knowledge - encumbered knowledge. unencumbered knowledge is that which gives the individual option (choice) in innovation. Encumbered knowledge is that which requires widespread acceptance without much option. (Emergency in India- vasectomy, Immunization in Rural Areas) Resistance may be a carefully planned and thought out position or it may be stubborn obstinate, persistent (Refractory), unwillingness to change.

Resistance Factors & solution26Resisting Factors Solution

1. Change not clearly understood Full knowledge should be given to the concerned people about the expected change

2. Change that does not seek community participation

Local people’s participation must be sought to bring change

3. Change which is difficult to adopt Alternative ways of bringing change should be provided which are practicable and easy to adopt

4. Changes which threaten their vested interest Any change should consider he need, interest and security of the people concerned

5. Changes advocated by those they do not like trust A change agent should try to be familier with the concerned people and establish credibility by showing his concern, sincerity etc

6. Changes which do not fit into the cultural values of the community

Changes should not contradict with the cultural values of the community. Existing beliefs, norms, values etc. should be considered.

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Adoption Process• Definition • Stages• Factors• Adopter categories• Characteristics of Adopter

categories

What is Adoption & Adoption Process?Adoption: Adoption is a process whereby a new idea is received and accepted by the individual. This is a mental process which takes place within the individual resulting in action.Adoption process: Adoption process is a mental process through which an individual passes from first hearing a new idea to its final adoption.

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Factors affecting adoptiona) Cost and Economic returnb) Complexityc) Visibilityd) Divisibilitye) Compatibility

Cont…1. Cost and Economic return:New ideas which are costly are adopted more slowly than

less costly ones. However, regardless of the cost these ideas which produce high economic returns are adopted more quickly than those with low economic return.

2. Complexity: Ideas which simple and easy to understand are accepted more quickly than complicated ideas.

3. Visibility: Those ideas whose results are easily demonstrated and seen are accepted more quickly.

4. Divisibility: A new practice which can be tried on a small scale are adopted more rapidly than those which can not be tried on a small scale.

5. Compatibility: A new idea which is consistent with existing beliefs of the people are more easily accepted than those which are against people's beliefs.

  The new practices or innovations in the field of health in many cases do not fulfill the above mentioned characteristics. For example immunization, Surgical methods of conception control, legalized abortion, Sanitary Latrine, vitamin "A" Capsules.

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Adopter CategoriesAdoptor Categories have been divided into 4 major groups:

a)Innovators: (1 in 40)b)Early adopters: (5 in 40)c)Majority of Adopters (28 in 40) d)Late adopters (6 in 40)

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Cont… Innovators: Are a very small number of persons who adopt the innovation very early in the program. They are usually leaders and have higher education.

 Early adopters: These group of adopters follow the innovators and are also educated and are local leaders. They depend upon the example set by innovators.

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Majority of adopters: The adopters are further divided to early and late majority. The bulk of the population fall in this category.

  Late adopters: This small group are late to accept an innovation. They are also known as laggards. They are usually backward socially and economically and believe on magic and folklore.

Application to Health Education

The above information helps the Health Education to organize the educational programme for accepting health innovation, (IUD), communication Latrenes, vitamin, "A" Iron Tablets) in a systemic manner. It in clear that the educational progamme for innovators, early adaptors, Majority, Late adaptors, are quite different.The Innovators though a small group can not be ignored. They should be kept informed through scientists and publications . The acceptance of the Innovators is important as the early adaptors are waiting to see the results of their adoption.

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Cont…

Early adaptors have to be convinced through proof of applicability. Early adaptors are important as the majority are not only observing that but are consulting them before adoption.The Late majority are those who do not attend meetings or Educational sessions. They take the longest time to adopt. It is therefore, not very productive to continue to pressurize them to accept during the initial stage of the program.

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Reference Books A Text Book of Health Education (Philosophy and Principles) by Hari Bhakta Pradhan, Educational Resources for Health, Kathmandu, Nepal. Introduction to Behavioral Science by S. Aminul Islam et al. The University Press Limited, Dhaka, Bangladesh. Behavioral Science by Prof M.D. Hussain, Bangladesh Foundations and Principles of Health Education by Nicholas Galli, University of Illinois, Illinois

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questionsWritten

Define Motive. What are the types of ‘Motive’? Can you explain biogenic and sociogenic motives with

example? Define ‘Motivation’. Explain Maslow’s Need Hierarchy theory Write briefly the developmental stages according to Erikson Discuss the degree of needs according to Maslow. What are the factors for Motivation? What do you understand by internalizing Incentives? What do you understand by ‘Health behaviour’, explain the

types. What factors influence Health Behaviour? Write something about the desirable health behaviour and

categories of people. What is ‘Attitude’? What are the components? What do you understand by ‘Change Process’? Explain What are the models of Change Process? Discuss them What are the resistance to change? Define ‘Adoption’? what are the factors affecting adoption? Discuss the categories of adopter

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Thank you