NUTRITION AND DIET THERAPY
NUTRITION EDUCATION AND COUNSELING: BEHAVIORAL
CHANGE
TOPIC OUTLINE:
o Behavior Theories used in Nutrition Education and
Counseling
o Programs and Services available in GO’s and
NGO’s
BEHAVIOR THEORIES USED IN NUTRITION EDUCATION
AND COUNSELING
Theory – A set of interrelated concepts, definitions, and
propositions that presents a systemic view of events or
situations in order to explain and predict future event or
situations
HEALTH BEHAVIOR THEORY
Describes the relations among variables influencing a
behavior and specify targets for facilitating behavior change
Issues that theories look into:
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Motivation to change
•
Resources to change
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Processes of change
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Procedures of change or strategies of change
ECOLOGICAL PERSPECTIVE
– Emphasize the interaction between and
interdependence of factors within and across all levels
of health problem
– Highlights the physical and socio-cultural environments
Key concepts to identify intervention points for
promoting health:
•
Behavior both affects multiple levels of influence
•
Individual behaviors both shape and is shaped by the
social environment
THEORY OF REASONED ACTION AND THEORY OF
PLANNED BEHAVIOR
THEORY OF REASONED ACTION
– The Theory of Reasoned Action, or TRA, theory posits
that behavioral intention is shaped by three elements or
factors: The individual’s attitude, or personal opinion,
on whether a specific behavior is good or bad, positive
or negative, favorable or otherwise.
THEORY OF PLANNED ACTION
– The Theory of Planned Behavior allows organizations
to predict the likelihood that an individual will hold an
intention to carry out a specific behavior. It provides an
understanding of the factors that lead to a behavioral
intention.
MCLEROY’S LEVELS OF INFLUENCE FOR HEALTHRELATED BEHAVIORS AND CONDITIONS
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Intrapersonal of Individual Factors
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Interpersonal Factors
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Institutional Factors
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Community Factors
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Public Policy Factors
CONCEPTS INVOLVED IN THE FACTORS:
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Behavior is mediated by cognitions
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Knowledge is necessary for most behavior change
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Perceptions, modifications, skills, and the social
environment are key influences on behavior
THEORIES ON INDIVIDUAL ON INTRAPERSONAL LEVEL
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HEALTH BELIEF MODEL
The Health Belief Model (HBM) is a behavioral health
theory used in professional nursing practice. A
behavioral health theory is a combination of knowledge,
opinion, and actions taken by an individual or group in
reference to their health.
This particular theory is intrapersonal, meaning that it is
based on the knowledge and beliefs of each individual
person. The HBM is used to develop preventative
health programs, as well as design appropriate
intervention programs where prevention has failed.
TRANS-THEORETICAL
The Trans-Theoretical or Stages of Change Model posits
that individuals move through six stages of change:
precontemplation, contemplation, determination, action,
maintenance, and recurrence
STAGES OF CHANGE:
1.
PRECONTEMPLATION
– In this stage, people do not intend to take action in
the foreseeable future (defined as within the next
6 months).
– People are often unaware that their behavior is
problematic or produces negative consequences.
– People in this stage often underestimate the pros
of changing behavior and place too much
emphasis on the cons of changing behavior.
2.
CONTEMPLATION
– In this stage, people are intending to start the
healthy behavior in the foreseeable future (defined
as within the next 6 months).
– People recognize that their behavior may be
problematic, and a more thoughtful and practical
NUTRITION AND DIET THERAPY
NUTRITION EDUCATION AND COUNSELING: BEHAVIORAL
CHANGE
–
3.
consideration of the pros and cons of changing
the behavior takes place, with equal emphasis
placed on both.
Even with this recognition, people may still feel
ambivalent toward changing their behavior.
DETERMINATION
– In this stage, people are ready to take action
within the next 30 days.
– People start to take small steps toward the
behavior change, and they believe changing their
behavior can lead to a healthier life.
4.
ACTION
– In this stage, people have recently changed their
behavior (defined as within the last 6 months) and
intend to keep moving forward with that behavior
change.
– People may exhibit this by modifying their problem
behavior or acquiring new healthy behaviors.
5.
MAINTENANCE
– In this stage, people have sustained their behavior
change for a while (defined as more than 6
months) and intend to maintain the behavior
change going forward. People in this stage work
to prevent relapse to earlier stages.
6.
RECURRENCE
– In this stage, people have no desire to return to
their unhealthy behaviors and are sure they will
not relapse. Since this is rarely reached, and
people tend to stay in the maintenance stage, this
stage is often not considered in health promotion
programs.
THEORIES ON INTERPERSONAL LEVEL
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PRECAUTION ADAPTION MODEL
The PAPM attempts to explain how a person comes to
decisions to take action and how he or she translates
that decision into action.
It describes a set of categories (stages), defined in
terms of psychological processes within individuals. All
stages are defined in terms of mental states, rather
than factors external to the person, such as current or
past behaviors.
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•
SOCIAL LEARNING THEORY
Self-efficacy is based on the dynamic interaction of a
person’s behavior, thoughts and environmental
influences.
SOCIAL COGNITIVE THEORY
A dynamic, ongoing process in which personal factor,
environmental factor, and human behavior influence
upon each other
BEHAVIORAL INTENTIONS THEORY
A person would adopt a desired behavior that can be
predicted by assessing their attitudes toward and
perceptions of benefits of the behavior, along with how
they think their peers will view the behavior.
An individual’s attitude and society’s perceived attitudes
are an important predecessor to action.
NUTRITION AND DIET THERAPY
NUTRITION EDUCATION AND COUNSELING: BEHAVIORAL
CHANGE
THEORIES ON INSTITUTIONAL LEVEL
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INTEGRATIVE MODEL
Designed for Nutrition Education
Combination of theoretical models or frameworks
related to behavior change
Health Belief Model (HBM), Theory of Reasoned Action
(TRA), Theory of Planned Behavior (TPB), and the
Trans-Theoretical Model (Stages of Change Model)
The only one designed directly to facilitate behavioral
change
COMMUNITY LEVEL MODELS
COMMUNITY ORGANIZATION AND OTHER
PARTICIPATORY MODEL
GENERAL TYPES
A. LOCALITY DEVELOPMENT (COMMUNITY
DEVELOPMENT)
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Process-oriented.
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Aims to develop group identity and cohesion.
•
Focuses on building consensus and capacity.
B. SOCIAL PLANNING
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Task-oriented.
•
Stresses problem solving.
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Relies on expert practitioner.
C. SOCIAL ACTION
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Both process and task oriented.
•
Increases the community’s capacity to solve
problems and to achieve concrete changes that
redress social injustice.
•
Uses different approach in that it is grass roots
based, conflict oriented, and geared to
mobilizing disadvantaged people to act on their
own behalf.
COMMUNITY ORGANIZATION: CHARACTERISTICS AND APPLICATION STRATEGIES
CONCEPT
Empowerment
Community Capacity
Participation
Relevance
Issue Selection
Critical Consciousness
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DEFINITION
A social action process through which
gain mastery over their lives and their
communities
A characteristic that affect its ability to
identify, mobilize around, and address
problems
Engagement of community member as
equal partners
Community organizing that “starts where
the people are”
Identify immediate, specific, and
realizable targets for change that unify
and build community strength
Awareness of social, political, and
economic forces that contribute to social
problems
DIFFUSION OF INNOVATION THEORIES
Diffusion – the process through which an innovation is
communicated through channels over time among
members of a social system or audience
Innovation – an idea, practice, service, or object that is
considered new by an individual or social group
New products or ideas are “diffused” to the audience
Whether the audience accepts the ideas depend on:
CONCEPT
Complexity
Compatibility
Relative advantage
Flexibility
Trialability
Observability
a)
b)
c)
d)
e)
f)
POTENTIAL CHANGE STRATEGIES
Community members assume greater
power to create desired change
Member participate actively in
community life, gaining leadership skills,
social network and access to power
Members develop leadership skills,
knowledge, and resources
Members create own agenda based on
felt needs, shared power, and
awareness of resources
Members participate in identifying
issues; targets are chose as part of a
larger strategy
Community members discuss the root
causes of problems and plan actions to
address them
Perceive it as beneficial
See it in accordance with their needs and
values
Find it easy/difficult to understand
Can use it in a variety of setting
Can try the behavior
Feel that the use if valued positively by their
peers
DEFINITION
How difficult the innovation is to
understand/use
How consistent the innovation is with
values, habits, experiences, and needs
of potential adopters
Degree to which an innovation is seen
as better that idea, practice, program, or
product it replaces
Range of settings and situations the
innovation can be adapted to fit
The extent to which the innovation can
be experimented with before a
commitment to adopt is required
Extent to which the innovation provides
tangible result
POTENTIAL CHANGE STRATEGIES
Create program/idea/product to be easy
to use and understand
Tailor innovation for the intended
audience’s values, norms, or situation
Point out unique benefits: monetary
value, convenience, time saving,
prestige
Demonstrate how the innovation can be
used in a variety of circumstances
Provide the opportunities to try on a
limited basis
Assure visibility of result: feedback or
publicity
NUTRITION AND DIET THERAPY
NUTRITION EDUCATION AND COUNSELING: BEHAVIORAL
CHANGE
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COMMUNICATION THEORY
Explores “who says what, in which channels, to whom,
and with what effects.”
Investigates how messages are created, transmitted,
received, and assimilated
PHILIPPINE NUTRITION PROGRAM
PLANNING MODELS
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PRECEDE-PROCEED MODEL
A useful framework for planning and implementing
health education and health promotion programs.
PRECEDE (Predisposing, Reinforcing, and Enabling
Constructs in Educational Diagnosis and Evaluation).
Outlines a diagnostic planning process to assist in the
development of targeted and focused public health
programs.
PROCEED (Policy, Regulatory, and Organizational
Constructs in Education and Environmental
Development).
Guides the implementation and evaluation of the
programs designed.
INFANT AND YOUNG CHILD FEEDING
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Health Systems Support
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Community-based health and nutrition support
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Enforcement of the Philippine Milk Code (E.O. 51)
INTEGRATED MANAGEMENT OF ACUTE
MALNUTRITION
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Enhancement of Facilities (ready-to-use therapeutic
food/ ready-to-use supplementary food).
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Building of Capacity of Local Implementeras.
NATIONAL DIETARY SUPPLEMENTATION PROGRAM
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Supplementary feeding of pregnant women.
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Supplementary feeding of children 3-23 months old.
NATIONAL NUTRITION PROMOTION PROGRAM FOR
BEHAVIOR CHANGE
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In communities
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In the workplace
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SOCIAL MARKETING
Use of creative planning efforts, based in marketing to
address target audience
Centered in the identification and satisfaction of the
needs and desires of the population
Uses marketing concepts and tools to increase
acceptability of the proposed practices
Effective on a population level across a wide range of
public health and health care domain
PROGRAMS AND SERVICES AVAILABLE IN GO’S AND
NGO’S
Goal of the Philippine Nutrition Program:
To improve the nutrition situation of the county as
contribution to:
•
The achievement of Ambisyon 2040 by improving the
quality of the human resource base of the country
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Reducing inequality in human development outcomes
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Reducing child and maternal mortality
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MICRONUTRIENT SUPPLEMENTATION
Includes vitamin A, iron-folic acid, multiple micronutrient
powder, zinc
In health units
Communication support
MANDATORY FOOD FORTIFICATION
Includes technology development, capacity building,
regulation and monitoring, promotion.
Rice fortification with iron
Flour fortification with iron vitamin A Cooking oil
fortification with vitamin
NUTRITION IN EMERGENCIES
Capacity building for mainstreaming nutrition protection in
emergencies
OVERWEIGHT AND OBESITY MANAGEMENT AND
PREVENTION PROGRAM
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Healthy food environment
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Promotion of healthy lifestyle
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Weight management intervention (for overweight and
obese individuals)