Why conventional
Hygiene Education does
not change behavior?
Fallacy 1
Universal hygiene 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
Practices which are most costeffective in prevention of faecaloral diseases
1. Preventing faeces from gaining access to the
environment;
2. Handwashing, after defecation and before touching
food;
3. Maintaining drinking water free from faecal
contamination.
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