Health knowledge,
attitudes and behaviour
R.Fielding
Learning objectives
• At the end of this lecture, you
should be able to
–give a balanced account of the
role of knowledge in behaviour
change
–define “attitudes” and explain how
they relate to both knowledge
and behaviour
Continued
–define “self-efficacy” and
explain why it is important
in behaviour change
–give examples of barriers
to behaviour change and
examples of ways to
overcome these.
Why is this topic important?
• CHD, HT, CVD and Cancers are
commonest causes of death in HK
and many other countries. Most
can’t be cured, but a majority of
cases could be prevented.
• Most of these diseases arise from
people’s lifestyle (i.e. their
behaviour), e.g. no exercise, diet,
smoking.
Why is health knowledge
important?
• To prevent disease people must
change their hazardous behaviour.
• Why do people behave in ways
hazardous to their health? Because
most people don’t think of their
health until it is threatened or they
lose it, preferring instead to pursue
their goals.
So why is knowledge important?
• Ignorance of health hazardous
behaviour. Knowledge is a first
step to changing behaviour.
• But knowledge alone
insufficient to change
behaviour.
Is knowledge alone sufficient?
• Not usually, although it helps.
• Knowing something can affect
your health and perceiving a
health threat are not the same.
• Once a threat is recognised,
people may be more motivated
to change their behaviour,
except....
Except what???
• Unless the threat is imminent (with
severe consequences), most
people will ignore or forget it.
• Conversely, where a threat is
perceived significant changes in
behaviour may occur. e.g. belief
that tap water in HK is unsafe to
drink.
...and...
• e.g. UK, BSE in beef --> drop in
beef consumption. Though beef is
now safe, consumption remains
low.
• e.g. most people who smoke know
health risks, but continue to smoke
(Li et al, 1996).
Why is attitude relevant?
• Attitudes are evaluative social
judgements -orientations that locate
objects of thought on dimensions of
judgement
• Mixtures of components
–cognitive: beliefs
–emotional: feelings
–behavioural: predispositions to act
Do attitudes predict behaviour?
• Usually not very well. Giving
information which changes attitudes
doesn’t always change behaviour.
Why?
–attitudes are generalisms,
behaviours are more specific;
–attitudes are only predispositions to
act.
Changing attitudes
• To effectively change attitudes you
need:
–credibility (expertise/ trustworthy)
–likeability (physical attractiveness)
–persuasive arguments
–to consider listener’s original
position.
To effectively change
behaviour, you need...
• Recognition that behaviour change
is needed / desirable
• Motivation to make change
• Belief that change can occur and be
maintained (perceived self-efficacy)
• Triggers/cues to initiate change
• Perceived benefits of that change.
What is perceived self-efficacy?
• Modelling w. guided mastery --> new
skills, but these not applied if no use.
• Acquiring vs. using skills effectively
under different circumstances.
• “Success requires not only skills, but
also a strong self-belief in one’s
capabilities to master problems.”
(Bandura, 1986)
• PSE affects every stage of change
process:
–whether or not people consider
changing
–how hard they try if they choose
to do so
–their resiliance following setbacks
–how well they maintain the gains
achieved (Bandura, 1986, p.162).
...and Modelling?...
• Seeing effective practices in use is
v. persuasive.
–greater demonstrable benefits,
greater likelyhood example will
persuade.
–exhortations to change are by
themselves mostly useless.
Confucian society relies on
example for changing behaviour.
Knowledge
Attitude
Behaviour
This is not how it works.
So..is health behaviour change hard
to achieve...?
• Yes.
–Treatment non-adherence ranges
from 30-60%
–Prophylactic treatment adherence
only 30-35%
–Protective health behaviour 1030%
• Yet, people indulge in all kinds of
health related activities - clearly it
isn’t an aversion to these so much
as an unwillingness or inability to
adopt specific regimens prescibed
by health professionals.
Is it really that bad?
• Yes. Health behaviour change
approaches usually ineffective. Few
achieve more than the preoportions
of people who successfully keep
their New Year’s Resolutions.
• But if health workers adopted better
methods, they would be more
effective.
…Are health professionals better?
• Literature indicates HCPs do not
follow clinical procedures they know
should be implemented:
–Physician performance ranges
between 48-72% of professional
standard (Peterson etal, 1980)
–Nurses deviate from infection
control rules (Raven & Harley,
1982)
–Dentists fail to adequately shield
patients during x-rays (Green &
Neistat, 1983),
–20% error rate in care procedures
in old people’s homes (Kayne &
Cheung, 1973). etc...
Do HCPs modify their behaviour?
• Self-imposed protocols designed to
improve care for UTI in primary care
clinics were adhered to
between100%-38% of the time.
(Sullivan et al, 1980)
Cont.
• US Residents in internal
medicine given update reading
materials on 13 common
preventive care actions:
adherence to recommendations
<10% of time. (Cohen, 1985).
Why are things so poor among HCPs?
• The same factors that influence the
public probably influence HCPs.
These include:
–beliefs & attitudes of people about
their actions
–the complexity of the procedures
advocated
–the perceived costs (ie effort)
versus benefits
Cont.
–low perceived self-efficacy
–faulty memory
–inadequate skills and resources
–previous failures.
Implications
“There is enough evidence of
professional non-compliance for
it to seem likely that even if
clinicians were aware of these
techniques, they would not
necessarily use them.” Ley,
(1986).
Implications cont.
If clinicians will not change their
behaviour, are we being
realistic in expecting patients to
do so just because we exhaut
them to? No, we need to
change our behaviour if we
expect patients to change
theirs.
The End.
• Attitudes 2: Interactions with patients.
• Addiction and behaviour.
• Who are you? Individuals and groups.