BEHAVIORAL DIAGNOSIS:

ASSESSING HEALTH ACTIONS

Module 7

HEALTH PROMOTION & EDUCATION (DEMA 3253)

DIPLOMA IN ENVIRONMENTAL HEALTH
VICTORIA INTERNATIONAL COLLEGE

PREPARED BY: MR KHAIRUL NIZAM MOHD ISA

 PRECEDE FRAMEWORK
Phase 6 Phase 4-5 Phase 3 Phase 1-2
Administrative diagnosis Educational diagnosis Behavioral diagnosis Epidemiological & social diagnosis

Predisposing
Direct factors:
communication: knowledge,
public, patients attitudes, values, Nonhealth factors
perceptions
Nonbehavioral Quality of life
causes
Health education Enabling factors:
Availability of Health problems Subjectively
components of Behavioral causes
resources, defined problems
health program
accessibility, of individuals or
referrals, skills Behavioral Vital indicators: communities
indicators: Morbidity,
utilization, Mortality, fertility, Social indicators:
Indirect Reinforcing preventive actions, disability illegitimacy,
communication: factors: Attitudes consumption population,
staff and behavior of patterns, welfare,
development, health and other compliance, self- Dimensions: unemployment,
training, personnel, peers, care incidence, absenteeism,
supervision, parents, prevalence, alienation,
consultation, employers, ect. distribution, hostility,
Dimensions:
feedback intensity, discrimination,
Earliness,
duration votes, riots,
frequency, quality,
crime, crowding
range, persistence
BEHAVIOR
• Behavioral problems refers to the behaviors believed to
cause health problems for the people for whom the
educational intervention is intended.
• After considerable analysis, target behaviors are
selected and the approach to changing them stated in
term of behavioral objectives.
• Behavioral objectives are the means by which program
objectives and programs goals are achieved.
BEHAVIOR
• Health problems have both behavioral and non-behavioral
causes.
• Non-behavioral cause are personal and environmental factors
that can contribute to health problem but that are not
controlled by behavior of the target population.
• Non-behavioral causes include:
▫ Genetic
▫ Climate
▫ Work place
▫ Residence
▫ Environmental (air, water, soil, roads, fluoridation, food, ect.)
▫ Technological (adequacy of medical care, facilities)
BEHAVIOR

Nonbehavioral Nonhealth
causes factors

Quality of life

Behavioral
Health problems
causes
BEHAVIOR
• Behavioral causes can be influenced by certain non-behavioral
causes, especially through collective action.
• Eg. Communities, neighborhoods, or special interest groups
can organize, vote, boycott, lobby, or support and prevent
certain environmental and technology changes.
• Thus, behavior can influence health in 3 ways:
▫ Direct
▫ Indirect (2 ways)
Environmental
causes
1

Behavioral 2
Health
causes
3
Technological
causes
5 BASIC STEPS IN BEHAVIORAL
DIAGNOSIS

• Step 1: Differentiating between behavioral and non-behavioral

causes of health problem
• Step 2 : Developing an inventory of behaviors
• Step 3 : Rating behaviors in terms of importance
• Step 4 : Rating behaviors in term of changeability
• Step 5 : Choosing behavioral targets
Step 1: Differentiating between behavioral
and non-behavioral causes of health
problem
• Differentiate between the behavioral and non-behavioral
causes of health problem by listing the known risk factors for
that problems/diseases.
• eg. Risk factors for cardiovascular diseases
Smoking Heavy alcohol consumption
Gender Diabetes
Inactive life-style Obesity
Stress Age
High serum cholesterol Family history of diseases
High blood pressure High fatty-acid intake
Step 2 : Developing an inventory of
behaviors

• Once the behavioral and non-behavioral factors have been

listed, the list of behavioral factors should be refined.
• Procedure:
a) Identify the behavioral associated with preventing the health
problem and state them in term of actions to be taken.
b) Identify the treatment procedures of the health problem in
sequential order. What are the steps that people have to go
through to comply with a recommended method of prevention
treatment.
Inventory of behaviors

• Develop a flow chart of causation or transition from beginning

to end of a behavioral process or event.
• Eg. The behavior of involve in recycling campaign:
▫ Taking care  willing to separate/sort trash  send to
recycling center

• It can be sabotaged at many points along the way, for

example, when they mix up organic wastes and glasses.
• This level makes it possible to isolate concrete behavioral
events from non-behavioral factors in such a way as to ensure
that intervention-education and administrative- are highly
targeted.
Inventory of behaviors

Preventive behaviors
1. Maintain or attain desirable weight
2. Stop smoking or don’t start
3. Stop heavy or abusive drinking or don’t start
4. Continue or begin regular exercise
5. Avoid excessive, constant stress and/ or do relaxation exercise
6. Participate in high blood pressure screening programs
Treatment behaviors
1. Make informed decisions regarding medication, surgery and so forth
2. Take prescribed medication
3. Maintain or attain desirable weight
4. Stop smoking
5. Stop heavy or abusive drinking or don’t start
6. Continue or begin regular exercise
7. Avoid excessive, constant stress and/ or do relaxation exercise
Step 3 : Rating behaviors in terms of
importance

• Reduce the extensive list of behavior to a manageable length

by establishing which behaviors are the most important.
• Steps:
▫ Available data are linked to the behavior and health problems
▫ Put them in sequence and rationality

• Behavior can be considered important if a strong theoretical

cases available causally related to a health problem.
• The stronger the rationale, the greater the probability that the
behavior selected for intervention program.
 Rating behaviors

Important Basis for rating behavior

Smoking Very strong association; high incidence
Eating foods with high fatty-acid content Strong association; high incidence
Over eating Moderate association; high incidence
Lack of exercise Moderate association; high incidence
Not relaxing Moderate association; high incidence

Not (less) important Basis for rating behavior

Not monitoring blood pressure Not related to the desired outcome of the
Not adhering to medical regimen program: primary prevention
Making uniformed decision about
treatment matters
Step 4 : Rating behaviors in term of
changeability
• Guideline to determine the potential for behavior changeability:
▫ Probably when behaviors are still in the development stages or
have only recently been establish
▫ When behaviors are still only superficially tied to established
cultural patterns or life-styles
▫ Have been successfully changed in other programs

• Behavior have low changeability when they:

▫ Have long been established
▫ Are deeply rooted in culture patterns or life-style
▫ Have not been changed in previous attempts
Step 5 : Choosing behavioral targets
• Time to select the behavior that will be focus of the
educational intervention.
• To facilitate the selection, the results of the importance and
changeability ratings are arranged in a simple matrix table.

Important Not (less) important

1. High priority for 3. Low priority except to
Changeable program demonstrate change for
“political” purposes
2. Priority for innovative 4. No program
Not (less) Changeable program: evaluation
crucial
Choosing behavioral targets
Important Not (less) important
1. High priority for 3. Low priority except to
Changeable program demonstrate change for
“political” purposes
2. Priority for innovative 4. No program
Not (less) Changeable program: evaluation
crucial

• Depending on the program objectives, the priority behaviors

will be more likely come from quadrants 1 and 2.
• Behavior in quadrant 3 likely accepted when there is a
political need to document change. Eg. Drive over limit
among bus express drivers – installation of black box in buses.
Choosing behavioral targets
• Matrix of health behavior in preventing cardiovascular
diseases

Important Not (less) important

Changeable 1. None 3. None
2. Smoking 4. None
Eating food with high
Not (less) Changeable fatty-acid content
Overeating
Lack of exercise
Not relaxing
Stating behavioral objectives
• This is the final step after the target health behavior has been identified.
• The behavioral objective should answer these questions:
▫ Who – the people expected to change
▫ What – the action or change in behavior or health practice to be
achieved
▫ How much – the extent of the condition to be achieved
▫ When – the time in which the change is expected to occur
eg.
Who – residents aged 15-25 in BTP
What – the reduction in the incidence of cigarette smoking
How much – 20% decline in smoking prevalence
When – the time of the proposed follow-up evaluation, 2 years after the
program is initiated.
Young adults aged 15-25 years in BTP will show a 20% reduction in
incidence of cigarette smoking within 2 years of program implementation.
Thank you