Behaviour change and behavioural - PDF document

6/25/2013 ،ما هداد وا ﮫﺑ ﮫﮐ یددﻌﺗﻣ یﺎھ شزوﻣآ دوﺟو ﺎﺑ نﻣ رﺎﻣﯾﺑ ارﭼ Behaviour change ؟دﻧﮐ ﯽﻣﻧ هدﺎﻔﺗﺳا کاوﺳﻣ زا and behavioural models in oral health ﯽﻣ ار ندﯾﺷﮐ رﺎﮕﯾﺳ یﺎھررﺿ ﮫﮑﻧﯾا ﺎﺑ دارﻓا زا ﯽﺧرﺑ ارﭼ ؟دﻧﺷﮐ ﯽﻣ رﺎﮕﯾﺳ مھ زﺎﺑ ،دﻧﻧاد Dr. Zahra Saied Moallemi رﺿﻣ ﯽﺗﻣﻼﺳ یارﺑ دووﻓ تﺳﻓ ندروﺧ مﻧاد ﯽﻣ ﮫﮑﻧﯾا ﺎﺑ ارﭼ Khordad 1392 ؟مروﺧ ﯽﻣ ازﺗﯾﭘ ردﻘﻧﯾا ،دوﺷ ﯽﻣ ﯽﻗﺎﭼ ثﻋﺎﺑ و تﺳا Behavioural theories and models K A B ﯽﻣ ﯽﻌﺳ و هدﺷ عادﺑا نﺎﺳﺎﻧﺷﻧاور طﺳوﺗ یرﺎﺗﻓر یﺎھ لدﻣ دﻧﻧﮐ ﺢﯾرﺷﺗ ار یرﺎﺗﻓر تارﯾﯾﻐﺗ دﻧﻧﮐ. تﯾﺎﮭﻧ رد و تادﺎﻋ و شرﮕﻧ رﯾﯾﻐﺗ ﮫﺑ رﺟﻧﻣ ﯽھﺎﮔآ و شﻧاد دوﺷ ﯽﻣ رﺎﺗﻓر رﯾﯾﻐﺗ ﮫﺑ رﺟﻧﻣ . یﺎھ هدﻧﻧﮐ نﯾﯾﻌﺗ مﮭﻣ شﻘﻧ و دراد دﯾﮐﺎﺗ درﻓ رﺑ ﺎﮭﻧآ رﺗﺷﯾﺑ تﺳا ﮫﺗﻓرﮔ هدﯾدﺎﻧ ار ﯽﻋﺎﻣﺗﺟا . لﻣاوﻋ رﮕﯾد ﯽﺧرﺑ ﺎھ تﯾﻌﻗوﻣ و ﺎھ تﺻرﻓ زا یا هدﯾﭼﯾﭘ ﮫﻋوﻣﺟﻣ رد رﺎﺗﻓر ﺎﻣا تﺳا هداد رارﻗ رظﻧ دﻣ زﯾﻧ ار ﯽﻋﺎﻣﺗﺟا. ددرﮔ ﯽﻣ نﯾﯾﻌﺗ و ﮫﺗﻓرﮔ لﮑﺷ . 1

6/25/2013 Health behavioural models Stages for behavioural studies • A first stage of psychological research on • provide useful methods to promote individual behaviour change (1920s): behaviour and health • classical conditioning (Pavlov, 1927) • provide a framework for understanding the • sound of a high-speed hand-piece and dental pain process of behaviour change and the influence of social circumstances of individuals upon • The second stage (1950s and 1960s): their behaviour. • focused on underlying cognitive information • Bandura’s theory: observational cognitive learning (Yevlahova & Satur, 2009) Health locus of control ( HLOC ) • The third stage of research (1970 so far): – a specific social-cognitive approach to تﺣﺗ هزادﻧا ﮫﭼ ﺎﺗ ﺎﮭﻧآ ﯽﺗﻣﻼﺳ ﮫﮑﻧﯾا ﮫﺑ دارﻓا دﺎﻘﺗﻋا نازﯾﻣ behaviour change دوﺟوﺑ ﯽﺟرﺎﺧ لﻣاوﻋ رﺛا رد ﺎﯾ تﺳا ﺎﮭﻧآ دوﺧ رﺎﺗﻓر رﯾﺛﺎﺗ • Health Belief Model (Becker, 1974) , دﯾآ ﯽﻣ. • Self-Efficacy (Bandura, 1977), • Internal HLOC: impact of their own action on • the Theory of Reasoned Action (Ajzen & Fishbein, 1980) health outcomes • External HLOC:  powerful others HLOC  chance HLOC 2

6/25/2013 Examples for periodontal disease Health Belief Model (HBM) دھد ﯽﻣ نﺎﺷﻧ یرﯾﮔ مﯾﻣﺻﺗ رد ار دﺎﻘﺗﻋا شﻘﻧ ﯽﺑوﺧﺑ لدﻣ نﯾا. • Internal HLOC: ﯽﻣ رﺎﮑﺑ ﯽﺗﺷادﮭﺑ صﺎﺧ رﺎﺗﻓر ﮏﯾ ﯽﻧﯾﺑ شﯾﭘ یارﺑ لدﻣ نﯾا • my ability and skill to effectively remove plaque دور. • Powerful others HLOC: ﮏﯾ ،دھد ﯽﻣ رﯾﯾﻐﺗ ار شرﺎﺗﻓر یدرﻓ ﯽﺗﻗو دﯾوﮔ ﯽﻣ لدﻣ نﯾا • Dentists can help me: regular dental visit دوﺳ زﯾﻟﺎﻧا-دھد ﯽﻣ مﺎﺟﻧا ﮫﻧﯾزھ. • Chance HLOC: • This is my chance that I have good gingival health 3

6/25/2013 HBM and ECC Theory of Reasoned Action • mother should believe • This theory stresses the importance of attitudes • that the child is susceptible to dental caries, and intentions in changing behaviour. • that primary teeth are important and dental • subjective norm in this theory includes the role caries is a serious threat to them, of other people in behaviour. • that dental caries can be prevented, and • the mother must be willing to limit the child’s • A firmer intention to brush the teeth has been exposure to fermentable carbohydrates and related to a higher reported frequency of tooth • must assist the child in practicing good oral brushing hygiene (Tedesco et al., 1991; Syrjälä et al., 2002) (Hollister & Anema, 2004) Stage of change model or Ttranstheoretical model (TTM) • A process of change behaviour • Smoking cessation 4

6/25/2013 New Century Model of Oral Health Promotion • patients’ behaviour is formed by cognitive, affective, and behaviour factors interacting in a complex pattern with the time perspective and the patients’ situation. These authors argued that past behaviour is the best predictor of future behaviour. In addition, general health-related behaviour (such as diet and smoking) and dental health-connected behaviour (such as teeth grinding) should be considered as predictors of behaviour. A life-span approach to oral health promotion (time perspective) explains that oral health care practices must become a habitual part of a person’s life to be effective (Inglehart and Tedesco , 1995) Individual level: knowledge, attitudes, belief Levels of behavioural models • HBM, Stage of change model • Behavioural change interventions are targeted at three main tiers: Interpersonal level: the individual is influenced by close relationships with family, – individual, friends, and colleagues. How the person – interpersonal, and interacts with his or her immediate – community level (Linden & Roberts, 2004). environment so that the desired behavioural change is achieved Some models combine elements of the • the Social Learning Theory (SLT) individual, interpersonal, and community levels. 5

6/25/2013 • Community level:  heart of public health approaches to preventing and controlling disease  Community factors include norms or standards of behaviour that all individuals are expected to follow within that community.  These norms include lifestyle behaviours as well as the threats posed by environmental factors. • Diffusion of Innovations Theory: how new ideas, products, and social practices spread within an organization, community, or society, or from one society to another. Combination of models is the best PRECEDE-PROCEED Model (PPM) • A planning model that provides a structure for • No single theory or model is appropriate as a the process of systematic development and guide in designing health interventions evaluation of a behaviour-change intervention. • combine various behavioural models under • PRECEDE ( Predisposing, Reinforcing, and the umbrella of an intervention is preferable. Enabling Constructs in Educational Diagnosis • models combine elements of the individual, and Evaluation) • interpersonal, and community levels: • PROCEED ( Policy, Regulatory, and  PRECEDE-PROCEED Model Organizational Constructs in Educational and (Green et al., 1980; Green & Kreuter, 1991) Environmental Development) 6

6/25/2013 The ultimate goal of Health is to reach Quality of Life: PRECEDE-PROCEED MODEL Phase 5 Phase 4 Phase 2 Phase 1 Phase 3 Administrative & Educational & Epidemiological Social Behavioral & policy assessment ecological assessment assessment environmental assessment assessment Predisposing Health Program* Health education Behavior Reinforcing Quality of Health life Policy regulation Environment organization Enabling Phase 6 Phase 7 Phase 8 Phase 9 Implementation Process evaluation Impact evaluation Outcome evaluation *New in 4 th ed., Green & Kreuter, Health Promotion Planning . Model from Saied-Moallemi Z. 2010 References • Essential Dental Public Health. Daly B, Watt R, Batchelor P, and Treasure E. Oxford University Press, UK, 2003. chapters 10 . • Saied Moallemi Z. Oral Health among Iranian Preadolescents: A School-Based Health Education Intervention. University of Helsinki, Finland, 2010. chapter 2, pp 16-19 . 7