BEHAVIOR CHANGE

Samsriyaningsih Handayani
 BEHAVIOR CHANGES AT DIFFERENT LEVELS
INDIVIDUAL LEVEL INTER- COMMUNITY
PERSONAL LEVEL
LEVEL
Theory of Diffusion of
Health Belief Stages of Change Social Innovation
planned (Transtheoretical learning
Model Theory
behavior Model) Theory
Focusing on
- Perception of Behavioral Readiness of Dynamic, the way new
individuals’ intention of individuals to reciprocal ideas,
on health individuals is alter or effort to interactions products and
issues the most alter toward of personal social
- Evaluation on significant healthy behavior aspects, practices
advised determinant environment disseminated
behavior for of behavior influence and within one
prevention or behavior society or
control of the
between
issue
societies
Individual Level
HEALTH BELIEF MODEL

Explain and predict health behaviors focusing on

personal attitudes and beliefs
Principle : individuals’ perception determines their
success in embracing a behavior change.
Elements: perceived-susceptibility/ severity/
benefits/barriers, readiness to act, cues to action, and
self-efficacy
H Perceived-benefits
E
Modifying vs
A
L variables Perceived-barriers
T Age, gender, race, an individual's weighing on
“benefits of doing a healthy
Likelihood
economy
H of
behavior to decrease risk of
Perceived-severity disease” embracing
B vs health-
E subjective evaluation on a “obstacles to behavior change”
health problem’s: related
L
- severity Perceived-threats behaviors
I - potential consequences
E Self-efficacy
Perceived-
F
susceptibility an individual's perception of his/
her competence to successfully
M subjective evaluation on
perform a behavior.
whether an individual
O has the risk for Cues to action
D acquiring a health
Internal (pain, symptoms) or external
E problem
(information from others) triggers
L that activate healthy behavior
 Modifying Perceived- perceived
Variables Severity benefit
(age, gender, + - Cues to taking action
+ + + =
race, economy, Perceived- Action (or not)
perceived
characteristics) Susceptibility barriers
(base score for (base score for the
(base score
this individual's belief that vaping
for vaping
health) will harm
behavior)
individual's health)
THEORY OF
Behavioral beliefs Attitude towards the
behaviors
P Normative beliefs Subjective Norms
L an individual's perception
an individual perceives
A that he/she should or about the particular
N should not perform a behavior, which is affected
by the judgment of Behavioral intention
behavior because of:
N - social normative significant others an indication of an
"Most of my friends breastfeed," individual's readiness to
E pressures,
or perform a given behavior
Behavior
- or significant others'
D beliefs
"I feel ashamed of breastfeeding
in front of a group of friends who
don't breastfeed"
A Perceived behavioral
C Control beliefs control
T an individual believes an individual perceives that
that there are factors performing a behavior is
I that may facilitate or easy or difficult Actual behavioral control
O deter performance of the
"I am sure I can ...
behavior.[
N "It would be really easy for
me to quit."
(Azjen 1985)
Trans-theoretical or stages of change model

An integrative theory of therapy that

evaluates an individual's preparedness to act on a new healthier
behavior,
provides strategies or processes of change to guide the individual

Composed of constructs such: stages of change, processes of change,

levels of change, self-efficacy, and decisional balance

problem  individual falls back into earlier stages, because :

external factors (weather or seasonal changes), and/or
personal issues a person is dealing with.
Trans-theoretical or stages of change model
Trans-theoretical or stages of change model
• Pre-contemplation ("not ready") – "People do not have intention to
take action in some period in the future, and may not know that their
behaviour is problematic“
• Contemplation ("getting ready") – "People start to know that their
behaviour is problematic, and begin to look at the pros and cons of
their continued actions“
• Preparation ("ready") – "People want to take action in the near future,
and may begin taking small steps toward behaviour change“
• Action – "People have made specific obvious alteration in modifying
their problem behaviour or in gaining new healthy behaviours“
• Maintenance – "People have been able to sustain action for at least six
months and are working to prevent relapse“
• Termination – "Individuals have zero temptation and they are sure they
will not return to their old unhealthy habit as a way of coping"[
Interpersonal Level
Social Cognitive Theory

By Bandura
Social cognitive theory is a learning theory based on the
idea that people learn by observing others.
The core concepts of triadic reciprocal causation, an
observed behavior is influenced by the interaction of :
Personal ,
behavioral
environmental
 PERUBAHAN PERILAKU DENGAN
TEORI BELAJAR KOGNITIF SOSIAL
Prinsip teori ini adalah
1. terdapatnya interaksi timbal balik faktor perilaku, kognitif dan lingkungan
(reciprocal determinism atau triadic reciprocity)

Individu
Perilaku
Lingkungan

Triadic reciprocity
Sumber: Bandura (1986) dalam Simmon-Morton, McLeroy & Wendel (2012)

2. penekanan pada pemikiran sadar, keyakinan self-efficacy, regulasi

diri dan penetapan tujuan
Social Cognitive Theory

Determinan perilaku yang lain adalah lingkungan, yaitu:

● Motivasi insentif yaitu pemberian penghargaan atau

hukuman untuk memodifikasi perilaku

● Fasilitasi yaitu menyediakan alat, sumber daya, atau

perubahan lingkungan yang membuat perilaku baru lebih

mudah dilakukan
Social Cognitive Theory

Environmental: Aspects of the environment or setting

that influence the individual's ability to successfully
complete a behavior (Make environmental conditions
conducive for improved self-efficacy by providing
appropriate support and materials).[
learning most likely occurs if there is a close identification
between the observer and the model and if the observer
also has a good deal of self-efficacy
 Social Cognitive Theory

Study by Ahmed, 2009

• personal – showing models performing
breastfeeding correctly to improve self-efficacy,
• behavioral –weekly check-ins for three months
reinforced participants' skills,
• environmental – mothers were given an
observational checklist to make sure they
successfully completed the behavior
Community Level
 • Diffusion of Innovations
• Everett Rogers (2003) •
• Seeks to explain how, why, and at what rate new ideas and
technology spread.
T
• Diffusion is the process by which an innovation is communicated H
• over time among the participants in a social system.
• Four main elements influence the spread of a new idea: E
• the innovation itself, O
• communication channels
• time, and R
• a social system.
• The process relies heavily on human capital Y
Diffusion of Innovations theory

Adoption of Innovations (Rogers)

 ELEMENTS OF ADOPTION OF INNOVATIONS
Element Definition

Innovation Any idea, practice, or object that is perceived as new by an individual/other unit

individuals, organizations (businesses, schools, hospitals, etc.), clusters within

Adopters
social networks, or countries
allow the transfer of information from one unit to the other (telephone, WA, sms,
Communication teleconference, Facetime).
channels Communication patterns or capabilities must be established between parties as a
minimum for diffusion to occur.

Time Adopters rarely adopt instantaneously. Can be as long as ten years

The combination of
• external influences (mass media, surfactants, organizational or governmental
mandates) and
Social system • internal influences (strong and weak social relationships, distance from
opinion leaders).
There are many roles in a social system, and their combination represents the
total influences on a potential adopter.
 Diffusion of Innovations Theory
Categories of adopters (over time)
innovators,
early adopters
early majority,
late majority,
laggards
 Diffusion of Innovations Theory
• Related to diffusion of innovations is Rogers’ theory:
• Awareness  interest evaluation  trial  adoption/rejection
• Potential adopters evaluate an innovation on:
• its relative advantage (the perceived efficiencies gained by the
innovation relative to current tools or procedures),
• its compatibility with the pre-existing system, its complexity or difficulty
to learn,
• its trialability or testability, its potential for reinvention (using the tool
for initially unintended purposes), and
• its observed effects.
• an extremely complex innovation reduces its probability to be adopted
and diffused, but it might be very compatible with a large advantage
relative to current tools.
Diffusion of Innovations Theory

Use of diffusion of innovations theory in public health:

Choose “early adopters” to start socializing or planning to
implement your new ideas
Do not choose innovators as they tend to perceived as “weird”
or eccentric by the community  less followers
When 84% of your targeted community already adopt the
innovation you introduce, stop expecting that you will get
another adopter (16% laggards); rather, start to diffuse new
innovations
GOOD LUCK