Steps of changing and attitude for health behaviour of human

1. Health Promotion
And
Health Education
DR NATASHA K (MBBS, MPH, PHD FELLOW)
ASST PROF BUHS
DRNATASHA1976@GMAIL.COM

2. Lecture 7,
CHANGE PROCESS, ATTITUDE
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3. What is Attitude?
Attitude may be defined as a tendency to react to a person, object or event in a
particular way. Knowing the attitude of their patients, doctors can be aware how to
handle their patients or change the attitude of their patients in a positive direction.
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Components of Attitude
Persons’ attitude towards some object, event, person, situation, policy or action has
three distinct components:
 Cognitive component : consists of the beliefs, concepts or ideas of the individual
about the object
 Feeling component : refers to the emotions related to the object.
 Action tendency component : The action tendency component of an attitude
includes all the behavioral preparedness associated with the attitude.

4. Cont…
Example: If a mother has a positive cognition and positive
feeling regarding ‘breastfeeding her child’, she would
behaviorally develop readiness to do it.
If on the other hand, a mother has some form of negative
cognition and negative feeling on the same issue, she would
be behaviorally ready not to do it, will avoid doing it, and will
find excuse not to do it, even if she is under pressure from
doctors, husband, mother or any close person to her.
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5. Dissociation between Cognition and
Emotion
Only providing information, education and
knowledge regarding any community issue,
like ‘safe drinking of tube well water’ is not
going to produce change in practice
regarding drinking water choice, unless the
community’s level of emotion regarding this
issue is raised up to the positive and effective
level.
Any health campaign only emphasizing
behavioral change through education
without adding positive emotion, will fail to
produce its desired impact, almost always.
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6. Change of Attitude
The attitude of an individual is not a static phenomenon. There are
several factors which will help change attitudes, while there are
factors which might resist such change. The major factors in this
regard are:
 The personality of the individual
 The group affiliation or approval in which the individual lives
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 Depend upon the individual’s intelligence and perception about the
welfare of others
 Upon the capacity of the individual either to accept or to reject
depending upon the benefit or gain of the new ideas to be adopted
 Upon the needs and lifestyle of the individual concerned

7. What is Social Change?
Society changes over large blocks of time. Whether this change is for the better or for
the worse is a matter of discussion among economists and other social scientists.
Every country, specially the developing countries, are interested in quickening the
changes in many development fields.
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Therefore, they have planned time bound plans like 5 years plans, with definite
targets to be achieved. In order to achieve this target changes in the society is
required. There are several categories of change agents in the welfare Departments
(health, Agriculture, Education, Adult Education Cottage Industries etc.) to bring
about this change in a planned manner.

8. What is Change process?
A Change Process is a set of procedures that help teams to control change
effectively. It's not that you have to prevent change from happening; it's how you
manage change once it occurs that really matters. The Change Process allows to
record change requests, and review and approve those requests, before
implementing them.
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Peoples health related attitudes and practices have their roots in century old customs,
beliefs, habits, style of living etc. Unhealthy practices give rise to many health
problems. So, such practices have to be changed to improve health. It is not an easy
task to bring change and develop sustained healthful behavior.

9. Ways to bringing change
Herbert C. Callaman has identified three different ways of
bringing change:
1. Change by compliance or force
2. Change by identification
3. Change by internalization
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10. Cont…
A. Change by compliance or force
It is unwilling change brought by force, enforcement of law, fear, incentive, punishment,
etc. Such kind of coercive change does not last long to occur sustained positive result. This
kind of change does not involve individual’s knowledge and self decision.
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11. Cont
…
B. Change by identification
This kind of change occurs among some people who want
to maintain their prestige and status. They adopt change for
their recognition in the community.
e.g. A rich family may maintain a sanitary latrine to keep their
prestige in the community. Some other families may even
imitate them and build latrines again to keep their prestige
before others.
This kind of change also does not base on knowledge and
attitude development. Such change also will not be
sustained satisfactorily.
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12. Cont
…
C. Change by internalization
This kind of change is brought about by people’s voluntary or
conscious efforts. It based on the development of
appropriate knowledge and attitude which help in making
thoughtful decision.
Several mental stages undergo in a stepwise process to occur
change in behavior which is adopted for satisfactory period
of time.
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13. Stages of Change Process/
Planned Change
E.M. Roger’s and Lewin Kurt are two important workers who
have studied the change process.
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14. E.M. Roger’s Model
Rogers put forward the theory of
diffusion and adoption of ideas. Roger
was a pioneering scientist who did
research in the field of diffusion and
adoption process in accepting a new
idea or innovation (New idea).
Diffusion: Diffusion is the process whereby
information about the new idea or
innovation is disseminated (dispatched)
to the people i.e. Transfer of knowledge
from one person to other.
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E.M. Roger’s Model of
adoption suggests five
sequential stages as follows:
a) Awareness stage
b) Interest stage
c) Evaluation stage
d) Trial stage
e) Adoption stage

15. Cont…A. Awareness stage
The individual knows about the new idea but lacks information.
B. Interest stage
The individual becomes interested and collects more information
about it.
C. Evaluation – Application - Decision stage
The individual makes mental application of the new idea to his
present and future situation and makes a decision to try it or not to try
it.
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D. Trial stage
The individual uses the new practices on a small scale. In some cases this
may not be possible.
E. Adoption stage
If the trial is to his liking than the individual will practice it on a full scale
and it will become a part o his life.
Each individual takes his own time to pass through these stages.

16. Field Theory of Change by Lewin Kurt
He used the example of an Ice-block freezing-Moving-Refreezing as shown
in the figure below:
(1) Freezing (2) Moving (3) Refreezing
Old position New position
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17. Cont…..A man who has to change his practices must:-
 Be dissatisfied with his old practice (freezing)
 He must move towards the new practice (Moving) action
 He will follow the new practice and this will become a part of
his life by (Refreezing) repetition and permanency. Roger was
a pioneering scientist who did research in the field of diffusion
and adoption process in accepting a new idea or innovation
(New idea).
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18. Five Phases Unfreezing to Refreezing
Theory of Change by Lewin Kurt
Freezed phase: it is not included in change process in this
theory as change has not started yet
a) The unfreezing phage
b) The problem-diagnosis phage
c) The goal-setting phage
d) The new behavior change
e) The refreezing phage
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19. Cond…A. The unfreezing phage
Unfreezing phase is a state of readiness for
change in individual's basic attitudes and
behavior. When people become ready to
consider the changes to be for themselves
they are said to be undergoing a process of
unfreezing.
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20. “MOVING TO A NEW
LEVEL”
Problem Dx
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B. The problem-diagnosis
phage
At this stage the individual’s
identity supporting as well
as opposing forces for
change, and analyze them
in terms of how and where
changes can be
introduced. That is what we
call problem diagnosis.

21. Cond…
C. The goal-setting phage
Once the problem is
understood the individuals are
then able to establish specific
goals for desired change in
behavior.
D. The new behavior change
After the goals are specified
the individuals try new
behavior as trial and see the
consequences. The behavior
should base on alternative
course of action.
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Goal setting
New behaviour

22. Cond…E. The refreezing phage
The individual after experiencing
optional behavior as trial will be
able to identify and decide for a
beneficial change. At this stage
the individual/s will be well
motivated to act for the expected
change. It will manifest on-going
behavior or sustained change. In
this case individual/s can be said
to have undergone the refreezing
phase.
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23. Resistance to Change
Definition of Resistance:
Resistance has many components. It can not be
considered as a single entity.
Some of the major feature of resistance are as follows:
a) Threat to the established social structure
b) Threat to vested interest
c) Threat to the individual himself
d) Late adopters
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24. Resistance to Change
1. Threat to the established social structure. In each
community there are traditional and established ways which
are accepted by the people as important. When innovations
are against these norms it poses a threat to the community
(Late marriage-society requires early marriage).
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2. Threat to vested interest. In the community there are individuals for
gaining money or power from certain practices. When innovations
reduce these practices, then the vested interest practice are threatened
(Family Planning, Doctor-malaria, Temple-small pox vaccination)

25. Cont…
3. Threat to the individual himself. Many health innovations are unpleasant, painful
and difficult go perform. Many of these are therefore posing personal threats.
(vasectomy importance loss of health, surgery- expensive, Immunization- distance and
loss of time.)
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4. Characteristics of knowledge - encumbered knowledge. unencumbered
knowledge is that which gives the individual option (choice) in innovation. Encumbered
knowledge is that which requires widespread acceptance without much option.
(Emergency in India- vasectomy, Immunization in Rural Areas) Resistance may be a
carefully planned and thought out position or it may be stubborn obstinate, persistent
(Refractory), unwillingness to change.

26. Resistance Factors & solution
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Resisting Factors Solution
1. Change not clearly understood Full knowledge should be given to the concerned
people about the expected change
2. Change that does not seek community
participation
Local people’s participation must be sought to bring
change
3. Change which is difficult to adopt Alternative ways of bringing change should be
provided which are practicable and easy to adopt
4. Changes which threaten their vested interest Any change should consider he need, interest and
security of the people concerned
5. Changes advocated by those they do not like trust A change agent should try to be familier with the
concerned people and establish credibility by showing
his concern, sincerity etc
6. Changes which do not fit into the cultural values of
the community
Changes should not contradict with the cultural values
of the community. Existing beliefs, norms, values etc.
should be considered.

27. 27
Adoption Process
• Definition
• Stages
• Factors
• Adopter categories
• Characteristics of Adopter
categories

28. What is Adoption & Adoption Process?
Adoption: Adoption is a process whereby a new idea is received and accepted by
the individual. This is a mental process which takes place within the individual
resulting in action.
Adoption process: Adoption process is a mental process through which an individual
passes from first hearing a new idea to its final adoption.
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Factors affecting adoption
a) Cost and Economic return
b) Complexity
c) Visibility
d) Divisibility
e) Compatibility

29. Cont
…1. Cost and Economic return: New ideas which are costly are adopted more slowly than less
costly ones. However, regardless of the cost these ideas which produce high economic
returns are adopted more quickly than those with low economic return.
2. Complexity: Ideas which simple and easy to understand are accepted more quickly than
complicated ideas.
3. Visibility: Those ideas whose results are easily demonstrated and seen are accepted more
quickly.
4. Divisibility: A new practice which can be tried on a small scale are adopted more rapidly
than those which can not be tried on a small scale.
5. Compatibility: A new idea which is consistent with existing beliefs of the people are more
easily accepted than those which are against people's beliefs.
The new practices or innovations in the field of health in many cases do not fulfill the
above mentioned characteristics. For example immunization, Surgical methods of
conception control, legalized abortion, Sanitary Latrine, vitamin "A" Capsules.
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30. Adopter Categories
Adoptor Categories have been
divided into 4 major groups:
a)Innovators: (1 in 40)
b)Early adopters: (5 in 40)
c)Majority of Adopters (28 in 40)
d)Late adopters (6 in 40)
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31. Cont…
Innovators: Are a very small number of persons who adopt the innovation very early in
the program. They are usually leaders and have higher education.
Early adopters: These group of adopters follow the innovators and are also educated
and are local leaders. They depend upon the example set by innovators.
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Majority of adopters: The adopters are further divided to early and late majority. The
bulk of the population fall in this category.
Late adopters: This small group are late to accept an innovation. They are also known
as laggards. They are usually backward socially and economically and believe on
magic and folklore.

32. Application to Health Education
The above information helps the Health Education to
organize the educational programme for accepting health
innovation, (IUD), communication Latrenes, vitamin, "A" Iron
Tablets) in a systemic manner. It in clear that the educational
progamme for innovators, early adaptors, Majority, Late
adaptors, are quite different.
The Innovators though a small group can not be ignored.
They should be kept informed through scientists and
publications . The acceptance of the Innovators is important
as the early adaptors are waiting to see the results of their
adoption.
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33. Cont…
Early adaptors have to be convinced through proof of
applicability. Early adaptors are important as the majority
are not only observing that but are consulting them before
adoption.
The Late majority are those who do not attend meetings or
Educational sessions. They take the longest time to adopt.
It is therefore, not very productive to continue to pressurize
them to accept during the initial stage of the program.
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34. Reference Books
 A Text Book of Health Education (Philosophy
and Principles) by Hari Bhakta Pradhan,
Educational Resources for Health,
Kathmandu, Nepal.
 Introduction to Behavioral Science by S.
Aminul Islam et al. The University Press
Limited, Dhaka, Bangladesh.
 Behavioral Science by Prof M.D. Hussain,
Bangladesh
 Foundations and Principles of Health
Education by Nicholas Galli, University of
Illinois, Illinois
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35. questionsWritten
 Define Motive. What are the types of ‘Motive’?
 Can you explain biogenic and sociogenic motives with
example?
 Define ‘Motivation’.
 Explain Maslow’s Need Hierarchy theory
 Write briefly the developmental stages according to Erikson
 Discuss the degree of needs according to Maslow.
 What are the factors for Motivation?
 What do you understand by internalizing Incentives?
 What do you understand by ‘Health behaviour’, explain the
types. What factors influence Health Behaviour?
 Write something about the desirable health behaviour and
categories of people.
 What is ‘Attitude’? What are the components?
 What do you understand by ‘Change Process’? Explain
 What are the models of Change Process? Discuss them
 What are the resistance to change?
 Define ‘Adoption’? what are the factors affecting adoption?
 Discuss the categories of adopter
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36. Thank you