1. The document discusses human behavior and factors that influence it. It defines behavior as actions that have specific frequency, duration and purpose, whether conscious or unconscious. 2. Human behavior is influenced by many intrinsic and extrinsic factors, including culture, attitudes, emotions, values, genetics, social norms, and environmental incentives or restrictions. 3. Learning plays a key role in shaping behavior over time through experiences and reinforcement. Learning occurs through association and is strengthened by positive or negative reinforcement.

1. CHAPTER 2
HEALTH AND BEHAVIOR
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2. What is behavior ?
• Behavior- is an action that has specific frequency,
duration, and purpose, whether conscious or
unconscious,
It is both the act and the way we act.
Action – drinking/smoking
To say a person has drinking/smoking behavior
Duration –is it for a week/month?
Frequency- how it is repeated?
Purpose –is he/she doing consciously or not
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3. What is behavior ?
Behavior can be conscious or unconscious, overt
or covert, and voluntary or involuntary.
Human behavior is influenced by culture,
attitudes, emotions, values, ethics, authority,
rapport(relationship), persuasion(influence),
coercion and/or genetics.
 The acceptability of behavior is evaluated
relative to social norms and regulated by various
means of social control.
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Life style, Customs and Traditions are different
words of the same thing.
Life style: refers to the collection of behaviors that
make up a person’s way of life-including diet,
clothing, family life, housing and work.
Customs: It represents the group behavior. It is the
pattern of action shared by some or all members of
the society.
Traditions: are behaviors that have been carried
out for a long time and handed down from parents to
children.

5. Healthy Behaviour
Definition:
Healthy behaviour-is an action that healthy people
undertake to keep themselves or others healthy
and prevent disease.
Healthy behavior aimed to prevent disease
Health behaviour is any activity undertaken by a
person believing him/herself to be healthy for the
purpose of preventing disease or detecting it at
an early stage.4/15/2019 5

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Utilization behavior: - utilization of health services
such as antenatal care, child health, immunization,
family planning…etc
Illness behavior: - recognition of early symptoms
and prompt self referral for treatment.
Compliance behavior: - following a course of
prescribed drugs such as for tuberculosis.
Rehabilitation behavior: - what people need to do
after a serious illness to prevent further disability

7. Healthy Behaviour...
 Well/healthy behavior can promote health
Eg. Physical exercise, BF, seeking treatment
 Ill/unhealthy behavior can harm health
Eg. Smoking, chat chewing, excessive alcohol
consumption, unsafe sex , sedentary life style etc.
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8. Health Behaviour...
The study of health behaviour is based upon
two assumptions:
a substantial proportion of mortality and
morbidity is caused due to a particular
pattern of behaviour and that these
behaviour patterns are modifiable.
It is recognized that individuals are the
major producers/contributors of their health
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9. Health Behaviour...
Research on health behaviour is based on
two main aims:
To design interventions to improve such
health compromising behaviours.
To gain more general understanding of the
reason why individuals perform a variety of
behaviours
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10. Healthy Behaviour...
The focus is in various health behaviours
running from health enhancing behaviours
like: regular exercise, screening, healthy
eating etc. to health harming behaviours like:
smoking, alcohol and drug abuse, and sick role
behaviours such as non-compliance with
medical regimens
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12. Healthy Behaviour...
Epidemiological studies have revealed
considerable variations in who perform these
behaviours.
Broadly these factors are divided in to two.
Intrinsic factors:
Socio-demographic factors, personality, social
support, cognition
Extrinsic factors which can be divided into two
again as;
Incentive structures such as: taxing tobacco &
alcohol and subsidizing sporting facilities
Legal restrictions such as: banning dangerous
substances, fining individuals for not wearing seat
belts
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13. Can we predict and understand who performs
health behaviour?
 This would enable us to contribute to the
understanding of the variation in the distribution
of health across society.
 It might also indicate for intervention
designing to change health behaviours.
 demographic factors: age (shows a curvilinear
relationship in smoking, where young children
and the elderly not smoking)
 Social factor: parental models and peer
influence, and community values.
 Cognitive factors: knowledge, (the reduction of
smoking in the past 20 yrs) is the result of health
promotion4/15/2019 13

14. Factors affecting human behavior can
be classified into 3 major categories
1. Predisposing factors
Are antecedents or prior to behavior that
provide the rationale or motivation for the
behavior to occur.
Knowledge, beliefs, attitudes, confidence,
values, perceptions.
These can facilitate or hinder a person`s
motivation to change and can be altered
through direct communication
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15. 2. Enabling factors
These are barriers or vehicles created mainly
by societal forces or systems.
Antecedents to behavior that enable a
motivation to be realized
Availability, accessibility of health
resources;
Referrals to appropriate providers
Community, government laws, rules,
priority and commitment to health
Health related skills
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16. 3. Reinforcing factors.
Reinforcing factors are those factors
subsequent to a behavior that provide the
continuing reward or incentives for the
behavior to be persistent and repeated.
 They comprise the different types of feedback
and rewards received after behavior change
which may either encourage or discourage
the continuation of the behavior.
Family, peers, teachers, employers, health
providers, community leaders, decision-
makers, self or others who control rewards.
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17. Social benefits such as recognition,
appreciation, or admiration;
physical benefits such as convenience,
comfort, relief of discomfort or pain;
tangible rewards such as improved
appearance, self-respect, or association
with an admired person who demonstrates
the behavior are all reinforcing factors.
Eg 1. The woman does not adopt FP because her
husband disapproves.
2. The young man who starts smoking because
his friends encourage him to do so.
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19. Definitions of factors affecting
Behaviors
1.Knowledge or cognition: Knowledge often
comes from experience/information, from
teachers and parents, friends, books, etc.
Example, knowledge about disease
transmission and causation.
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20. 2. Attitudes (feelings) – It is the degree to which
the person has a favorable or unfavorable
evaluation of the behaviour in question.
A tendency of mind or of relatively constant feeling
toward a certain category of objects, persons and
situations. Attitudes can be considered as a
collection of beliefs that always include an
evaluative aspect. Reflect our likes and dislikes
(can be positive or negative). They often come from
experience or from people who are close to us
(friends, parents, etc.).
Knowledge + Feeling/ sense of like or dislike =
Attitude
Example attitude towards FGM
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21. 3. Beliefs
A belief is a conviction that a phenomenon or
object is true or real. They are usually derived
from parents, grandparents and other people we
respect (accepted as true). People usually do
not know whether they are true or false and
they are often difficult to change. Faith, truth,
trusts imply belief.
Example belief of many people that cold may
cause respiratory problems.
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22. 4. Values
The cultural, inter-generational perspectives on
matters of consequence reflect the values
people hold.
They are the basis justifying one’s actions in
moral or ethical terms. They are standards
most important to us.
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23. Some Values in our community
 Being a good mother
 having many children/cattle
 Being approved by friends
 masculinity and sexual prowess
 Being attractive to opposite sex
 Having beautiful girl friend
 academically success
 Being a man of God /Allah
 success in foot ball events
 Being modern
 being healthy4/15/2019 23

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25. 5. Skills
Skills refer to a person’s ability to perform the
tasks that constitute a health related behavior.
E.g giving IV injection
6. Culture
The normal forms of behavior, beliefs,
values and use of resources form a pattern or
way of life.
7.Lifestyle: Consciously chosen, personal
behavior of individuals. E.g. Urban Vs rural
life style
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26. 8. Social Norms – the influence of social
pressure that is perceived by the individual
(normative beliefs) to perform or not perform a
certain behaviour.
9.Perception: a process by which individuals
organize and interpret their sensory information
in order to give meaning it.
Perception is a means of acquiring knowledge.
And it is highly subjective
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29. 10. Perceived Behavioral Control – the
individual’s belief concerning how easy or
difficult performing the behaviour will be.
11. People who are important to us greatly
influence our behavior. Examples: parents,
elders, friends, experienced people, highly
educated people, teachers, etc.
12. Resources: facilities, money time, labor
services, skills, materials and their distribution
and their location affect behavior. Example:
availability
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30. Changes in behavior
 Changes in behavior can be natural or planned
changes.
a) Natural change - our behavior changes all the time.
Some changes take place because of natural events or
processes such as age-sex related behaviors. E.g. eating
clay during pregnancy.
b) Planned change - we make plans to improve our lives
or to survive for that matter and we act accordingly.
Example: plan to stop smoking or drinking, plan to
become a health professional.
Planned change in behavior can be faster or slower
depending on the response of the acceptor and adapter of
the behavior.
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31. LEARNING
Learning is relatively permanent change
in behavior as a result of knowledge,
experience or practice.
Learning is acquiring new knowledge,
behaviors, skills, values, preferences or
understanding, and may involve synthesizing
different types of information.
The ability to learn is possessed by humans
and animals. Progress over time tends to follow
learning curves.
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32. The study of how learning occurs is part of
neuropsychology, educational psychology,
learning theory, and pedagogy.
 Learning may occur as a result of habituation
or classical conditioning, seen in many animal
species, or as a result of more complex
activities such as play seen only in relatively
intelligent animals and humans.
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33. Learning is understood as the
modification of behavior through practice,
training, or experience. This is
supplemented with five important
components of learning:
1. Learning involves change: a change may
be for good or bad. Change may not be
evident until a situation arises in which the
new behavior can occur. Learning is not
always reflected in performance
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34. 2. Not all changes reflect learning: to constitute
learning, change should be relatively permanent.
Temporary changes may be only reflective and fail
to represent any learning. This requirement,
therefore, rules out behavioral changes caused by
fatigue or drugs
3. Learning is reflected in behavior: a change in an
individual’s thought process or attitude, not
accompanied by behavior, is not learning. It should be
further clarified that learning needs to result in
behavior change potentiality.4/15/2019 34

35. 4. The change in behavior should occur as a
result of experience, practice or training:
this implies that behavior caused from
maturity, disease, or physical damages does
not constitute learning.
5. The practice or experience must be
reinforced in order for learning to occur: if
reinforcement does not accompany the practice
or experience, the behavior will eventually
disappear
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36. THEORIES OF LEARNING
There are four theories which explain how
learning occurs. They are
1. Classical conditioning
2.Operant conditioning
3.Cognitive theory
4.Social learning theory
Read for details!!!
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37. Principles of learning
There are three principles of learning:
1. Learning by association
2. Learning by reinforcement , punishment and,
3. Learning by motivation
Learning by association - Connection between
events in time, place, etc.
It is the most important part of the learning
process.
 It is first formed in the physical environment.
See the following examples,
 If we see lightening we expect thunder
 When we see a needle/syringe, we think of
injection
 When we see pregnancy we expect delivery
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38. Reinforcement & punishment
Reinforcement and punishment play a key role
in learning process.
Reinforcement is used to enhance desirable
behavior; punishment is employed to minimize
undesirable behavior.
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39. Reinforcement is the attempt to develop or
strengthen desirable behavior. There are two types
of reinforcement: positive and negative.
a. Positive reinforcement strengthens and enhances
behavior by the presentation of positive reinforcers.
There are primary reinforcers and secondary
reinforcers.
 Primary reinforcers satisfy basic biological needs
and include food and water. However, primary
reinforcers do not always reinforce. For instance,
food may not be a reinforcer to someone who has
just completed a five course meal.
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40. Reinforcement…
Most behaviors are influenced by secondary
reinforcers.
These include such benefits as money, status,
grades, trophies and praise from others. These
become positive reinforcers because of their
associations with the primary reinforcers and
hence are often called conditioned reinforcers.
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41. Reinforcement…
b. Negative reinforcement, an unpleasant event that
precedes a behavior is removed when the desired
behavior occurs.
 This procedure increases the likelihood that the
desired behavior will occur. Just as there are positive
reinforcers, there are the stimuli that strengthen
responses that permit an organism to avoid or
escape from their presence.
 Thus, when we perform an action that allows us to
escape from a negative reinforcer that is already
present or to avoid the threatened application of
one, our tendency to perform this action in the
future increases.
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42. Reinforcement…
Thus, both positive and negative reinforcement
are procedures that strengthen or increase
behavior.
Positive reinforcement strengthens and
increase behavior by the presentation of
desirable consequences.
Negative reinforcement strengthens and
increases behavior by the threat of and the use
of an undesirable consequence or the
termination or withdrawal of an undesirable
consequence.
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43. Reinforcement…
Negative reinforcement is sometimes confused
with punishment, because both use unpleasant
stimuli to influence behavior.
However, negative reinforcement is used to
increase the frequency of a desired behavior,
where as punishment is used to decrease the
frequency of an undesired behavior.
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44. Reinforcement…
Examples
1. Driving in heavy traffic is a negative condition for
most of us. You leave home earlier than the usual
morning, and don't run into heavy traffic. You leave
home earlier again the next morning and again you
avoid heavy traffic. Your behavior of leaving home
earlier is strengthened by the consequence of the
avoidance of heavy traffic.
2. The dog with the electronic fence not only learns to
not cross the barrier, he also learns that if he turns
and runs parallel to the fence or away from the
fence, he can avoid the shock all together. The
behaviors of turning and running parallel to the
fence and running away from the fence increase as a
result of negative reinforcement learning.4/15/2019 44

45. Punishment
 is the attempt to eliminate or weaken undesirable
behavior. It is used in two ways. One way to punish a
person is to apply a negative consequence called
punishers – following an undesirable behavior.
 For example, a professional athlete who is
excessively offensive to an official (undesirable
behavior) may be ejected from a game (punished).
 The other way to punish a person is to withhold a
positive consequence following an undesirable
behavior. For example, a sales representative who
makes a few visits to companies (undesirable
behavior) is likely to receive less commission at the
end of the month.
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46. Learning by reinforcement
Reinforcement increases the likelihood of the
occurrence of the situation.
 It increases the association between the
response and stimulus. For example, mothers
who are getting ANC services. Therefore,
attendance is associated with better outcome. A
mother will learn that ANC is important both for
her child and herself.
Reinforcing tools (reinforcers): Asking ,
Praising, Encouragement, Advice, Checking, and
Listening.
These may be long-lasting or short-lasting.
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47. Motivation
The concept of motivation is basic because,
without motivation learning does not take
place or, at least, is not discernible.
Motivation may be seen at different levels of
complexity of a situation. A thirsty rat will learn
the path through a maze to a dish of water; it is
not likely to do so well, or even more
purposefully at all, if it is satiated.
On a broader level, a college student must have
the need and drive to accomplish a task and
reach a specific goal.
An individual who is not motivated will gain or
learn nothing i.e. it can affect the learning process
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48. Thank you!!!