Behavioral theories explained with examples from dental evidence.

1. SEMINAR NO:20

2. CONTENTS
• Introduction
• Health behaviour
• Overview of behaviour change
• Theories of Health Behaviour
- Concept
- Limitations
- Application
• Barriers preventing behaviour change
• Conclusion

3. BEHAVIOUR SCIENCE AND PUBLIC HEALTH
02
CULTURAL
ANTHROPOLOGY
05
01SOCIOLOGY
04 ECONOMICS
03
SOCIAL
PSYCHOLOGY
POLITICAL
SCIENCE
Refers to the voluntary movements and purposive acts arising out of
decisions taken by an individual. Behaviour is usually purposive.

4. HEALTH BEHAVIOUR
“those personal attributes such as beliefs, expectations, motives, values,
perceptions, and other cognitive elements; personality characteristics,
including affective and emotional states and traits; and overt behaviour
patterns, actions, and habits that relate to health maintenance, to health
restoration, and to health improvement” (Gochman, 1982, 1997).

5. BEHAVIOUR SCIENCE AND PUBLIC HEALTH
Although individual behaviour is the ultimate target for change, effective
interventions to change behaviour may be delivered at population, community,
organizational or individual levels.
For example, effective interventions to tackle the biggest behavioural threat to
public health, smoking, range from population-wide mass media to stop smoking
courses for individuals.

6. Improved population health depends on changing behaviour:
of those who are healthy (e.g. stopping smoking), those who
are ill (e.g. adhering to health advice) and those delivering
health care.
Health-related risk behaviors (e.g., smoking, excessive drinking) are actions that may result in
immediate or long-term negative health consequences, whereas health-related protective
behaviors (e.g., condom use, seat belt use)are actions that maintain or improve health status.

7. Public health efforts to enhance population health attempt to reduce
risk behaviors and to promote protective behaviors, and are
considered most successful when guided by theory.
Behaviourist theories

8. BEHAVIOURIST THEORIES
1. Psychological perspective
2. Socioeconomic perspective
3. Culture and health related behaviour

9. Psychological perspective
CLASSICAL
CONDITIONING
BY PAVLOV
OPERANT CONDITIONING
BY SKINNER
The repeated pairing of targeted behaviour with
a reinforcement or punishment to either
strengthen the association with the former or
weaken or extinguish the behaviours with the
latter
Conditioned response to a neutral stimulus
after having been paired repeatedly with an
unconditioned stimulus.

10. Knowledge attitudes and practices
(KAP)• Traditionally health professionals who provide relevant information
that increases knowledge , which in turn change attitudes and leads
to improvement s in health behaviour.
• Known as KAB model but this may not necessarily correspond. It is
important to recognize that predicting health behaviour is far from
straight forward.
• Large number of factors involved in consistency of opinions and held
by a group of individuals and their behaviour such as specificity and
time frame when attitudes being assessed

11. HEALTH BELIEF MODEL
• The Health Belief Model (HBM) is an intrapersonal (within the individual, knowledge
and beliefs) theory used in health promotion to design intervention and prevention
programs.
• It was designed in the 1950’s by Hockbaum and continues to be one of the most
popular and widely used theories in intervention science.
• The model was created in reaction to a failed, free tuberculosis screening program.

12. The HBM assumes that behavior change occurs with the existence
of three ideas at the same time:
1. An individual recognizes that there is enough reason to make a
health concern relevant (perceived susceptibility and severity)
2. That person understands he or she may be vulnerable to a
disease or negative health outcome. (perceived threat)
3. Lastly the individual must realize that behavior change can be
beneficial and the benefits of that change will outweigh any costs
of doing so. (perceived benefits and barriers).

14. Limitations
• Research has not supported HBM to be a model that will
produce predictable changes.
• This model might help in changing beliefs but may not
be sufficient for behavior change.
• Behavior changes rarely follow a logical stepwise
pattern.

15. EXAMPLES

17. Transtheoritical model- Prochskaand Diclemente 1982
• Evolved through studies examining the experiences of smokers who quit on their own with
those requiring further treatment to understand why some people were capable of quitting
on their own.
• Focuses on the decision-making of the individual and is a model of intentional change.
• The TTM posits that individuals move through six stages of change

19. LIMITATIONS
 TTM considers Individual health behaviour change in isolation from social and
environmental factors.
 TTM aims to produce individual change and not structural change, so interventions
are usually limited to the individual level.
 Increased responsibility is placed on the individual-Potential for victim-blaming.
 TTM interventions usually target people with change potential.
 Model does not acknowledge that people with lower change potential are often
socially or economically disadvantaged.
 Can further increase inequities.

20. APPLICATION

21. Theory of reasoned action / Theory of planned
behaviour
• Human behavior is under the voluntary control of the individual
• People think about the consequences and implications of their
actions, then decide whether or not to do something.
• Therefore, intention must be highly correlated with behavior.
• Whether or not a person intends to perform a health behavior
should correlate with whether or not they actually DO the behavior

22. Components of the Model
Behavior is a function of 2 things:
Attitudes toward a specific action
 What will happen if I engage in this behavior?
 Is this outcome desirable or undesirable?
Subjective norms regarding that action
 Normative beliefs: others expectations
 Motivation to comply: do I want to do what they tell me? How

23. Theory of Reasoned Action
LIMITATIONS
• People who have little power over their behaviors (or believe they have little power).
• As a result, Ajzen added a third element to the original theory: Perceived Behavioral Co

24. Theory of planned behaviour

25. LIMITATIONS
• Factors such as demographics and personality still not in model.
• No clear definition of perceived behavioral control (hard to measure).
• Assumption that perceived behavioral control predicts actual behavioral
control.
• The more time between behavioral intent and actually doing the behavior,
the less likely the behavior will happen.
• Theory assumes people are rational and make systematic decisions based
on available information.

26. Uses for TRA/TPB
TRA works best when applied to behaviors that are
under the person’s control (or they think they are)
TPB works best when the behavior is NOT perceived to
be under the person’s control.

27. APPLICATION

29. SOCIAL COGNITIVE THEORY by bandura
1986
 Social cognitive learning theory highlights the idea that much of
human learning occurs in a social environment.
 By observing others, people acquire knowledge of rules, skills,
strategies, beliefs, and attitudes.
 Individuals also learn about the usefulness and appropriateness
of behaviors by observing models and the consequences of
modelled behaviors and they act in accordance with their beliefs

30. Assumptions / Basic Principles:
1. People learn by observing others:
Modeling
2. Learning is internal.
3. Learning is goal-directed behavior.
4. There are ways to reinforce behaviors:

31. Behavioral Reinforcers
There are 3 types of reinforcers of behaviors:
A. Direct reinforcement -- direct reinforcement would be directly
experienced by the learner.
B. Vicarious reinforcement -- vicarious reinforcement would be
observed to be consequences of the behavior of the model.
C. Self reinforcement -- self reinforcement would be feelings of
satisfaction or displeasure for behavior gauged by personal

32. Limitations
 No big picture of the person
 Too much focus on situations
 Ignore biological factors
 Mechanical -- No free will

33. APPLICATION

34. Health locus of control
The concept was developed from social learning theory (Rotter et al 1972) and
measures the extent to which individuals believe that their health is influenced either
by their own behaviour or by external causes.
It is not a measure of actual control of behaviour and rather perceived control over
outcomes .

35. Types of locus of control
A belief that reinforcement is brought about by
one’s own behavior.
A belief that reinforcement is under the control
of

36. Scales to measure Locus of Control

37. APPLICATION

38. Life course analysis Salutogenesis
Social Capital
This theory is based upon analysis of the complex
ways in which biological risk interacts with economic,
social and psychological factors in the development
of chronic disease throughout the entire course of
life.
Importance of absolute poverty and the material and
structural basis for health inequalities.
Stressors are a standard feature of human existence
and that individuals and communities with a stronger
sense of coherence are better equipped to deal with
them and therefore maintain good health and well
being.

40. Behavior Modification in Primary Care:
The Pressure System Model
TWO OPPOSING FORCES
1. The desire to change
(Motivation)
2. The impediments to change
(Resistance)

41. Barriers preventing behaviour change - Jacob and
Plamping 1989
1. Lack of opportunity eg , limited access to healthier snacks in
school campus
2. Lack of resources for example , unable to afford new toothbrushes
for large family
3. Lack of support for example , living with a smoker when you want
to quit
4. Conflicting information on nature of change – for example
confusion over health education messages

42. 6. Long term nature of benefit – for example , lung cancer does not
affect teenagers for another 40 years and smoking has immidiate and
social benefits
7. Belief that change not possible _for example , when someone has
tried to improve their toothbrushing technique without success
8. No clearly defined goals – for example asking someone to stop
eating sugar altogether when so many processed foods have sugars
added to them
9. Lack of knowledge on what to change – for example lack of

43. CONCLUSION
• Within dentistry, social and behavioral sciences have proven to be important contributors to
the understanding of dental treatment. ‘Behavioral dentistry’ offers interesting aspects of the
valuable influence of behavioral knowledge on dentistry .
• Oral health care professionals need to study and understand people’ risk behaviours,
multiple diseases, time and cost of care, and how these factors should be considered in
organizing services.
• Acknowledging these issues points to more collaboration and outreach with a
multidisciplinary approach involving health care professional from diverse backgrounds as

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