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Behavioral Science in Medicine

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Behavioral Science in Medicine

  1. 1. Behavioral Science in Medicine Col Zulfiquer Ahmed Amin M Phil, MPH, PGD (Health Economics), MBBS Armed Forces Medical Institute (AFMI)
  2. 2. Behavior -The way in which one acts or conducts oneself, especially towards others is Behavior. -Behavior can be defined as the way in which an individual behaves or acts. It is the way an individual conducts herself/himself. 1. Behavior is everything a person does. 2. Behaviors that can be observed • Behaviors that can be heard/seen • Behaviors that can be measured
  3. 3. Eight parameters of behavior are: B = Behavior I= Identity of the individual who is behaving W- Want K= Knowledge (Cognition) K-H= Know-How P= Performance A= Achievement PC= Personal Characteristics S= Significance.
  4. 4. Causes of Individual Behavior • Inherited characteristics • Learned characteristics
  5. 5. Learned characteristic
  6. 6. Perception is a way of regarding, understanding, or interpreting something; a mental impression.
  7. 7. Perception A drowning person is asking for help; and the gentleman has perceived his call for help as asking for soap. This is how our behavior is influenced by variations in our perception of situations.
  8. 8. Personality Personality is the combination of characteristics or qualities that form an individual's distinctive character. Type-A personality seeks challenges and Type-B personality seeks status quo.
  9. 9. Attitude Attitude is a settled way of thinking or feeling about someone or something, typically one that is reflected in a person's behavior.
  10. 10. Values -Values are the moral principles and beliefs or accepted standards of a person or social group. -Values are a person's or society’s beliefs about good behavior and what things are important.
  11. 11. Mechanism of Behavior ActionBehavior Behavior Intention Personal Attitude Norms Beliefs Direct Observation Information from various sources. eg TV infer basing on information Belief about an object or person Belief about some performing Belief about some performing with knowledge of ‘approval’/ ‘disapproval’ of people, or things Our actions are determined by our behavior. Behavior is influenced by attitude and norms; which again depend on our beliefs, learnt through observation, information from various sources, including education and inferences drawn from any information interacting with past experiences. Similarly ,behavior can be changed by providing appropriate education
  12. 12. Suppose you have a patient sitting in front of you. She is a 58-year- old woman who works a lot and reports a high level of daily stress. She is hypertensive, smoker for more than 30 years, is overweight and has not been exercising regularly. She came to see you because of low back pain and poor sleep. As a healthcare professional, you want to help her.
  13. 13. One major goal is to address the risk factors for cardiovascular disease, but you will also want to alleviate her current acute conditions. At this stage, you can simply follow the guidelines and give her advice on the benefits of exercise, weight loss, healthy eating and decreased sodium intake, inform her about atherosclerotic cardiovascular disease risks and prescribe medication on an evidence basis.
  14. 14. But will these recommendations really work? Do you take the patient through all of these topics, select a few, or let her direct the conversation? Will she adhere to your recommendations? And how can you know? What are the applicable incentives and penalties for complying or not with these guidelines? Are there other variables that should be included in this equation?
  15. 15. Behavioral sciences provide a starting point for healthcare professionals to address the questions raised above and improve health care delivery.
  16. 16. Behavioral Science Behavioral science is a branch of social science that derives its concepts from observation of the behavior of living organisms. Broadly defined, behavioral science is the study of human habits, actions, and intentions. Combining knowledge of sociology, psychology and anthropology with strong observation, research, and communication skills, a behavioral scientist works with communities and individuals examining behavior and decision-making.
  17. 17. Behavioral science has three domains: 1. Psychology 2. Sociology 3. Anthropology
  18. 18. Psychology -Psychology is the scientific study of the human mind and its functions. -Psychology is the scientific study of the mind and behavior. -Psychology is focused to individual person.
  19. 19. Sociology Sociology is the study of the development, structure, and functioning of human society. It is focused to a group of people belonging to a society. Sociology is the scientific study of society, including patterns of social relationships, social interaction, and culture.
  20. 20. Anthropology Anthropology is the study of what makes us human. Anthropology is the study of people throughout the world, their evolutionary history, how they behave, adapt to different environments, communicate and socialize with one another. The study of anthropology is concerned both with the biological features that make us human (such as physiology, genetic makeup, nutritional history and evolution) and with social aspects (such as language, culture, politics, family and religion).
  21. 21. Components of Behavioral Science • Is a discipline • Emphasizes human mental process • Gives a ‘I’ feeling • Individual demands empirical evidence Psychology • Is a discipline • Emphasizes human society • Gives a ‘we’ feeling • Society demands empirical evidence that links sociological ideas to live experience Sociology • Is a discipline • Emphasizes human society, & association in the past • Empirical evidence that links with documents, tools, fossil… Anthropology
  22. 22. Topic domains for the behaviour science in medical teaching: 1. Mind body interaction 2. Patient behavior 3. Physician role and behavior 4. Physician patient interaction 5. Social and cultural issues in health care 6. Health policy and economics
  23. 23. Relevance and importance of Behavioral Science to Health & Medicine Relevance is demonstrated in the: -Aetiology of illness, -Presentation of illnesses, -Delivery of health care, -Aspects of social and psychological treatment.
  24. 24. -Behavioral and social factors are important in planning for health care with assessment and treatment of both physical and psychiatric disorder. -Cultural factors play a role in the behavior of the patient and treatment. -Psychological tests help in the psychiatric diagnosis.
  25. 25. -Systematic study of psycho-social phenomena (including problems) in health and disease -Understanding problems of psycho-social exclusion and marginalization in care services (e.g., sex workers, poor, people living with HIV/AIDS & STDs) -Investigating and understanding psycho-social crises related to health and disease (e.g., disease outbreak) -Explaining social responses to poverty, exclusion, marginalization, prejudice and discrimination which influences healthcare services
  26. 26. -Justice through medicine in crime, delinquency, social arbitration -Development of systems of medical knowledge and medical care -Integration of alternative medical systems in culturally diverse environments -Address the issues of healthcare provider - patient relationship
  27. 27. Categories of Behavioral Sciences Decision Sciences: Decision sciences deals with the decision processes . It concentrate mainly on Psychology. Communication Sciences: Communication Sciences deals with communication strategies used by human. Communication does not mean 'speech‘ rather communication implies human interaction and relationship. It concentrate mainly on Sociology and Anthropology.
  28. 28. Concepts of Psychology Concepts of Anthropology Concepts of Sociology Decision process Communication strategies The scope of behavioral science encompasses linking the concepts of psychology, sociology and anthropology with decision process and communication strategies. Scope
  29. 29. •Health behavior is a behavior that affects health: –Health impairing habits, which is called "behavioral pathogens" (for example smoking, eating a high fat diet) –Health protective behaviors, which is defined as "behavioral immunogens" (e.g. attending a health check). •Illness behavior is a behavior aimed at seeking a remedy (e.g. going to the doctor). •Sick role behavior is an activity aimed at getting well (e.g. taking prescribed medication or resting). In other words, sick role is behavior and obligations expected from a sick person. Health related Behaviors
  30. 30. -Illness behavior is described as the state when the individual feels ill and behaves in a particular way -Illness is a psychological concept: – It has different meanings for different people – It’s based upon an individual’s personal evaluation of his/her bodily state and ability to function Illness Behavior
  31. 31. Disease versus ill/illness behavior:  Disease is physical malfunctioning of the body.  Illness is subjective perception of whether one is sick or not. It is possible to have a disease and not feel ill, e.g., undetected diabetes. Also possible to feel ill without any detectable disease, e.g., hypochondriasis.
  32. 32. Sick Role • The sick role – any activity undertaken for the purpose of getting well by those who consider themselves ill • This is a social role • A patient who enters the sick role has both rights and obligations • There are positives and negatives to the sick role.
  33. 33. Sick Role Behavior There are four aspects of sick role behavior: •The sick person is not at fault for being sick •The sick person is excused from usual (everyday) responsibilities •The sick person must get well as soon as possible •The sick person must seek professional help
  34. 34. Behavior causing ill-health
  35. 35. Behavior related to Chronic Illness
  36. 36. Five key health-related behaviors for chronic disease prevention are: -Never smoking, -Getting regular physical activity, -Consuming no alcohol or only moderate amounts, -Maintaining a normal body weight, and -Obtaining daily sufficient sleep.
  37. 37. How to change a behavior
  38. 38. In the past, ‘Fat TV’ without remote control, ensured slim owner. With change of technology, ‘Slim TV’ with remote control has gifted a fat owner. Technology also changes behavior.
  39. 39. The Health Belief Model (HBM) is a psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. The health belief model suggests that people's beliefs about health problems, perceived benefits of action and barriers to action, and self-efficacy explain engagement (or lack of engagement) in health-promoting behavior. A stimulus, or cue to action, must also be present in order to trigger the health- promoting behavior. Health Belief Model (HBM)
  40. 40. Yellow marked boxes are the target for educational intervention, to ensure healthy practices.
  41. 41. Components of HBM -Perceived susceptibility: This refers to a person's subjective perception of the risk of acquiring an illness or disease. -Perceived severity: This refers to a person's feelings on the seriousness of contracting an illness or disease. There is wide variation in a person's feelings of severity, and often a person considers the medical consequences (e.g., death, disability) and social consequences (e.g., family life, social relationships) when evaluating the severity. -Perceived benefits: The course of action a person takes in preventing (or curing) illness or disease relies on consideration and evaluation of both perceived susceptibility and perceived benefit, such that the person would accept the recommended health action if it was perceived as beneficial.
  42. 42. -Perceived barriers: This refers to a person's feelings on the obstacles to performing a recommended health action. There is wide variation in a person's feelings of barriers, or impediments, which lead to a cost/benefit analysis. The person weighs the effectiveness of the actions against the perceptions that it may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time-consuming, or inconvenient. -Cue to action: This is the stimulus needed to trigger the decision- making process to accept a recommended health action. These cues can be internal (e.g., chest pains, wheezing, etc.) or external (e.g., advice from others, illness of family member, newspaper article, etc.). -Self-efficacy: This refers to the level of a person's confidence in his or her ability to successfully perform a behavior.
  43. 43. Conclusion • Mere focus on medicine and clinical domain of healthcare are not sufficient to ensure health. • Combination of knowledge of medicine and skill in behavioral science are complimentary for effective healthcare services. • Focus on behavioral changes for compliance to treatment, healthy practices and healthy life-style are the challenges against prevailing Chronic Diseases.

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