Module 3: Choices for Change: A Healthy Decision 2019

Introduction

Let me introduced this module by sharing you some timeless quotes about habits by some famous personalities
that somehow inspire you to break that bad habits of yours:

Mark Twain said that "habit is habit, not to be flung out the window by anyone, but coaxed downstairs a step at
a time." Stephen Covey said: "Our character is basically a composite of our habits. Because they are consistent, often
unconscious patterns, they constantly, daily express our character," while Aristotle mentioned that "Excellence is an art
won by training and habituation."

The development and maintenance of health behaviors however do not necessarily conform to a model in
which we can assume that if we have knowledge, our attitudes and behaviors will change automatically. If this were so,
then knowledgeable people would not behave in ways that will put their health in danger. Health researchers have
studied health behaviors for decades and continue to analyze the reasons why one person chooses to act responsibly
while another ignores obvious health risks.

Several factors contribute to our health status, but not all of them are within our control. Our beliefs and
attitudes, intentions to change, support from significant others, and readiness to change is all that places us to have
some degree of control. Access to health care, genetic history, health policies that are supportive of our very actions and
other factors are all potential reinforcing, predisposing and enabling factors that may influence our health decisions.

Applying behavior change techniques will help you to be successful in making behavior changes and following
DECIDE model can assist you to make behavior change.

Learning Outcomes
At the end of this module, I learned to:
1. examine how predisposing factors, beliefs, attitudes and others facilitate or hinder the adoption of new behaviors
2. identify decision making skills that promote individual, family and community health based on health information
3. identify the processes involved in choosing and achieving goals for a healthy change

Personality Check *improved quality of life, in addition to an increased

life span;
What makes every person unique? It is the *greater energy levels and increased capacity for and
complexity of your very personality. Let us say how interest in having fun;
does staying up late affect you in the morning? How *a stronger immune system, which enhances your
about after engaging in physical activity, how do you ability to fight infections;
feel afterwards? Actions you take regarding one aspect *improved self-confidence, self-concept and self-
of your health will cause an effect on the other aspects esteem and self-efficacy;
as well. *enhanced relationships with others due to better
communication and quality time spent with others;
Hands-On ACTIVITY *an improved ability to control and manage stress;
Please make use of the What Influences Me Most *a reduced reliance on the health-care system;
Activity Template. In a week time, record activities that *improved cardiovascular functioning;
influence your physical, mental/emotional, and social health. *increased muscle tone, strength, flexibility, and
Identify the element of health being affected and whether endurance, which results in improved physical
the influence is positive or negative. Compare your grid with appearance, performance, and self-esteem;
your seatmate. How your influences similar and different? *a more positive outlook in life, fewer negative
Did you respond to similar influences in different ways? thoughts, and an ability to view life as challenging
and negative events as an opportunity for growth;
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*improved environmental sensitivity, responsibility,
and behaviors;
Influences of Health *enhanced levels of spiritual health, awareness, and
feelings of oneness with yourself, others, and the
Individual behavior is believed to be a major environment.
determinant of good health. Reduction in risk for major
diseases is just one of the benefits that possibly you can
achieve whenever you choose to be healthy. Among the
others are listed as follows:

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Module 3: Choices for Change: A Healthy Decision 2019
Survey Says…… Major changes in health behavior are not made by
Accurately describe your own behaviors by filling up following easy one-step process. Careful thought,
the appropriate responses for itemized health behaviors individual analysis, and considerable efforts are
indicated in the Survey Sheet. Please use the Activity required to have a lasting behavior changes that
Template on Health Behaviors Checklist. ultimately improve your overall health and wellbeing.

********************
Table 3.1 Factors Influencing Behavior Change on
What is your Health Status? Childhood Obesity and Skin Cancer
Health Status is the sum of the positive and negative Examples Predisposing Enabling Reinforcing
Factors Factors Factors
influences on a person’s health and wellbeing. A few to
mention factors affecting your health status may Childhood Insufficient Poor Media
obesity knowledge availability influence,
include: health knowledge, access to health about healthy of low-cost family and
information, products and services, communication food choices, healthy food societal eating
skills, decision making, health advocacy skills, random low levels of options, culture,
events, and influences on your health such as heredity, physical poor access parenting
environment, attitude, behavior, media/technology. activity, low to safe play style.
self-esteem areas and
neighbor-
hoods, poor
socio-
economic
status of
parents.
Skin cancer Genetics, wide-spread Skin tanning
insufficient low-cost culture, media
knowledge skin tanning influence
about risk services /definition of
factors /businesses, beauty
associated unshaded /rewards, peer
with skin neighbor- pressure
cancer, low hood pools, /accolade
self-esteem, high cost
preference /expensive
for light skin, sunscreens
Figure 3.1. Factors Influencing Your Health Status poor
perception of
risk
Factors Influencing
Behavior Change Decisions Your Beliefs and Attitudes
on Behavior Change
1. Predisposing Factors – Life experiences, knowledge,
attitudes, cultural and ethnic inheritance, and current Belief is an appraisal of the relationship between some
beliefs and values, personal preferences, existing skills, object, action, or idea and some attribute of that object,
and self-efficacy are all predisposing factors. Factors action or idea.
that may predispose us to certain conditions include our An attitude is a relatively stable set of beliefs, feelings and
age, sex, race, income, family background, educational behavior tendencies in relating to something or someone.
background and access to health care. Attitudes have been described as hypothetical
constructs that represent a person's like or dislike for
2. Enabling Factors – Skills or abilities; physical, anything. Attitude is a judgment made on the 'attitude
emotional and mental capabilities; and resources and object' (a person, place, task, event, skill, etc.).
accessible facilities that make health decisions more Judgments from attitude can range from positive,
convenient or difficult are enabling factors. Positive negative or neutral.
enablers encourage you to carry through on your In our various roles, our beliefs, values and attitudes
intentions. Negative enablers work against your are constantly interacting with those of our peers,
intentions to change friends, family or teachers. We seem to instinctively
'like' the individuals who share our core values and
3. Reinforcing Factors – Factors that reward or beliefs. Harmonizing our value systems is what make a
reinforce the desired behavior change include social relationship successful be it personal, educational or
support, economic rewards and changing social norms. professional (Mohan Kumar, 2018)

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Module 3: Choices for Change: A Healthy Decision 2019

intoxication from an unhealthy environment, and

smoking, inadequate treatment by health services,
accidents and violence. The basic factors, in turn, relate
to lack of food security, lack of safe water, unsafe
working conditions and the way the health services are
organized in terms of their accessibility, adequacy and
quality. The underlying causes are those major cross-
cutting issues such as the following: the shape of the
economy, environment, and agriculture, and
employment, fairness of wages, human rights, gender
issues, and education.
These factors are interrelated and reflect the
economic and socio-political conditions of a country –
and increasingly, our globalized world. In order truly to
achieve health for all, far-reaching transformation of
society at the underlying level is needed. Such
transformation must be directed towards a more
equitable distribution of power and resources,
participatory democracy and good governance with
improved accountability and transparency.
Figure 3.2 Attributes of Beliefs, Values and Attitudes

Health literacy is the degree to which

As mentioned by Kumar positive attitudes are
individuals have the capacity to obtain, process and
needed in an individual in order for them to be
understand basic health information and services
motivated and engaged in a task. Attitudes arise out of
needed to make appropriate health decisions. Defined
core values and beliefs we hold internally. Beliefs are
in Healthy People 2010 Objective 11-2, health literacy
assumptions and convictions we hold to be true based
requires a complex group of reading, listening,
on past experiences. Values are worthy ideas based on
analytical, and decision-making skills, and the ability to
things, concepts and people. Behaviors are how these
apply these skills to health situations. This includes the
internalized systems (attitudes, beliefs and values) are
ability to understand instructions (on prescription drug
expressed.
bottles, appointments slips, educational brochures,
written directions, and consent forms) and the ability to
Health Behavior and Health Literacy negotiate complex healthcare systems.

Health behavior is defined as those personal Individual behavior is a major determinant of

attributes such as beliefs, expectations, motives, values, good health, but heredity, access to health care, and
perceptions and other cognitive elements; personality the environment can also influence health status.
characteristics, including affective and emotional states
and traits; and overt behavior patterns, actions and
habits that relate to health maintenance, to health
restoration, and health improvement (Gochman, 1982).
HEALTH BELIEF MODEL AS PREDICTOR OF
PREVENTIVE HEALTH BEHAVIOR
For pharmacists working in the field of public
health, an expanded categorization of health behavior In 1966, psychologist I. Rosenstock developed a
may be more applicable: preventive health behavior, model for explaining how beliefs may or may not
illness behavior, and sick-role behavior. A healthy influence subsequent behaviors. His Health Belief
individual engages in preventive health behavior when Model provides a means to show when beliefs affect
he or she engages in any activity for the purpose of behavior change. HBM is one of the most widely
preventing or detecting illness in an asymptomatic accepted models.
state. An ill individual engages in illness behavior when
he or she engages in activity to first define the state of The HBM suggests that whether or not a person
health and then to discover a suitable remedy. Ill changes their behavior will be influenced by an
individuals also engage in sick-role behavior when they evaluation of its feasibility and its benefits weighed
engage in activities for the purpose of getting well. against its cost. In other words, the belief influences
Different factors, acting at different levels, behavior.
determine the health of individuals, families, HBM hypothesizes that health-related action
communities, and nations. depends upon simultaneous occurrence of three classes
The most immediate factors that affect health of factors perceived susceptibility to and perceived
relate to starvation, lack of access to water, inadequate severity of disease or injury, and perceived benefits or
food intake, exposure to infectious diseases, efficacy of preventive/recommended action vis-à-vis the

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Module 3: Choices for Change: A Healthy Decision 2019

perceived costs or barriers. It suggests that behaviors 1. What do I want?

reflect a person’s subjective view of a situation, 2. Which change is the greatest priority at this
readiness to take action, and perception that benefits time?
outweigh “cost.” It also assumes the existence of 3. Why is this important to me?
sufficient motivation or concern to make health issues. 4. What are the potential positive outcomes?
5. What are health-promoting programs and
services can help me get started?
6. Are there family or friends whose help I can
enlist?

What Behavior Change Technique

is Suitable for You?
Changing health-related behaviors in people
can have a major impact on their risk of lifestyle-related
Figure 3.3 Health Belief Model disease (e.g. cardiovascular disease, type II diabetes).
This is because behavior plays an important role in the
Key elements of the Health Belief Model focus health and well-being of people (e.g. smoking, poor
on individual beliefs about health conditions, which diet, lack of physical activity). Research shows peoples'
predict individual health-related behaviors. The model behavioral patterns are largely determined by their
defines the key factors that influence health behaviors social circumstances and cultural contexts. Although
as an individual's perceived threat to sickness or genetic pre-dispositions contribute to physical illness in
disease (perceived susceptibility), belief of some people, they are generally less important than
consequence (perceived severity), potential positive many people think.
benefits of action (perceived benefits), perceived
barriers to action, exposure to factors that prompt Behavior change interventions are usually
action (cues to action), and confidence in ability to complex and may include many interacting components
succeed (self-efficacy). or techniques. Behavior change techniques (BCTs) are
Our attitudes tend to reflect our emotional observable and active intervention components aiming
responses to situations and also tend to follow from our to regulate behavior (e.g., goal setting, self-monitoring,
beliefs. According to the Theory of Reasoned Action, and feedback) However, health behavior change
our behaviors result from our intentions to perform requires motivation and persistence, and persuasive
actions. An intention is a product of our attitude toward design] also appears to play an important role in this
an action and our beliefs about what others may want setting. Persuasive design of services or technologies
us to do. A behavioral intention, then, is a written or focuses on influencing human behavior in a positive
stated commitment to perform an action. way. As such, persuasive system design (PSD) principles
Many people are highly influenced by the approval or can be applied in eHealth design to match user profiles,
disapproval (real or imagined) of close friends and loved motivate users to engage in self-management, and
ones and of the social and cultural groups to which they trigger health behavior change. Several behavior change
belong. Such influences can offer support for health theories, BCTs, and PSD principles can be involved in an
actions, making healthy behavior all the more possible eHealth intervention, alone or in combination.
to attain; they can also affect behavior negatively, (Asbjørnsen R et al Persuasive System Design Principles and
Behavior Change Techniques to Stimulate Motivation and
interfering with even the best intentions of making a
Adherence in Electronic Health Interventions to Support Weight Loss
positive change. Maintenance: Scoping Review J Med Internet Res
2019;21(6):e14265)
The chances of successfully changing negative
behavior improve when you make gradual changes that 1. Shaping
give you time to unlearn negative patterns and to Using a series of small steps to get to a
substitute positive ones. particular goal gradually, the process is known as
shaping. Whatever the desired behavior change, all
Setting Realistic Goals shaping involves:
- starting slowly and trying not to cause undue
Changing behavior is not easy, but sometimes stress during the early stages of the program
we make it harder by setting unrealistic and - keeping steps small and achievable
unattainable goals. To start making positive changes, - being flexible and ready to change if the
ask yourself the following questions: original plan proves uncomfortable
- refusing to skip steps or to move to the next
step until the previous step has been mastered.

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Module 3: Choices for Change: A Healthy Decision 2019

Behaviors do not develop overnight, so they Making Responsible Decisions

won’t change overnight. Making responsible decisions and setting
meaningful goals are important skills that can promote
2. Visualizing or Imagined Rehearsal individual, family and community health.
Practicing through mental imagery, to become Decision making skills are steps that enable you
better able to perform an event in actuality is termed as to make a healthful decision.
imagined rehearsal. Most athletes and others used this
technique. By visualizing their planned action ahead of Step 1: State the Situation
time, they were better prepared when they put Examine the situation and ask yourself: What
themselves to the test. decisions need to be made? Consider all the health
information and who else is involved.
3. Modeling
Learning behaviors through careful observation Step 2: List the Options
of other people is one of the most effective strategies What are the possible choices you could make?
for changing behavior. If you carefully observe Remember that sometimes it is appropriate not to take
behaviors you admire and isolate their components, action. Share your options with parents or guardians,
you can model the steps of your behavior change siblings, teachers, or friends. Ask for their advice.
strategy on a proven success.
Step 3: Weigh the possible Outcomes
4. Controlling the Situation Weigh the consequence of each option. Use the
An attempt to influence a behavior by using word HELP to guide your choice.
situations and occasions that are structured to exert H (healthful): What health risks, if any will, this
control over that behavior is termed as situational option present?
inducement. E (Ethical): Does this choice reflect what you
and your family believe is right?
5. Positive reinforcement L (Legal): Does this option violate any local,
A positive reinforcement seeks to increase the national laws?
likelihood that a behavior will occur by presenting P (Parent Approval): Would your parents or
something positive as a reward for that behavior. Each guardians approve of this choice?
of us is motivated by different reinforcers. What are
these? They can be classified as consumable such as Step 4: Consider Values
candy, cookies, chocolates or gourmet meals; activity Values are the ideas, beliefs, and attitudes
such as opportunities to watch TV, to go on a vacation, about what is important that help guide the way you
to go swimming or to do something else enjoyable; live.
manipulative such as incentives as lower rent in
exchange for mowing the lawn or the promise of a Step 5: Make a Decision and Act on It
better grade for doing an extra-credit project; Use everything you know at this point to make a
possessional such as new and latest smartphone, a responsible decision. You can feel good that you have
sports car; and social such things as loving looks, carefully prepared and thought about the situation and
affectionate hugs and praise. your options.

6. Changing Self-Talk Step 6: Evaluate the decision

Self-talk, or the way you think and talk to After you have made the decision and taken
yourself can play a role in modifying your health related action, reflect on what happened.. What was the
behaviors. outcome? How did your decision affect your health and
the health of those around you? What did you learn?
************** Would you take the same action again?
Learning to recognize the antecedents of a
behavior and acting to modify them is one method of
changing behavior. Behaviors, thoughts and feelings
always occur in a context – the situation. Situations can
be dividied into two components: the events that come
before and those that come after a behavior.
Antecedents are the setting events for a behavior; they
cue or stimulate a person to act in certain ways.
Consequences – the results of behavior – affect
whether a person will repeat a behavior.

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Module 3: Choices for Change: A Healthy Decision 2019

Checklist for Change:

***************************
Making Personal Choices
/ - Are you ready to make this change? Are you Reminder:
in healthy emotional state? Are you doing it for yourself Please have a printed copy of Activity templates for
or please someone else? Module 3 found in a separate file. Thank you.
Have you:
Taking charge of your ADDITIONAL NOTES!
/ - Completed a personal health history to
Use the space below.
assess your risks from various sources?
/ - Developed an action plan with short- and
long-term goals? Have you set priorities?
/ - Assessed your personal resources? Where
can you go for support and advice?
/ - Planned alternative actions in case you run
into obstacles or begin to sabotage yourself?
/ - Set up a list of reinforces and supports that
will keep you motivated along the way?
/ - Established a set of guidelines for success?
Will you set small goals to achieve at selected intervals,
or will you consider yourself successful only if you meet
your ultimate goal?

Making Community Choices

/ - Have you taken time to become educated
about issues and concerns affecting others in your
community?
/ - Have you prioritized actions to take to help
change community behaviors? Do you have particular
goal?
/ - Do you analyze what is happening in your
school, community, city, and nation by reading about
issues, actively discussing problems and possible
solutions, and developing personal opinions?
/ - Do you listen carefully to what your elected
officials say and take constructive actions if you
disagree with them?
/ - Do you vote for officials whose policies,
rhetoric, and past histories indicate that they support
improvements in health care for all people, the
environment, and education?
/ - Do you at least once every term volunteer to
help others who are less fortunate?
/ - Do you purchase products and services from
companies that have proven records of supporting the
health and well-being of others through their
organizational practices?

---------------------------------------♥

GROUP DISCUSSION:
1. Explain the predisposing, reinforcing, and
enabling factors that might influence a young
welfare mother as she decides to sell drugs to
support her children?

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Prepared by:
Mrs. Ivy T. Echano, RPh., MS Pharm

Supplemental Notes in PCPM100 Page 6