Challenges to changing health behaviours in developing countries: A critical overview (original) (raw)
Related papers
Health Psychology Review
Interventions to change health-related behaviours typically have modest effects and may be more effective if grounded in appropriate theory. Most theories applied to public health interventions tend to emphasise individual capabilities and motivation, with limited reference to context and social factors. Intervention effectiveness may be increased by drawing on a wider range of theories incorporating social, cultural and economic factors that influence behaviour. The primary aim of this paper is to identify theories of behaviour and behaviour change of potential relevance to public health interventions across four scientific disciplines: psychology, sociology, anthropology and economics. We report in detail the methodology of our scoping review used to identify these theories including which involved a systematic search of electronic databases, consultation with a multidisciplinary advisory group, web searching, searching of reference lists and hand searching of key behavioural scie...
Using Health Education Theories to Explain Behavior Change: A Cross-Country Analysis
The International Quarterly of Community Health Education, 2006
Scholars within the fields of public health, health education, health promotion, and health communication look to specific theories to explain health behavior change. The purpose of this article is to critically compare four health theories and key variables within them with regard to behavior change in the area of reproductive health. Using cross-country analyses of Ghana, Nepal, and Nicaragua (data sets provided by the Center for Communication Programs, Johns Hopkins University), the authors looked at the Health Belief Model, Theory of Reasoned Action, Extended Parallel Process Model, and Social Cognitive Theory for these two defined objectives. Results show that all four
This study examines determinants of health and explores how these interact to help man attain or defer from the desired health outcomes. It further examines the role communication plays in an attempt to " influence " the actions of man towards attaining the desired health outcomes emphasizing man's interaction with his natural environment. Challenges that ensue in this context were analyzed from a programmatic point of view as seen in developing countries and recommendations made based on this hindsight.
An Introduction to Behaviour Change Communication
Introduction A person's behaviour is how they act or carry themselves, particularly about other people (Lexico, 2020). Another way of defining a person's behaviour is what they do to either create an event, alter an existing situation, or remain unchanged (NSW Health, 2020). This behaviour is affected by internal and external factors. The internal factors are knowledge, attitude, perceived risk, consequences, self-efficacy, personal advocacy, perceived social norms, and emotions. The external factors are access, policy, and culture. Health communication is the study of communication methods, as well as their application, with the goal of informing and influencing choices and activities that will promote health. (CDC, 2020). Strategic health communication means using different communication methods and techniques for the purpose of advancing health promotion, disease prevention, and enhancing health outcomes and behaviours within both individual and communal contexts. The primary elements of strategic health communications are Advocacy, Social Mobilization, Behaviour Development Communication and Behaviour Change Communication. Behaviour Change Communication (BCC) can be described as an interactive process that involves engaging with communities in order to create customised messages and strategies utilising diverse communication channels. The primary objective of BCC is to cultivate positive behaviours, facilitate and uphold individual, community, and societal behaviour change, as well as encourage the maintenance of appropriate behaviours (FHI 2002). UNFPA (2002) refers to BCC as a dynamic process including the implementation of interventions aimed at people, groups, or communities. The primary objective of BCC is to cultivate effective communication methods that encourage the adoption of beneficial behaviours that align with specific contexts. By doing so, BCC endeavours to address the most urgent global health challenges. Consequently, this fosters a conducive atmosphere that empowers individuals to commence, maintain, and perpetuate favourable and wanted behavioural consequences. Behaviour change communication refers to the deliberate and planned use of communication techniques to facilitate the attainment of favourable health outcomes. This approach is grounded on established theories as well as models of behaviour change that have shown efficacy. (CDC 2018).
Toward a Global Theory of Health Behavior and Social Change
The Handbook of Global Health Communication, 2012
Our own experience as scholar-practitioners reinforces this view. Early applications of theory in health communication emphasized individual-level theories of learning, persuasion, and decision making as they related to health behavior and, especially, behavior change. Programs used psychosocial theories such as Reasoned Action/Planned Behavior (Fishbein and Ajzen, 1975; Ajzen and Fishbein, 1997) and Social Cognitive Theory (Bandura, 1986, 1995) to guide strategic planning, then evaluated the programs guided by the same frameworks (e.g., did communication affect efficacy beliefs and did efficacy beliefs in turn affect behavior?). The systematic application and testing of theories in this way over time, in varied settings and for many health issues demonstrated that it was possible to measure communication processes and outcomes reliably, spurring the field away from the notion of communication impact as an unobservable "black box" process (Friedenberg and Silverman, 2006, pp. 85-88) and toward more sophisticated models of change. It is true that the early modern history of communication theory, including its application to health issues, overemphasized individual-level behavior change. This was soundly criticized, particularly by Latin American scholars (Beltrán, 1974; Diaz Bordenave, 1976), who noted a lack of attention to structural factors in social change and to power inequities that can stifle change. In response, more structurally oriented theories of change arose (Rogers, 1976) that acknowledged additional higher-order determinants of health, such as network structures and access to resources, as well as individual-level psychosocial factors. For example, by the third edition of Diffusion of Innovations, Rogers (1983) had moved beyond an information dissemination model of communication toward the convergence model (Kincaid, 1979, 2009; Rogers and Kincaid, 1981). Convergence describes a process of change grounded in socially situated dialogue, not the result of simple exposure to new information. Thus, behavioral choices take into account the appropriateness of a new practice within the social milieu; the social, economic, and, presumably, cultural costs of a change in practices; the relative advantageeconomic, social, material-of a new practice over an existing one; the complexity of the practice, including access to the resources and social support one needs to actualize change; and whether it is possible to see what happened to others who have tried to change. This version of diffusion also implicitly acknowledged the importance of powerthe capacity to exercise control over others-as a function of network structures and of the relationships between communicators that sometimes distort and sometimes strengthen communication and the process of change. Although commonly measured at the individual level, most of the factors listed above are inherently social and structural, not strictly individual, because they require consideration of one's neighbors, of what is acceptable and possible in one's community and society, of control over resources and access to social support and, in the case of some new practices, the extent to which one can or must collaborate with others to achieve (or resist) change. Demand for Accountability At the same time that a shift was happening toward more social and structural views of communication, more and more opportunities for applied research in diverse settings were being funded under a series of global procurements for health communication
Informing a Behavior Change Communication Strategy
Food and Nutrition Bulletin, 2015
Background: Nutrition interventions targeting the first 1000 days show promise to improve nutritional status, but they require effective implementation. Formative research is thus invaluable for developing such interventions, but there have been few detailed studies that describe this phase of work within the Scaling Up Nutrition (SUN) movement. Objective: To inform a stunting prevention intervention in Cabo Delgado, Mozambique, by describing the sociocultural landscape and elucidating characteristics related to young child food, illness, and health. Methods: This formative research utilized a rapid assessment procedures (RAP) approach with 3 iterative phases that explored local perceptions and behaviors around food and illness among the Macua, Mwani, and Maconde ethnic groups. Ethnographic methods, including in-depth interviews, direct observations, free lists, and pile sorts, were used to collect data from community leaders, caregivers, and children 6 to 23 months. Data were analy...
To Advance Population Health, We Need to Be “Well Behaved”: The Science of Health Behaviour Change
Information Technology Based Methods for Health Behaviours, 2020
As technological innovations continue to be developed and introduced within healthcare, public health, and our daily lives, human beings now have access to sophisticated and powerful tools that could be used in a variety of ways to change health behaviours. Information and communications technology (ICT) features prominently among 21st century innovations, and we must consider how they may be used to help or hinder our efforts to address population health challenges. There are numerous relevant challenges that need to be addressed within healthcare, public health, and other areas relevant to population health. The Australian population is aging (increasing in both the absolute number, and also proportion of older adults), along with having greater levels of obesity, diabetes, cardiovascular diseases, cancers, and other chronic diseases that will take a large toll on Australia. There are many lifestyle determinants of chronic disease that could potentially be addressed through ICT-based intervention efforts to improve diet, physical activity, alcohol, tobacco, sleep, and sexual behaviour. Challenges also include better delivery of what innovations or interventions have been shown to work, how we can best help those who need help the most, and how to implement policy, systems, or environmental interventions that can help to make healthy behaviours more convenient, attractive, and normative. As the name suggests, ICT involves any technology that allows us to store, retrieve, manipulate, transmit, or receive information electronically in a digital form. Although such technologies may allow us to reach more people than we could without them, and to do so in more rapid manner, with better geographic reach than ever before, ICT does not automatically provide any advantage in addressing the key drivers of health behaviour. Information itself could be useful-but is almost never sufficient-to facilitate health behaviour change; rather, information must instead be placed within the context of the key drivers of behaviour change. These drivers can be described most simply as factors that enhance people's capability, opportunity, and motivation to engage in health promoting behaviour, or their obverse, behaviours that undermine health. Beyond the storage, retrieval, manipulation, transmission, or receipt of information, we must ensure that key drivers of behaviour are built into ICT approaches. Understanding, predicting, and influencing human behaviour is crucially important if we aim to address relevant population health challenges, and to achieve better health and wellness within populations. In other words, if we want to be well, we need to be "well behaved." Illustrative examples will be shared from the author's research studies, primarily focused on motivating and building the capability of adult leaders to provide better opportunities for children to be physically active, eat healthfully, and to establish health promoting habits. These studies range from interventions set in girl scouts, schools, and whole communities, with a variety of ICT approaches.