Understanding Health and human

behavior

Why do people do what they do?

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 outline
 Behaviors-definitions
 Healthy behaviors
 Factors affecting human behaviors
 Predisposing factors
 Enabling factors
 Reinforcing factors
 The role of human behaviors in level of disease prevention

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 Learning outcome
 At the end of this session you will be able to ;
 Define correctly what behavior mean?
 Describe factors that affect human behaviors
 Discuss the role of human behaviors in disease prevention

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 Human behavior

 What is behavior?

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 Human behavior….

 What is behavior?
Behavior-is any overt action that has specific frequency
duration, Intensity and purpose, whether conscious
or unconscious

• It is both the act and the way we act

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 Behavior..
 Action-
E.g- Drinking/smoking
- Breast feeding
 Frequency-how many times the behavior occurs in a given time
period . how it is repeated, regularity
 Duration-the amount of time on each session .
is it for week/month?
 Intensity –how intensely or how hard the behavior is performed

 Purpose- doing consciously or not

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 Why do we need to study human behaviour?

 Most health issues could not be addressed by treatment alone

 Health is determined by ordinary human actions and behaviours

 These behaviours are modifiable through public health efforts

 However, most health education programs failed because they

neglected to understand factors that influence actions

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 Why do we need study health behaviour?

 To design interventions to improve health comprising

behaviours
 To gain more general understanding of the reason why
individuals perform a variety of behaviours
 Because human behaviors are the main cause as well as the
main solution!
 Human behavior is a key factor in determining health.

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 Components of behavior

Basically human behavior has three domains

 Cognitive domain( knowledge ,perception)
 encodes , stores, retrieves ,processes information;
 Purpose is manipulation of information
 Affective domain- cognition +feeling
 Attitude, Beliefs
 Purpose is to create arousal or awakening
 psycho-motor domain

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 healthy behavior Vs unhealthy behaviors
 Healthy behavior-
 is an overt behavioral patterns, actions, and habits that relate
to health maintenance, to health restoration, and to
health improvement

 All actions with potentially measurable frequency, intensity,

duration performed at individual ,interpersonal, organizational,
community, public policy level for primary, secondary and
tertiary prevention

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 Causes of health problems ;Shift in cause of ill health

Bacteria Behavior

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  The behavior-health link becomes clear when examining the
10 leading risk factors for preventable death and disease
worldwide.

 According to WHO, 40% of deaths worldwide are

due to these 10 risk factors alone (behaviors).

 Global healthy life expectancy could be increased by

5-10 years if we reduce these risks.

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 Top risk factors leading to disease, disability, or death

 Poorest countries Developed countries

1. Underweight 1.tobacoo
2. Unsafe sex 2. High blood pressure
3. Unsafe water ,sanitation & hygiene 3.Alcohol
4. Indoor smoke from solid fuel 4. High cholesterol
5. Zinc deficiency 5.High BMI
6. Iron deficiency 6. low fruit vegetable intake
7. Vitamin A deficiency 7.physical inactivity
8. High blood pressure 8.illicit drugs
9. Tobacco 9.unsafe sex
10. High cholesterol 10.Iron deficiency
Source:m.ezzti.et.al.selected major risk factors and global regional burdens of
disease. The lancet 360,no,9343(2002)

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 Human behaviors important for health promotion

 Preventive behaviors
 Promotive behaviors
 Utilization behaviors
 Illness behaviors - recognition of symptoms and prompt
self-referral .
- It is what people do when they feel ill.
aimed to seek remedy
 Compliance (adherence) behavior– following course of
prescribed medicines
 Community action

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 Factors affecting...
 Factors affecting human behavior
Lawrence Green identified three categories of factors
affecting individual or collective behavior. These are;

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 Factors affecting human behaviors
Predisposing
factors

Enabling
Cultures/norms behavior factors

Reinforcing
factors

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 Factors..
 Predisposing factors are antecedents or prior to behavior that
provide the rationale or motivation for the behavior to occur.

 Knowledge, attitude, perception, beliefs, values, self efficacy etc.

 The key consideration in understanding predisposing factors is the

extent to which behavior can be predicted

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  Enabling factors- are antecedents to behavior that facilitate a
motivation to be realized.

 Availability, affordability, accessibility, personal skills,

resources to accomplish the behaviors

 The key consideration for these factors and health behavior is

the extent to which their absence will prevent an action from
happening.

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 Reinforcing factors are those factors subsequent to
a behavior that provide the continuing reward or
incentives for the behavior to be persistent and
repeated

 Reinforcing factors –peer pressures, influential others,

perceived social pressure, significant others
Encouragement/discouragement

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 Predisposing ...
 knowledge or awareness
 Knowledge is, “A clear and certain mental perception,
understanding, the fact of being aware of something, experience of
acquaintance of familiarity with information , learning that which
is known, fact learned or study of.”

 Therefore, one`s knowledge of something include some

combination of
 simple awareness of facts and
 Understanding of how these facts relate to one another

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  Knowledge and skills are interrelated in that skills are the
practical application of essential knowledge

 knowledge can be viewed as an accurate impression of some

phenomenon.

 Perception +storage of information in the brain=knowledge

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 Predisposing ...

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”
—Goethe

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  Knowledge is necessary but not sufficient in behavior change.
 It is necessary, because, without adequate knowledge , people
may unaware of and concerned about health problem and
unable to manage their behavior

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 knowledge about/awareness vs how to
k/ge or essential knowledge
 Knowledge about/awareness: Knowledge about a topic may
be important in developing interest in the topic and may even
motivate the behavior

 How-to/ essential knowledge: Intentional behavior change

depends on it
 It is practical/applicable

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  Therefore, one of the main task in health education is helping
the learner to become knowledgeable about some health
topic.

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  Skill is the capability of accomplishing something with
precision and certainty.

 Skills require practical knowledge and ability

 On many occasions inappropriate or ineffective health
behavior may result from the lack of mastery of specific skills

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 Perception
Perception: a process by which
individuals organize and interpret
their sensory information in
order
to give meaning to their
environment.

Perception is means of acquiring

knowledge.

And it is highly subjective

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 4/10/20
25

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 perception

“ WE DON’T SEE THINGS

AS THEY ARE, WE SEE

THINGS AS WE ARE.”

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 Belief

 Belief refers to the conviction that a phenomenon or

object is true or real

 It is different from knowledge in that it is perceived

whereas knowledge is accepted objective truth

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 Types of beliefs
 Harmful belief
 Helpful beliefs
 Neutral beliefs

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 Difficulty index of changing beliefs
 It is usually easier to influence those beliefs that:
Are held by individuals
 Have been acquired recently
 Come from not highly respected sources( religion ,traditional
medical system)

• And it is usually difficult to change those beliefs that

 Are held by the whole community
 Have been deep rooted in the culture
 Come from respected and trusted sources

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 Measurement
 How do you know /measure the awareness/knowledge of an
individuals about certain health condition?

 Usually knowledge questions are administered in yes

or No format or in form of open ended questions.

Be sure that you have measured both awareness and

essential knowledge

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 Attitude
 Social psychologists define an attitude as an enduring
evaluation, positive or negative, of people, objects, or ideas
 We are not neutral observers of the world we evaluate what we
encounter

 Attitudes are often a matter of good or bad; as soon as you know

what something is, you start to know whether you like it or
dislike it.

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  Mucchielli (1970) describes attitude as
 “a tendency of mind or a reltively constant feeling
towrds a certain category of objects,people,or situation”

 Characteristics of attitude
1. Predisposition- exposure related to an attitudinal object. No
exposure, no attitude
2. Has direction- polar ,+ve or –ve ,negative or positive
3. Evaluation-can be evaluated by intensity or judgment
e.g. Favorable or unfavorable

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 4.changeability- can be changed ,not static
It is relatively constant
5.Stability or consistency
 stability=related to time
 Consistency= sameness of attitude

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 Link between knowledge(K) and Attitude (A)

Feeling/sense of
Attitude
knowledge like or dislike

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 Link between knowledge(K) and Attitude (A)

With the knowledge or information that we have on

things, the mind is able to develop a sense of like or
dislike, positiveness or negativeness /feeling.

It is thus, the feeling component is added to the

knowledge which keeps the individual react to a
stimulus positively or negatively.

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  Link among knowledge(k), Attitude(A) and practice(p)

practice
knowledge Attitude

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 Link among knowledge(K) and Attitude (A) and
Practice (P)
 The general trend or normal way of thinking and acting
the proper sequence and linkage among KAP is that
knowledge (K) is followed by attitude (A) and is
followed by practice (P).

 But this rule is not universally applicable to every

behavior i.e. different possibilities and combinations can
come across with regard to KAP.

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  When P or A precedes K, it is due either to an imitation
(modeling) or compulsion

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  KAP gap curve

A
P

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 KAP ….

 In health education, we try to close these gaps by helping

people to practice at least what they know.

 Apply cognitive consistency theory

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 Cognitive consistency theory

 states people prefer to be consistent in their

knowledge, attitude and practice.

 New information creates dissonance between

knowledge, attitude and behavior and this
stimulates alternation in their behaviors consistent with
knowledge and attitude

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  Attitude measurement
 Self-reported attitudes- asked direct questions about
their feelings.

 The Likert Scale –is one the mostly commonly used scale
to measure attitude.
 In Likert scale, respondents are asked how strongly they
agree or disagree with carefully selected statements on
five point scale.

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  Attitude scale is usually stated in form of statement

E.g. Testing for HIV during my pregnancy makes me

frighten
1,Strongly disagree 2.disagree 3.neutrl/undecided
4.Agree 5. strongly Agree

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  Belief vs Attitude
Our beliefs about things affect our attitude
towards it.
Our beliefs, in turn, are influenced by our attitudes.
 The judgment as good or bad and worth
carrying out a behavior will depend on the beliefs
about the consequences of performing the behavior

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 Value
 The relative worthy/preference/judgment
individual gives every thing around is known as value
-Are standards most important to us

 value is something is held to be important or worth; and

prized by an individuals or community.

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 Value...
 Value exert strong and enduring influence on behaviors
 The values that have advantages for the self
and for the society are known as positive values.

 And the values that are harmful and disadvantageous are

known as negative values.

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 value conflict and value clarification
 People value life, health. However, in opposite engaged in
unhealthy behavior, for instance, smoking. This reveals
conflict of values=inconsistencies between two or more
values.

 In health education one shouldn’t seek to change values

rather should help people recognize inconsistencies
between and among their values.

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  But we can sometimes bring about changes by
emphasizing values which don’t involve health.

 We, often trying to encourage people to think about

their values. This process is called value-clarification

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 Relationship between attitude and value

 Values are more permanent and resistant to change than

attitudes and beliefs and they determine attitude.

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 Educational approach to behavior
change

Determinants of behavior Approaches to change

Direct communication with target

PREDISPOSING FACTORS
individuals-educational approach

Organizational change, Avail

ENABLING FACTORS
services,advocacy

Indirect communication with social

REINFORCING FACTORS
environment,Influential people

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 Behavior change is complicated

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 How to improve behavior change
interventions
1. Specify target behavior precisely

2. Use behavioral theory to develop interventions systematically

3. Describe mechanisms through which these work

4. Specify behavior change techniques, linking these to theory

5. Improve reporting, using standardized, shared terminology

6. Facilitate combining evidence in systematic reviews to inform practice

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 Behavior Change Process
Identify Identify content
Understand the
intervention &implementation
behavior
option option

1. Define the
problem Identify:
Identify:
5.Intervention
2.Select target 7.Behavior change
function
bhr techniques
6. Policy category
8.Mode of delivery
3.Specify target bhr

4.Identify what needs

to change

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 Step 1. DEFINING BEHAVIOUR
Examples:

1)Intending to eat 3 pieces of fruit a day

2)Washing your hands

3)Reducing cholesterol

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 Step 2: Select the target behavior
 Multiple potentially relevant behaviors
 Consider:
 Impact

 likelihood that such a behavior will be implemented

 , spread out,/generalizability to other behaviors and people

 Ease of measurement

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 Step 3: Specify the target behavior
 More precise the better
 Will help in developing and evaluating intervention

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 Step 4: Identify what needs to change
 Target behavior identified and specified
 But why not currently being carried out?
 Need to understand behavior change in context
–Population
–Environment
•Need to understand predictors of the behavior

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 The Capability Opportunity Motivation
–Behaviour (COM-B) Model

Changing any behavior

involves identifying what
needs to change in terms
of:
Capability
Motivation
Opportunity

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 Step 5: Identify intervention Functions

 The Behavior Change Wheel: a procedure for intervention

development
 Allows the selection of selecting intervention functions and
policy options

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 The Behaviour Change Wheel

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 Behavior Change
Can be natural or planned changes.
 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.
Planned change – We make plans to improve our
lives or to survive and we act accordingly.
 It can be faster or slower depending on the
response of the acceptor and adapter of the
behavior.
 Example: plan to stop smoking or drinking
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 Behavior Change approach
• Persuasion Approach: is the deliberate attempt to
influence the other person to do what we want
them to do.
– Used during serious threat like epidemics and
natural disasters
• The informed decision making approach: Giving people
information, problem-solving and decision-making
skills to make decision but leaving the actual choice
to the person.
– ‘open’ or ‘non judgmental’ approach.

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 Learning

Is relatively permanent change in behavior

as a result of knowledge, experience or
practice.
 Is acquiring new knowledge, behaviors, skills,
values, understanding, and may involve
synthesizing different types of information.
 The ability to learn is possessed by humans
and animals.

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 Learning…
 Learning may occur as a result of
habituation or classical conditioning,
So, learning is the modification of behavior
through practice, training, or experience.
Five important components of learning

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 Learning…
1. Learning involves change
 A change may be for good or bad.
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 rules out behavioral changes caused by
fatigue or drugs
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 Learning…
3.Learning is reflected in behavior
 A change in an individual’s thought process, not
accompanied by behavior, is not learning.
 This clarified that learning needs to result in
behavior change.
4. The change in behavior should occur as a result
of experience, practice or training:
 Behavior caused from maturity, disease, or
physical damages does not constitute learning.

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 Learning
…
5. The practice 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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 Principles of learning
There are three principles of learning:
1. Learning by association - Connection
between events in time, place, etc.
 It is the most important part of learning.
 It is first formed in the physical environment.

Examples,
 If we see lightening we expect thunder
 When we see a needle, we think of injection
 When we see pregnancy we expect delivery

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 Principles…
2. Learning by 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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 Principles
…
 Reinforcement: is the attempt to develop or
strengthen desirable behavior. There are two types
 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.
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E.g. food may not be a reinforcer
25 to someone who has
just completed a five course meal.
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75
 Principles…
 Secondary reinforces: include benefits such 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.
b. Negative reinforcement, an unpleasant event that
precedes a behavior is removed when the desired
behavior occurs.

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 Principles
…
Punishment
 Is the attempt to eliminate or weaken undesirable
behavior. It is used in two ways.
 First is to apply a negative consequence called
punishers – following an undesirable behavior.
E.g. A football player 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.
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 Principles
…
 Reinforcement increases the likelihood of the
occurrence of the situation.
 It increases the association between the
response and stimulus.

 Reinforcing tools (reinforcers): Asking ,

Praising, Encouragement, Advice, Checking,
and Listening.
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78 Meron A.
 Principles
3. Learning by Motivation

 The concept of motivation is basic because, without motivation learning

does not take place or, at least, is not noticeable.
 Motivation may be seen at different levels of complexity of a
situation.
 On a broader level, a college student must have the need and drive to
accomplish a task and reach a specific goal.

 A n individual who is not motivated will gain or learn nothing i.e. it can
affect the learning process

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 Disease prevention
Prevention can be divided into three levels for
comparison.
Primary prevention directed toward
preventing the initial occurrence of disorders
Secondary prevention seeks to retard
existing disease and its effects
Tertiary prevention seeks to reduce the
occurrence of relapses.

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A. 25
 Levels of Health Education in Health-illness
continuum
1. Primary health education
Directed at healthy people
The primary aim is to prevent occurrence of
ill-health.
It is a focus of health promotion programs
E.g. Health education programs on good
nutrition, immunization, and breastfeeding

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A. 25
Levels
…
2. Secondary Health Education
 Educating patients about their condition and
what to do about it.
 The aim of this level is to stop the progress
of diseases to the severest form.
At this level complete recovery from the
diseases is possible, but if neglected
complications may occur.
e.g. Early treatment of Malaria, Tuberculosis
treatment
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A. 25
 Levels…
3. Tertiary health education
 Used in patients whose ill-health can not be completely
cured.
 It is concerned with educating the person or his or her
relatives about how to make the remaining potential for
healthy living and had to avoid unnecessary
hardships, restrictions and complications.

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A. 25
 THEORIES & MODELS IN HEALTH
EDUCATIONS

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 OBJECTIVE

At the end of this lecture students will be able to:

 Discuss the role of the theories/models in HE

 Describe the most common theories used in HE

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 What is theory

Theory is
“A set of interrelated concepts, definitions, and
proposition
 present a systematic view of phenomena
 by specifying relations among variables with the purpose of
explaining and predicting the phenomenon”

 Theories explain why, what, how and when a particular

behavior occurs.
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 Why theories/models?
 Provides a road map for studying problems, developing

appropriate interventions, and evaluating their successes.

 Help to explain the dynamics of health behaviors.

 Help planners identify the most suitable target audiences,

methods for fostering change, and outcomes for evaluation.

 Guides the search for reasons why people do or do not

engage in certain health behaviors;

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 Role...
 Helps pinpoint what planners need to know before they

develop public health programs;

 Suggests how to plan program strategies that reach target

audiences and have an impact.

 Theory also helps to identify which indicators should be

monitored and measured during program evaluation.

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 Population

Interpersonal

Individual
/intrapersonal

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 1. Individual Health Behavior Model

 Focus on individual characteristics that influence behavior, such

as knowledge, attitudes, beliefs, and personality traits

• Health Belief Model

• Theory of Reasoned Action/Planned Behavior
• Trans-theoretical Model/Stages of Change .etc.

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 2.Interpersonal health behavior
theories
Focus on interpersonal processes including relationship
with family, friends, and peers

 Social Cognitive Theory(SCT)

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 3. Community level Models

 Community-level models are frameworks for understanding how

social systems function and change, and how communities and
organizations can be activated

 Diffusion of Innovation

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 HEALTH BELIEF MODEL

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 HBM
Focus:
 Individuals’ perceptions of the threat posed
by a health problem, the benefits of avoiding the threat, and
factors influencing the decision to act.

 Six main constructs influence people’s decisions about

whether to take action to prevent, screen for, and control
illness

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1. The health belief model (HBM)

 The HBM has been developed by a group of psychologists in the

1950s to explain why people would or would not use health
services

 The model is used in explaining and predicting preventive health

behavior, as well as sick-role and illness behavior.

 It emphasizes the intellectual dimension of health

behavior.
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 constructs of the HBM

 Perceived Susceptibility-the belief that one is at risk of contracting

a health problem
 Perceived severity-the belief that a health problem is serious
 Perceived benefit-the belief that changing one's behavior will
reduce the threat
 Perceived barriers-a perception of the obstacles to changing
one's behavior eg. Cost, side effect, culture…
 Self efficacy-the belief that one has the ability to change one's
behavior
 Cues/reminder to Action - may be internal or external.
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 HEALTH BELIEF MODEL
Individual perception Modifying Factors Likelihood of action

•Demographic variables (OUT COME EXPECTATION)

•Socio-psychological •Perceived benefits of preventive
variables (personality, peer action
pressure etc) Minus
•Structural variables (e.g. •Perceived barriers to preventive
knowledge about the action
disease.

•Perceived susceptibility
to Disease "X“ Perceived threat
Likelihood of taking
+ of Disease "X" recommended
•Perceived seriousness
(Severity) of Disease "X"
preventive health
action
Cues to action
•Mass media campaigns
•Advice from others
•Reminder postcard from health workers
•Illness of family member or friend

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 Health belief model…
 Individual perceptions are factors that affect the perception of
illness or disease. It includes:
general health value, perceived susceptibility, perceived severity,
Self efficacy

Behavior not so affected by social norms

 The likelihood of action is the likelihood of taking the
recommended preventive health action.

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 Perceived threat
 is made up of the perception that one is susceptible to illness (i.e.
Personal risk) & the perception that the illness is serious.

 The perception of personal health threat is influenced by at least

three factors:

 general health values

 specific beliefs about vulnerability &
 Beliefs about the consequences of the disorder.

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 Out come expectation
 Is made up of the perceived benefits of the specified action minus
the perceived barriers to the action

 Overall, perceived barriers to the practice of the health behavior

is the most powerful dimension influencing whether or not people
actually practiced a particular health behavior.
NB
 Once an individual perceives a threat to his/her health and is
simultaneously cued to action, and his/her perceived benefits
outweighs his/her perceived barriers, then that individual is most
likely to undertake the recommended preventive health action.
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 Drawbacks of the HBM

HBM is limited in that it is cognitively based model and

does not consider the emotional component

Factors other than health beliefs like SES also heavily

influence the practice of health behaviors.

The HBM appears to predict health behaviors best when

other demographic factors, such as SES and education,
have already been considered.

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 Theory of Reasoned Action
(TRA)
&
Planned Behavior (TPB)

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 Introduction
 TRA was introduced by Fishbein in 1967
 Modified & Refined over time (eg. Ajzen & Fishbein,
1980)
- concerned with the prediction and understanding
of human behavior

 It was designed to explain all human behavior that is

under volitional control

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 Assumption:-
 The theory rests on the assumptions that
humans are:
- rational,
- have control over their behavior, and
- seek out, utilize, and process all available
information about pending decisions before they
take actions.

 therefore, Ajzen and Fishbein refer to their

approach as "a theory of reasoned action"

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 Behavioral belief
&
Outcome
Attitude

BEHAVIOR
INTENTION
Evaluation

Normative beliefs
of referents Subjective
& norms
Motivation to
comply

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The theory of reasoned action.
106 4/10/2025
 TRA…

 Intentions are most immediate influence or

determinant of behaviors

If one has intend to perform a behavior then it is

likely that he/she will do so, if not intend then it is
unlikely to be performed.

 Performing a behavior is a function of intention to perform the

behavior

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 TRA…

 Intention :- function of two basic determinants:

 one personal and the other social

 Personal factor = attitude toward the behavior

 The social factor = subjective norm (SN)

SN is the person's perception of the social pressures put on

that person to perform or not perform the behavior in question.

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 TRA…

In general, individuals will intend to perform a

behavior when they evaluate it positively and when
they believe that important others think they
should perform it.

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 TRA…

Determinants of Attitude toward an Act

-Behavioral beliefs = The person’s beliefs that the behavior leads

to certain outcomes and
e.g physical exercise in reducing body weight

- Evaluation of outcome = his or her evaluations of those

outcomes

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 TRA…
Determinants of Subjective Norms
1. Normative beliefs
2. Motivation to comply
1. Normative beliefs = belief about what a specific
referent person thinks one should or should not do
regarding the behavior

Referent = specific individual or group who may influence

one’s behavior

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 TRA…

 For any given behavior at a given time, we will have a set of

salient referents

 For each referent, we have a normative belief, what we

think that referent would want us to do

2. For each referent, we have a specific level of motivation to

comply with their wishes for us

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 TRA…

 A person’s subjective norm is a function of their

normative beliefs for salient referents, and motivation to
comply with these different referents

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 Limitations
 Not appropriate for predicting or explaining behavior in
situations where people had little power over events
around, i.e if there is non volitional control

 It is almost entirely rational and does not provide explicitly

for emotional fear arousal elements such as perceived
susceptibility to illness

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 Extensions (TPB)
 To improve the predictive power of TRA, Ajzen(1985) added a
third construct (Perceived behavioral control) to the original
theory to account for the performance of behaviors which are not
completely under the subject's control.

Theory of
Planned Behavior
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116 4/10/2025
 TPB…

Perceived behavior control:

 is a perceived ease or difficulty in performing a behavior

It Cover non volitional factors which interfere with ones

attempt to perform a behavior

Made up of control beliefs and perceived power of a

control

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 TPB…

The TPB predicts two possible effects of perceived behavioral

control (PBC)on behavior:

(1) PBC reflects motivational factors that have an indirect effect on

behavior through intentions, also

(2) PBC reflects actual control and has a direct link to behavior not
mediated by intentions.

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 Measurement of constructs
 Direct measures and
e.g. by asking respondents about their overall attitude
 indirect (belief-based) measures
indirectly e.g. by asking respondents about specific
behavioral beliefs and outcome evaluations
• Measuring the same construct the direct measure &
indirect measure scores are expected to be positively
correlated
• ELICITATION STUDY –For indirect measures

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 Reliability

 Index of internal consistency for direct measures

 test-retest reliability for indirect measures by administering
the questionnaire twice to the same group of people

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 Tr a n s - t h e o r e t i c a l
model
(stages of
change)

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  To be continued……

122 Meron A. 4/10/2025

 Thank you

123 Meron A. 4/10/2025