Green-Behav-Dx-04

BEHAVIORAL & ENVIRONMENTAL

DIAGNOSIS
Behavioral Dx: - systematic analysis of the behavioral
links to the goals/problems that were identified
in epid / social Dx

Environmental Dx: paralel analysis of factors in the social

and physical environment, that could be
causally linked to the behavior that was
identified.

 WHY AN EMPHASIS ON BEHAVIOR?

BEHAVIOR INFLUENCE HEALTH IN THE

THREE WAYS: 1 DIRECT & 2 INDIRECT

PHYSICAL &
SOCIAL
ENV. CAUSES

BEHAV. HEALTH
CAUSES

HEALTH-CARE
ENV. CAUSES

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DECREASING PERSON’S YEARS OF

POTENTIAL LIFE --- ROUGHLY ESTIMATED:
BEHAVIORAL / LIFESTYLE : ENVIRONMENT,
GENETIC, BIOLOGICAL = 50%

 THE FIVE STEPS IN BEHAVIORAL DX

1. SEPARATING BEHAVIORAL AND NON

BEHAVIORAL CAUSES OF THE
PROBLEM

LEADING CAUSES OF DEATH

RISK FACTORS :

- BEHAVIORAL
- BIOLOGICAL
- ENVIRONMENTAL
- SOCIAL

NonBehavioral Behavioral Related to Behav.

Gender Smoking Hypertension
Age High fat diet High Cholest.Serum
Family history Heavy Alcohol Stress
consumption
Diabetes Sedentary life Obesity
style

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2. DEVELOPING AN INVENTORY OF
BEHAVIOR

INVENTORY OF BEHAVIORS ASSOCIATED WITH

REDUCTION OF MORTALITY FROM
CARDIOVASCULAR DISEASE.

PREVENTIVE BEHAVIORS
1.Maintain/ attain desirable weight
2.Stop smoking / don’t start
3.Stop heavy drinking
4.Continue / begin regular exercise
5. Reduced consumption of foods high in saturated fats
6.Avoid excessive, constant stress and/or do relaxation
exercise
7.Participate in high blood pressure and cholesterol
screening programs

TREATMENT BEHAVIORS
1.Make informed decisions regarding medication &
surgery
2.Keep scheduled appointment with health providers
3.Take medications as prescribed
4.Maintained / reduced weight as prescribed
5. stop smoking,
6.Cut down alcohol consumption as prescribed
7.Continue/begin regular exercise as prescribed

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3. RATING BEHAVIORS IN TERMS OF

IMPORTANT

THE IMPORTANCE OF A BEHAVIOR IS

INDICATED:
a. Occurs frequently
b. Clearly linked to the health problem

MEASURE OF DISEASE ASSOCIATION:

Incidence of the problem

In those exposed to the rsik factor
Relative risk = ------------------------------------------------
Incidence of the problem in
Those not exposed to the risk factor

RELATIVE RISK FOR CORONARY HEART DISEASE

RSIK FACTORS IN MIDDLE-AGED MEN

RISK FACTORS RELATIVE RISK

Smoking 2.0
Hypertension 2.4
Elevated serum cholesterol 2 – 3 (depend on
level of elevation)
Diabetes 2.5
Obesity 2.1
Physical activity 1.9

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RATING THE RELATIVE IMPORTANCE OF BEHAVIORS

ASSOCIATED WITH CARDIOVASC. DISEASE

IMPORTANT Basis for rating behavior

-Smoking -very strong risk ratio,

High prevalence
-Eating high-fat foods -Strong rsik ratio,
Very high prevalence
-Lack of exercise
-High stress

LESS IMPORTANT All unrelated to the

desired outcome:
primary prevention
Not monitoring blood pressure
Not adhering to medic.prescription
Not keeping medical appointments
Making uninformed decision about treatment

4. RATING BEHAVIORS IN TERMS OF

CHANGEABILITY

Relative Changeability based on perceived attributes of

selected preventive health behaviors
HEALTH a b c d e f g
BEHAVIOR

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a.RELEVANCE
b.SOCIAL APPROVAL
c.ADVANTAGES
d.COMPLEXITY
e.COMPATIBILITY with values, experiences & needs
f.DIVISIBILITY or TRIALABILITY
g.OBSERVABILITY

CODE: + (POSITIVE), 0 (NEUTRAL), - (NEGATIVE)

Rating the Changeability of behaviors associated with

Cardiovascular disease

Changeability Basis for rating behavior

MOST CHANGEABLE
-Smoking prevention Recent trends & new
Research
LESS CHANGEABLE
-Eating foods with high fatty These practices are
Acid content deeply rooted in
-overeating culture, soc.relationship
-exercise and lifestyle. Previous
Attempts to change
them have had limited
success.

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More less
Important Important
High priority for Low priority except
More Program focus to demonstrate
changeable change for political
purposes
(quadrant 1) (quadrant 3)

Priority for No program

Less innovative program;
Changeable evaluation crucial
(quadrant 2) (quadrant 4)

Matrix of health behav.in CVD prevention in youth.

_____________________________________________
More less
Important Important
Smoking Medical treatment
More Related behaviors
changeable
(quadrant 1) (quadrant 3)

Eating foods with

High fatty-acid Not relaxing
Less Content
Changeable Overeating
Lack of exercise
(quadrant 4)
(quadrant 2)

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SETTING BEHAVIORAL OBJECTIVES

- WHO? The people expected to change

- WHAT? The action or change in
behavior / health practice to be achieved
- HOW MUCH? The extent of the
condition to be achieved
- WHEN? The time which the change is
expected to occur

SMART in behavioral term

- Specific
- Measurable
- Attainable / appropriate
- Realistic
- Time bound

 WHY EMPHASIS ON
ENVIRONMENT?