|Education for Health (WHO, 1988, 261 pages)|
|Chapter 1: Health behavior and health education|
There are many reasons why people behave the way they do. If we want to use health education to encourage healthy ways of life, we must know the reasons behind behavior that causes or prevents illness. This knowledge will help us select the right educational methods for the problem at hand. Four main reasons for people's behavior are given below.
Thoughts and feelings
We have many kinds of thoughts and feelings about the world we live in. These are shaped by our knowledge, beliefs, attitudes, and values, and they can help us decide whether to behave in one way or in another.
Knowledge often comes from experience. We also gain knowledge through information provided by teachers, parents, friends, books, and newspapers. We can usually verify whether our knowledge is correct or not. If we cannot verify this directly ourselves, we know people who can. The child who puts a hand in the cooking-fire gains knowledge about heat and pain. That knowledge stops the child doing the same thing again. A child may see a hen cross the road and be hit by a vehicle. From that experience the child should learn that the road can be dangerous, and to be more careful when crossing.
These are usually derived from our parents, grandparents, and other people we respect. We accept beliefs, without trying to prove that they are true. For example, in many countries there are beliefs regarding which foods a pregnant woman should and should not eat. In one country people believe that a pregnant woman must avoid eating certain meats: if not, her baby will behave like the animals from which the meat comes. These beliefs discourage pregnant women from eating certain foods. Think of other examples.
Every country and community has its own beliefs. In one country people believe that if a pregnant woman eats eggs, she will have a difficult delivery. But in another country people believe that a pregnant woman must eat eggs so that her baby will be strong and healthy. Beliefs are part of the way people live. They indicate what is acceptable and what is not. As beliefs can be held very strongly, they are often difficult to change. Sometimes health workers themselves believe that any traditional belief is bad and must be changed. This is not necessarily right. First, health workers should find out if the belief is harmful, helpful, or neutral. Once you understand how the belief affects people's health, then you can concentrate on trying to change only the harmful beliefs.
The belief that pregnant women should not eat eggs looks like a harmful one because eggs are a good source of protein, and the mother needs to produce a strong and healthy baby. Before making a judgement about changing this belief, one should find out if the mothers in question are allowed to eat other good sources of protein such as meat, fish, beans, cheese, and groundnuts. If they get plenty of protein from other foods, it is not necessary to worry too much about the belief concerning eggs.
In one country there is a belief that, if a pregnant woman walks in the hot sun in the middle of the day, evil spirits will enter her body and damage the unborn child. One may not think that this belief is true. But it is sensible to encourage pregnant women not to overwork themselves when it is too sunny and hot. This type of belief may actually be helpful.
In many countries mothers put beads and charms on their children. They believe these beads will help the child. Some beads are believed to make teething easier, some to prevent illness, and others to protect against evil eye. One may doubt these beliefs. At the same time it is difficult to see any danger in the beads. Belief in their powers is probably a neutral belief, doing neither good nor harm.
If it is not certain that a belief is harmful, it is better to leave it alone. If too many of their beliefs are challenged people may get angry and not cooperate with the health workers.
If we study people's beliefs carefully, we may even find ways of making them useful. For example, one health worker found it possible to tell if children were growing or losing weight by observing the beads they wore. The beads around a growing child's arm would be tight. The beads would hang loosely if the child was losing weight.
Make a list of the beliefs people in your community have about food. Which of these are harmful, helpful, or neutral? What do people in your village believe is the cause of fever? Which of these beliefs are harmful, helpful, or neutral? In some cases you may not be able to tell whether a belief is helpful, harmful, or neutral. In this case you must study the belief more carefully until you are certain of its effect on health.
These reflect our likes and dislikes. They often come from our experiences or from those of people close to us. They either attract us to things, or make us wary of them. Here is an example.
Mrs Mendoza's baby had a mild cold, so she took the baby to the health centre. The staff on duty that day were very busy and shouted at Mrs Mendoza 'Do you want us to waste our time over a simple cold? Come back when we are less busy.
Mrs Mendoza did not like being shouted at. This experience gave her a bad attitude toward the health staff. She does not like or respect them now. This bad attitude could discourage Mrs Mendoza from attending the health centre next time her child is sick. However, an attitude about one thing alone does not always change how a person will behave. Mrs Mendoza may feel strongly that the drugs given at the health centre are very effective. Because of her attitude toward the drugs, Mrs Mendoza may still go to the health centre for help even though she still has a bad attitude towards the staff.
Attitudes can also come from other people's experiences.
Mrs Toro, for example, remembered that her neighbor's baby was successfully treated at the health centre. The positive attitude towards the health centre, which Mrs Toro had gained from her neighbor's experience, encouraged her to go to the health centre next time her own baby was sick.
On the other hand, situations do not always allow us to behave according to our attitudes. Maybe Mrs Toro is afraid of the dark, or possibly the health centre might be closed at night. If the baby fell sick at night, she might go to the old grandmother next door instead of walking to the centre in the dark. This does not mean her attitude towards the health centre has changed.
Attitudes are sometimes based on limited experience. We may form attitudes without understanding the whole situation. For example:
Mr Nola had bad results from a packet of seeds he bought in the town From his experience with only one packet, he formed the attitude that the shopkeeper who sold the seeds was a bad person Because of this attitude, Mr Nola decided never to go to that person's shop again
There are many possible reasons why the seeds grew poorly. It was not correct to blame the shopkeeper without looking into the situation more deeply.
Think about your own attitudes Take, as an example, sprays for
killing insects You may have seen many different sprays which do you think are
good? Which is the best? Why do you have these attitudes about these sprays? How
do these attitudes affect your behavior? Do you always buy the spray you feel is
best If not, why not?
These are the beliefs and standards that are most important to us. People in a community share many values. For example they may want their community to be stable and happy. One way to work towards these values is by cooperation. Cooperation means working together to solve problems. It makes life easier. For example, in a community that values stability and happiness if one family wants to build a new house, the other villagers will cooperate together and help with the building.
The welfare of children is another value. By taking good care of children, parents will benefit: when healthy children grow up, they will be able to take care of their parents in old age. The value attached to children may encourage a mother to stay at home and care for a sick child instead of going out to visit her friends.
Think about your own values . What are the things that are most
important in your life? How do the values affect your own behavior? Think about
the values of the community where you work What values do you share with these
people? Are any of your values different from theirs? How do the community's
values encourage people to behave towards each other and with regard to health?
People who are important to us
A second reason for our behavior is the influence of people who are very important to us. When someone is important to us, we often listen to what he or she says and try to do what he or she does.
Among these important people are parents, grandparents, village leaders, religious leaders, close friends, workmates, people with a lot of experience and special skills, and people who try to help us when we need it (teachers, health workers, social workers).
Schoolteachers are very important to their pupils. If pupils see teachers washing their hands before eating, they may copy this behavior.
Everyone likes to have friends. Because they are important to us, we often copy their behavior. If a teenage boy has close friends who smoke cigarettes, he may start to smoke too.
Mr Tome is an old, experienced farmer. When he tells the other farmers not to plant their crops until they see the new moon after the first rain, they will follow his advice. Even if the agricultural agent gives them different advice, these farmers may tend to respect and copy the actions of the old man. They may not want to listen to a young extension agent who, in addition, may come from a different town.
Who are the respected people in your family? Who are the important
and respected people in your village? What kinds of behavior do these important
people encourage in your family and in the community?
A third reason for people's behavior is whether or not they have certain resources. Resources include facilities, money, time, labour, services, skills, and materials. The location of material resources is also important. If a resource is found a long way from the community it may not be used. Having a lot of things to do in a short time often affects people's behavior. For example:
Time is a valuable resource.
Mr Aba is a tailor. He has a lot of work to do because a holiday is coming soon. If he cannot deliver orders on time, his customers will get angry and may go to another tailor next time. But Mr Aba has a headache and catarrh today. His wife suggests that he goes to the health centre for help. He tells her 'The health centre is always crowded. If I go there, I will waste too much time. I shall go to the drug-seller and buy my own medicines.'
Time has affected Mr Aba's behavior. The health service is an important resource but it may not be useful if it is too crowded.
Money is needed for some kinds of behavior. For example:
Mrs Ebra has four children. Her husband died last year in an accident. She does not have a trade and has no particular skill (another important resource). She collects and sells firewood to make money to feed her children. The health worker tells Mrs Ebra that she should give her children meat, eggs, and milk to make them strong. Mrs Ebra says that she cannot afford these expensive things. The health worker has to think carefully. What can Mrs Ebra buy with her few resources? Finally, they agree that beans and rice can be afforded, with some fish added once or twice a week. Then the health worker sends Mrs Ebra to the social development worker to see about training in a skill that will help her to earn more money.
Some people carry on doing dangerous work because of money, or for cultural reasons. For example the man in the illustration is a palm-wine tapper. He runs the risk of falling and injuring himself or of suffering from back pains. He may carry on doing this work for several reasons. Perhaps his father did the same kind of work, and influenced him to continue in the same line; or perhaps he believes there is a spirit protecting him from injury; or this may be the only job he can find to earn money for his family.
Drinking water directly from a stream is a behavior that causes many diseases. A hygienic well is a facility that prevents those diseases.
The people in Pembo village want a well in order to reduce the number of illnesses they suffer from. They first need the skills that will enable them to find a place for a well that will have enough water. They ask their health worker to contact the right ministry or agency and request an expert to help them find a good place for the well. Next the villagers need materials, such as cement and shovels, for which they may also need to raise money. The people are willing to contribute their labour for digging the well. When the expert comes he shows them several places in which they could dig the well. They choose the place closest to the village, as they know that if the distance to the well is too great people may not want to use it.
These are some of the resources the people of Pembo need in order
to change their behavior and begin drinking clean water. Can you think of
Most of the issues presented in the previous sections vary from one community to another. The normal forms of behavior, beliefs, values, and use of resources in a community form a pattern or way of life. This is known as culture. Cultures have been developed over many hundreds or thousands of years by people living together and sharing experiences in a certain environment. Cultures continue to change, sometimes slowly, sometimes quickly, as a result of natural or social events or contact with people of other cultures. What is important here is to note that culture or life-style is a combination of most of what has just been discussed. While normal behavior is one of the aspects of a culture, culture in its turn has a deep influence on behavior.
In a practical sense, you can see, hear, and understand culture whenever you are in the community by observing people's dress, common foods, and organization of work or by listening to songs, proverbs, fables, and ordinary speech.
Greetings vary among cultures-an embrace, a handshake, a kiss, special words, to mention a few. The way people eat is part of culture: with wooden sticks, with fingers, or with metal cutlery; in family groups, groups of children, or groups of men only; sitting on chairs, mats, or benches. There are many possibilities. Each culture has its own special way of doing things, and beliefs about why things should be done in that way.
This common pattern of behavior, beliefs, and values helps people understand and feel comfortable with life. Each culture represents one way that people have found for living together in their environment. When people come to a new community and culture, they are unsettled at first because they do not know what behavior and ideas are acceptable. Health workers, teachers, and other community workers are often in this situation. Their training has made them part of a 'professional' culture. They have their own ideas and ways of doing things, which are often quite different from those of the community. Before they begin their work, they should learn as much as possible about the reasons for people's behavior in the community. This will help them to work in an acceptable way with the community they wish to serve.
As we have seen, there are many reasons for people's behavior. It is even possible that different people or communities may behave in the same ways but for very different reasons, as the following examples show.
Three mothers may all give fruit to their children. When you ask why, they give different answers.
Mrs Gomez says, 'I believe that if my children eat fruit they will be healthier.'
Mrs Paulo says, 'My mother-in-law lives with us. She said that she always gave my husband fruit when he was small, so I must give fruit to my own children.'
Mrs Andre says, 'I prefer to buy fruit for my children. It costs less than sweets and snacks'.
There may be concern about the safety of the water in your community. When you visit the different neighborhoods, you find that three of them have wells but for different reasons.
People in the first neighborhood tell you, 'We dug our well because we learned that well-water is cleaner than stream-water.'
In the second neighborhood you hear, 'We saw that the leading people in town had wells, so we decided to build our own.'
Residents of the third neighborhood say, 'We used to collect water from a far-away stream. That wasted time and energy. We built a well to make life easier.'
By knowing something about the possible reasons for a given form of behavior, you will be able to suggest appropriate changes and solutions to the problems you have noticed. Now look at your own community. What are the eating habits of the people? What are some of the reasons for people eating one food and not another? How do people dispose of refuse in your village? Why do they do it that way? How do people in your area keep their mouths and teeth clean? What are the reasons for these ways of behaving? How can you find out about the reasons?