Facilitating decisions and follow-through

What are the things we value most?

As we said in Chapter 1, values are standards and beliefs that are very important to us and that therefore affect our behavior. Some of the things people value include progress, happiness, friendship, security, and comfort. If asked, most people would say that they value health, but too often they do not think about their health until they have lost it.

Although people feel strongly about their values, they do not always seem to behave in ways that match them. People often do not even realize that the way they are behaving is not consistent with their values. The examples below show this clearly.

People value their children very highly. They consider it an honour to be a parent. Caring for children is a special duty not to be taken lightly. But sometimes you see a family spending their extra money on new clothing, cigarettes, or alcohol, even though the children are underweight and sickly. It may be that the family wants new clothing so that they can all feel proud when they attend a relative's marriage. Maybe they drink alcohol because their friends do or because it seems a way to help them mix easily with other people. Maybe they believe cigarettes will help them concentrate better at their work. Perhaps the family does not know that children need to eat certain foods to be healthy. You can probably think of other reasons for this family's behavior. It is unlikely that the mother and father want to hurt their children. They probably do not realize that their behavior is out of line with the value they place on their children.

Look now at the example of a schoolboy who has an infected toe. He complains a lot about the pain. He says he values his health. The health worker tells him to come to the clinic for injections for five days. After the second day, the boy does not come again. There are many possible reasons for this. Maybe the pain has been relieved and he thinks two injections are enough. Maybe it is a long way to the clinic. Maybe the boy has important work or ah examination at school. He may be afraid of the health worker or the injections. Whatever the reason, the boy probably does not see that his behavior is working against his stated value of health.

Adjusting behavior to values

It is our role to help people see clearly how their values may not be matched by their behavior. Then perhaps, they will try to change. If they are to do so, we need to help them find out what matters most in their lives. This is best done with individuals, although it can also be done in small groups. Values are very personal. People are unlikely to talk in front of others about their values and the contradictions in their behavior.

The discussions of this topic would usually be part of an individual counselling session. You would already have found out some of the problems the client is facing, and some of the reasons for these problems. Begin by asking what the client sees as the most important things in lifewhat is valued most. Ask what the client does to live up to these values. If health is valued, what does the client do to keep healthy? If children are valued, what does the client do to make sure children grow up to be strong and successful?

Once people are clear about the things they value most in life, ask them if they always act in ways that are in harmony with their values. If they say 'No', ask them why. Find out what makes it difficult for them to live always according to their values. Also if you have noticed any differences in the values a person holds and the person's actions, gently point them out. The realization of such differences is a very important step towards the decision to change one's behavior. But once a person has decided to modify certain habits, that decision has to be kept to day after day, until the changes in behavior have become part of a way of life. This is often very difficult. We will see now how people can be strengthened in their decision to adopt healthy practices.

Using self-rewards

If people receive a benefit for an action, they will be encouraged or motivated to repeat that action. Rewards can encourage good health behavior. But they must be used with caution. First, they should be used only when a form of behavior is very difficult to change (for example, cigarette-smoking).

Secondly, a health worker should be aware that it is quite possible to mislead someone by using rewards and thus cause many problems. To avoid this, always make sure, first, that people choose the kind of healthy behavior that they want to achieve and, second, that they choose their own rewards. Otherwise a problem like the following may result.

Mr Tem has hypertension. He is supposed to come to the clinic once a month to have his blood pressure checked and his supply of medicaments renewed. Unfortunately, Mr Tem comes to the clinic only when he is feeling unwell.

The physician on duty is worried about Mr Tem. He tells him that he will give him the money for his transport if he comes every month. Mr Tem agrees and begins coming to the clinic regularly.

Several months later the physician is transferred to another hospital. When Mr Tem meets the new physician, he asks for his transport money. The physician is surprised and says that he cannot afford to give patients money every month. Mr Tem is angry at this. Since that day he has not returned to the clinic. When he feels unwell, he buys drugs from a local drug-seller.

In the above example, the first physician failed to help Mr Tem, because the physician made all the choices. In health education, people must choose to change their own behavior and choose the rewards they will give themselves if they are successful. It is also important to try other methods first. If Mr Tem was having money problems, a better method would have been to link him with a social welfare agency.

Here is an example of how a health worker encouraged her client to participate in choosing self-rewards.

Mr Solo had been coughing for some years. The health worker helped Mr Solo understand that cigarettes made him cough more. When he understood this, he said he wanted to stop smoking. He tried to cut down, but by the next week he was smoking as much as before. He came back to the health worker for help.

The health worker listened to Mr Solo. She agreed that he was having a difficult time. She asked Mr Solo to tell her some of the things he liked to do in his free time. He said he really enjoyed playing draughts with his neighbor. She asked if he had any favourite foods. He said that chicken was his favourite, but that he could not afford to have it very often. His wife prepared chicken only once or twice a month.

The health worker then explained the idea of rewards to Mr Solo. She said that he could reward himself with something he liked, if he stopped smoking. Mr Solo thought about this. Then he said he would talk to his wife and his neighbor. On days when he did not smoke a cigarette, he would play draughts with the neighbor; if he smoked, he would stay at home and not play. He liked draughts very much, so playing would be a reward. While playing, the neighbor could help to remind Mr Solo not to smoke. (Support from friends and relatives is another important factor in health education.) Also, he would put aside the money saved by not smoking and give it to his wife so that she would make him a chicken dinner as a reward.

Finally, rewards should be something that is good for the person. A child may say 'I want candy if I clean my teeth every day.' Eating candy every day is not very healthy for a child. Maybe a small amount of candy at the end of the week would be possible. Better still, find another reward.