4.3.1 Predisposing factors
Predisposing factors are those characteristics of a person or population that motivate behaviour before the occurrence of that behaviour. Peoples’ knowledge, beliefs, values and attitudes are predisposing factors and always affect the way they behave. Predisposing factors are motivational factors subject to change through direct communication or education. All of these can be seen as targets for change in health promotion or other public health interventions. We will look at each of them in turn.
Knowledge is usually needed but is not enough on its own for individuals or groups to change their behaviour. At least some awareness of health needs and behaviour that would address that need is required. Usually, however, for behaviour change some additional motivation is required. For example, even if a mother knows in general about using oral rehydration salts (ORS) when her child is dehydrated due to diarrhoea, she may need a reinforcing message from you before she will actually use them.
Beliefs are convictions that something is real or true. Statements of belief about health include such negative comments as, ‘I don’t believe that exercising daily will improve my health’. More positive health beliefs might include statements such as, ‘If I use an insecticide treated bed net at night I will probably not get malaria.’
Often a potent motivator related to beliefs is fear. Fear combines an element of belief with an element of anxiety. The anxiety results from beliefs about the severity of the health threat and one’s susceptibility to it, along with a feeling of hopelessness or helplessness to do anything about the threat.
Values are the moral and ethical reasons or justifications that people use to justify their actions. They determine whether people consider various health-related behaviours to be right or wrong. Similar values tend to be held by people who share generation, geography, history or ethnicity. Values are considered to be more entrenched and thus less open to change than beliefs or attitudes. Of interest is the fact that people often hold conflicting values. For example, a teenage male may place a high value on living a long life; at the same time, he may engage in risky behaviours such as chewing khat and drinking alcohol. Health promotion programmes often seek to help people see the conflicts in their values, or between their values and their behaviour.
Attitudes are relatively constant feelings directed toward something or someone that contains a judgment about whether that something or someone is good or bad. Attitudes can always be categorised as positive or negative. For example, a woman may feel that using contraception is unacceptable. Attitudes differ from beliefs in that they always include some evaluation of the person, object or action.
The most important predisposing factor for self-regulating one’s behaviour is seen to be self-efficacy, that is the person’s perception of how successful he or she can be in performing a particular behaviour. Self-efficacy is learning why particular behaviours are harmful or helpful. It includes learning how to modify one’s behaviour, which is a prerequisite for being able to undertake or maintain behaviours that are good for your health. Health education and behavioural change programmes help a person to bring the performance of a particular behaviour under his or her self-control.
Make a list of some health beliefs that you think that some people in your own community have which affect the way they behave — in other words beliefs which pre-dispose them to have certain health behaviours.
Of course beliefs can cover a huge range. They could equally be ‘I don’t believe that smoking harms my health’ through to ‘I do believe that smoking harms my health’. The same may be true of people’s beliefs about exercise, alcohol and so on. The important thing is that beliefs don’t always coincide with facts. For example the evidence is that smoking does harm health. But many people believe that it doesn’t affect their health.