Understanding behaviour: the key to successful health education.

Effective health education requires an understanding of the factors which underlie a person's behavior. This paper describes "BASNEF," a simplified approach to understanding behavior, which is based on the PRECEDE model and on Value Expectancy Theory. Value Expectancy Theory holds that people will only perform a given behavior if they themselves see that it will provide benefits according to their perception of their situation and needs. Community beliefs and values may differ from those of health care workers. The perceived likelihood of different consequences of an act and the relative values of those outcomes determine the individual's attitude towards that act. The subjective norm consists of the net balance of the perceived attitudes of other people concerning the act. The person's attitude and the subjective norm must be balanced to arrive at the behavioral intention, the decision of whether or not to perform a behavior. Applying the BASNEF approach requires determining community perspectives regarding the behavior. The behavior must be defined as specifically as possible, and the materials and knowledge required for a motivated person to carry out the behavior must be considered. Some behaviors can be identified in which it is unrealistic to expect a change. The 1st priority must be toensure that all the enabling factors required for a motivated person to carry out the behavior, such as time, materials and education, are available. Social pressures must be addressed, particularly the opinions of influential persons. Changing the individual's beliefs and attitudes must come last. The proposed behavior may need to be modified to be acceptable. It is difficult to change beliefs which arise from direct experience, wider belief systems or which have been held for a long time. This BASNEF model can be used to design health education programs based on an understanding of the community.