Behaviour Change Sequencing in the Household Production of Health: a Study in the Management of Child Survival in Bondo Division of Western Kenya
Abstract
In this study, we examined the sequence of health
behaviour in households in Bondo Division of the then
Siaya District of Western Kenya. Child survival is a
socio economic problem In Bondo division.
However, little is known about how health behaviour in
households contributes to the problem and how
behaviour change can be initiated to Improve child
survival rates In the area. This study focuses on the
sequence of behaviour through which household
members produce health for their children under
different levels of perceived risk. It also focuses on
the factors that influence behaviour change in the
household.
We hypothesised that there 1S a specific sequence
of behaviour thro ugh which household members
produce health in children, and that this sequence 1S
associated with the level of perceived risk posed by a
child's health problem. We then examined the factors
that influence adoption of specific health behaviour
modalities in each sequence of behaviour.
The purpose of the study was to understand the
sequence of behaviour through which household
intended to show that the prov1s10n of health care
services is not the most important determinant of child
survival rn the household. Rather, health behaviour
change is the critical factor in child survival.
The study was undertaken intermittently over a
period of three years between 1995 and 1998. One of
the objectives was to examine the sequence and
structure of health behaviour as an input into the way
household members seek to produce healthy children.
We also sought to analyse the factors that influence
disease prevention, protection from disease, detection
of disease and promotion of health in children.
The study utilized a combined quantitative and
qualitative research design which included a survey
questionnaire, direct observation, focus group
discussions and key informant interviews.
The study found that the health behaviour of
household members 1S structured into a horizontal
sequence that is associated with the perceived level of
risk of disease. The perceived level "of risk, in turn,
influences the health activities of household members.
within households were found to be income, technology,
the social network and knowledge of disease risk.
These factors determine whether or not household
members will apply specific health behaviour modalities
and activities aimed at the prevention, detection and
protection of children from disease as well as
promotion of health in children. The factors are also
associated with the perceived risk of disease and only
influence health behaviour at specific risk levels.
The study, therefore, recommends that in order to
initiate comprehensive disease control, health providers
should focus on the sequence of health behaviour and
undertake the activities that are associated with a
specific sequence of behaviour. This would enable them
to concentrate resources only at particular sequence
levels and the amount of resources will be determined
by each sequence level. This model promotes efficient
use of resources by uSing only the necessary and
sufficient resources to tackle the relevant level of risk
in the population. Long-term· health' interventions
should focus on the factors that influence behaviour
rather than the behaviour itself.
Citation
Doctor of PhilosophyPublisher
University of Nairobi, Institute of African Studies