Behaviour change sequencing in the household production of health: a study in the management of child survival in Bondo Division of Western Kenya
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.