Scattered Thoughts on Behavior Change

I have been on a quest to find cough syrup that I can take that is safe for nursing mothers to use. I have been assured two times that the cough syrup I’m examining in the pharmacy or grocery store is quite safe for nursing mothers. Two times I have bought & brought it back to my cottage and googled the active ingredients to find that (per most google results) they are not considered safe to use if you are a nursing mother. So, I now have one unopened bottle of each of the following:

Rhinathiol Promethazine

Prunol Cough Syrup

The Prunol contains ipecac, a substance that is no longer easily available (or perhaps  even at all) in the United States. This is because people were abusing it for its emetic properties (mostly people with bulimia). No information that the active ingredient was ipecac on the outside package.

Another thing that they sell here is caustic (otherwise known as lye). Collin and I looked in so many stores in the United States for this before Christmas and no one carries it anymore. You can only buy it online. People were using it to make meth or something. We just wanted to make some homemade soap for Christmas presents.

I think that raises the interesting issue of whether to pull these things form the shelf because some people are abusing them or not. Looking back on my health behavior theory class, I guess restricting accessibility is creating a barrier to an unhealthy behavior. In my opinion, this is a very basic and external way to approach an attempt at health behavior change. I guess if the consequences of the unhealthy behavior are severe and the person is unable to exercise any kind of self-control, then this can be a useful approach. It’s just a bit of a bummer for those of us who want to make homemade soap a week before Christmas.

On the upside, it limits the chances that an average American girl like myself will set out to make soap and then suddenly become overwhelmed with the desire to make homemade illicit drugs instead. Money has been tight. Kidding. Really, I don’t really have a very strong opinion on whether or not these things should be easily available or not; I just think it’s an interesting phenomenon.

It touches on important concepts related to behavior change. Like behavioral intent and beliefs, attitudes, knowledge…how do these personal factors affect the decisions that one ultimately makes? Now throw in the concept of social support and social norms and things become more complex. Add in a dash of systemic issues such as inequality, one’s role and status in society, one’s race, class, and education level. Behavior change is one crazy complex beast to tackle.

But to go back to the restriction of access to certain items that used to be considered common. I think that ultimately intent and the factors that shape one’s intent–knowledge, attitude, beliefs–these interpersonal factors overrule the presence or absence of barriers. I think that the change needs to happen on an internal level most importantly.

I think that when people intend to do something good but don’t do it–often there are self-efficacy issues, or there is a lack accurate knowledge. Perhaps these people have debilitating beliefs or unhealthy attitudes. I think that oftentimes when people intend to do something destructive they will find a way to do it whether or not it’s easy.

But I think that behavioral capability is an important consideration—the availability of the tools that people need to perform a certain behavior. For example, condoms. Access to condoms in an HIV/AIDS and sex education program is controversial. But that issue is in phase two of our study here in Kenya.

Phase one is the “social diagnosis” in health promotion terms: focus groups, interviews, and questionnaires in schools. Tomorrow we begin to distribute the consent and assent forms to students, parents, and teachers. We will have someone explaining the forms in detail in Swahili and English. The participants can all read English because that is the primary language of instruction in the schools. Swahili and English are both the national languages here.

Today we got to see Terry and Paul and their two children, Dave and Pendo. It was great to see them again after a year and a half. We keep in close contact over email during the months apart, but there’s nothing like seeing people you love face to face.

We charted out our next few weeks, and we all feel excited about the work ahead of us. And now, I’ll close with my latest favorite picture:

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