Thursday, May 30, 2013


The primary motive of any living organism is to live and exist. This is one of Darwin’s theories. In the life process or growth and activity there are numerous involuntary and voluntary acts. The involuntary acts or movements within the body are controlled by the autonomous nervous system and are essential for the fundamental physiological processes of life, like breathing, circulation of blood, digestion, excretion, etc. The lowest order of living beings like the protozoa and bacteria undergo only physiological processes of absorption of food, respiration and movements in search of food. The higher order of animals like mammals and birds exhibit a variety of behavioral patterns to satisfy many of their needs beyond hunger, thirst, sex and other basic needs. They are able to interact among themselves and show friendliness, animosity, sympathy, sacrifice, etc. They are capable of such behaviour because of their better evolved intellect which is able to perceive some needs beyond the mere biological needs. Still higher animals like primates and man have different aspirations in life and pursuits to satisfy their ego. When the highest order of animal is reached the behaviour is governed by the need of satisfying’ the want or desire as perceived by the five senses and also the intellect. If a man wants to commit a theft it is not a physiological want that he is satisfying but something beyond. The motive for theft may be acquisition of wealth or property or competition, jealousy, love, etc. The person who commits theft is driven to do it because of a strong urge to perform the act of theft. His conscience may not permit it in the beginning and he may think of various bad things associated with theft and its consequence but at the time of committing the theft, his own selfish motive to get rid of some one else dominates all other feeling in him.
It is this direction of the mind as a strong force of feeling towards a particular act or goal which is called motivation. If there is no

Motivation a particular act will only be contemplated but not be performed. Motivation is, therefore, that stage in the thinking process which gets sufficient intensity to direct the body to do a particular thing to satisfy the perceived want. In social psychology, motivation has a special meaning, if a person does an act merely to please other persons or obey but does not feel like doing so him self, the motivation is lacking. Only when a person performs an act out of his own volition and is determined to achieve something out of that act, can we call it motivation.
To sonic extent every act routine, spontaneous or deliberate, whether it is of very minor significance or major, is the result of a motor force originating from the motor cortex of the brain. In other words, all purposive movements are motivated. However, in social psychology, motivation is not used in the general physiological sense. Motivation is associated with a social and psychological component. It is, therefore, pertaining to an act which denotes a change of behaviour or an acceptance of a new idea for translating into action. Further in social psychology we refer to motivation as a combination of forces rather than a single force which determine the change of behaviour towards a goal. To understand the concept of motivation which has been defined by Lindsay as, ‘a combination of forces which initiate, direct and sustain behaviour toward a goal,’ we have to realize that there are certain forces (psychological) arising from within the individual and various other forces from outside which due to a close interaction may result in a strong force which may motivate or make the person change his attitude and behaviour, If the forces outside and inside result by interaction in an unfavourable disposition there will be no motivation.
it is also implied that when we talk of motivation we refer to a state of mind in which after considerable analysis, and deliberation a strong force has resulted which is capable of a continued or’ sustained change of behaviour. That is why we always refer to the process of motivation as a necessary precursor of change of behaviour. Generally when a person is referred to as having been motivated, we consider that he has been sufficiently (or strongly) motivated to render himself liable for a change in behaviour.
To give the example of the inner forces and outside forces we can think of a sick person who may or may not go for treatment. In this case, the inner forces are discomfort, pain, etc. The Outer farces are the awareness of the possibility of getting treatment, and the result of treatment, the confidence in the person who will treat, etc. There may be certain discouraging factors like cost, distance, fright,

60 Health Education: A New Appr

doubt, lack of faith, etc. Such forces have to play on the mind of the sick person and if he is sufficiently convinced about the benefit of treatment, about his financial capacity to undergo it, about the faith in the doctor and above all if his pain and discomfort are so intense that he will feel strongly urged to go in for treatment, then he gets motivated. In such a situation the person who gives health education has to take into consideration, all the influences or forces and discuss then’ with the sick person in such a way that he decides to going for treatment.
Behaviour is looked upon as an activity which arises when there is a state of tension in the organism. Activity itself is looked upon as tension reducing. When the activity leads to reaching of the goal, at that time the organism becomes quiet. It is, therefore, necessary for motivation that there should be a state of tension or disturbance. Wants, desires, urges, needs, drives, striving, etc., are used to describe the internal psychological tension creating factors.
The needs can be broadly classified into biogenic and sociogentic needs. The biogenic needs are physiological needs like hunger, thirst, etc. Eating is a behaviour arising out of a biogenic motive. How we is is the result of sociogenic factor. We develop habits of eating certain things and not eating certain things. We develop ways of eating. Such behaviour arises from sociogenic motive. Motives are the urge tf the mind to do a-thing or behave in a particular manner.
Physiological or biogenic motives. Whatever the cultural pattern may be, whether it is western or eastern, industrialised or very primitive, rich or poor, certain universal activities are purely biogenic. Sleeping, seeking shelter, trying to protect from sun, rain and wind, etc. are efforts at sustaining life as a biological organism. It is a reaction to an organic at homeostasis equilibrium. Another distinguishing feature of physiological drives is that they are innate and not learned to start with. They may later on be modified by conditioning. Even though food serves to satisfy hunger, a primitive need, type of food which you look for to satisfy this need is conditioned by the culture in which you live.
Sociogenic needs. Human beings belong to a group and strive to acquire a position or status and their day-to-day activities of work, rest recreation, etc., are effected by the social setting. Social motives are those that provide for group life, particularly the interaction with other organism’s o the species also. Physiological motives are more primitive in the hierarchy of Maslow.. Physiological motives are ranked thereafter.
Motives which prompt the individual to interact with others in

Motivation, Decision Making and Defence Mechanism 61.

the society are social motives. Playing different roles and exhibiting different types of behaviour- affection, dominance, submission, anger, etc. Among social motives some are meant for survival of the species and may not be very important to individual himself. For example, maternal love, domination and submission. 
Motives integrated or identified with self or ego development is more important for the individual. Namely: (a) the need for affection, (b) self assertion, (c) desire to grow, to raise the status, to lead fuller life, etc., (d) desire to help others, (e) desire to do outstanding things in life.
According t. Maslow, the human drives are in a hierarchy follow ing human development as follows:

1.   Basic physiological needs—needs basic to physiological survival such as         food, air, water, rest, exercise, shelter, etc.
2.   Safety needs—needs for protection from danger, threat, deprivation.
3.   Social and biological needs—needs for association, for acceptance of one’s   fellows, for giving. and receiving, friendship, love and affection.
4. Self esteem and recognition needs—for self respect, self achievement,            prestige, competence, knowledge status, appreciation.
5.   Self-fulfillment needs—this is still higher than the self esteem and       recognition needs. Needs for realizing one’s full potentialities, what is      known as self-actualization. Trying to be creative to the fullest possible     extent and do outstanding things. It is said that depending on the     development and evolution of a person’s mind and behaviour these drives             are perceived in this order and that lower order of drives when satisfied may give rise to the higher order of drives.

It is needless to say that social drives are affected by social norms and culture. Also that many motives are learned from past experiences. Motives are influenced by (1) incentives—conditions set up in order to alter behaviour of individuals—may be positive and negative. Positive—rewards and gains, praise and appreciation. Negative—loss, failure, disappointment, frustration, disapproval, reproof, etc. (2) competition, (3) cooperation, (4) rivalry and jealousy.
Though broadly we say that motives determine patterns of behaviour it s very difficult indeed to single out separately one motive and one action as a one-to-one relationship. Every individual tends to react as a total organism; and a complex of conscious and unconscious

motivating forces seem to underlie his every action.
The educator has to identify motives in individuals and draw them or arouse them so that behaviour can be changed. Motives can be influenced by a certain extent by creating a sense of discomfort or making it appear to the individual that things as they are, are not all right and are not going to be all right till a particular course of action is taken by the social forces in which he lives.
Forcing an individual by an external force is against the very principle and Maslow says that his inner urge influences his action. Only influence that affects them is the social influence, which may affect him to some extent.
Deficiency and abundancy motives. While Maslow described a step ladder pattern or hierarchy of levels of needs and drives, krutch Field has described the same by dividing all needs and motives into two broad categories of deficiency motives and abundancy motives. According to this classification the basic requirements for survival and security become the deficiency motives and whatever motive arises in the mind after the basic motives have been satisfied and classified as abundancy motives. They have further classified these deficiency and abundancy motives. They have further classified these deficiency and abundancy motives under four areas as follows:

Survival and Security
(deficiency motives)

Satis faction and Stimulation
(abundancy motives)
Pertaining to
the body

Avoiding of hunger, thirst, oxygen lack, excess heat and cold, pain, overfull bladder and colon, fatigue, over tense muscles, illness and other disagreeable bodily states, etc.  

Attaining pleasurable sen-sory experiences of tastes, smells, sounds etc; sexual pleasure; bodily comfort; exercise of muscles, rhyth-mical body movements, etc.
Pertaining to relations with environment

Avoiding of dangerous ob-jects and horrible, ugly and disgusting objects; seeking objects necessary to future survival and security; maintaining a stable, clear, certain environment, etc.

Attaining enjoyable posses-sions constructing and investing, objects, under-standing the environment; solving problems playing games; seeking environmen-tal novelty and change, etc.
Pertaining to relations with other people

Avoiding interpersonal con-flict and hostility; maintaining group membership, prestige, and status; being taken care of by others; conforming to group standards and values; gaining power and dominance over others, etc.

Attaining love and positive identifications with people and groups; enjoying other people’s company; helping and understanding other people; being independent, etc.

Motivation, Decision Making and Defence Mechanism 63.

Pertaining to the self

Avoiding feelings of infer-iority and failure in com-paring the self with others or with the ideal self; avoiding loss of identity; avoiding feelings of shame, guilt, fear, anxiety, sadness, etc.

Attaining feelings of self respect and self confidence expressing oneself; feeling sense of achievement; feeling challenged; establishing moral and other values; discovering meaningful place of self in the universe.

        Thus, we have seen that for a positive course of action or behaviour to take place in a sustained manner the mind has to undergo considerable thinking process. The thinking process is due to a variety of internal and external forces. The most essential factor that is at the base of any change of behaviour is the need or tension-creating factor. However this need itself has to be felt by the individual as a need. If it gets a low priority or importance in the mind of the individual there is not uh change of behaviour or action to satisfy it.
        For example, when a person is busily engaged in his work and is passing through a critical stage and also he is rushed for time or does not have enough money with him it is very unlikely that he will attach any importance to a minor ailment or pain and seek treatment. In that context his mind will feel the need for the business much more than the need for treatment of the ailment. On the contrary, if the pain is unbearably severe and does not permit the man to do his normal work, it will get top priority and he will be motivated to go for treatment at whatever cost.For every decision to be taken for change of behaviour the individual is subject to internal influences and influences from outside. The internal influences are from the individual perception or private world.

64 Health Education: A New Approach

        The external forces are a multiplicity of social, economic and physical forces. Kurt Lewin has given a scientific description of these forces as in a magnetic field. He compares them to the positive and negative magnetic waves and says that a set of forces which are stronger will decide the occurrence of motivation or otherwise.
In the following the forces acting on a patient of leprosy, the f .r1 cc the community with regard to leprosy and the forces acting on the health worker are depicted to show how motivation n take p or be restarted. Arising out of a study of such forces the action to be taken by the health educator for proper motivation is described.Apart from this an attempt is also made to depict the inner feelings of the workers in the leprosy department who are supposed to provide the diagnostic and treatment facilities.

Motivation, Decision Making and Defence Mechanism 65.

By understanding these restraining forces, driving forces and neutral forces which are influencing the life space or the force field of individual, patient, family, community and leprosy worker, the Health Educator can bring desired changes in it to achieve the aim and objective of the Leprosy Control Programme.
The following are the steps in effecting the change:
1. Analyzing the present or existing situation by studying the various driving forces and restraining forces.
2. Determining the changes required.
3. Making the changes indicated by
(a) Reducing and removing the restraining forces,
(b) Strengthening or adding driving forces,
(c) Changing the direction of forces.
4. Stabilizing the new changed state.
        App1icazion. This theory of Kurt Lewin’s is of vital importance to any educator whether in the field of general education or Community Development or Health Education. It is this theory that opens the eye of the educator to the fact that education is not mere transfer (pumping) of information. Since education implies a change of behaviour and since behaviour depends on the multiplicity of internal and external forces, the educator has to base his education on a proper diagnosis of all such forces. The study of the various factors (that are favourable or unfavourable)) has to be carried out before any health education programme can be introduced. Generally we refer to such studies as
66 Health Education: A New Approach

        The same concept of multiplicity of forces responsible for motivation has been dealt with in a slightly different manner by Rosenstock (Rosenstock principle). There are three components in this.
        First, it is considered necessary that a person should understand that he is susceptible or he is already under the influence of some disturbing force. It is such a disequilibrium or discomfort that can initiate the process of motivation. Rosen stock refers to this as ‘perceived susceptibility’. This is necessary with regard to health. Unless somebody realizes that he is either susceptible or already undergoing the disease process, it is very unlikely that he will think of any treatment or remedial measure.
        According to Rosenstock, it is not enough if the susceptibility is perceived. The next component is the ‘perceived severity’ or intensity of the discomfort. In fact, it is this component which has greater significance than the perceived susceptibility itself. In some persons who are highly sensitive and widely aware the perception of susceptibility may be enough to motivate towards treatment. In the majority of’ people, however, it is the perceived severity of the condition which actually prompts further action and therefore can be called the trigger point of motivation.
        Rosenstock goes further to state that for a person to seek treatment or seek a solution to the problem he should also be aware of a possible solution within his reach. Otherwise his mind may not try to seek treatment.
        To quote an example a patient suffering from tuberculosis may or may not be aware of the severity of the condition that he is suffering from. Even if he is aware of the condition he is not likely to go in search of treatment unless he knows that there is a treatment available and possible and also that the treatment is sure to give him beneficial results without undergoing any pain or trouble.
        In fact, in the control of tuberculosis we have a high defaulter rate (cases of drop outs after initial treatment) because the treatment regimen is too prolonged and the patient is not sure of complete cure. In some cases, it also happens that there is a rapid remission or lessening of symptoms with a few months’ treatment. And the patient feels that he has been cured and stops treatment because he does not perceive the severity of the condition any more.
        The principles of Rosenstock and Kurt Lewin are more or less the same. In both we find that there are forces acting for and against a particular behaviour—Kurt Lewin’s theory is more comprehensive and generalized in that it includes all the forces arising within the individual and from outside. In Rosenstock’s principle the forces are

Motivation, Decision Making and Defence Mechanism 67.

Arranged in a pattern mostly related to the individual only and his perception and it is implied that his perceptions are influenced by the external forces.
        As has been mentioned in the definition of motivation by Lindsay there are three stages that can be identified in a process of motivation. The first stage is that of ‘initiation’. In this the mind starts thinking as to whether a change in behaviour is of utilitarian gain or not. This is closely following the formation of attitude which is further subjected in the mind to the other forces in society and in the physical environment. For the initiation stage the main requirement is the creation of a tension or discomfort which is otherwise known as need, want or desire, etc. It is only when the tension mounts up and there is a great urge for relief from tension that the initiation of motivation occurs.
        The second stage is that of ‘direction’. In this the behaviour is directed towards the attainment of the goal. In other words, the behaviour is so patterned or organized that it is possible to reach the goal. It means that the individual is aware of the solution to the problem and that he wants to apply himself to the solution.
        The third stage is that of ‘sustained behaviour’. This means the individual is accustomed to behave in the same manner after having experienced and realised the beneficial results of the changed behaviour. Since he is mentally and physically convinced of the results, he is encouraged to prolong the same behaviour which gets reinforced further and further with that same experience.
        It may be worthwhile now to recapitulate the Rosenstock principle and appreciate its correspondence to these stages. The initiation stage corresponds to the existence of a perceived susceptibility and perceived severity. The direction stage corresponds to perceived means for the solution or effective ways to overcome the risk.
        Though the third stage may not be possible to correlate to the Rosenstock’s principle we can extend the concept by saying that continued provision of facilities and follow up services are necessary for reinforcement to ensure sustained behaviour.
        Further while discussing motivation psycho-socialists have described a health belief model as shown in the diagram on page 68.
        In this diagram one can appreciate the synthesis of Kurt Lewin’s and Rosenstock’s principle. For a person to be motivated for a change of behaviour for the improvement of health, a realization of lack of health, its severity and consequence, it is necessary to initiate the process of motivation. It is the awareness of the availability and possibility of suitable remedial measures that lead the individual

68 Health Education: A New Approach

Towards that course of action. There may be many barriers in the form of physical disadvantages or social perception, Prejudices, habits, attitude, etc., which may try to counteract the positive force. It is Only if the motivating force is stronger than all the barrier forces that the real motivation with its direction and behaviour can take place.

Decision Making
        For every voluntary action there is a need for a motor stimulus in the brain. In other words, we can say that every action is preceded by a decision in the train. All the motor movements are the results of stimuli.
        However in social psychology and social sciences including administration, political science, etc., decision means settlement, firmness and stability of purpose, resolution.
        Decision is used largely with reference to vital issues, when sufficient thought or examination on the merits and demerits •of course of action precedes the judgment. Decision making is an important topic for discussion. It is a complex process consisting of certain internal process of the individual and group and some external forces.

Motivation, Decision Making and Defence Mechanism 69.

It is a process of committing oneself to a particular course of action or behaviour to achieve a particular goal. It is defined as commitment to carry out a specific task or to adhere to a particular course of action in the future. It can be used with reference to an individual, to a group or any organization. In public administration decision making is a very important aspect of function of management. In social psychology the term decision making is used with reference to individual or groups. Though decisions are required in almost all our activities, they assume special importance for important vital matters. For example, while, whether to eat or not, to eat at a particular time or not, etc., is a minor affair and not very difficult to decide, to undergo vasectomy is a major event which requires careful consideration of the advantages and disadvantages.
        The decision making is used with reference to the final judgment a person has to make with regard to a change of behaviour or adoption of new practice. It will be appreciated that decision making is an indivisible component of motivation and adoption process.
        Psychologists have tried to demarcate 3 phases in the decision making process. There is a predecisional phase, a decisional phase and post decisional phase. In the pre-decisional phase the individual analysis within him self the good and bad of the particular behaviour or action that is recommended. In this analysis his own perception are set against what the group or community feels on the subject. The individual tries to find out whether his own gain by adopting the behaviour will meet with the approval of the significant others or he tries to find out what the significant others would unanimously like and also his own personal gain. In tbe decisional phase the individual comes to a conclusion that the particular course of action is not only advantageous but is an immediate must, at least from the self utilitarian point of view. So he decides finally to adhere to the course of action. This applies to the group also in taking a group decision.
        After having taken a decision it is not as if the mind immediately comes to rest and feels fully satisfied or complacent. The experience by having taken the decision and fohowed a course of action brings to mind the good and bad points again, the gains, and losses, advantages, disadvantages, etc. Apart from the meaning it gives to the self by way of personal gain or loss, prestige, admiration, etc., the individual is also interested in what the significant other and the group feels. If a disapproval or adverse criticism creates a disturbance in the mind it is a ‘post decisional conflict’. Even a personal disadvantage or lack of utilitarian gain for the individual himself may cause a post decisional conflict, from which the. Individual would like to relieve

70 Health Education: A New Approach

himself. The relief can be had either by reversing the decision, which means giving up the new behaviour, or by making suitable mental adjustment to reconcile to the situation. Such reconciliation or adjustment can take place through a suitable defence mechanism. In other words the post decisional conflict can either continue to be a strain or conflict to the individual and gradually wear out or can undergo a resolution by means of suitable psychological defence mechanism in which the mind undergoes a process to narrow the cognitive dissonance.

 In considering the group or community we can think of the 3 levels of decision making. (1) At individual level (micro level) decision are taken in accordance with one’s own judgment taking into account the personal gains and the group acceptance. (2) At the group level decisions are taken after collective discussions and thinking. Such decisions are necessarily of common interest and are fully binding on every individual member. There is no scope for extreme views. The majority opinion or consensus forms the decision. (3) At the macro or mass level, the decisions are usually taken b prominent and influential opinion leaders. It is not necessary that such decisions are fully accepted by everybody in the macro level but majority of the people abide by such decisions because they have been taken by influential people.
        Sometimes pressure groups have sway on the mass (or) entire community. For example, a leader takes a decision on behalf of the group. In a democratic set up the group takes a decision-which is applicable to every individual. A group of legislators take a decision for the entire mass.
        Important theories that are decision making are
        1. Kurt Lewin’s Force Field Theory.
        2. Festinger’s Cognitive Dissonance.

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