Thursday, May 30, 2013


The baby cries due to some discomfort. Whether it is due to hunger or an uncomfortable temperature condition or an uncomfortable surface on which it is lying, is difficult to say. The baby stops crying when it is put to the breast for milk or wrapped costly and
Snugly in a warm clothing or next to the body of the mother. When the wet clothing is removed and the condition is dried up. In physiology it has been said that the sensory function is not yet fully developed in the new born and it takes almost one year for developed. However, the new born baby is not fully without
Sensations. Otherwise, it will but cry out of hunger or any discomfort. The crying response is due to the appreciation by the brain of the baby of a disturbance in the normal state of things as far as the baby is concerned for its existence. The satisfaction of a particular need or want is shown by the cessation of crying. This implies two things (1) the baby can express itself
About its discomfort by crying. The discomfort is an experience which is interpreted by the baby's brain, and (2) the removal of disturbance is also recorded in the brain and it is appreciated and, therefore, the cry stops. This experience becomes a past experience for uteri occasions and thebe by know that if it cries somebody
Will do something to remove the discomfort. When the baby grows up it is able to experience through all its sensory organs. When the eye, ear, nose, tactile and taste functions develop, the baby is able to give some meaning in its own way to every thing. This is called perception.

According to the oxford dictionary 'to perceive' means, "to apprehend by the senses; to discover; to discern." The noun, 'perception' means, "the act or faculty of perceiving through the intellect or senses; consciousness; intuition; insight." In this context it is better to know the difference between what is 'to perceive' and what is 'to think'. According to the oxford dictionary, to think
means 'to exercise or reasoning or contemplative faculty; to reason within the mind to mediate or reflect; to be of an opinion; to reason within the mind to mediate or reflect; to be of an opinion; to believe without certainly knowing; to hold in the mind’. It will be realized that the difference between perception and thinking is very subtle. By perception one is able to give meaning to what he gathered through
senses. This naturally implies a thinking process. However, when we talk of thinking we refer to what the mind thinks by reasoning. Perception will definitely have its influence on thinking. The one important difference between thinking and perception is that for perception the stimuli originate from outside the body and are received by the sense organs.
The stimuli reach the brain and get interpreted in meaningful ideas. It is at this stage that the thinking starts. With regard to various ideas crossing in the mind thinking becomes purely an internal process. In other words, perception ends up with thinking. Thinking can be the product of perception or can be by itself an internal mental process or exercise.


   We have already considered in the first chapter how every act in every living organism is either an involuntary process of life or voluntary action arising out of a particular stimulus. Such voluntary action is done in order to help the organism to find its food, find shelter and perform actions under the emotional influences and also for the sake of resting.

Voluntary action, whether repetitive and routine, or changing from time to time, is governed by the response to the stimulus. Before the action can take place there is a stage of awareness of some thing in the brain, for which a decision is taken within the brain to react suitably. The brain is capable of gathering information and uses it along with past experience and previous lesson learnt, to get into a particular behavior
For the present and future. The acquisition of information to be made use of or at least kept recorded in the brain is known as knowledge.

Dictionary meaning of knowledge is, “A clear and certain mental perception, understanding, that fact of being aware of something; experience of, acquaintance or familiarity with information of, learning that which is known, facts learned or acquired or study of.”

Knowledge, therefore, knows things, objects, events, persons, situations and every thing in the universe. It is storage of information in the brain. The means of acquiring knowledge by the brain is by perception.

It will thus be seen that perception is the act or faculty of receiving sensations and giving them a meaning in the intellect and knowledge is the accumulation of such registered information. This information may or may not be used on future occasion.

Knowledge is very much related to memory because whatever information is stored in the brain amounts to memory or retention of facts collected in the past. It is also a common experience that we form ideas on names, objects, things, persons, etc. and we associate them with related facts or information. For instance, a Cross is a symbol which brings to the mind either the crucifixion of Christ or the Church religion of Christianity. We describe the stool passed by a Cholera patient as rice water stool. This description is an association of ideas. Like this there are ever so many things in this world in which the brain is able to establish an association or relationship.


  Closely following knowledge is attitude. With the information that we have on things, objects, persons, events, etc. The mind is able to develop a sense of like or dislike, pleasure or pain, joy or sorrow, anger or hatred, etc. These are feelings which are experienced
by the mind and which make the person to be favorably or unfavorably disposed to anything. At the time the information is collected and stored in the form of knowledge the experience of the brain can be termed as 'cognitions'. The super-imposition of a feeling to cognition is called
'connation' or ‘affect'. This predisposes the individual with a tendency to act on the receipt of a stimulus arising out of an idea or person or object, event, etc. This combination of knowing about a thing and forming a tendency to react is the attitude of a person. (Attitude = Knowledge + feeling) It is thus the feeling component added to the knowledge which keeps the individual in readiness to react to a stimulus positively or negate
If the attitude is favorable towards a thing or person or object or event it means that the person not only likes to do something with that thing or object or person or event but is also ready and mentally prepared for such an action.

Attitude indicates the mental and physical disposition towards all things around individual for easy comprehension at this stage. We may consider the attitude as described above. The general trend is that attitude follows the possession of knowledge but there can also be instances when attitude has been formed without any basic knowledge. For example, when one sees a mountain one may feel desirous to climb it without knowing exactly the conditions on the mountain.

Definition of attitude. It is a relatively enduring organization of beliefs around an object or situation predisposing one to respond in some preferential manner. It is a state of preparation for discriminating any stimuli or a state of preparation for reacting as quickly as possible upon the occurrence of a definite stimulus.
Attitude organization is conceived to have 3 components:

1. A cognitive component, representing the person’s knowledge, held with varying degrees of certitude, about what is true or false, good or bad, desirable or undesirable.
2. An effective component, belief or awareness is capable of arousing effects of varying intensity centering around the object or the belief, or around other objects taking a position around the belief itself, when its validity is seriously questioned, as in an argument.
3. A behavioral component, because the belief being a response predisposition of varying threshold, must lead to some action when it is suitably activated.


    All living organisms display different types of activities. The life processes are going on within the organisms and this is what we refer to as physiology (and as pathology when it is abnormal). To support the life processes every living organism from the tiniest microbe to the most evolved man-kind manifests or engages itself in actions which are purposeful. The search for food, the ingestion of food, its excretion, going away from danger, going in search of shelter or food,
And living with other fellow-beings in harmony, etc. are the various types of action caused by the voluntary effort to do them. The in circulation of blood, digestion, etc. is necessary for the continuation of life from birth to death. It will be of interest to know that from the time the embryo is growing there is not only division and multiplication of cells but a combined process called differentiation and specialization. By this different types of tissues, organs, etc. are formed to perform different functions. Each cell, tissue and organ acts in a particular manner for the maintenance of growth and good repair other cellular activities. Cells and tissues. This can also be called behavior of the cell, tissue and organ. Such behavior of cells and tissues which goes on continuously for the continuation of life is involuntary. They are not guided or directed by any will or desire on the part of the individual. In other words, they are automatic, rhythmic, and ever continuous till death occurs. The voluntary activities, on the other hand arise out of decisions taken in the brain which are translated through selected muscles all over the body through neuro-muscular mechanism. There are also sensory impulses from the sense organ which receive information from outside to be registered in the brain. This has already been discussed under perception and knowledge.

The various voluntary movements undertaken by the body are in response to motives and decisions. They are described as a whole as behavior. Behavior can refer to every activity of the body as an individual. Similar activities are thus classified as patterns o behavior. According to oxford dictionary, behavior means, “the way in which a thing or person acts, conduct, manners, mode of behavior; reaction under a set of imposed conditions.”

In social psychology we refer to single acts as behavior and also group of acts as behavior. For instance, if a person is running we refer to his behavior with reference to the motive behind this running. We say that he is frightened or in a hurry or impatient or wanting some exercise. Depending on the motivation behind the particular act we describe the behavior as fright, impatience, etc. Also the different responses to stimuli from an object or thing or other lives in the environment are described as behavior. In other words, what a person does is behavior and it is generally described by bringing into the picture the reason for doing so. As we shall see later groups have also different patterns of reactions to stimuli.

Since behavior is mostly purposive in character it is governed or influenced by a variety of factors which are required to satisfy motives. Action is mostly need based. Even rest is based on a need of recovery from fatigue.

Purposive behavior is generally borne out of utilitarian gain for the individual or to get accepted by others who matter and with whom one has to mix and live in society. Any behavior will generally fall under these two categories, namely a behavior by which an individual has to satisfy a need or a want and a behavior which becomes necessary on the part of the individual to become and remain an accepted member of that group or society to which he belongs.

Some psychologists have identified two types of behavior in every individual depending on whether the behavior is merely a tendency to act or whether it is overtly performed and sis played, so as to be seen by others. The first type of behavior under this classification is called covert or closed behavior. In this there is a strong likelihood of the individual behaving in a particular manner and it is decided by his motivation and attitude or desire to behave in a particular manner, if it becomes necessary. In other words, covert behavior is a strong favorable attitude which is most likely to give rise to the behavior of a particular fashion.

A strongly motivated couple is very serious and keen about accepting a contraceptive method but they are probably postponing sterilization operation waiting for an auspicious day or to finish some important function at home. So the strong desire to do a thing is a covert behavior.

Overt behavior is any action which is outwardly seen and performed, because the act is done and there is no doubt about it.

There is a subtle difference between attitude and covert behavior. When covert behavior is translated into action it becomes overt behavior. It is an observable or measurable performance which is generally demonstrated by application of knowledge and skill.

It is only a very strong attitude that is very much likely to result in action that can be considered as covert behavior. Covert behavior is mostly the feeling part of action and that is why, it is very much like attitude. When action is done it becomes overt behavior.

It is common to describe an individual as pleasant, aggressive, rude, patient, sincere, etc. These are personality traits which are given as attributes to describe individuals according to their behavior on a large number of occasions. This will be something like summing up of somebody’s innate qualities and summing up of his behavior pattern by generalization.

Since individual exists alone and also as part of a group in the family or in a community, social psychologists, have observed that there is always interaction between individuals have observed that there is always interaction between individuals and groups and arising out of such interaction there are patterns of group behavior and patterns of individual behavior. By and large it has been observed that it is the group behavior which has controlling fluencies on the behavior of the individual belonging to that group. In fact, in the growth and development of man the individual learns by observing others and always tends to do as others are doing in order to be accepted in the group as an individual with normal behavior. This is important for us from two view points. This helps to understand how socialization takes place. Secondly, it helps us to understand how individual takes decisions or thinks or does things in a certain way with group acceptance.

While it has become an accepted and common practice to carry out KAP (knowledge, attitude, behavior) studies, a note of caution is also necessary to know the limitation of KAP studies. As already mentioned under attitude, the measurement of attitude can be found or made only through the behavior or through the opinion or verbal expression. The human mind is a very unpredictable one. Human behavior is also not infallible or unchangeable. Moreover, people can say something for the sake of saying but may be having just the opposite in mind. For example, a person may not like latrine but in an interview for KAP he may pretend to like a latrine and may express it that way. The answer in the question may not, therefore, bee a reflection of the person’s real attitude. Like this, there may be misleading answers even while trying to find out the knowledge content. Yes/No answers can also be misleading. Sometimes the subject matter given as answer may be knowledge acquired superficially and without proper assimilation or understanding. In the same manner even behavior sometimes may be a false behavior more to please others than arising out of a genuine motivation or desire within the self. Thus, KAP studies have some limitations. Just because some answers are given for questionnaires one cannot come to a 100 per cent conclusion.

There is yet another important aspect of KAP where the sequence may not hold good. One cannot enunciate or dogmatically emphasize tat always knowledge and attitude are necessary for behaviour. This may sound contrary to the more or less generalized rule that psychologists state that knowledge gives rise to attitude and results in behaviour. It is granted that for every voluntary action, attitude results in behaviour. The brain is conscious of what it is doing and, therefore, there is an element of knowledge and motivation to perform the act. But from the broader perspective or understanding how and why people behave in different ways, it must be appreciated that the rule is not universally applicable to every behaviour. The point that is made by this argument is that different possibilities and combinations can be come across with regard to KAP. There can be knowledge and behaviour without attitude. There can also be behaviour, even without knowledge and attitude. There can be only knowledge without attitude and behaviour. It is also possible that the behaviour takes place first and later followed either by knowledge or attitude. It is also possible that the attitude develops first even without knowledge, and behaviour follows and still later the knowledge develops.

It will be seen that whenever the behaviour or attitude procedes knowledge, it is due either t an imitation or compulsion.

In the above discussion we have been able to recognize that though there is a link between knowledge, attitude and behaviour it is possible for behaviour to happen either without knowledge or attitude, or without knowledge but with attitude. For example: (1) A rural family accepts a latrine without really knowing its significance and its utility merely for the sake of pleasing or obliging the health personnel; (2) A mother presents her children for immunization without exactly knowing what the immunization is about. She knows in a general manner that it is something good and after having seen other children being immunized she also forms a favorable attitude.

It is possible in both the above cases and similar instances that the knowledge may be acquired later, through the experience of the practice. Such experiences are also described in the theories of communication and learning. In the normal processes of socialization either in childhood or in later age periods the individual learns by seeing others and tries to do the same things such as, mere imitation, without knowing the purpose or the idea behind it; the imitation may later be followed gradually by knowing the purpose of the behaviour.

In the same way the attitude for doing a thing may already be formed or may get formed after the behaviour is manifest. It is implied in such cases that the knowledge, attitude and behaviour precede or succeed one another and it depends on different situations. Such phenomenon is quite common in conformity or in consonance with each other. In other words each one leads to the other. In such cases, it is hoped that the behaviour will be enduring and continuing, since the behaviour displayed is the outcome of a previous desired knowledge and attitude through experience or behaviour. There is no room for any mental strain or conflict. The individual or group which has such consonance of knowledge, attitude and behaviour is mentally satisfied with the behaviour and has no doubt or reservation about its genuineness or utility.

The theory of cognitive dissonance has been introduced by Festinger. The belief or opinion or idea of a subject may be viewed from two detect angels with regard to an intellectual understanding or the thing and for translating it into action. For example, when you believe in religion, you say that all human beings are equal in the eyes of God; but in actual daily life you have the caste system. These two things are in dissonance. It is only a person who has clear logic in him and who has the courage of his conviction that will treat all human beings alike and change his behaviour from castism to non-castism. When he does so there is no dissonance. Here for breaking the dissonance there was need for clear thinking. Dissonance can be removed in another way. For example, a strict vegetarian by prolonged association in the company of non-vegetarians starts eating meat much against his conscience in the beginning but gradually after having eaten meat a number of times in company rationalises his own behaviour and starts describing the advantages of meat eating. Here the behaviour changes first and slowly the attitude or opinion is brought near to the behaviour to suit it. According to this theory the element bringing about a favorable change is not familiarity or the liking but  the discrepancy between the belief and action.

There is a third way of this happening. As already mentioned a person may do something much against his own opinion or belief to suit the expectations of the group or the community and it may become a public commitment, so to say. Having done so, he starts living up to it and changes his opinion also. For example, a politician or a leader approves of a programme in a public platform though inwardly he is not in favor of the programme. Since he has made a public statement he slowly falls in line and accepts the programme. Both attitude and behaviour change because of the opinion expressed in public. While it is important to know the knowledge and attitude of an individual and groups when we want to change the behaviour, it is also equally important to know the queer complex of cognitive dissonance that occurs very often.

All these beliefs may be totally wrong according to acience but if the health educator tells the community the correct cause it will immediately create a cognitive dissonance because it will be difficult for them to dispel a deep rooted belief or idea and to accept something very new. In such a situation the dissonance should be gradually overcome by proper demonstration. Sometimes it may even be necessary to narrow down the dissonance to an extent possible, if not completely, so that people understand at least what is relevant to the programme.

For example, in the malaria eradication programme, the people are believing that malaria is due to bad water. It may be enough to show them the mosquito and relate malaria to the mosquito-bite rather than talking about a parasite, they find difficult to imagine and conceptualist. Since mosquito is commonly seen by them on the water and they are also being bitten by mosquitoes it may be easy for them to visualize that mosquitoes from bad water is giving them the malaria.

In other words dogmatic statements and one sided arguments are to be avoided by health educator. He has to say something which will support already existing ideas and beliefs and gradually introduce fresh ideas to replace wrong ones.

Cognitive dissonance is of common occurrence in the context of preventive health care and it is actually a great obstacle for the acceptance of preventive health programme. An injection or medicine or oral administration of medicine, for the care of an illness is more readily accepted by the patient than immunization by injection and prophylactic oral therapy. In the latter case the effectiveness is only to be guessed and there is no way of demonstrating it; whereas the curative care has the demonstrable effect and is, therefore, acceptable more often than not

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