Health Belief Model

explaining health behaviors History and Orientation The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services. The model was developed in response to the failure of a free tuberculosis (TB) health screening program. Since then, the HBM has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS. Core Assumptions and Statements The HBM is based on the understanding that a person will take a health-related action (i.e., use condoms) if that person: 1. feels that a negative health condition (i.e., HIV) can be avoided, 2. has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., using condoms will be effective at preventing HIV), and 3. believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence). The HBM was spelled out in terms of four constructs representing the perceived threat and net benefits: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. These concepts were proposed as accounting for people's "readiness to act." An added concept, cues to action, would activate that readiness and stimulate overt behavior. A recent addition to the HBM is the concept of self-efficacy, or one's confidence in the ability to successfully perform an action. This concept was added by Rosenstock and others in 1988 to help the HBM better fit the challenges of changing habitual unhealthy behaviors, such as being sedentary, smoking, or overeating. Table from ³Theory at a Glance: A Guide for Health Promotion Practice" (1997) Concept Definition One's opinion of chances of getting a condition One's opinion of how Application Define population(s) at risk, risk levels; personalize risk based on a person's features or behavior; heighten perceived susceptibility if too low. Specify consequences of the

Perceived Susceptibility

Perceived

Severity

serious a condition and its consequences are One's belief in the efficacy of the advised action to reduce risk or seriousness of impact One's opinion of the tangible and psychological costs of the advised action Strategies to activate "readiness" Confidence in one's ability to take action

risk and the condition

Perceived Benefits

Define action to take; how, where, when; clarify the positive effects to be expected. Identify and reduce barriers through reassurance, incentives, assistance. Provide how-to information, promote awareness, reminders. Provide training, guidance in performing action.

Perceived Barriers

Cues to Action Self-Efficacy

Conceptual Model

Source: Glanz et al, 2002, p. 52 Favorite Methods Surveys. Scope and Application

The Health Belief Model has been applied to a broad range of health behaviors and subject populations. Three broad areas can be identified (Conner & Norman, 1996): 1) Preventive health behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking) behaviors as well as vaccination and contraceptive practices. 2) Sick role behaviors, which refer to compliance with recommended medical regimens, usually following professional diagnosis of illness. 3) Clinic use, which includes physician visits for a variety of reasons. Example This is an example from two sexual health actions. (http://www.etr.org/recapp/theories/hbm/Resources.htm) Concept 1. Perceived Susceptibility 2. Perceived Severity Condom Use Education Example Youth believe they can get STIs or HIV or create a pregnancy. Youth believe that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid. Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy. STI Screening or HIV Testing

3. Perceived Benefits

4. Perceived Barriers

5. Cues to Action

Youth believe they may have been exposed to STIs or HIV. Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid. Youth believe that the recommended action of getting tested for STIs and HIV would benefit them ² possibly by allowing them to get early treatment or preventing them from infecting others. Youth identify their personal Youth identify their personal barriers barriers to using condoms (i.e., to getting tested (i.e., getting to the condoms limit the feeling or they clinic or being seen at the clinic by are too embarrassed to talk to someone they know) and explore their partner about it) and explore ways to eliminate or reduce these ways to eliminate or reduce these barriers (i.e., brainstorm barriers (i.e., teach them to put transportation and disguise options). lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level). Youth receive reminder cues for Youth receive reminder cues for action in the form of incentives action in the form of incentives (such as pencils with the printed (such as a key chain that says, "Got message "no glove, no love") or sex? Get tested!") or reminder reminder messages (such as messages (such as posters that say, messages in the school "25% of sexually active teens newsletter). contract an STI. Are you one of

6. Self-Efficacy

Youth confident in using a condom correctly in all circumstances.

them? Find out now"). Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment).

Health Belief Model
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The Health Belief Model is a health behavior change and psychological model developed by Irwin M. Rosenstock in 1966 for studying and promoting the uptake of health services.[1] The model was furthered by Becker and colleagues in the 1970s and 1980s. Subsequent amendments to the model were made as late as 1988, to accommodate evolving evidence generated within the health community about the role that knowledge and perceptions play in personal responsibility.[2] Originally, the model was designed to predict behavioral response to the treatment received by acutely or chronically ill patients, but in more recent years the model has been used to predict more general health behaviors. [3]

[edit] Constructs

The Health Belief Model.

The health belief model, developed by researchers at the U.S. Public Health Service in the 1950s, was inspired by a study of why people sought X-ray examinations for tuberculosis. The original model included these four constructs:
y y y y

Perceived susceptibility (an individual's assessment of their risk of getting the condition) Perceived severity (an individual's assessment of the seriousness of the condition, and its potential consequences) Perceived barriers (an individual's assessment of the influences that facilitate or discourage adoption of the promoted behavior) Perceived benefits (an individual's assessment of the positive consequences of adopting the behavior). A variant of the model include the perceived costs of adhering to prescribed intervention as one of the core beliefs.

y

Constructs of mediating factors were later added to connect the various types of perceptions with the predicted health behavior:
y

Demographic variables (such as age, gender, ethnicity, occupation)

y y y

y y y

Socio-psychological variables (such as social economic status, personality, coping strategies) Perceived efficacy (an individual's self-assessment of ability to successfully adopt the desired behavior) Cues to action (external influences promoting the desired behavior, may include information provided or sought, reminders by powerful others, persuasive communications, and personal experiences) Health motivation (whether an individual is driven to stick to a given health goal) Perceived control (a measure of level of self-efficacy) Perceived threat (whether the danger imposed by not undertaking a certain health action recommended is great)

The prediction of the model is the likelihood of the individual concerned to undertake recommended health action (such as preventive and curative health actions).

The health belief model, developed by researchers at the U.S. Public Health Service in the 1950s, was inspired by a study of why people sought X-ray examinations for tuberculosis. It attempted to explain and predict a given health-related behavior from certain patterns of belief about the recommended health behavior and the health problems that the behavior was intended to prevent or control. The model postulates that the following four conditions both explain and predict a health-related behavior: 1. A person believes that his or her health is in jeopardy. For the behavior of seeking a screening test or examination for an asymptomatic disease such as tuberculosis, hypertension, or early cancer, the person must believe that he or she can have the disease yet not feel symptoms. This constellation of beliefs was later referred to generally as "belief in susceptibility." 2. The person perceives the "potential seriousness" of the condition in terms of pain or discomfort, time lost from work, economic difficulties, or other outcomes. 3. On assessing the circumstances, the person believes that benefits stemming from the recommended behavior outweigh the costs and inconvenience and that they are indeed possible and within his or her grasp. Note that this set of beliefs is not equivalent to actual rewards and barriers (reinforcing factors). In the health belief model, these are "perceived" or "anticipated" benefits and costs (predisposing factors). 4. The person receives a "cue to action" or a precipitating force that makes the person feel the need to take action. 1. feels that a negative health condition (i.e., HIV) can be avoided, 2. has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., using condoms will be effective at preventing HIV), and 3. believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence).

The model soon changed shape when applied to another set of problems concerning immunization and more broadly to (the variety of) people's different responses to public health measures and their uses of health services. In these wider applications, the model substituted a belief in susceptibility to a disease or health problem for the more specific belief that one could have a disease and not know it, which had been featured in Godfrey Hochbaum's original study as the most important belief accounting for seeking screening examinations. In the mid-1970s, a monograph devoted to the wide-ranging applications of the model described its history and experience (Becker, 1974). This was soon followed by a review of the standardized scales for measuring its several dimensions (Maiman et al., 1977). The model continued to evolve into the 1980s, largely at the hands of Marshall Becker at Johns Hopkins University and later at the University of Michigan School. The Health Belief Model relates largely to the cognitive factors predisposing a person to a health behavior, concluding with a belief in one's self-efficacy for the behavior. The model leaves much still to be explained by factors enabling and reinforcing one's behavior, and these factors become

increasingly important when the model is used to explain and predict more complex lifestyle behaviors that needs to be maintained over a lifetime. A systematic, quantitative review of studies that had applied the Health Belief Model among adults into the late 1980s found it lacking in consistent predictive power for many behaviors, probably because its scope is limited to predisposing factors (Harrison, Mullen, and Green, 1992). One study that specifically compared its predictive power with other models found that it accounted for a smaller proportion of the variance in diet, exercise, and smoking behaviors than did the theory of reasoned action, theory of planned behavior, and the PRECEDE-PROCEED model (Mullen, Hersey, and Iverson, 1987). Nevertheless, the health belief model continued to be the most frequently applied model in published descriptions of programs and studies in health education and health behavior in the early 1990s. It has since been displaced in frequency of application by the transtheoretical model of stages of change. It remains, however, a valuable guide to practitioners in planning the communication component of health education programs.