HEALTH BELIEF - IRMA KHRISNAPANDIT -

CASE STUDY
Judy, 19 tahun, telah berpacaran selama 6 bulan. Mereka melakukan
hubungan seksual dan bercakap mengenai kontrasepsi dengan malu-malu.
Pacarnya berfikir kondom sulit digunakan dan malu ketika membelinya.
Judy memutuskan untuk menggunakan pil KB. Dokter menganjurkan untuk
menggunakan keduanya (pil KB dan kondom) untuk mencegah kehamilan
dan penyakit menular seksual (PMS). Judy sangat takut hamil seperti teman
sekolahnya yang hamil diusia 17 tahun. Judy tidak khawatir akan PMS
karena ia kenal baik pacarnya dan hanya melakukan hubungan seksual
dengan pacarnya tersebut. Enam bulan kemudian, Judy mengalami keluhan
keputihan dan mengetahui bahwa pacarnya juga tidur dengan gadis lain di
kampusnya. Ia pun menjadi sangat marah
 A. WHAT ARE HEALTH BEHAVIOURS?
3 types of health-related behaviour: Health behaviours :
• A health behaviour • Health-impairing habits
a behaviour aimed to prevent disease ‘behavioural pathogens’
• An illness behaviour • Health protective behaviours
A behaviour aimed to seek remedy ‘behavioural immunogens’
• A sick role behaviour Matarazzo (1984)
Any activity aimed at getting well
Kasl and Cobb (1966)

Generally health behaviours are regarded as behaviours that are related to the
health status of the individual
WHY STUDY HEALTH BEHAVIOUR
BEHAVIOUR AND LONGEVITY
BEHAVIOR AND MORTALITY
 B. THE ROLE OF HEALTH BELIEF
• Knowledge does play a role 4 key approaches to health beliefs:
in how we behave ▪ Role of individual beliefs
• Health beliefs as the key ▪ Stage models
predictors of behaviour
▪ Social cognition models
• Knowledge alone cannot
predict or change behaviour ▪ Integrated models
and that we need to
understand the ways in
which people think about
their behaviour.
 INDIVIDUAL BELIEF
There are 4 sets of individual beliefs that related to health behavior:
1. Attribution theory
2. Risk perception
3. Motivation and self-determination theory
4. Self-efficacy
1. Attribution Theory
• The origins: “Individuals are motivated to see their social world as
predictable and controllable; Heider (1958) → there is a need to
understand causality
• Kelley (1971), attributions about causality were structured according
to causal schemata made up of the following criteria:
• Distinctiveness
determines the extent to which the cause of a
• Consensus behaviour is regarded as a product of a
• Consistency over time characteristic internal to the individual or
external to them
• Consistency over modality
Redefined dimensions of attribution:
• Internal vs external Health locus of control
• Stable vs unstable
• Global vs specific
• Controllable vs uncontrollable

Health locus of control

Individuals differ as to whether they tend to regard events as
• controllable by them (an internal locus of control) or
• uncontrollable by them (an external locus of control)
2. Risk Perception
• perception of risk and their sense of
whether or not they are susceptible to any
given health problem
• Frameworks:
• unrealistic optimism: selective focus,
egoscentrism

• risk compensation: one set of risky behaviours

can be neutralized or compensated for by
another
3. Motivation And Self-determination Theory
• An individual needs to be motivated to either start a new behaviour
or change an existing one
• SDT focuses on the reasons or motives that regulate behaviour and
distinguishes between 2 kinds of motivation
• autonomous motivations/intrinsic motivation
• controlled motivations/extrinsic motivations
4. Self-efficacy
• ‘the belief in one’s capabilities to
organize and execute the sources of
action required to manage
prospective situations’ (Bandura
1986)
• very closely related to feeling
confident in one’s ability to engage in
any given behaviour
 C. STAGE MODELS
Some models of health beliefs and health behaviour consider individuals to
be at different ordered stages and describe how they move through these
stages as they change their behaviour.

Four basic properties (Weinstein et al. 1998):

1. A classification system to define the different stages
2. Ordering of stages
3. People within the same stage face similar barriers
4. People from different stages face different barriers
 Child development

Stage models focus

Stage models of
Grief & bereavement
on the movement
behaviour

Adjustment to serious
between stages as
illness/accident an individual
changes their
Change model
behaviour.
Health Action
Processs Approach
The Stages Of Change Model (SOC) Prochaska and DiClemente (1982)
• Describing the processes involved in eliciting and maintaining change
Components If applied to smoking cessation

Pre- not intending to make any changes. I am happy being a smoker and intend to
contemplation continue smoking

Contemplation considering a change ‘I have been coughing a lot recently, perhaps I

should think about stopping smoking’
Preparation making small changes will stop going to the pub and will buy lower
tar cigarettes’
Action actively engaging in a new I have stopped smoking
behaviour.
Maintenance sustaining the change over time I have stopped smoking for four months now

• do not always occur in a linear fashion, dynamic and not ‘all or nothing
The Health Action Process Approach (HAPA) Schwarzer (1992)
The distinction:
• Motivation stage (self-
efficacy, outcome
expectancies, threat
appraisal)
• Action phase (volitional,
situational, behavioral
factor)
 D. SOCIAL COGNITION MODELS
• Examine the predictors and precursors to health behaviours and take a continuum
approach to behaviour and behaviour change.
• attempt to place the individual within the context both of other people and the
broader social world,
• Behaviour is governed by:

Expentancies Incentives Social Cognitions

Situation outcome a behaviour is governed Reflect the individual’s
expectancies by its consequences representations of their
Outcome expectancies: social world
Self-efficacy expectancies
The Health Belief Model Rosenstock (1966)
• used to predict a wide variety of
health-related behaviours

• suggests that these core beliefs should

be used to predict the likelihood that a
behaviour will occur
Protection Motivation Theory Rogers (1975, 1985)

These components predict behavioural intentions,

which are related to behaviour
The Theory Of Reasoned Action (TRA) Fishbein 1967;
Fishbein and Ajzen 1975).

• concerning the relationship between attitudes and

behaviour
• emphasized a central role for social cognitions in the
form of subjective norms
• included both beliefs and evaluations of these beliefs
The Theory Of Planned Behaviour (TPB) Ajzen and colleagues.

That intentions should be conceptualized as ‘plans of

action in pursuit of behavioural goals’ and are a result of
the following beliefs
E. USING INTEGRATED MODELS : THE COM-B Michie & Col.
F. THE INTENTION–BEHAVIOUR GAP

Past
Behaviour Specific Plan