Individual health beliefs

Presenter
Dr kamal Eldin Hussein

Date : March, 2022

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Our Objective
By the successful completion of this
presentation, you are expected to:
Specific Learning

1.Explain the concept of health belief

model, individual perception and its modifying
Outcomes

factors
2. Describe how the health beliefs of
an individual can affect the management
of health and disease
3. Describe how the health beliefs of
an individual can be changed to improve health

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 Behavioural factors affecting longevity
(how long we live)
q Belloc & Breslow (1972) found a correlational
relationship between mortality rates and behaviour
in a study of 7,000 people
q The seven health behaviours identified - show a
correlation with mortality in a prospective study
carried out at 5.5 and 10years follow-up
1.Having breakfast every day
2.Not smoking 3.No use of alcohol
4.Rarely eating between meals
5.Being near or at prescribed weight
6.Taking regular exercise
7.Sleeping 7-8 hours a day

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 Theories of health belief
Approaches
• Social – how others influence our behavior this
the main approach
• Cognitive – assumes that we think through our
actions logically, before rationally choosing a
behavior to adopt
• Do we always think logically ? No, There are still
times where we will choose to adopt an illogical
behaviour
What are Health Beliefs?
What are Health Beliefs?

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 Psychology and Health Beliefs.
Psychologists have been interested in finding out what
beliefs are behind:
1. Reasons for going or not going to the doctor
2. Decision making behind unhealthy or healthy
behaviours (It is okay to eat cake all day because I
deserve it)
3. How seriously we view different illnesses (I fear all
cancer because it kills you)
4. Beliefs based on religion or culture
5. A range of different health beliefsand water)
 3 lifestyle theories
If we know what people believe we have more chance of
understanding and predicting their behaviours and then
possibly changing those behaviours!
To explain our adoption of health behaviours
• Health belief model – predicts uptake of health behaviours
based on several factors
• Locus of control – where people believe their health is
controlled by themselves or others
• Self–efficacy – how effective people believe they will be in
changing their behaviour directly influences their tendency
to change

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 The Health Belief Model
In the 1950s psychologists started to investigate why so many
people ignored preventative health campaigns such as free
tuberculosis screening!
Tuberculosis screening.
ü At the beginning of the twentieth century tuberculosis (TB)
was a major cause of death.
ü Later when screening and treatment became readily
available, people did not go for screening
ü They did not go even when the screening came to them in
the form of mobile units which came to where they lived and
all they had to do was to step out of their homes and walk a
few metres to be X-rayed for the disease
.

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 The Health Belief Model
qHochbaum (1958) first developed a model about
health beliefs when he found that:
1. Those who believed TB was very dangerous
2. Those who believed they were susceptible to
developing TB
3. Those who believed x-ray screening was useful in
early detection
4.Those who perceived few barriers to attending the x-
ray
Ø Were most likely to attend for screening.
 Health Belief Model (HBM)
Developed in 1950s by social psychologists (Godfrey
Hochbaum, Irwin Rosenstock, Stephen Kegels) working in
the U.S. Public Health Services in response to the failure of a
free tuberculosis health screening programme.
Focus is on individual’s decision to avoid a negative health
consequence and considers the following factors identified by
Hochbaum (1958) as deciding whether a person would attend
for screening:
• Severity
• Susceptibility
• Costs/Benefits
• Barriers
 Health Belief Model
v Adopts the Cognitive approach
Why people did or did not go for tuberculosis screening. The four
factors: severity , susceptibility, costs/benefits, barriers -
indicated how serious they perceived TB to be to their health.
Serious threat to health = screened and treated
Beck and Rosenstock developed the HBM from this study on
tuberculosis screening
v The HBM has been since adapted to explore various long-
term and short-term health behaviours, including:
ü Cervical cancer screening
ü Behaviours associated with high risk for CHD
ü Managing diabetes and Sexual risk behaviours
ü Transmission of HIV/AIDS and many others

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 Core assumptions of HBM
A person will take a health-related action (i.e. take regular
exercise) if the person:
Ø Feels that a negative health condition can be avoided (e.g.
CHD)
Ø Has a positive expectation that by taking the
recommended action, he will avoid the negative health
condition (e.g. exercise will prevent CHD)
Ø Believes that s/he can successfully take the recommended
health action (e.g. is able to exercise regularly without
unreasonable effort)

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 Factors affecting adoption of health behaviours:
q There are 2 aspects to any perceived threat to health
ü Perceived seriousness (will it actually kill me)
ü Perceived susceptibility (am I likely to get it)
q Also Cost benefit analysis
ü The cost and benefits of adopting a behaviour are
weighed up and the individual decides whether the costs
outweigh the benefits
q Barriers
How difficult is it for me to engage in these behaviours?
This may include distance to health facility or feeling
embarrassed about having a medical examination
.

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The four constructs of the HBM:
The 4 constructs of the HBM were defined as the person’s
„readiness to take action”.
Perceived severity
Perceived susceptibility
Perceived benefits and
Perceived barriers
Example : Jane is not likely to continue smoking because
ü She thinks that she might get lung cancer if she continues to smoke
(susceptibility).
ü She believes that dying from lung cancer is terrible (severity).
ü Jane does not find smoking very pleasurable (cost/benefits).
ü Her friends are supportive of her giving up (absence of barrier)

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 John is likely to continue smoking because:
ü He agrees with the tobacco industry--smoking doesn’t cause lung
cancer (susceptibility).
ü He believes that dying from lung cancer is not any worse than any
other way of dying (severity).
ü John feels that smoking relaxes him (cost/benefits).
ü His friends offer him cigarettes (barrier to quitting)
However There are other factors that influence our health
beliefs. These can be :-
Cultural
Related to age
Related to gender
Or information from the media

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 Health Motivation: The individual’s general interest
in health matters, which may correlate with
personality, social class, ethnic group, religion etc
Demographic variables: Can influence the final
decisions e.g. income, age, sex, occupation,
education, family size
External and internal cues may remind us about the
behaviour. TV adverts and Period of ill health
ü External Cues :Trigger factors such as alarming
symptoms, advice from family or friends,
messages from the media, disruption of work or
play.

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 The Health Belief Model
was then developed by Becker 1970
Becker added other factors to the HBM: Factors which affect
our beliefs / decisions are:
1) Demographic variables like age, sex, education, occupation,
family size, income etc.
Then our decision making is based on cost benefit analysis
between:
1) Perceived seriousness of the decision (will it actually kill me?)
2) Perceived susceptibility (am I likely to get it?)
3) Cues from external factors like advertising
4) How motivated we are

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 Rotter’s (1966) locus of control theory
• 2nd theory, From the Latin meaning ‘place’
• This theory looked at the beliefs or perceptions of an
individual about the underlying causes of the main events in
their lives.
• Think of something important to you – taking an exam.
What things made it good and what things made it bad?
How much of your life is affected by fate or chance?
• Some people have a powerful belief in fate and the power of
external forces to shape their lives
• Other people have a strong belief that what happens in their
lives is all down to themselves and their own actions and
choices

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 Rotter’s Locus of Control Theory
• Reductionist = reduces the explanation down
to a person’s locus of control
• Deterministic theory which is quite pessimistic
Suggests that where a person thinks the control
of their health lies will influence whether they
adopt a certain health behaviour
üJames et al (1965) found that male smokers
who did not relapse had a higher level of
internal locus of control than those who did
not quit smoking.
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 Rotter’s studies
• He found that people with an „internal locus of control” were
more able to show behaviours that would enable them to
cope with a threat than those who had an „external locus of
control”.
• Rotter concluded that „locus of control” affects many of our
behaviours, not just health.
• The concept continues to be widely used, especially in
industry
• Bandura introduced another key concept:
Efficacy expectation :A person’s belief that they can successfully
do whatever is required to achieve the outcome

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 Self Efficacy: Bandura 1986
• Self efficacy: the belief in oneself to organize and execute a
course of action. Your belief in your ability to succeed or fail
in a particular situation
• People with a strong self efficacy: View challenging
problems as tasks to be mastered.
• People with a weak self efficacy: Avoid challenging tasks
Bandura suggests that LOC and SE are different:
• Locus of control Concerned with the outcome (Internal and
external )
• Self-efficacy Linked to the cognitive idea of locus of control
Is a person’s conviction that their own behaviour will
influence the outcome (Unchangeable belief )

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 3 key factors which affect efficacy expectation
1. Vicarious experience– seeing other people do something
successfully
2. Verbal persuasion – someone telling you that you can do
something
3. Emotional arousal – too much anxiety can reduce a person’s
self-efficacy
Example :Weight watchers and the 3 factors
• Vicarious experience – seeing someone else losing weight (you
can lose it)
• Verbal persuasion – meeting is about achievable goals and
building self confidence.(you can do it).
• Emotional arousal – standing on the scales creates anxiety (I
can’t do this)

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 How do we develop self efficacy?
• Life experiences, being successful or
unsuccessful previously at tasks?
• Seeing other people succeed (modelling and
vicarious reinforcement)?
• Verbal support and encouragement from
others?
• Our psychological responses (mood stress and
emotional state can effect self efficacy) for
example if we are naturally nervous?

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 THEORY OF REASONED ACTION FISHBEIN (1975)
• The theory states that intention is the best predictor of health
behaviour
• Attitudes: One’s positive or negative evaluation of performing
a behaviour
• Beliefs: about the consequences of performing the behaviour
(outcome expectancies)
• Values: appraisal (importance) of the consequences
ATTITUDE: Ali feels positive about smoking because he expects it will relax
him and being relaxed is important to him (beliefs about the consequences
and values)
SUBJECTIVE NORM: Other students encourage ALi to smoke (belief) and he
wants them to like him(motivation to comply)
INTENTION: Ali intends (expects) to smoke with friends after school

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 THEORY OF PLANNEDBEHAVIOUR

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 Theory of Planned Behaviour
• Behavioural Control/Locus of Control/ Self
Efficacy
• Intention to behaviour link is problematic
when not fully under the individual’s control
• Past Behaviour Always the best predictor of
future behaviour

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■References
https://ocw.jhsph.edu/courses/HealthBehaviorChange/PDFs/C04_20
11.pdf

https://sphweb.bumc.bu.edu/otlt/mph-
modules/sb/behavioralchangetheories/BehavioralChangeTheories7.ht
ml
Health Psychology by Jane Ogden Chapter 2: HEALTH BELIEFS

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