Part 3 - Health Believe Models

IKM19016 MATA KULIAH
HEALTH BEHAVIOUR
Dosen Kesehatan Masyarakat
081234219424 Kang Sodik Kang Sodik Kang_Sodik

Historical Perspectives
• Early 1952: U.S. Public Health Service hired G. Hochbaum to study
the reasons for low participation in TB screening programs
• Geoffrey Hochbaum, along with Stephen Kegels and Irwin
Rosenstock, proposed the basic health belief model (HBM) in the
late 1950s
• Expanded in the 1980s by Becker
• Based on general principles of value expectancy—desire to avoid
sickness (value), belief in availability of preventive tools
(expectancy)
Muhammad Ali Sodik - IIK Strada Indonesia

Scopus ID: 57207822853 - WA: 081234219424 - IG: Kang_Sodik - FB : Kang Sodik
Constructs of the HBM

Constructs of the HBM
• Perceived susceptibility: Belief of a person regarding
the possibility of acquiring a disease or harmful state as
a result of a particular behavior
• Define population at risk (apply descriptive epidemiology)
• Personalize risk (discussion, role play, simulation, case
study)
• Consistent with actual risk (apply analytical epidemiology)

Constructs of the HBM (cont’d)
• Perceived severity: Belief of a person regarding the
extent of harm that can result from the acquired
disease or harmful state as a result of a particular
behavior
– Specify consequences of the risk and the condition
(lecture, discussion, self-reflection, case study, case
narration, video presentation)

• Perceived benefits: Belief of a person regarding the
usefulness of the methods suggested for reducing risk
or seriousness of the disease or harmful state resulting
from a particular behavior
– Define action to take (clear steps, specific demonstration, re-
demonstration)
– Clarify the positive effects to be expected (discussion, lecture,
self-reading, video presentation, computer-aided presentation)

• Perceived barriers: Belief of a person regarding actual
and imagined costs of performing the new behavior
• Reassurance (one-on-one counseling, case study, discussion,
active listening)
• Correction of misinformation (lecture, video presentation, role
play)
• Incentives (tangible and intangible aids, verbal encouragement,
case accounts)
• Assistance (providing services, transportation)

• Cues to action: Precipitating force that makes
the person feel the need to take action
– Provide how-to information (lecture, demonstration,
re-demonstration, role play)
– Employ reminder system (buddy system, log, diary,
Post-it notes)

• Self-efficacy: Belief or confidence in performing a
behavior
– Provide training in small steps (demonstration, re-
demonstration)
– Progressive goal setting (self-reflection, diary)
– Verbal reinforcement (one-on-one counseling)
– Reduce anxiety (stress management techniques)

Applications of HBM
• Screening behaviors (TB, breast cancer, colorectal cancer, influenza
vaccinations, Tay-Sachs disease, high blood pressure, etc.)
• Preventive behaviors (seat belt use, smoking cessation, physician
visiting, etc.)
• Health promotion behaviors (exercise, healthy nutrition, etc.)
• Treatment compliance behaviors (diabetes, end-stage renal disease,
bronchial asthma, weight loss, etc.)

Specific Examples of HBM
HBM’s Application to Stress Management
• Perceived susceptibility: If we believe that stress has
the potential to produce some negative consequences
for us, then it is likely that we will act to reduce stress in
our lives. Therefore, the health educator attempts to
build activities that help the participants personalize the
possibility of negative outcomes due to stress (lecture,
discussion, role play, simulation).

HBM and Stress Management (cont’d)
• Perceived severity: If we believe that stress has the
potential to produce serious negative consequences, such
as heart disease, for us, then it is likely that we will act to
reduce stress in our lives. Therefore, the health educator
informs (lecture) and helps participants personalize the
seriousness of negative outcomes due to stress
(discussion, self-reflection).

HBM and Stress Management
• Perceived benefits: If we believe that by learning stress
management techniques, such as relaxation, we will
benefit, then it is likely that we will perform these new
behaviors. Therefore, the health educator helps the
participants appreciate the benefits of learning stress
management techniques (discussion, lecture, role play,
simulation, one-on-one counseling, peers, case study).

• Perceived barriers: If we can reassure ourselves that
applying stress management techniques have minimal
expense on our part and maximal benefit in the long run,
then it is likely that we will perform these new behaviors.
Therefore, the health educator helps the participants
grasp the understanding of barriers (lecture, discussion,
role play, simulation).

• Cues to action: If we can identify our personal stressors
that trigger the negative consequences for us, then it is
likely that we will perform the new behaviors that reduce
stress in our lives. Therefore, the health educator helps
the participants identify triggers to stress (diary, log,
worksheets, Post-it notes).

• Self-efficacy: If we can practice new stress
management behaviors (e.g., assertiveness, relaxation,
cognitive restructuring) in small steps and demonstrate
that we have acquired mastery over these new
behaviors, then it is likely that we will perform these new
behaviors. So the health educator arranges for practice
sessions (demonstrations, re-demonstrations,
observational learning methods, role models).

Application of HBM to Safer Sex
How the health belief model can be used to modify sexual behavior in youth to promote safer sex.

Strengths of HBM
• Only model from health field
• Tested extensively
• Simple and easy to understand
• Parsimonious, not unmanageable number of constructs
• Can be applied to both one-time and long-term behaviors

Limitations of HBM
• Model lacks consistent predictive power mainly because it focuses
on a limited number of factors; factors other than health beliefs
(such as cultural factors, socioeconomic status, previous
experiences, etc.) also shape health behaviors but are not
accounted for in the model
• Measurement error in operationalization
• Cross-sectional data’s failure to provide evidence of temporality

Limitations of HBM
• Comparative studies are few and lacking
• Need to understand relative importance of constructs
• Need to use behavioral anchors in articulating
questions, for example, ―If you do not practice safer sex,
how likely are you to become infected with HIV/AIDS?‖
as opposed to ―How likely are you to become infected
with HIV/AIDS?‖

Application Exercise
• One HBM example is the development of an instrument for breast
cancer screening behaviors
• She delimited her instrument development parameters to the
constructs of the health belief model, namely, perceived
susceptibility, perceived severity, perceived benefits, perceived
barriers, cues to action, and self-efficacy.
• She developed items for each construct and used a Likert scale.

Application Exercise
• She established construct validity of the scale through a
panel of national experts.
• She established construct validity by factor analysis.
• Cronbach’s alpha reliability coefficients for various
construct scales ranged from 0.80 to 0.93.
• Test-retest correlations ranged from 0.45 to 0.70.
• Locate the full-text article for this study and prepare a
250-word critique.

Skill Building Activity
• Identify at least two strengths of the example of
application of HBM to stress management.
• Identify at least two weaknesses of the example
of application of HBM to stress management.
• Discuss the strengths and weaknesses and
ways of application of HBM to specific chosen
health behaviors.

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IKM19016 MATA KULIAH

Dosen Kesehatan Masyarakat

081234219424 Kang Sodik Kang Sodik Kang_Sodik

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

Muhammad Ali Sodik - IIK Strada Indonesia

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