Health Belief Model

A new viral disease called Coronavirus Disease 2019 (COVID-19) has sparked a global
epidemic. The only means of overcoming the disease due to the lack of vaccines and effective
treatments are preventive habits. Each individual is the most crucial aspect in promoting health;
their ideas, values, preferences, and habits have an impact on whether they engage in healthy or
unhealthy behaviors (Chan et al., 2020). The health belief model is one of many ideas and
models put forth by sociologists, psychologists, and anthropologists to explain the factors
influencing health behavior of individuals. In the context of public health research, this model,
which was first presented by Rosenstock et al., serves as a general conceptual framework and
theoretical direction for health behaviors. The health belief model's widespread acceptance and
popularity are a result of its strong predictive power (Nemcek, 2018)

A study in assessing preventive health behaviors from COVID-19 revealed that rate of
adherence to preventive behaviors of the virus was at a desirable level. The constructs of the
health belief model were utilized by creating questions related to each of the construct in order to
determine which is the most significant factor that contributes to the adherence of preventive
behaviors. Moreover, other variables that predicted disease prevention activities included
perceived benefits. In other words, by increasing the perceived benefits, people perform better.
Perceptions of the benefits of routine hand washing, wearing personal protective equipment like
masks and disposable gloves, and other factors are powerful incentives for taking preventive
action against this disease. Women demonstrated higher observance than men, likely because
they were more motivated by their health than males, which was a significant factor determining
preventative behaviors. Interventions must therefore be carried out to raise male knowledge and
encourage healthy behavior. By demonstrating the advantages of preventative behaviors, one can
overcome the COVID-19 hurdles to prevention by raising perceived self-efficacy. (Shahnazi, et
al., 2020)

Another study that utilized the Health Belief Model in investigating how university
students’ nutrition beliefs influence their health behavioral intention generated significant data
that will improve foodservice for college students in Kyungsung University. The health belief
model, rather than a model of disease treatment, was initially intended to explain a model of
disease prevention. Several factors were examined using a structured survey questionnaire,
including (a) Objective Nutrition Knowledge, (b) Nutrition Confidence, (c) Benefit, Barrier,
Susceptibility, and Severity, (d) Behavioral intention to eat healthily and Behavioral intention to
engage in physical activity, and (e) Demographic data. Thus, these factors that influenced the
health behavior of college students are investigated in order to determine whether these
underlying causes are interrelated.

The results of the survey showed that positive behavioral intentions to eat healthfully and
engage in physical activity are influenced by the relative importance of the benefits and the
relative absence of the barriers associated with doing so. Increased nutrition confidence results
from increased nutrition knowledge; increased nutrition confidence also influence health
benefits. Which is why college students did not perceive a threat, including the Susceptibility to
and/or Severity of four types of diseases (Obesity, Diabetes, Cardiovascular Diseases, and
Osteoporosis). This is because college students may already understand how to prevent those
diseases, the four mentioned diseases are also not common among younger people.

Furthermore, the university foodservice applied the Health Belief Model to determine
whether or not college students’ health beliefs lead to appropriate health choices. According to
the Health Belief Model, attitudes toward the likelihood that an activity would result in a
perceived Benefit have an impact on whether or not people engage in healthy habits. The
positive value of the Benefit must exceed the perceived Barriers or “cost of, and/or resistance to,
the action.” So, it is crucial for foodservice managers to promote healthy meal selections and
remove barriers so that students can act on their health beliefs. (Kim, Ahn, & No, 2012)

The most common non-communicable disease affecting the general Ghanaian population
is hypertension (HTN), which is a major risk factor for cardiovascular disorders like heart failure
and myocardial infarction. (Lo et al., 2016). The health belief model was used in this study to
identify noncompliance of antihypertensive treatment and its contributing factors in the Ghanian
community. Before making a choice, a patient with HTN can use the health belief model to
weigh the benefits of compliance (behavior), determine whether the cost is worthwhile, and
determine the severity and susceptibility of HTN problems. Using the health belief model
questionnaire, this study assessed antihypertensive therapty (AHT) noncompliance and related
variables among hypertension patients in the Kintampo Municipality. More than half of the
individuals were not in compliance with their medicine regime, according to the percentage of
noncompliance to AHT, which was 58.6%. It was found that the strongest predictor of treatment
noncompliance was perceived barrier. Additionally, the likelihood of not complying with AHT
rose with larger degrees of perceived barriers. Lower risks of noncompliance with AHT are
significantly connected with higher perceived benefits of utilizing medication and cues to
activities. Cost of medication, discontinuing medication when feeling well, fear of side effects,
forgetfulness, and usage of conventional treatment were the main causes of noncompliance cited
by participants. (Almas et al., 2012)

Previous research has shown that patients who are adequately informed about their
hypertension had higher drug adherence and better blood pressure control. In this study,
participants with tertiary education had much lower odds of not complying with AHT. Patients
with higher education are more compliant with their medicines. It could seem logical to assume
that patients with greater educational levels would be more obedient since they would have a
better understanding of their condition and the available treatments. Previous research have
shown that patients who are adequately informed about their hypertension had higher drug
adherence and better blood pressure control. (Yaa Obirikorang, 2018)

Early detection of breast cancer resulted in a nearly complete cure, and with prompt
diagnosis and efficient treatment, the survival rate can reach 90 percent. Self-examination is the
most crucial step in detecting cancer in its early stages, according to earlier studies. Nevertheless,
despite its high effectiveness in lowering mortality, numerous research results revealed that the
adoption of such behaviors by women in various communities are low. (Shobiri et al., 2016.,
Farshbaff et al., 2009., Hasani et al., 2011). The Champion Health Belief Model (CHBM), which
Champion introduced in the 1980s, is one of many theoretical models used in health education to
examine health behavior. According to this model, behavioral beliefs and modifying factors are
effective in influencing behavior, and when a woman is perceived to be at risk for breast cancer
(perceived susceptibility), aware of the threat the disease poses to her health (perceived severity),
and also aware of the benefits of screening methods (perceived benefits) compared to their
drawbacks (perceived barriers), she is most likely to adhere to these screening practices. (Hasani
et al., 2011., Avci, 2008).

Using the health belief model, a study was conducted to identify the predictors of breast
cancer screening behaviors. The study's goal was to identify the variables influencing these
behaviors in women living in East Guilan cities between the ages of 20 and 65. The primary
predictors of breast self-examination were perceived benefits and self-efficacy. Positive
outcomes by avoiding illness exposure are considered as perceived benefits. For instance, a
monthly breast self-exam can find even the slightest suspicious lump (Hasani et al., 2011).
Mammography was directly predicted by perceived advantages, while its opposite was predicted
by perceived barriers (Hatefnia et al., 2013). Reducing barriers can boost perceived benefits, and
self-efficacy influences perceived benefits and perceived barriers to mammography indirectly
(Taymoori et al., 2014). Mammography is impeded in Iran by cultural factors such as discomfort,
anxiety, radiation phobia, and the lack of clinical breast cancer symptoms (Abedian et al., 2006.,
Mokhtari et al., 2011). Thus, in order to minimize these variables and give context for
encouraging women to adopt healthy behaviors, careful planning is advised (Darvishpour, Vajar,
& Noroozi, 2018).

Studies on individuals were undertaken in the early phases of the HIV/AIDS pandemic,
with a primary focus on their sexual behaviors (Walker et al., 2004). It was anticipated that
people's behaviors would change once they became aware of HIV and its route of transmission.
The majority of HIV/AIDS information campaigns are based on behavioral and behaviorist
theories, such as the Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB),
Social Learning/Cognitive Theory (SCT), Bruner's Theory of Discovery Learning, Theory of
Classical Conditioning, and the Health Belief Model (HBM). These theories begin with the idea
that a person's intentions and behaviors determine their actions (Pryor & Reeder, 1993). These
group behavior theories can be applied to the study of individuals as a whole. In order to evaluate
the factors linked to consistent condom usage to prevent HIV/AIDS among senior secondary
school female students in rural Cameroon's Mbonge subdivision, researchers adopted the HBM
as one such theory. One of the earliest theories created to describe the process of change in
connection to health behavior was the HBM (Dennill et al., 1999., Polit et al., 2004). When
applied properly, it offers organized assessment information regarding clients' capacities and
drive to improve their health. Programs for health education can be created to better meet client
needs (Stanhope et al., 2000).

The majority of global efforts to prevent HIV have been built on hypotheses about how
people alter their behavior because behavioral variables drive HIV transmission. These ideas
were developed using affective-motivational and cognitive-attitudinal constructs (Abrahan et al.,
1997). Perceived susceptibility is the first HBM concept. This describes a person's perspectives
about the likelihood of developing a health problem. When a person believes a health issue is
personally important, they are more likely to take the necessary steps to prevent it. People who
believe they are at risk for HIV/AIDS are more likely to use condoms to prevent sexual
transmission of the illness.

Perceived severity is the second HBM concept. This has to do with how seriously one
takes a condition and its repercussions. When one is aware of the severity of a condition's
negative effects, one is better able to take the required steps to mitigate them. Before adopting
preventative measures (such persistent condom usage against HIV/AIDS infection), people must
first consider HIV/AIDS as a serious infection with major ramifications and implications on their
social and physical life. (Groenewold et al., 2006., Programs - Program Success Center, 2007)

One's perceptions of the advantages of the suggested action to lessen risk or the severity
of an impact are referred to as perceived benefits. The person must feel that by acting in a certain
way, they can avoid or stop a problem from happening. Due to the anticipated results, this belief
provides someone the confidence to act. The HBM suggests that regular condom use should
positively correlate with beliefs of its efficacy in preventing HIV/AIDS. Significant psycho-
social elements that influence consistent condom use include the partner's willingness to use
condoms and parental support for condom use.

The term "perceived barriers" refers to one's perception of the actual and perceived costs
of following recommended behavior. There may be a number of obstacles that influence people's
choices of actions. The perceived barriers to taking health-related action include phobias,
accessibility issues, personal traits, and potential obstacles to engaging in preventative behaviors,
including things like expense, hassles, and unpleasantness.

The HBM identifies events or experiences as cues to action. These events or experiences
might be personal (physical signs of a health condition), interpersonal, or environmental (media
attention). When someone feels the urge to act after believing they are capable of doing so, they
are said to be in a cue to action state. When one knows how to overcome the anticipated
obstacles, they can take the necessary action.
 Self-efficacy is the HBM's sixth concept. This is the degree to which someone believes
they can react appropriately to unusual or challenging circumstances and overcome any
accompanying challenges or failures. Self-efficacy is the capacity to behave successfully. One
should have the confidence to take the necessary activity appropriately because doing so will
drive them to start and continue the action. Self-efficacy in this literature is the assurance in one's
capacity to utilize condoms. (Groenewold et al., 2006., Programs - Program Success Center,
2007)

A wide range of health behaviors and populations, including health education subjects
like sexuality education, have been studied using the HBM. The HBM is applicable to sexuality
education programs that focus on: (1) Primary prevention, such as those that increase condom
use to prevent pregnancy, STDs, and HIV/AIDS; and (2) Secondary prevention, such as those
that increase early detection of STIs or HIV to reduce their spread via unprotected intercourse
and to ensure the early treatment of the condition. (Tarkang & Zotor, 2015)

Health Seeking Behaviors

Today, the importance of health care has increased in order to create a healthy society.
All facets of human life are impacted by health, which has wider implications on a person's
social life. Social scientists as well as medical professionals find it challenging to improve
people's health state. The behavior of those seeking health care is influenced by a variety of
characteristics, including sex, age, ailment type, availability to services, and perceived quality of
those services. With time, the idea of studying health-seeking behaviors has changed. It is now a
method for analyzing how individuals interact with healthcare systems based on their unique
sociocultural, economic, and demographic contexts. At many institutional levels, including the
family, community, health care system, and the state, all of these behaviors can be categorized.
Understanding health seeking habits of various communities and population groups is vital to
battle the high costs of healthcare in areas with expensive health care systems and a large variety
of public and private health care service providers.

A specific type of help-seeking behavior is the need for medical care. The willingness of
individuals to use healthcare services varies. Some people seek care right away, while others
wait until they are in severe pain and a serious state of illness. In particular, data on the length of
time between the onset of an illness and contacting a healthcare provider, the type of healthcare
provider patients sought assistance from, the degree to which patients adhere to prescribed
treatments, the reasons for choosing the healthcare professional, and the reasons for not seeking
assistance from healthcare professionals, can be used to describe health-seeking.

The health belief model, developed in 1950s, is the most well-known in public health. It
is based on various individual perceptions and motivations, as well as utility-driven healthcare
seeking decision steps. When it comes to an individual's healthcare seeking behavior, the
emphasis is on contextual factors specific to that individual as well as the prevailing health
system characteristics. As a result, the goal of healthcare services utilization research from a
behavioral perspective is to pinpoint the elements (both personal and environmental) that are
most likely to have an impact on the selection of the healthcare services provider. (Kanbarkar &
K.B., 2017)

Health promotion practitioners struggle to create durable and successful techniques to

promote changes in health-seeking behavior that lower risk factors for lifestyle diseases. The
misalignment of priorities between persons and programs could be a contributing factor to the
problem (Rollnick et al., 1993). While health care professionals emphasize the long-term
advantages of behavior change, individuals can be more concerned with the immediate costs to
themselves. It is acknowledged that immigrants confront a number of challenges keeping their
health in check in their new country, especially those with weak proficiency in the local tongue.
According to reports, this is a key contributing element in the lower levels of health-seeking
behavior (HSB) that lead to worse health outcomes (De Rose et al., 2007).

A total of 380 (69%) of the 552 people answered the larger survey's open-ended
questions. The results of this study showed that migrants from the Philippines who had lived in
Australia for an average of 18 years came from a firmly established community. It's interesting to
note that many respondents assessed their health as good or outstanding despite the high
prevalence of chronic diseases in the sample. This is consistent with the findings of Dela Cruz et
al., who discovered that despite having higher than average anthropometric measurements, which
indicate an elevated risk for chronic diseases, Filipinos have good self-rated health. Minimizing
the impact or presence of illness is a cultural trait of Filipino Americans, according to Becker,
which may assist to explain this finding. Despite their high self-rated English language skills, it
cannot be dismissed that it could also be a sign of a lack of understanding regarding chronic
disease (Carolan et al., 2010). If the differences between literal and clinical comprehension of
language are not taken into consideration, it could result in misunderstandings between
healthcare professionals and patients.

With regards to the facilitators and barriers to HSB, many of the respondents wrote about
behaviors they thought promoted health, such as good eating and exercise, but it's unclear if they
actively engage in these behaviors or just know they should in order to stay healthy. Participants
in this study typically identified personal concerns including a lack of money and time as
obstacles to HSB. This research confirms that, especially for recent immigrants, meeting daily
needs and establishing roots in a new nation take priority over health care. Employment was a
personal factor that caused ambivalence because it was cited as both a facilitator and a barrier to
HSB (Chiswick & Miller, 2002). Having a job improved one's financial situation and social
networks, which both aided in HSB. Given the administrative requirements of taking a leave of
absence, it was difficult to schedule medical appointments throughout the workweek.
Participants also viewed stress and work obligations as obstacles to HSB (de Castro et al., 2008).
For several individuals, getting access to healthcare services was difficult. The universal health
care program and Australian health regulations allowed for discounted general practitioner visits
and medication for pensioners, however new immigrants and the elderly may find it difficult to
adjust to Australia's diverse health system structure and deal with new terminologies and
contexts. Some participants reported having trouble recognizing Australian accents and being
understood by healthcare providers, two acknowledged impediments to cross-cultural
communication (Sommer et al., 2012, Gluszek et al., 2010)

A cultural characteristic known as "hiya," which can be interpreted as "shame" or "a

sense of propriety" (Pe-Pua et al., 2000), may discourage Filipino patients from approaching
healthcare professionals for additional information or explanation. Filipino patients may become
more reserved out of fear of upsetting healthcare professionals or appearing to question their
knowledge and authority, which could have an impact on HSB. Being "time-poor" was
commonly cited in this study as a barrier to HSB. This result is in line with that of Ko et al, who
found that Filipino American women's lack of time was a barrier to breast screening. The
Filipinos considered this to be a socially acceptable reaction since it followed the cultural
tradition of indirectly declining without offending. As an alternative, this is a manifestation of
the Filipino cultural tendency known as "bahala na," which is approximately translated as
"submissive fatalism," which is the conviction that nothing can be done to stop the inevitable
(Wu et al,. 2006).

Behaviors are influenced by cultural meanings, attitudes, and beliefs. It can be

challenging to express these cultural ideas to medical professionals with varying cultural
perspectives, linguistic abilities, and levels of authority. It might be possible to improve the
patient-health practitioner interaction by taking a tolerant stance toward the various cultural
beliefs on the causes of sickness. The cultural context of migrants must be considered in order to
understand HSB. Despite having a functional command of English, Filipino immigrants are
culturally diverse, and as a result, cultural and traditional attitudes and beliefs may have an
impact on heart disease and stroke (HSB). This is something that health promotion and other
health care practitioners must recognize. (Maneze, DiGiacomo, Y, J, & Davidson, 2017)

The American population is aging quickly. Despite recent substantial population growth,
Filipinos continue to be one of the most misunderstood and ignored racial/ethnic minority
groups. It can be exceedingly difficult for elderly minorities to access healthcare, use it, and
integrate into the US healthcare delivery system. Elderly Filipinos usually follow a road to
healthcare that begins with self-monitoring conditions, discussing problems with reliable family,
friends, or spiritual healers, which may cause the family financial or emotional hardship (Nadal
& Monzones, 2010). Some potential causes of elderly minorities' inadequate access to healthcare
services include social and political injustice (Adini, 2019; Heron et al., 2003). Inadequate access
to timely and suitable healthcare services not only jeopardizes the health and wellbeing of older
minorities (United Nations, 2015), but it also worsens the unpleasant experiences that make it
difficult to lead a successful life (Cene et al., 2016; David, 2010).

Numerous factors were noted by elderly Filipino women who sought medical care in the
United States. They described their encounters with healthcare professionals and their ability to
acquire healthcare services as being enjoyable and rewarding. They expressed worry that
because healthcare insurance was always changing, they might soon no longer be able to get
these services. Four topics arose from conversations of older Filipino women's healthcare-
seeking behavior: (a) family support; (b) faith and cultural understanding; (c) communication
and emotions of intimidation; and (d) healthcare insurance and financial worries. Their reliance
on their family and support system was the primary emphasis of the first theme on family
support. Older Filipino ladies kept saying that they would typically ask their families for advice
when they confronted anything they did not understand. The elderly Filipino women's reactions
to their disease and how their faith and culture affected their treatment decisions served as the
focal point of the second theme on faith and cultural understanding. When the elderly Filipino
women discussed their interactions with healthcare professionals and how they had trouble
understanding some of the medical terminology but were afraid of making mistakes when
seeking healthcare services, the third theme on communication and feelings of intimidation
became apparent. Finally, the topic of healthcare insurance and financial worries became clear
when senior Filipino women spoke up about their worries about the rising expenses of healthcare
and how changes to the healthcare system had impacted their access to quality care, particularly
after retiring. When considered as a whole, these findings highlight the need for policies that will
improve elderly Filipinos' access to healthcare. Healthcare professionals will be able to develop
more equitable and culturally appropriate health treatments for this vulnerable demographic in
order to improve health outcomes by understanding the health-seeking behaviors of older
Filipino adults. (Ramos & Rita, 2020)

In order to comprehend the elements affecting human health, the social, cultural, and
biological anthropologies are all incorporated into the field of medical anthropology. This
encompasses the science underlying how illness and disease are felt and understood, how they
are prevented and treated, and how they heal. (Abion et al., 2018., Bhasin, 2007). Medical
anthropology includes folk medicine as a subfield. It refers to conventional medical knowledge
and treatment techniques founded on indigenous ideas about body physiology and maintaining
good health. It combines manual techniques, physical exercise, spiritual therapies, animal
derivatives, natural minerals, herbal or plant-based medicines, and manual or physical therapy
that may be used singly or in combination with the goal of maintaining health or of diagnosing,
treating, and preventing illness. (Wangkheirakpam, 2018., Fokunang et al., 2011).

Dubbed as the "Quiapo Medical Center" and is the focal point of folk medicine in the
National Capital Region (Tan, 2015). Despite the lack of a true Quiapo Medical Center in terms
of infrastructure or institution, Filipinos will immediately think of herbal medicine, lucky charms
and amulets, and other folk remedies when hearing the word Quiapo, aside from the well-known
church and plaza.10 Throughout the kiosks and booths in the neighborhood, the abundance of
folk medicine can be found (Flores et al., 2016., A Year of Stories and Photos: Introducing ‘The
Informal City Reader’ – the Informal City Dialogues, 2013., Tan, 2018). According to a study,
people in rural areas exhibit distinctive health-seeking behaviors and have conflicting views on
medical pluralism, which helps to explain these people's behavior (Nanjunda, 2014). Quiapo's
accessibility to medicinal plants and the way certain Filipinos use them are examples of the
nation's wider cultural variety. Boiling, concoction, and decoction are some of the folk remedy
preparation techniques that were found to be similar in a previous study and in this one as well
(Cerio, 2020). In addition, herbal medicine has been used for centuries in most cultures as
effective therapies for the treatment and even prevention of a variety of illnesses. Customers now
have more access to herbal items worldwide because to current advancements in the internet.
The surge in customers seeking Quiapo's folk medicine services attests to the fact that a sizable
portion of the populace continues to employ herbal remedies. Folk medicine is frequently used in
conjunction with mainstream treatment, according to studies from the past (Kristoffersen et al.,
2019., Riveral et al., 2013). Its widespread usage and accessibility are the biggest drivers of self-
medication. Self-medicating individuals appear to rely more on complementary and alternative
therapies than their prescription drug-using peers. They believe that because these are considered
natural medicines, their safety is assured. The rise in popularity of folk medicine is due to a
number of claims about the potency of plant- or herbal-based treatments. The current trend is to
become "natural." It's likely that the public's changing perspective of herbal plants has
contributed to their use as both a preventative and a therapeutic measure. (Rondilla, et al., 2021)

High caries susceptibility in Filipinos has been linked to genetic predisposition

impacting salivary flow and diet preference (Heinrich-Weltzien et al., 2013). Dental caries has
also been linked to demographic, socioeconomic, and body mass index factors (BMI). Due to the
Philippines' archipelagic geography, status as a low-middle income country, and the country's
high rate of underweight children, this issue is especially crucial there. The milk tea craze began
in the Philippines in 2008 and was separated into two waves: the first wave began in December
2008 and the second wave began in 2013 and afterwards. With 99% of internet users using at
least one social media site and an average daily usage of 10 hours and 2 minutes, the Philippines
leads the globe in internet usage. As a result, web searches are a valuable source of data on
Filipinos' information-seeking habits. According to a survey by the Philippine Statistics
Authority, milk tea consumption is on the rise in the country. Increased drinking of milk tea may
cause tooth decay and toothaches (Suprane, 2019).

Based on the findings of this study, the significant decline in the low devaluing trend for
toothache (TA) from 2017 to 2019 may indicate the devaluation of oral health among Filipinos
as a result of the DOH, the government's 1, 5, and the Philippine Dental Association's (PDA)
inadequate programs. The sharp increase in web searches for milk tea (MT) demonstrates the
Filipinos' preference for high-sugar foods content. This increase in popularity can be linked to a
milk tea obsession brought on by effective marketing tactics and the domination of social media.
The nation's fascination with milk tea has gone through two rounds. On the other hand, based on
related searches, it's also possible that people are self-medicating in an effort to make up for the
absence of dental insurance and programs nationwide (Dalonon, Diano, & Matsuka, 2022).