Faculty of Social Sciences & Education

Health adherence models

Presented in partial fulfilment of the

requirements for the module
Health Psychology
PSY 108

Lecturer: Mrs Deborah Naicker

Student: Ms Eleonora Maag

04902

Date: 20 September 2024

Declaration of Academic Integrity

I hereby declare that this assignment/project is my own work. All material used from books or
journals or internet sources have been correctly quoted and referenced. I fully understand the policy
on plagiarism as found in the prospectus of the College. If I am found guilty of plagiarism even due to
negligence or ignorance, I will receive a failure grade for the paper or for the whole module; and may
face additional academic penalties that could include dismissal from the College.
Table of contents

Introduction ............................................................................................................................... 1

Description of the Health Belief Model .................................................................................... 2

Case study discussion ................................................................................................................ 4

Strengths and weaknesses ......................................................................................................... 6

Lifestyle behaviours ................................................................................................................. 8

Conclusion ................................................................................................................................ 9

References ............................................................................................................................... 10
Introduction

This paper will discuss health adherence models, developed to understand why and how people
practice healthy behaviours (Brannon et al., 2018). Specifically taking into consideration the
Health Belief Model (HBM). Perceived susceptibility, severity, benefits, and barriers will be
explained, as well as cues to action and self efficacy, in relation to how these factors affect
behaviour. This model, which sustains that these six factors influence behaviour, will be
applied to a case study of a 59-year-old man and his health status. Taking into consideration
how these factors influenced his choices and course of action. The strengths and weaknesses
of the HBM will be mentioned, considering also that several health adherence models exist –
each with advantages as well as limitations. Two of these adherence models will be mentioned
and briefly elaborated upon, including the Theory of Planned Behaviour (TPB) and
Transtheoretical Model (TTM) (Champion & Skinner, 2008). In conclusion, lifestyle
behaviours will be discussed, particularly which ones are likely to be predicted by the Health
Belief Model.

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Description of the Health Belief Model

Health adherence models can be divided into continuum and stage models (Brannon et al.,
2018). While continuum models view behaviour change and adaptation in an individual to be
linear and continuous, stage models sustain there are different steps or stages. The Health Belief
Model (HBM) is a continuum health adherence model, focusing on how health beliefs affect
and influence behaviour (Connor & Norman, 2005).

Fig. 1: The Health Belief Model (Connor & Norman, 2005)

Referring to the figure above, there are several factors that influence the action, or behaviour,
of an individual. Influenced by demographic and psychological variables, these factors include:

1. Perceived susceptibility
2. Perceived severity
3. Perceived benefits
4. Perceived barriers
5. Cues to action &
6. Self efficacy (Champion & Skinner, 2008)

Perceived susceptibility refers to the belief a person has regarding the likelihood of
experiencing a risk or developing a disease (Ranby et al., 2010). For example, someone
believes they are at high risk for heart disease seeing their current health status and genetic
predisposition point towards a heightened vulnerability. They might ask themselves questions
such as “How likely is it that I develop this condition or really be affected at all?” – which will
either increase or decrease their perceived susceptibility. As perceived susceptibility increases,
meaning that a person believes it is more likely they are at risk, they are also more inclined to
adapt their behaviour accordingly in order to promote their health.

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Perceived severity refers to how serious an individual believes a health condition could be, as
well as its consequences (El-Toukhy, 2015). For example, upon diagnosis for high blood
pressure, one person believes they are not at risk for anything serious, while another person has
lost family members due to heart disease related to untreated high blood pressure.
Consequently, the second individual understands the severity of developing this condition,
which motivates them to act accordingly and adopt healthy habits – such as taking eating well,
exercising regularly, and taking prescribed medication. They understand what is at stake and
that health needs to be taken seriously. Thus, they are more inclined to adapt their behaviour
accordingly compared to the first individual who experiences a sort of optimism bias –
underestimating risks and overestimating positive outcomes (Masiero et al., 2018).

The perceived benefits of a course of action refer to how effective an individual thinks his or
her actions will be in reducing the risk or seriousness of a condition (Carpenter, 2010). If an
individual believes their behaviour will lead to positive outcomes and noticeable improvements
in their health, they are more likely to engage in that behaviour. If a person believes that their
efforts will be useless, they are less likely to adpot them. On the other hand, Carpenter (2010)
describes perceived barriers are things that might prevent an individual from taking the same
health promoting behaviours. For example, a person might sustain that the costs involved are
too high, time is too short, or that the obstacles and difficulties involved with improving their
health are too great – despite the potential benefits.

Cues to action can either be internal or external, such as experiencing pain or receiving advice
from a medical professional, and are what push an individual to take action (Paek et al., 2017).
Cues can be considered triggers that motivate and remind someone to, in this case, take care of
their health. If an individual has been advised to exercise repeatedly by their physician (external
cue) but soon begins experiencing pain and swelling in their legs, the symptoms acting as
internal cues would likely prompt them to act. After a long walk, they might return home with
improved circulation and less discomfort. According to the Health Belief Model (HBM), the
sixth and final factor that influences action and behaviour is self efficacy. In other words, how
much a person believes in their ability to perform said action as well as how confident they are
in achieving their desired outcome (Bandura, 1997). For example, if a person wants and needs
to lose weight yet does not believe they will be able to stick to a weight loss plan, their lack of
confidence could compromise reaching their goal. Thus, they may be less likely to maintain a
healthy lifestyle. In the next chapter, we will discuss a case study and take into consideration
the health behaviour and condition of a middle-aged man, in light of the six factors mentioned
above.
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Case study discussion

Lance Johnson, a successful 59-year-old businessman, experienced a lot of pressure at work.

He barely spent time at home, and as a consequence did not eat healthy home cooked meals
but often ordered take out. His wife, Rebecca, noticed he had gained over 30 kgs and along
with his unhealthy eating habits had stopped exercising altogether. The couple used to enjoy
walking around the neighbourhood together, but ever since his work became more demanding,
Lance spent most of his time behind his desk.

His health soon began to deteriorate, and he started to experience painful chest pain. After
rushing him to the hospital, the doctor diagnosed him with severe hypertension. He was told
that if he did not start taking better care of his health, specifically his nutrition and exercise
routine, he could end up with heart disease. Upon receiving this news, his wife seemed to be
more concerned than he was. He thought she was overreacting and did not think much of his
visit to the doctor, especially since no one in his family had ever had heart disease. Lance
reckoned he just needed to take the blood pressure medication that his doctor had prescribed.

His wife became more forceful in advocating a healthier diet and regular exercise routine. She
cooked meals for him to take to the office, encouraged him to walk more, and come home
earlier from work. However, Mr. Johnson would not eat the food she packed him, refused to
take the time to walk, and continued to work late hours. He did not change his lifestyle
whatsoever and stopped taking his blood pressure medication without telling anyone. In
synthesis, he did not sustain it was necessary to adapt the recommended changes in his
behaviour despite experiencing symptoms that had landed him in the hospital.

Taking the Health Belief Model (HBM) into consideration, Mr. Johnson’s perceived
susceptibility did not increase after his visit to the doctor, and it is apparent that he does not
believe his condition will worsen. He sustains that he is not at risk for heart disease, seeing that
there is no history of the disease in his family. Therefore, his risk assessment is low and he
believes his condition is manageable without any lifestyle changes. Similarly, his perceived
severity of hypertension is low and he is convinced not to be at risk for heart disease. His wife,
on the other hand, experienced an increase in perceived susceptibility and severity of his
condition, convinced that if he did not adopt new health habits, things could worsen, and he
could very possibly develop a heart condition. She understands that peventing this has to be
taken seriously or it could otherwise lead to death.

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Although Mr. Johnson took no steps in improving his health, his wife became more forceful in
advocating for a healthier lifestyle. They had perceived benefits differently, and while Mrs.
Johnson believed that proper nutrition and regular exercise would make a difference, Mr.
Johnson did not. Although she packed lunches for him to take to the office, he did not eat them.
Thus, his desire for take-out is clearly greater than the perceived benefits of a healthy meal,
and remains convinced that his eating habits do not make much of a difference. Rather, Mr.
Johnson perceives barriers. The cost of giving up fast food is apparently too high, and the time
he has at his disposal is there to invest into work and not on physical exercise. His behaviour
indicates therefore a lack of health motivation to change (Connor & Norman, 2015).

Cues to action, such as the medical advice he received, his wife’s efforts, and the chest pain he
experienced, were not sufficient for him to engage in health promoting behaviour. Perhaps his
symptoms would need to get worse in order to modify his habits. If he were to make the
decision to improve his lifestyle, simple cues such as setting an alarm to take his medication or
buying new training shoes could encourage him to sustain it. Finally, and perhaps most
importantly, if Mr. Johnson does not believe he is capable of adopting healthier practices into
his life, he may never do so. Encouragement from Mrs. Johnson could make a huge difference
in contributing to his self-efficacy, as well as evaluating whether his career should take priority
over his wellbeing.

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Strengths and weaknesses

As mentioned above, health adherence models aim to predict why, how, and to what extent
people adhere to health behaviours (Brannon et al., 2018). Reflecting on the strengths of the
Health Belief Model (HBM), it predicts simple health behaviours well thanks to the six core
constructs of the model. They are clear, simple, and easy to understand, contributing to the
efficacy of the model. On the other hand, a weakness to consider is that it does not take factors
such as addiction into account, which could negatively influence health behaviour despite an
individual having firm beliefs. Furthermore, the model does not predict adherence too well. As
adherence refers to sticking to something consistently, the model does not account for changes
in behaviour over time (Jones et al., 2014).

The model strongly focuses on personal beliefs and perceptions, through a framework that is
easy to understand and apply. However, environmental or emotional factors are given less
importance. For example, someone can have all the right beliefs, perceptions, and intentions,
yet be conditioned by social pressure or even their own emotions or impulsiveness. As a result,
they could very well not follow through on health recommendations and end up seeing effective
changes. Thus, Jones (2014) sustains that the model can easily predict what an individual
believes and intends to do, rather than which actions they will carry out in the long term.

In reference to the case study discussed above, Mr. Johnson could hypothetically have
experienced a momentary increase in perceived susceptibility, severity, benefits, cues to action,
and self efficacy, yet still have fallen back on old patterns of behaviour after a short period of
time. In his case, his wife took his health more seriously than he did – however, neither of them
could retrieve practical guidance or strategies from the model promoting healthier lifestyle
choices. The model does not offer practical advice on how to change health behaviours beyond
influencing beliefs. According to Harrison et al. (1992), the Health Belief Model (HBM) shows
weak effect sizes and lack of homogeneity, making it premature to draw conclusions about its
predictive validity in adult health-related behaviors.

The Theory of Planned Behaviour (TPB) accounts for subjective norms, considering social
pressure to or expectations to engage in a behaviour. Meanwhile, the Transtheoretical Model
(TTM) accounts for whether an individual sustains new health behaviours over time. While the
Health Belief Model (HBM) and Theory of Planned Behaviour (TPB) are continuum health
models, the Transtheoretical Model (TTM) is a stage model, sustaining that behaviour change
occurs in distinct stages (Champion & Skinner, 2008).

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Fig. 2: Schematic representation of the Theory of Planned Behaviour (Prapavessis et al., 2005)

Fig. 3: The Transtheoretical Model of behaviour change (Wang et al., 2019)

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Lifestyle behaviours

Will individual A stop smoking? Will individual B see a psychologist? Will individual C take
their prescribed medication? Will individual D practice safe sex?

In attempt to answer the following questions applying the Health Belief Model (HBM), we will
focus on how the beliefs of these individuals would influence their decision making. Individual
A may stop smoking if, for example, their perceived susceptibility for smoking-related illnesses
increased, as would their perceived severity for a life-threatening disease – the perceived health
benefits would likely outweigh the barriers. One might fear that they may experience
withdrawal symptoms (perceived barrier), or that they may not be able to maintain a nicotine-
free lifestyle due to their dependance on the substance (self efficacy). However, graphic images
on cigarette packages could discourage tobacco use (cue to action).

In some parts of the world, there is still much stigma around seeing a psychologist (Schnyder
et al., 2017). Some cultures believe that therapy is only necessary for those who are severely
mentally ill, and that seeking this kind of professional help is shameful. If individual B were to
have this misconception (perceived barrier), they would most likely not pursue therapy despite
possibly having all the means to do so. However, if the positive outcomes of engaging in
counselling treatment could outweigh the social or self stigma (perceived benefits), they could
make the decision to carry out the action.

Individual C, upon believing in the efficacy of the prescribed medication (perceived benefits),
they would most likely need reminders either through the use of a calendar, cellphone, or family
members (cues to action). Understanding the consequences of not taking their medication, or
remembering their health status before diagnosis, would strongly contribute to their
consistency (perceived severity). Based on their beliefs, the Health Belief Model (HBM) is
likely to predict whether this individual will regularly take their medication.

Individual D is more likely to practice safe sex if, for example, they are aware of the sexually
transmitted infections (STI’s) they could get, whether they believe that using a condom can
prevent pregnancy, or if they are in a committed monogamous relationship (perceived
susceptibility). Perceived severity would depend on a number of factors, such as contracting
an easily curable STI or contracting a life altering virus such as HIV. In case of pregnancy,
including abortion as an option or not.

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Conclusion

We can conclude that the Health Belief Model (HBM) provides a valuable framework for
understanding how individual beliefs influence health behaviours, particularly in relation to
perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. While the
model effectively explains simple health behaviours and highlights the role of personal beliefs
in shaping health decisions, its limitations lie in not addressing factors such as addiction, social
pressure, and long-term adherence. By comparing it with other models like the Theory of
Planned Behavior (TPB) and the Transtheoretical Model (TTM), it becomes clear that no single
model fully captures the complexities of health behavior change. The case study of Mr. Johnson
exemplifies how varying perceptions of risk and severity can impact decision-making.
Ultimately, while the HBM can predict certain lifestyle behaviors, its predictive power in the
long term remains limited, and incorporating insights from other models may enhance its
applicability in diverse health contexts.

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References

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Brannon, L., Updegraff, J. A., & Feist, J. (2018). Health psychology: An introduction to
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Carpenter, C. J. (2010). A meta-analysis of the effectiveness of health belief model variables

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Champion, V. L., & Skinner, C. S. (2008). The health belief model. Health behavior and health
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Conner, M., & Norman, P. (2005). Predicting health behaviour: a social cognition approach.
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El-Toukhy, S. (2015). Parsing susceptibility and severity dimensions of health risk perceptions.
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Harrison, J. A., Mullen, P. D., & Green, L. W. (1992). A meta-analysis of studies of the health
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Jones, C. J., Smith, H., & Llewellyn, C. (2014). Evaluating the effectiveness of health belief
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Masiero, M., Riva, S., Oliveri, S., Fioretti, C., & Pravettoni, G. (2018). Optimistic bias in young
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Paek, H., Shin, K., & Lee, B. (2017). Exploring Cues to Action in Health Belief Model. Pattern
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Prapavessis, H., Maddison, R., Ruygrok, P. N., Bassett, S., Harper, T., & Gillanders, L. (2005).
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Ranby, K. W., Aiken, L. S., Gerend, M. A., & Erchull, M. J. (2010). Perceived susceptibility
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Reach, G. (2023). How is patient adherence possible? A novel mechanistic model of adherence
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Schnyder, N., Panczak, R., Groth, N., & Schultze-Lutter, F. (2017). Association between
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Wang, Y., Fadhil, A., Lange, J. P., & Reiterer, H. (2019). Integrating taxonomies into theory-
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