The Health Belief Model
The Health Belief Model is one of the most commonly used models in the field of Health Promotion. Thinking about the various constructs of the model, what construct do you feel would motivate you to make a behavior change.
Chapter 3
Health Belief Model
History and Orientation
The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors.
This is done by focusing on the attitudes and beliefs of individuals.
The Services. HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health
In the 1950s, academic social psychologists were developing an approach to understanding behavior that grew from learning theories derived from two major sources:
Stimulus Response (S-R) Theory (Watson, 1925)
Cognitive Theory (Lewin, 1951; Tolman, 1932).
Stimulus Response Theory (What is it?) John Watson
Stimulus Response Theory is a concept in psychology that refers to the belief that behavior manifests as a result of the interplay between stimulus and response.
In particular, the belief is that a subject is presented with a stimulus, and then responds to that stimulus, producing “behavior” (the object of psychology’s study, as a field).
In other words, behavior cannot exist without a stimulus of some sort, at least from this perspective.
Cognitive Theory (Lewin, 1951 & Tolman, 1932)
Believe that behavior is a function of the subjective value of an outcome and of the subjective probability (expectation)—value-expectancy theory
Thinking, reasoning, hypothesizing, expecting are critical in cognitive theories
TELL ME MORE OF THESE SR THEORIESTS!! TELL ME MORE, TELL ME MORE, LIKE DOES HE HAVE A CAR?
S-R theorists believed that learning results from events (termed reinforcements) that reduce physiological drives that activate behavior.
Skinner (1938) formulated the widely accepted hypothesis that the frequency of a behavior is determined by its consequences or reinforcement.
In this view, concepts such as reasoning or thinking are not required to explain behavior.
Skinner, felt that the association between a behavior and immediate reward a method of increase the odds that a behavior would be repeated.
COGNITIVE THEORIESTS
Cognitive theorists, emphasize the role of subjective hypotheses and expectations held by individuals, believing that behavior is a function of the subjective value of an outcome and of the subjective probability, or expectation, that a particular action will achieve that outcome.
Such formulations are generally termed value-expectancy theories.
When value-expectancy concepts were gradually re-formulated in the context of health-related behaviors, it was assumed that individuals:
value avoiding illnesses/getting well
expect that a specific health action may prevent (or ameliorate) illness.
So, does the HBM fall into the SR or Cognitive camp?
Health Belief Model
The Health Belief Model was one of the first theories of Health Behavior.
It’s a psychological model that attempts to explain and predict health behaviors, which is fought out by focusing on the attitudes and beliefs of individuals.
The Health Belief Model was first developed in the 1950’s by social psychologists Godfrey M. Hochbaum, Irwin M. Rosenstock and Stephen Kegels working in the U.S. Public Health Services
HBM WHY DO WE HAVE IT, AND WHAT IS IT DOING NOW?
The model was developed in response to the failure of a free tuberculosis (TB) health screening program.
Since then, the HBM has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS
Health Belief Model (HBM)
Focused on attitudes & beliefs of the individual
The HBM is based on the understanding that a person will take a health-related action if that person :
Believes a negative health condition can be avoided
Expects the health condition can be avoided by taking a recommended action
Believes in ability to succeed with the recommended health action
IF IT’S ALL ABOUT BELIEF SHOULD WE TALK ABOUT LOCUS OF CONTROLL?
A behavior is dependent on the individual’s beliefs regarding the value of the outcome (reinforcement) and the perceived probability of that reinforcement occurring (expectancy).
Reinforcement can be:
Internal Locus
Belief in level control and/or responsibility for own health status; events result from one’s own behavior & actions.
External Locus
Belief that events are determined by the actions of others, fate or chance (self-efficacy is likely to be low).
Identification of the locus of control (internal/external) will help the clinician choose the most effective lifestyle counseling approach.
WHAT MAKES UP THE HBM?
Modifying Factors
Age, Gender, Ethnicity, Personality, Socioeconomics, Knowledge.
Individual Belief’s
Perceived Susceptibility and severity, Perceived barriers and benefits, Perceived self-efficacy
Action
Individual behavior
Cues to Action
SO WHAT DOES THE HBM LOOK LIKE?
HBM: Key Concepts
| CONCEPT | DEFINITION | APPLICATION |
| Perceived Susceptibility | One’s belief regarding the chance of getting a condition | Define population(s) at risk and their risk levels Personalize risk based on a characteristic or behavior Make perceived susceptibility more consistent with actual risk |
| Perceived Severity | One’s belief of how serious a condition and its consequences are | Specify consequences of the risk and the condition |
| Perceived Benefits | One’s belief in the efficacy of the advised action to reduce risk of seriousness of impact | Define action to take: how, when; clarify the positive effects to be expected |
HBM: Key Concepts
| CONCEPT | DEFINITION | APPLICATION |
| Perceived Barriers | One’s belief about the tangible and psychological costs of the advised action | Identify and reduce perceived barriers through reassurance, correction of misinformation, incentives, assistance |
| Cues to Action | Strategies to activate one’s “readiness” | Provide how-to information, promote awareness, employ reminder systems |
| Self-Efficacy | One’s confidence in one’s ability to take action | -Provide training -Use goal setting -Give verbal reinforcement |
WHAT ABOUT THOSE OTHER VARIABLES
Well they can influence perceptions and, thus, indirectly influence health-related behavior.
For example, sociodemographic factors, particularly educational attainment, are believed to have an indirect effect on behavior by influencing the perception of susceptibility, severity, benefits, and barriers.
DOES THE HBM HAVE LIMITATIONS?
Limitations of the model include the following:
it does not account for other factors that influence health behaviors.
It does not account for a person’s attitudes, beliefs, or other individual determinants that dictate a person’s acceptance of a health behavior.
It does not take into account behaviors that are habitual and thus may inform the decision-making process to accept a recommended action (e.g., smoking).
It does not take into account behaviors that are performed for non-health related reasons such as social acceptability.
HBM HAVE LIMITATIONS CONT…..
The HBM is more descriptive than explanatory, and does not suggest a strategy for changing health-related actions.
It does not account for environmental or economic factors that may prohibit or promote the recommended action.
It assumes that everyone has access to equal amounts of information on the illness or disease.
It assumes that cues to action are widely prevalent in encouraging people to act and that “health” actions are the main goal in the decision-making process.
APPLICATION?
Interventions based on the health belief model may aim to increase perceived susceptibility to and perceived seriousness of a health condition by providing:
Education about prevalence and incidence of disease
Individualized estimates of risk
Information about the consequences of disease (e.g., medical, financial, and social consequences).
Interventions may seek to:
Change the cost-benefit analysis of engaging in a health-promoting behavior (i.e., increasing perceived benefits and decreasing perceived barriers)
Supplying information about the efficacy of various behaviors to reduce risk of disease
Identifying common perceived barriers
Providing incentives to engage in health-promoting behaviors
Engaging social support or other resources to encourage health-promoting behaviors.
Provide cues to action to remind and encourage individuals to engage in health-promoting behaviors
Scope and Application
The Health Belief Model has been applied to a broad range of health behaviors and subject populations.
Three broad areas can be identified (Conner & Norman, 1996):
Preventive health behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking) behaviors as well as vaccination and contraceptive practices.
Sick role behaviors, which refer to compliance with recommended medical regimens, usually following professional diagnosis of illness.
Clinic use, which includes physician visits for a variety of reasons.
Examples of HBM in action
| Concept | Condom Use Education Example | STI Screening or HIV Testing |
| Perceived Susceptibility | Youth believe they can get STIs or HIV or create a pregnancy. | Youth believe they may have been exposed to STIs or HIV. |
| Perceived Severity | Youth believe that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid. | Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid. |
| Perceived Benefits | Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy. | Youth believe that the recommended action of getting tested for STIs and HIV would benefit them — possibly by allowing them to get early treatment or preventing them from infecting others. |
Examples of HBM in action cont
| Concept | Condom Use Education Example | STI Screening or HIV Testing |
| Perceived Barriers | Youth identify their personal barriers to using condoms (i.e., condoms limit the feeling or they are too embarrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e., teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level). | Youth identify their personal barriers to getting tested (i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options). |
Examples of HBM in action Cont…
| Concept | Condom Use Education Example | STI Screening or HIV Testing |
| Cues to Action | Youth receive reminder cues for action in the form of incentives (such as pencils with the printed message “no glove, no love”) or reminder messages (such as messages in the school newsletter). | Youth receive reminder cues for action in the form of incentives (such as a key chain that says, “Got sex? Get tested!”) or reminder messages (such as posters that say, “25% of sexually active teens contract an STI. Are you one of them? Find out now”). |
| Self-Efficacy | Youth receive training in using a condom correctly. | Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment). |