The Health Belief Model

HBM has been adapted to explain & predict a variety of long- and short- term health behaviors: (3)

- Preventive behavior - Illness behavior - Sick role behavior

Perceived Barriers

An individual's own evaluation of the obstacles in the way of adopting a new behavior (including physical, psychological, and financial demands) - Inconvenient - Expensive -Unpleasant - Painful - Upsetting

Health Belief Model founder

Irwin M. Rosenstock - in 1966 for studying and promoting the usage of health services ● The model was furthered by Becker and colleagues in the 1970s and 1980s

HBM essence

Personal beliefs influence health behavior

SE application

Provide training, guidance in performing action

Subsequent amendments to the model were made as late as 1988, to accommodate evolving evidence generated within the health community about the role that

knowledge and perceptions play in personal responsibility

4 perceptions that serve as the main constructs of HBM

1) Perceived Seriousness 2) Perceived Susceptibility 3) Perceived Benefits 4) Perceived Barriers

Perception of seriousness effects can be based on (2)

1) medical information or knowledge (health related) - physical pain and discomfort, decreased functioning 2) beliefs a person has about the difficulties a disease would create or the effects it would have on his or her life in general (social) - loss of work, time, financial burdens, difficulties with relationships

Cues to action

Behavior is also influenced by cues to action (events, people, or things that move people to change their behavior)

_______ minus ______ provide the path of action

Benefits, barriers

Perceived Benefits application

Define action to take; how, where, when; clarify the positive effects to be expected

Perceived susceptibility application

Define population(s) at risk, risk levels; personalize risk based on a person's features or behavior; heighten perceived susceptibility if too low

Perceived Barriers application

Identify and reduce barriers through reassurance, incentives, assistance

Modifying variables

Individual characteristics that influence personal perceptions (culture, educational level, past experiences, and motivation)

HBM summary

Modifying factors (age, sex, ethnicity, personality, SES, knowledge) affect perceived benefits minus perceived barriers, which in turn affects likelihood of behavior. Modifying factors also influence perceived susceptibility and perceived severity, which in turn influences perceived threat, which in turn influences likelihood of behavior. Modifying factors AND cues to action also influence perceived threat, which in turn influences likelihood of behavior.

Flu example of perceived seriousness

Most people don't view the flu as too serious, however, if you have asthma, contracting the flu could land you in the hospital -- therefore, you're perception of the flu is that it is a serious disease

However, just as perception of increased susceptibility does not always lead to behavior change, neither does a perception of increased threat. What is an example of this?

Older people who are most vulnerable to foodborne illness and are among those for whom it can be particularly serious, still do not use safe food-handling practices all of the time

Cues to action application

Provide how-to information, promote awareness, reminders.

perceived threat colon cancer survivors example

Since colorectal cancer is very serious with a high risk of recurrence, this perception of threat of recurrence increases the likelihood of behavior change in people previously treated for this disease- changes occur in diets, exercise, and weight

Perceived seriousness application

Specify consequences of the risk and the condition

Article at end of chapter

Study described the design and implementation of an Osteoporosis Prevention Program for middle-aged women using the Health Belief Model. Results: improvements in knowledge, attitudes, or behaviors have resulted from participation in osteoporosis education. Increasing perceived severity, perceived susceptibility, perceived benefits, SE and cues to action while decreasing perceived barriers were actions that encouraged participation

Perceived Benefit

a person's opinion of the value or usefulness of a new behavior in decreasing the risk of developing a disease

Perceived Seriousness

an individual's belief about the seriousness or severity of a disease

breast cancer screening example of perceived barriers

barriers to performing BSE exert a greater influence over the behavior than does the threat of cancer itself (difficulty with starting a new behavior or developing a new habit, fear of not being able to perform BSE correctly, having to give up things in order to do BSE, and embarrassment)

Perceived susceptibility motivates people to

be vaccinated for the flu, use sunscreen to prevent skin cancer, floss to prevent gum disease and tooth loss

perceived susceptibility HIV example

because older adults generally do not perceive themselves to be at risk for HIV infection, many do not practice safer sex

Internal influences may include

bodily symptoms (e.g., physical symptoms of a health condition)

However, in ____________, perception of susceptibility is rarley linked to the adoption of healthier behaviors, even when the perception of risk is high

college students

example of college students not linking their perception of risk to behaviors

college students know they are at risk for HIV but still practice unsafe sex

People tend to adopt healthier behaviors when they believe the new behavior will _________ their chances of developing a disease

decrease

The greater the perceived risk, the _________ the likelihood of engaging in behaviors to decrease the risk

greater

The HBM is the most commonly used theory in

health education and health promotion

A perception of increased susceptibility or risk is linked to ________ behaviors, and decreased susceptibility to _________ behaviors

healthier, unhealthy

examples of cues to action

illness of a family member, media reports, mass media campaigns, advice from others, reminder postcards from a health care provider, or health warning labels on a product

Self-efficacy

in 1988 SE (belief in ones own ability to do something) was added to the HBM

External influences promoting the desired behavior, may include

information provided or sought, reminders by powerful others, persuasive communications, input of friends, media publicity

According to the HBM, ____________, ______________, and ____________ affect our perception of susceptibility, seriousness, benefits, and barriers, and, therefore, our behavior

modifying variables, cues to action, self-efficacy

Of all the constructs, perceived barriers are the _______ significant in determining behavior change and predicting and explaining health-related behaviors

most

In order for a new behavior to be adopted, a person needs to believe the benefits of the new behavior

outweigh the consequences of continuing the old behavior. This enables barriers to be overcome and the new behavior to be adopted.

When the perception of susceptibility is combined with seriousness, it results in

perceived threat

_________ is one of the more powerful perceptions in prompting people to adopt healthier behaviors

personal risk or susceptibility

Perceived benefits play an important role in the adoption of

secondary prevention behaviors, such as screenings (like for colon cancer)- they have to believe it is beneficial to them to adopt this behavior

Underlying concept of HBM is

that health behavior is determined by personal beliefs or perceptions about a disease and the strategies available to decrease its occurence

Personal perception is influenced by

the whole range of intrapersonal factors affecting health behavior

When people believe they are not at risk or have a low risk of susceptibility

unhealthy behaviors tend to result

Mediating factors (4)

● Demographic variables (such as age, gender, ethnicity, occupation) ● Socio-psychological variables (such as social economic status, personality, coping strategies) ● Health motivation (whether an individual is driven to stick to a given health goal) ● Perceived control (a measure of level of self-efficacy)

HBM Strengths (3)

● Includes common-sense constructs easy for non-psychologists to assimilate and apply ● Has focused research attention on modifiable psychological prerequisites of behavior ● Makes testable predictions

Researchers have applied the HBM to studies that attempt to explain and predict individual participation in programs for:

● Influenza inoculations ● High blood pressure screening ● Smoking cessation ● Seatbelt usage ● Exercise ● Nutrition ● Breast self-examination ● HIV/AIDS & sexual risk behaviors

HBM Limitations (4)

● Its common-sense framework simplifies health-related representational processes ● Its theoretical components are broadly defined, and therefore different specific behaviors may not be strictly comparable ● Lack of specification of a causal ordering ● Neglects social factors

Perceived Susceptibility question

● how likely do you think you are to have this health issue?

Perceived Seriousness question

● how serious a problem do you believe this health issue is?

Perceived Benefit question

● how well does the recommended behavior reduce the risk(s) associated with this health issue?

Perceived Barriers question

● what are the potential negative aspects of doing this recommended behavior? (perceived cost)