Health Belief Model

Health Belief Model

User-Friendly Health Belief Model

Marshall Becker’s Health Belief Model (HBM): analyzed why healthy people don’t always take advantage of screening/preventative care. HBM explores one of the biggest concerns that still plague public health.

Key Points of The Health Belief Model

  • One of the first theories of health behavior.
  • It was developed in the 1950s by a group of U.S. Public Health Service social psychologists who wanted to explain why so few people were participating in programs to prevent and detect disease.
  • HBM is a good model for addressing problem behaviors that evoke health concerns (e.g., high-risk sexual behavior and the possibility of contracting HIV) (Croyle RT, 2005)

–Current Nursing

Origins of HBM 

  • The Health Belief Model is one of the first theories of health behavior
  • Developed in 1950 by a group of U.S. Public Health Service Social Psychologists –Hochbaum, Rosenstock, and Kegals.
  • The model is influenced by the theories of Kurt Lewin, which states that it is the word of the perceiver that determines what an individual will and will not do.
  • This model was originally developed to predict the likelihood of a person following a recommended action and to understand the person’s motivation and decision-making regarding seeking health services
  • The model was developed in response to the failure of a free tuberculosis health screening program.

The Health Belief model proposes that a person’s health-related behavior depends on the person’s perception of 4 critical areas:

  1. The severity of a potential illness
  2. The person’s susceptibility to that illness
  3. The benefits of taking a preventive action
  4. The barriers (perceived costs) to taking that action

And more concepts were added later…

  1. Self -Efficacy: refers to an individual’s perception of his or her competence to successfully perform a behavior. Self-efficacy was added to the health belief model in an attempt to better explain individual differences in health behaviors.
  2. Cues/Triggers for Motivation: what’s necessary for prompting engagement in health-promoting behaviors.
  3. Modifying Factors: HBM suggests that modifying variables affect health-related behaviors indirectly by affecting perceived seriousness, susceptibility, benefits, and barriers.

Modifiable Factors
Personality & Patient Satisfaction
Socioeconomics
Knowledge

Non-Modifiable Factors
Age
Gender
Ethnicity or Culture

Metaparadigm (Concepts) & Relational Propositions in HBM

The metaparadigms noted in the Health Belief Model; Health, Human Beings, Environment, (+/-Nursing –not always). A person will take a health-related action if that person:

  • Feels that a negative health condition can be avoided.
  • Has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition and
  • Believes that he/she can successfully take a recommended health action.

Health vs Illness

  • Health: the favorable outcome, it’s the absence of disease
  • Illness: the not favorable outcome; noncompliance

Worldview: Reciprocal-Interaction

  • Humans are holistic.
  • Interactions between humans and their environment are in a reciprocal fashion.
  • Change can be continuous or only done for survival.
  • Reality is multi-dimensional, context-dependent, and relative.

The Focus of the Theory

Increase “threat” -make people ‘scared’ about getting a particular disease. Advancing the discipline of nursing:

  • Patient’s motives and beliefs
  • Identify barriers
  • Better care
  • Education
  • Health promotion

Purpose of HBM

  • Explain, describe, predict or prescribe?
  • Initially designed to explain
  • Currently used to predict

Overview of the 6 Major Concepts & Definitions 

  1. Perceived Seriousness: Is an individual’s personal belief of the seriousness or severity of a disease.
  2. Perceived Susceptibility: Is an individual’s belief in one’s personal susceptibility to disease.
  3. Perceived Benefits: Refer to the value placed on decreasing the risk of disease by adopting a new healthy behavior.  This is a positive consequence of the adoption of new health behavior.
  4. Perceived Barriers: Are an individual’s evaluation of obstacles preventing the adoption of new health behavior.  The barriers may have tangible or psychological costs.
  5. Motivation: includes the desire to comply with treatment and the belief that people should do what.
  6. Modifying factors: include personality variables, patient satisfaction, and socio-demographic factors.

Core Assumptions and Statements

The HBM is based on the understanding that a person will take a health-related action and behavioral changes if the person:

  • feels that a negative health condition (perceived susceptibility or severity)
  • has a positive expectation (perceived benefits)
  • believes that he/she can successfully take a recommended health action (self-efficacy)

Nursing Clinical Applicability

  • Assess attitudes and beliefs and obtain a complete history
  • Interventions based on assessment
  • help overcome barriers
  • provide cues to action

The focus of nursing assessment with this model would be related to getting a thorough history with direct questions related to the four major concepts:

  • perceived susceptibility
  • perceived seriousness
  • perceived benefits
  • perceived barriers

–also assess for modifying variables that may influence personal perceptions such as cultural beliefs, education level, and past experiences.

Nursing Interventions

  • Education
  • Clarification
  • Barriers
  • Cues to action

Community Clinical Applicability

  • Primary care/Risk reduction: in communities using surveys
  • Secondary care: adherence to a prescribed regimen
  • Tertiary care: Prevention of readmission

Limitations of Health Belief Model

There are several limitations of the HBM which limit its utility in public health. Limitations of the model include the following:

  • It does not account for a person’s attitudes, beliefs, or other individual determinants that dictate a person’s acceptance of 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.
  • 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 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.

The HBM is more descriptive than explanatory and does not suggest a strategy for changing health-related actions. In preventive health behaviors, early studies showed that perceived susceptibility, benefits, and barriers were consistently associated with the desired health behavior; perceived severity was less often associated with the desired health behavior. The individual constructs are useful, depending on the health outcome of interest, but for the most effective use of the model, it should be integrated with other models that account for the environmental context and suggest strategies for change.

–Boston University School of Public Health

Additional Information & References 

Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2015). The Health Belief Model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation. Health communication, 30(6), 566–576. doi:10.1080/10410236.2013.873363

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