Health Belief Model
explaining health behaviors
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 HBM
was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels
working in the U.S. Public Health Services. 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.
Core Assumptions and Statements
The HBM is based on the understanding that a person will take a health-related action (i.e., use
condoms) if that person:
1. feels that a negative health condition (i.e., HIV) can be avoided,
2. has a positive expectation that by taking a recommended action, he/she will avoid a negative
health condition (i.e., using condoms will be effective at preventing HIV), and
3. believes that he/she can successfully take a recommended health action (i.e., he/she can use
condoms comfortably and with confidence).
The HBM was spelled out in terms of four constructs representing the perceived threat and net
benefits: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers.
These concepts were proposed as accounting for people's "readiness to act." An added concept,
cues to action, would activate that readiness and stimulate overt behavior. A recent addition to
the HBM is the concept of self-efficacy, or one's confidence in the ability to successfully perform
an action. This concept was added by Rosenstock and others in 1988 to help the HBM better fit
the challenges of changing habitual unhealthy behaviors, such as being sedentary, smoking, or
overeating.
Table from “Theory at a Glance: A Guide for Health Promotion Practice" (1997)
Concept Definition Application
Define population(s) at risk, risk
One's opinion of levels; personalize risk based on
Perceived
chances of getting a a person's features or behavior;
Susceptibility
condition heighten perceived
susceptibility if too low.
Perceived One's opinion of how Specify consequences of the
serious a condition and
Severity risk and the condition
its consequences are
One's belief in the
Define action to take; how,
Perceived efficacy of the advised
where, when; clarify the
Benefits action to reduce risk or
positive effects to be expected.
seriousness of impact
One's opinion of the
Identify and reduce barriers
Perceived tangible and
through reassurance, incentives,
Barriers psychological costs of
assistance.
the advised action
Strategies to activate Provide how-to information,
Cues to Action
"readiness" promote awareness, reminders.
Confidence in one's Provide training, guidance in
Self-Efficacy
ability to take action performing action.
Conceptual Model
Source: Glanz et al, 2002, p. 52
Favorite Methods
Surveys.
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): 1) 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. 2) Sick role behaviors, which refer
to compliance with recommended medical regimens, usually following professional diagnosis of
illness. 3) Clinic use, which includes physician visits for a variety of reasons.
Example
This is an example from two sexual health actions.
(http://www.etr.org/recapp/theories/hbm/Resources.htm)
Condom Use Education
Concept STI Screening or HIV Testing
Example
1. Perceived Youth believe they can get STIs Youth believe they may have been
Susceptibility or HIV or create a pregnancy. exposed to STIs or HIV.
2. Perceived Severity Youth believe that the Youth believe the consequences of
consequences of getting STIs or having STIs or HIV without
HIV or creating a pregnancy are knowledge or treatment are
significant enough to try to avoid.
significant enough to try to avoid.
3. Perceived Benefits Youth believe that the Youth believe that the recommended
recommended action of using action of getting tested for STIs and
condoms would protect them HIV would benefit them — possibly
from getting STIs or HIV or by allowing them to get early
creating a pregnancy. treatment or preventing them from
infecting others.
4. Perceived Barriers Youth identify their personal Youth identify their personal barriers
barriers to using condoms (i.e., to getting tested (i.e., getting to the
condoms limit the feeling or they clinic or being seen at the clinic by
are too embarrassed to talk to someone they know) and explore
their partner about it) and explore ways to eliminate or reduce these
ways to eliminate or reduce these barriers (i.e., brainstorm
barriers (i.e., teach them to put transportation and disguise options).
lubricant inside the condom to
increase sensation for the male
and have them practice condom
communication skills to decrease
their embarrassment level).
5. Cues to Action Youth receive reminder cues for Youth receive reminder cues for
action in the form of incentives action in the form of incentives (such
(such as pencils with the printed as a key chain that says, "Got sex?
message "no glove, no love") or Get tested!") or reminder messages
reminder messages (such as (such as posters that say, "25% of
messages in the school sexually active teens contract an STI.
newsletter). Are you one of them? Find out
now").
6. Self-Efficacy Youth confident in using a Youth receive guidance (such as
condom correctly in all information on where to get tested)
circumstances. or training (such as practice in
making an appointment).
Health Belief Model
From Wikipedia, the free encyclopedia
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The Health Belief Model is a health behavior change and psychological model developed by
Irwin M. Rosenstock in 1966 for studying and promoting the uptake of health services.[1] The
model was furthered by Becker and colleagues in the 1970s and 1980s. 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.
[2]
Originally, the model was designed to predict behavioral response to the treatment received by
acutely or chronically ill patients, but in more recent years the model has been used to predict
more general health behaviors. [3]
[edit] Constructs
The Health Belief Model.
The health belief model, developed by researchers at the U.S. Public Health Service in the 1950s,
was inspired by a study of why people sought X-ray examinations for tuberculosis. The original
model included these four constructs:
Perceived susceptibility (an individual's assessment of their risk of getting the condition)
Perceived severity (an individual's assessment of the seriousness of the condition, and its
potential consequences)
Perceived barriers (an individual's assessment of the influences that facilitate or discourage
adoption of the promoted behavior)
Perceived benefits (an individual's assessment of the positive consequences of adopting the
behavior).
A variant of the model include the perceived costs of adhering to prescribed intervention as one
of the core beliefs.
Constructs of mediating factors were later added to connect the various types of perceptions with
the predicted health behavior:
Demographic variables (such as age, gender, ethnicity, occupation)
Socio-psychological variables (such as social economic status, personality, coping strategies)
Perceived efficacy (an individual's self-assessment of ability to successfully adopt the desired
behavior)
Cues to action (external influences promoting the desired behavior, may include information
provided or sought, reminders by powerful others, persuasive communications, and personal
experiences)
Health motivation (whether an individual is driven to stick to a given health goal)
Perceived control (a measure of level of self-efficacy)
Perceived threat (whether the danger imposed by not undertaking a certain health action
recommended is great)
The prediction of the model is the likelihood of the individual concerned to undertake
recommended health action (such as preventive and curative health actions).
The health belief model, developed by researchers at the U.S. Public Health Service in the 1950s,
was inspired by a study of why people sought X-ray examinations for tuberculosis. It attempted
to explain and predict a given health-related behavior from certain patterns of belief about the
recommended health behavior and the health problems that the behavior was intended to prevent
or control. The model postulates that the following four conditions both explain and predict a
health-related behavior:
1. A person believes that his or her health is in jeopardy. For the behavior of seeking a
screening test or examination for an asymptomatic disease such as tuberculosis,
hypertension, or early cancer, the person must believe that he or she can have the disease
yet not feel symptoms. This constellation of beliefs was later referred to generally as
"belief in susceptibility."
2. The person perceives the "potential seriousness" of the condition in terms of pain or
discomfort, time lost from work, economic difficulties, or other outcomes.
3. On assessing the circumstances, the person believes that benefits stemming from the
recommended behavior outweigh the costs and inconvenience and that they are indeed
possible and within his or her grasp. Note that this set of beliefs is not equivalent to actual
rewards and barriers (reinforcing factors). In the health belief model, these are
"perceived" or "anticipated" benefits and costs (predisposing factors).
4. The person receives a "cue to action" or a precipitating force that makes the person feel
the need to take action.
1. feels that a negative health condition (i.e., HIV) can be avoided,
2. has a positive expectation that by taking a recommended action, he/she will avoid a negative
health condition (i.e., using condoms will be effective at preventing HIV), and
3. believes that he/she can successfully take a recommended health action (i.e., he/she can use
condoms comfortably and with confidence).
The model soon changed shape when applied to another set of problems concerning
immunization and more broadly to (the variety of) people's different responses to public health
measures and their uses of health services. In these wider applications, the model substituted a
belief in susceptibility to a disease or health problem for the more specific belief that one could
have a disease and not know it, which had been featured in Godfrey Hochbaum's original study
as the most important belief accounting for seeking screening examinations.
In the mid-1970s, a monograph devoted to the wide-ranging applications of the model described
its history and experience (Becker, 1974). This was soon followed by a review of the
standardized scales for measuring its several dimensions (Maiman et al., 1977). The model
continued to evolve into the 1980s, largely at the hands of Marshall Becker at Johns Hopkins
University and later at the University of Michigan School.
The Health Belief Model relates largely to the cognitive factors predisposing a person to a health
behavior, concluding with a belief in one's self-efficacy for the behavior. The model leaves much
still to be explained by factors enabling and reinforcing one's behavior, and these factors become
increasingly important when the model is used to explain and predict more complex lifestyle
behaviors that needs to be maintained over a lifetime.
A systematic, quantitative review of studies that had applied the Health Belief Model among
adults into the late 1980s found it lacking in consistent predictive power for many behaviors,
probably because its scope is limited to predisposing factors (Harrison, Mullen, and Green,
1992). One study that specifically compared its predictive power with other models found that it
accounted for a smaller proportion of the variance in diet, exercise, and smoking behaviors than
did the theory of reasoned action, theory of planned behavior, and the PRECEDE-PROCEED
model (Mullen, Hersey, and Iverson, 1987).
Nevertheless, the health belief model continued to be the most frequently applied model in
published descriptions of programs and studies in health education and health behavior in the
early 1990s. It has since been displaced in frequency of application by the transtheoretical model
of stages of change. It remains, however, a valuable guide to practitioners in planning the
communication component of health education programs.
