Theory Literature Review

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November 17, 2012 by mfafard

 

 

 

Health Belief Model

 

The Health Belief Model (HBM) was developed in the 1950’s by U.S Public Health service social psychologists who wanted to explain, further understand and predict why so few people were participating in programs to detect and prevent disease (U.S. Department of Health and Human Services & National Institutes of Health, 2005; Gerend & Shepherd, 2012).  The social psychologists examined what was encouraging and discouraging participation which led to the development of theories that people’s beliefs about whether or not they were susceptible to disease and their perceptions of the benefits of working to avoid the disease influenced their readiness to act.  Eventually researchers concluded with six main constructs (see below) that influence people’s decisions on whether to take action to prevent, screen and control illness (U.S. Department of Health and Human Services & National Institutes of Health, 2005).  By the 1980s modifications to the HBM included the concept of self-efficacy to help the model fit the challenges of changing habitual unhealthy behaviors.

The HBM is one of the most commonly used frameworks to explain change in health behaviors and guide health interventions. It is one of the most studied theories in health education and used with various populations, health conditions and interventions.  The model provides a comprehensive framework for understanding psychosocial factors associated with compliance (Daddario, 2007).

According to the HBM, when individuals are faced with a potential threat to their health they consider the susceptibility to and the severity of the health threat. HBM proposes that cues to action are required, however several applications of the HBM focus on the relationships between four main dimensions and health behavior and a reliable prediction of health behavior (Norman & Brain, 2005).  HBM indicates that individuals change behavior if they first believe their health is at risk or their current behavior could lead to detrimental consequences; and that the benefits of making behavior changes out weigh barriers they face in making the changes (Daddario, 2007). The HBM addresses the effects of belief on health and the decision process in making behavioral changes. HBM is a good fit for addressing problem behaviors that evoke health concerns.  The constructs provide a framework for designing short and long term behavior changing strategies (U.S. Department of Health and Human Services & National Institutes of Health, 2005)

HBM consists of six constructs proposed to influence the likelihood an individual will engage in a given health behavior to avoid an undesirable health outcome.(Daddario, 2007)  These include:

  1. perceived susceptibility, – a person’s perceived risk for contracting an illness or health condition of concern to the researchers.
  2. perceived severity, -a persons perception of the personal impact (clinical or social) of contracting the illness
  3. perceived benefits-persons perceptions of the good things that could happen from undertaking specific behaviors especially in reference to reducing the threat of disease
  4. perceived barriers, -persons perceptions of both the difficulties in performing the specific behaviors of interest and the negative things that could happen from performing those behaviors
  5. cues to action- external factors that promote the desired behavior
  6. self-efficacy – a person’s belief or confidence that he or she can perform a specific behavior

 

 

  1. 1.     James, D. C., Pobee, J. W., Oxidine, D., Brown, L., & Joshi, G. (2012). Using the health belief model to develop culturally appropriate weight-management materials for african-american women. Journal of the Academy of Nutrition and Dietetics, 112(5), 664-670. doi: 10.1016/j.jand.2012.02.003
  • The purpose of the project was to explore the use of the HBM in developing culturally appropriate weight management programs for African American women.
  • The HBM was used as the study’s framework to explain why individuals change or maintain specific health behaviors and to guide development of culturally appropriate weight loss materials and intervention strategies for weight loss.  The HBM constructs were applied to obesity and weight management, which few previous studies have attempted. 

Through qualitative research methods, seven focus groups were conducted among 50 African American women and led by moderators who guided the group with 13 questions that covered topics such as perception of overweight, obesity, healthy weight; perceived consequences of obesity; barriers and motivations to weight loss; information needed to lose weight; and sources of dieting information.  Themes and codes of the data were generated from the data.

Each of the constructs was used in the study:

  1.  perceived susceptibility – was used to understand how African American women defined terms associated with a weight status (ex. Obesity)
  2. perceived severity, -provided researchers with an understanding of how women view health and consequences of obesity
  3. perceived benefits-the benefits of losing weight as motivators.
  4. perceived barriers, -to identify the external factors that may prevent weight loss
  5. cues to action- motivation led to weight loss
  6. self-efficacy – identified that women with high efficacy were likely to manage their weight
  • The HBM allowed researchers to use the themes generated from each theoretical construct to develop weight management materials for African American women. However since qualitative methods were used in the study, the results were not generalizable but the exploratory nature of the groups was useful in assessing the needs of a target group and therefore uncertain whether it would be effective when applied to other target populations/cultures. 
  • The strengths of the study were that the HBM proved to be successful in developing the weight management tools for African American women which were also the goals of the study.  The qualitative data collection approach provided a unique and effective way to gather the information for the HBM constructs for a specific group.  The weakness of the study was that the study was shown to be effective for the African American target population however; since qualitative data was applied to the HBM it is unclear whether this data collection method for filling in the HBM would be just as effective across other target populations.   

 

 

 

 

  1. 2.     Norman, P., & Brain, K. (2005). An application of an extended health belief model to the prediction of breast self-examination among women with a family history of breast cancer. British Journal of Health Psychology, 10(Pt 1), 1-16. doi: 10.1348/135910704X24752
  • The purpose of the study was to apply the HBM to the prediction of Breast Self Exam (BSE) among women with a family history of breast cancer in order to overcome shortcomings in previous applications of the HBM.  Through the prospective design of the HBM, the HBM variables were able to predict BSE. The study includes perceived barrier components of self efficacy and the influences of breast cancer worries on BSE performance.
  • The HBM was applied to the study to predict breast self examinations (BSE) among women with a family history of breast cancer.  The HBM was used as a framework and used the four constructs:
    • perceived susceptibility was measured and used since those susceptible were considered more likely to be motivated to take action
    • perceived severity provided important predictors in discriminating between excessive BSE and BSE
    • perceived benefits discriminated whether BSE was performed
    • perceived barriers was also used to determine BSE performance

These constructs were believed to be important in the prediction of an individual’s decision to perform a health protective behavior.  These four dimensions were specifically focused on to provide reliable predictions of health behavior among those participants who perceived themselves susceptible to breast cancer.  Over an 18 month period two questionnaires were used to collect data on 1000 women who had either been diagnosed with breast cancer or had bilateral breast cancer at any age. 

  • The findings were consistent with previous applications of the HBM that found perceived barriers to be the strongest predictor of BSE and health behavior. Perceived benefits were also predictive barriers which should be expanded to incorporate individuals’ feelings of confidence in their ability to perform as recommended behavior.  Perceived self efficacy barriers were the most powerful HBM variable for discriminating between the study participants.  Perceived severity was also an important discriminator between the excessive group and the two other participant groups. 
  • According to the article, the application of HBM in the prediction of BSE is criticized since the study only examined the frequency of BSE which did not provide information on methods to look at early detection attempts. Moreover, cues to action were not measured.  The strength of the correlation between the HBM and BSE variables may be inaccurate since respondents may not have been consistent in their responses since their beliefs and behaviors are measured in the same questionnaire.  Perhaps a study design that applied to all of HBM variables instead of only the four original constructs would have been a stronger predictor of the HBM model.

 

 

  1. 3.     Gerend, M. A., & Shepherd, J. E. (2012). Predicting human papillomavirus vaccine uptake in young adult women: Comparing the health belief model and theory of planned behavior. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 44(2), 171-180. doi: 10.1007/s12160-012-9366-
  • The purpose of the study was to compare the HBM and the Theory of Planned Behavior (TPB) in the prediction of HPV.  According to the authors, little is known about the relative efficacy of these theories in predicting health behavior. That in addition to predicting behavior directly, cues to action might affect intentions and behavior indirectly via peoples health beliefs
  • The 735 young adult women participated in the study by watching videos that emphasized the (1) benefits of getting HPV vaccinations, (2) the costs of not getting vaccinated that was matched by a control group.  Each video provided information on HPV and the cost of vaccination.  Pre and post- test surveys were distributed to the participants on sexual history and HPV knowledge.  This data provided the researchers with HBM and TPB constructs and characteristics.  In addition, the HBM and TPB models were then further assessed with items drawn from previous research. HBM constructs included perceived susceptibility, perceived barriers and cue to action.  TPB included attitudes, subjective norms, self-efficacy and intentions.  Statistical analysis was used to compare survey data and test which model was a better predictor for HPV vaccine uptake. 
  • The HBM provided a good fit to the data however the TPB outperformed the HBM in predicting vaccination behavior.  In a combined model attempt, independent predictors of HPB vaccine intake were from the TPB.  These findings in the effectiveness of models can lead to modifying perceptions that may improve future interventions.   
  • The study was effective in applying both the HBM and TPB models to determine which was more effective in predicting HPV vaccinations.  Moreover, the authors were able to combine the models into a specific model focused on the potential health risk. The study focused primarily on outcome beliefs and less on outcome evaluations which, may have not allowed for enough information to be captured on the participants attitudes on avoiding outcomes associated with HPV infection.  The authors’ measure of self efficacy captured limited perceived behavior controls.  Since the focus was on HPV using a convenience sample population, the authors may have been able to better compare the HBM and TPB had they focused on a different health behavior that would require consistent action.    

 

 

 

 

References

Daddario, D. K. (2007). A review of the use of the health belief model for weight management. Medsurg Nursing: Official Journal of the Academy of Medical-Surgical Nurses, 16(6), 363-366.

Gerend, M. A., & Shepherd, J. E. (2012). Predicting human papillomavirus vaccine uptake in young adult women: Comparing the health belief model and theory of planned behavior. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 44(2), 171-180. doi: 10.1007/s12160-012-9366-5

James, D. C., Pobee, J. W., Oxidine, D., Brown, L., & Joshi, G. (2012). Using the health belief model to develop culturally appropriate weight-management materials for african-american women. Journal of the Academy of Nutrition and Dietetics, 112(5), 664-670. doi: 10.1016/j.jand.2012.02.003

Norman, P., & Brain, K. (2005). An application of an extended health belief model to the prediction of breast self-examination among women with a family history of breast cancer. British Journal of Health Psychology, 10(Pt 1), 1-16. doi: 10.1348/135910704X24752

U.S. Department of Health and Human Services, & National Institutes of Health. (2005). Theory at a glance. A guide for health promotion practice. second edition. ( No. 05-3896).National Cancer Institute.

 

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