What is the Health Belief Model?
Welcome to this video about the health belief model for patient education. The primary focus of the HBM is the understanding of health-related behavior.
The health belief model was originally developed in the 1950s by social psychologists Godfrey Hochbaum, Irwin Rosenstock, S. Stephens Kegeles, and Howard Leventhal in the United States Public Health Service, in an effort to understand why people do or do not participate in disease screening and disease preventive measures.
The model was extended over time to study individuals’ response to disease and adherence to treatment.
The HBM is based on a number of constructs that predict behavior. These constructs include:
- Perceived susceptibility, which refers to people’s beliefs regarding their own risk of developing a disease or health condition
- Perceived severity, which refers to people’s beliefs about how serious a health condition or disease is and the degree of threat it poses to them personally
- Perceived benefits, which refers to people’s beliefs about the effectiveness of preventive measures and treatment AND
- Perceived barriers, which refers to people’s beliefs about the costs of taking action to prevent disease and promote wellness, including the monetary, physical, and emotional costs
These were the four original constructs, but three additional ones were added later as the model was modified by other researchers.
These three additional constructs are:
- Cues to action, which are those internal and external motivating factors that cause people to take action.
- Self-efficacy, which is the confidence that people have regarding the likelihood that their taking action will be successful, AND
- General motivation, which is people’s readiness to be concerned about and deal with health issues. In 1972, Becker argued for the addition of this last construct, but it’s not always included as part of the model.
Modifying factors that may influence perceptions and beliefs include both demographic and psychological factors.
- Demographic factors include such things as age, gender, ethnicity, socioeconomic status, occupation, and educational status.
- Psychological factors include such things as stress, anxiety, personality, confidence, and response to peer pressure.
When developing community health promotion programs, it’s important to have a thorough understanding of these constructs and to design programs so that perceived benefits outweigh other considerations. Let’s say, for example, that you are proposing a diabetes education and screening program in a community whose population has a high rate of diabetes with the aim of changing behavior.
The first thing to consider is perceived susceptibility: Unless people feel that they are at risk, they are unlikely to change their health behavior. Thus, people with family members who are diabetic may be more likely to believe they are susceptible to diabetes than others because they’ve seen real evidence. People who are young and healthy may believe that they are very unlikely to develop diabetes.
One way to increase people’s belief that they may be susceptible is to provide repeated education about the disease, including statistics about prevalence in the community.
The next thing to consider is perceived severity. People are more likely to undergo screening and change behavior if they believe that the consequences of developing diabetes are severe, although this alone is not often a motivating factor.
To help people understand the severity of diabetes, community education may include information about how diabetes can lead to kidney failure, impotence, stroke, heart disease, diabetic ulcers, blindness, and amputation. In a sense, the purpose of this type of information is to create fear of the disease so that people respond by making changes.
Then, it’s important to consider perceived benefits because, regardless of other considerations, people are unlikely to change behavior unless they believe they will get something out of it. Education must stress these benefits, such as better strength, better stamina, and longer life. A program may offer free attractive activities, such as exercise groups and cooking lessons.
In order to encourage people to change behavior, perceived benefits must outweigh perceived barriers, which are often the real stumbling blocks. People are unlikely to change behavior if doing so is too difficult. Some common barriers include the cost, time needed, inconvenience, and discomfort involved. Additionally, people may face social consequences.
For example, if a person has enjoyed having four or five beers after work with friends and suddenly switches to diet soda or goes home, this is likely to affect their relationships. It can be difficult to overcome perceived barriers.
A program may offer free screening and free diet counseling to decrease expenses, and may carry out education and screening outside of normal work hours to increase convenience.
One major barrier may be fear of a diagnosis, so it may be important for education to stress that behavior changes may prevent diabetes and that it’s possible to lead a long, healthy life even with diabetes.
Advertisements and commercials may, for example, include program participants of different ages, genders, and ethnic groups, talking about their success stories.
Cues to action include those things that get people thinking about the disease or health condition and taking action. These may include advertisements, commercials, public service announcements, posters, pamphlets, and word of mouth. The more cues to action people are exposed to, the more they are likely to consider change.
Next is self-efficacy. People are unlikely to make changes if they believe that they will fail or that changes will make no difference. A lack of confidence can be a big barrier to overcome, so nurturing self-efficacy should be an ongoing concern for any program. This may include providing positive feedback and giving rewards for participation and compliance. Participants may be encouraged to use tools, such as daily logs, to help build their confidence.
Last, but certainly not least, is general motivation. Some people are simply more motivated to make positive changes and to show concern for health than others, and the reasons for that can be very complex.
The health belief model works on the foundational proposition that people are generally not motivated to change until they believe they are susceptible and have sufficient self-efficacy to carry out changes. Lacking motivation and self-efficacy, people are more likely to engage in denial and rationalization than to change behavior.
Thanks for watching and happy studying!