One of my assignments in this course was to complete a literature review on one of the individual health behavior theories. I selected the Health Belief Model (HBM), mostly because of my background and interest in social psychology. I will continue to discuss this theory and its application to both maternal health and stress prevention in the next two posts. Meanwhile, the following is background information and my analysis of HBM:
Developed by leading social psychologists in the 1950s, the Health
Belief Model (HBM) has been a popular model used in public health. This is a
behavioral theory used to explain individuals’ perceptibility of a potential
health problem (NCI, 2005). HBM is rooted in both cognitive and
stimulus-response theories. Stimulus-response theorists posited that
consequences of behaviors are learned and eventually, reduce physiological
drives that initiate a behavior (Champion & Skinner, 2008, p. 46). Contrary
to this notion, cognitive theorists believed that a certain behavior is a mere
result of subjective value of an outcome and expectation that the behavior will
achieve a particular outcome, also known as value-expectancy theory. According
to cognitive theory, reinforcements influence expectations about a
situation, but do not directly influence behavior (Champion & Skinner, 2008,
p. 46). In terms of health-related behavior, value-expectancy was defined as: value
of avoiding diseases and getting well and the expectation that
a specific health action may prevent or alleviate disease burden (Champion &
Skinner, 2008, p.46). Today, these concepts are known as perceived susceptibility
and perceived severity, respectively, two of the six HBM constructs.
HBM is an investigative model used to explain why people are
either encouraged or discouraged from engaging in health-sustaining behaviors
(NCI, 2005). The six constructs are perceived susceptibility, perceived
severity, perceived benefits, perceived barriers, cues to action and
self-efficacy. Cues to action and self-efficacy are the most recent constructs.
Self-efficacy was added in 1988 and is based on Social Learning Theory (Edberg,
2007, p. 36). Perceived susceptibility is the “degree to which a person feels
at risk for a health problem” (Edberg, 2007, p. 37). If a person believes he or
she is at risk, then, he or she may perform certain behaviors to avert a
negative health outcome. Second, perceived severity is the “degree to which a
person believes the consequences of the health problem are severe” (Edberg,
2007, p. 37). The person is either aware or unaware of the severity of the
disease or illness, which also influences action. The third construct,
perceived benefits, are the positive outcomes the individual knows to be a
result of the behavior (Edberg, 2007, p. 37). If someone believes that
performing a certain behavior will benefit their health status, they are likely
to perform that behavior, vice versa. Conversely, the fourth construct,
perceived barriers, states that the individual knows negative outcomes will
result from an action (Edberg, 2007, p. 37). Cues to action refers to the
events that motivate the individual to act (Edberg, 2007, p. 37). Finally, the
self-efficacy construct, used for many health behavior theories, is one’s
belief in his or her ability to act (Edberg, 2007, p. 37). Self-efficacy
involves a person’s skill and will to take an action.
Click here to view an illustration of the Health Belief Model.
There are several things to consider when using the HBM for a
health promotion program. The aforementioned constructs are abstract and should
only be used as guides or influences on behavior. This error is known as the EZ
program structure illusion (Edberg, 2007, p. 37). In order to avoid this,
program planners must conduct extensive research on the target population and
not to rely solely on the theory or model; effective programs are beyond theory
and models alone. It takes real world information, resources and materials to
understand the potential efficaciousness of a program based on any behavioral
health theory or model. It is imperative to also note the shortcomings of the
HBM, too. First, it does not address social and environmental factors that
influence individuals’ behaviors. Secondly, it assumes that all people have
equal access to and the opportunity to have the necessary resources and
information to make rational decisions (Edberg, 2007, p. 38). As Edberg stated,
it is the obligation of health program planners to select and apply the most
appropriate theories and models.
REFERENCES
Champion, V.L. &
Skinner, C.S. (2008). The Health Belief Model. In Glanz, K (Ed.4), Health
Behavior and Health Education (pp. 45-65). San Francisco: Jossey-Bass.
Edberg, M. (2007).
Individual Health Behavior Theories. In Birtcher, K. (Ed.), Essentials of
Health Behavior: Social and Behavioral
Theory in Public Health (pp. 35-47). Sudbury,
MA: Jones & Bartlett.
National Cancer
Institute. (2005). Theory at a glance: a guide for health promotion practice (2
ed.), p. 9-18.
