Health Belief Model Analysis

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.

Cardiovascular Disease in African Americans

The following video, HealthWatch MD, features a short interview with an African American cardiologist in Atlanta. He addresses the health disparity of cardiovascular disease (CVD) in African Americans. This ethnic group has disproportionately higher rates of CVD than Caucasians. He does not believe that this is due to discrimination, but lifestyle and genetics. The cardiologists emphasizes the importance of patient education and promoting health literacy as a means of prevention for the African American community.

Although the interview is generally informative, I disagree with his statement about discrimination not being a determinant; it is major determinant of health. Discriminating is not always an overt act during the provision of care. This could entail access as a barrier because of institutionalized racism and discrimination. Perhaps, the facilities in one community are not available or the transit does not permit an individual to get to a health facility. The problem is not merely rooted in biological predispositions or even behavior; it is also social.

Health Disparities

This Prezi is my adaptation of the Healthy People 2020 social determinants of health diagram. I used a “journey” template to convey that community and culture, education, environment, economic climate are, not only interdependent factors, but they are a part of a trajectory towards access to services affecting health outcomes, primarily, quality of life. This journey begins with the community and its culture,which involves family structure, social cohesion, equality and discrimination. 

The values and perceptions of this community and culture affect education. Educated people are most likely to perform healthier behaviors, are typically health literate and are proactive when making health-related decisions. Moreover, the community, culture and peoples’ ways of thinking shape the environment in which they dwell. All of those factors can either perpetuate a healthy environment or one rife with crime, violence, poverty and disease. 

The fourth determinant is economic climate, which is easily determined by environment, education, and certain elements of the community and culture. For example, a place where there is high crime and where people are not educated beyond ninth grade, is less likely to have high employment rates and a thriving economy. 

The journey ends with accessibility to transportation, healthy foods, healthcare and any good or service that improves quality of life. I do believe people are a product of their environment and culture, but it is ultimately that person’s decision to make the changes to better his or her quality of life.

Public Health and Health Psychology Theoretical Commonalities

One of the course's first assignments, Social and Behavioral, core entailed exploration of public health professional opportunities, assumptions about the field and the basics of health behavior theory. 

As a past health psychology student, it is a pleasure to know that I can apply some of those theories to health promotion and education. I would like to focus on the connection between health psychology and public health.

I found a questionnaire featuring CDC's Dr. Rodney Hammond. He discussed the relationship between psychology and public health. Hammond was director of the CDC's Division of Violence Prevention, a position that relied heavily on his psychology expertise. His work involved epidemiology, development of evidence-based prevention strategies and community capacity building.

Dr. Hammond's statement (above) is quite profound. Throughout this course, I will be studying, analyzing and at some point apply health behavior theories.

According to Simon and Bennett (2004), public health has both implicitly and explicitly applied social and behavioral psychology theories to program planning and prevention strategies. Health communication, environmental health, behavior in relation to health promotion participation and empowerment. Psychology theories provide structural approaches to prevention through emphasis on barriers, cues and benefits that encourage or discourage a health behavior. 

I am elated that the CDC oversees the National Institute for Occupational Safety and Health (NIOSH). This institute strives to promote the application of psychology, particularly through Occupational Health Psychology. The inception of this field occurred after psychologists urged that the psychology field needs a proactive role in public health practice to prevent stress, illness and injury, especially regarding occupation. This is one major example of how psychology is being used in a major sector of public health. Thanks to the accomplishments of those like Dr. Hammond, we see these theories effectively applied as prevention strategies and program agendas materialize.  


References:

Rodney Hammond's Interview

Murphy, s., & Bennett, p. (2004). Health psychology and public health: Theoretical possibilities (English). Journal Of Health Psychology, 9(1), 13-27.

http://www.cdc.gov/niosh/topics/ohp/

Introduction

Hello and welcome! My name is Jasmine and I am a second year MPH student. The purpose of this blog is to document my progress in a Theory of Health Behavior course I am completing. I hope to expand upon the course content and use this as a digital portfolio. I would also like readers to learn more about the field of Public Health, too.

Here is a video my classmates and I viewed during a Foundations of Public Health course (first year, first semester). This is a general introduction to our field of study. Public Health is, indeed, everything and everywhere. Take a look for yourself. What does Public Health mean to you?