Vocabulary

• Tuberculosis

An infectious disease that most often affects the lungs and is caused by a type of bacteria.

• Susceptible

Easily influenced or affected by something; having a high degree of vulnerability to a specific condition.

• Cue

A signal or stimulus that elicits a specific response or action; a prompt that guides behavior or decision-making.

• Reinforcement

The process of strengthening a behavior by providing a stimulus or positive consequence, increasing the likelihood of that behavior recurring.

• Prescribed

Officially recommended or authorized by a medical professional; referring to a treatment or medication that is formally prescribed.

• Medication

A substance, often in the form of a drug, used to treat, prevent, or alleviate symptoms of a medical condition.

• Reassurance

A statement or comment to remove someone's doubts or fears.

• Misinformation

False or inaccurate information that is spread, often unintentionally, leading to misunderstandings or misconceptions.

• Hypertension

A medical condition characterized by elevated blood pressure levels, which can increase the risk of cardiovascular diseases.

• Contamination

Being made impure by exposure to or addition of a poisonous or polluting substance.

• Breastfeeding

The practice of feeding a baby with milk directly from the mother's breast, providing essential nutrients and antibodies.

1. Health Belief Model

(Boston University School of Public Health, n.d.; U.S. Department of Health & Human Services et al., 2005)

The Health Belief Model (HBM) was one of the first theories used to explain and predict health behaviors and is still one of the most widely used in the field. It was developed in the 1950s, when researchers wanted to explain why so few people were taking advantage of screening tests. The U.S. Public Health Service offered to screen for tuberculosis by sending mobile X-ray units out to neighborhoods for chest X-rays. The tests were offered free and in many convenient locations, yet few people came.

After many surveys, they concluded that the most important influences on their screening behavior were people’s beliefs about whether or not they were susceptible to the disease and its severity, and beliefs about the benefits and barriers of the offered tests. Later they expanded their conclusions, noting that people need a trigger or cue to action and they need confidence or self-efficacy before acting.

The HBM now includes these six main elements that influence decisions to take action for illness prevention. People are ready to act if they:

1. Believe they are susceptible to the condition (perceived susceptibility)
2. Believe the condition has serious consequences (perceived severity)
3. Believe taking action would reduce their susceptibility to the condition (perceived benefits)
4. Believe costs of taking action (perceived barriers) are outweighed by the benefits
5. Are exposed to factors that prompt action (cue to action)
6. Are confident in their ability to successfully perform an action (self-efficacy)

The central focus of HBM is health motivation, so this theory fits with addressing problem health behaviors such as high-risk sexual behavior and the possibility of contracting HIV. The six constructs of the HBM provide a useful framework for designing both short-term and long-term behavior change strategies. When applying the HBM to health programs, planners should understand how susceptible the target population feels to the health problem, whether they believe it is serious, and whether they believe action can reduce the threat at an acceptable cost. 

This Table shows examples of possible strategies to reach people with concerns about each of the 6 factors.

Case Study Example of a Health Program Using the HBM:

(U.S. Department of Health & Human Services et al., 2005)

Many people with high blood pressure never experience symptoms, so they do not follow medical advice to take prescribed medicine or lose weight. The HBM can help with strategies for such situations.

• Perceived susceptibility: Without symptoms they may not follow medical advice unless they accept that they do have hypertension
• Perceived severity: They must understand that hypertension can lead to heart attacks and strokes
• Perceived benefits: Taking prescribed medication or following a recommended weight loss program will reduce the risks
• Perceived barriers: Help them make plans without negative side effects or excessive difficulty
• Cues to action: Print materials, reminder letters, or pill calendars can help them consistently follow the recommendations
• Self-efficacy: If they had a hard time losing weight in the past, achievable, short-term goals can help build confidence

2. Limitations of the HBM
   

The six noted elements are not the only influences on behavior. The HBM does not account for environmental or economic factors that a person has no control over. It also fails to consider habitual or addictive behavior. The most effective use of the HBM is when it is integrated with other models that account for the environmental context. (Boston University School of Public Health, n.d.)

3. Best fit for Health Promotion Interventions using the HBM

• Health Education Strategies

• • Description: Education can help people have a more accurate perception of their susceptibility, severity and benefits.

  • Examples:

• • • Explaining the risks of using contaminated water.
    • Warning people of potential diabetes complications.
    • Telling mothers the benefits of breastfeeding.

• Health Communication Strategies

• • Description: Health messages can serve as effective Cues to Action

  • Examples:

• • • Billboards can remind people to wear seatbelts.
    • Social media posts can notify people where to get needed vaccines.
    • Public service announcements can remind people to have their blood pressure checked.

• Behavior Modification Activities

• • Description: Techniques to replace unhealthy behaviors with desirable habits can increase self-efficacy

  • Examples:

• • • Set easy goals at first, and celebrate even small successes.
    • Try new things and reward yourself for the attempts even if not successful.
    • Visualize yourself confronting a challenge and being successful.

References

Boston University School of Public Health. (n.d.). The Health Belief Model. https://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories2.html

U.S. Department of Health & Human Services, National Institutes of Health, & National Cancer Institute. (2005). Theory at a Glance: A guide for health promotion practice (2nd ed.). https://cancercontrol.cancer.gov/sites/default/files/2020-06/theory.pdf