587-Q2
Health Belief Model
The grandmother of health behavior theories
Note: Make sure you are able to view the notes for this lecture.
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Lesson objectives
By then end of your readings on HBM you should be able to:
Discuss the history of the HBM
Describe the constructs within the HBM
Create an example for behavior change using each of the constructs within the HBM.
So, what, exactly is a theory? While there are many different definitions, the one we’ll be using in this class is “A specification of the determinants and mechanisms governing a phenomena of interest.” It’s a definition that I suggest you memorize, but – more importantly – understand and be able to explain and apply in your own words. So, let’s take a closer look at the definition, shall we?
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Levels of influence
This figure demonstrates the various levels of influence that impact an individual’s health behavior.
Some models/theories focus on one of these levels, others may focus on multiple levels.
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HBM
The Health Belief Model addresses influences on the intrapersonal (or individual) level.
Focuses on individual perceptions of health behavior.
Background of HBM
1950’s by US public health psychologists
Godfrey Hochbaum, Irwin Rosenstock, and Stephen Kegels
Based on a value-expectancy model
Assumes that people will engage in a behavior if:
They value the outcome related to the behavior
The think the behavior will result in that outcome
Tuberculosis example
Think back to the example in Theory at a Glance. People were more likely to get the x-ray if:
They thought they were at risk (susceptible) to TB
They believed there was a benefit in early detection.
Constructs
Perceived Susceptibility
Perceived Severity
Perceived Benefits
Perceived Barriers
Cues to Action
Added later
Self-Efficacy
Influence of the Social Learning Theory
Added in 1988
Perceived Susceptibility
The degree to which a person feels at risk for a health problem.
Example: Diabetes runs in my family, so I worry I may get it.
Perceived Severity
The degree to which a person believes the consequences of the health problem will be severe.
Example: Diabetes is one of the leading causes of death in the U.S., I don’t want to die at a premature age.
Perceived threat is a combination of perceived susceptibility and perceived severity
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Perceived Benefits
The positive outcomes a person believes will result from the action.
Example: If I eat healthy foods, and exercise regularly, I will reduce my risk for Diabetes.
Perceived Barriers
The negative outcomes a person believes will result from the action.
Example: Healthy food is expensive, and working out takes up too much time.
Cues to Action
An external event that motivates a person to act.
Example: If I watch grandmother take insulin shots and monitor sugar constantly, it might made me more aware of my chance of getting Diabetes.
What other examples of Cues to Action can you think of?
Self-Efficacy
A person’s belief in his or her ability to take action.
Example: I know that I can reduce my risk of getting Diabetes and believe in my ability to do so.
Critiques
There is a need for an updated systematic review of evidence supporting the HBM in research (1984)
Some constructs, such as perceived susceptibility and perceived barriers, were found to be more powerful predictors of behavior (in the 1984 review) than other constructs, such as perceived severity.
Some constructs have been studied systematically, such as perceived severity and perceived susceptibility. Cues to action, however, have not been well-studied.
When measuring constructs, it is important to use scales that are valid and reliable. There have been issue with variability.
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References
Buckingham, R., Moraros, J., Bird, Y., Meister, E., & Webb, N. (2005, July). Factors associated with condom use among brothel-based female sex workers in Thailand. AIDS Care, 17(5), 640-647. Retrieved September 20, 2009, doi:10.1080/09540120412331319697
Edberg, M. (2007). Essentials of Health Behavior: Social and Behavioral Theory in Public Health. Sudbury, MA: Jones and Bartlett Publishers.
Glanz, K., Rimer, B., & Lewis, F. (Eds.). (2002). Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass.
Glanz, K., & Rimer, B. K. (1997). Theory at a glance: a guide for health promotion practice. Bethesda, Md.: U.S. Dept. of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute.
COMPONENTS AND LINKAGES
Individual Perceptions Modifying Factors Likelihood of Action
Age, Sex, Ethnicity
Personality
Socioeconomics
Knowledge
Perceived benefits minus
perceived barriers to change
Perceived susceptibility/severity
of disease
Perceived threat of disease Likelihood of behavior change
Cues to action:
Education
Symptoms, illness
Media information