Thehealth belief model (HBM)is one of the first theories developed
exclusively for health-related behaviors. Although labeled a “model,” the
HBM meets all the criteria for a theory. The HBM originated in the 1950s and
has been thoroughly tested in a variety of situations since that time. Today it
is one of the most popular models as it provides specific guidance at the
micro level for planning the “how to” part of interventions. Based on
experimentation over the years, the HBM has expanded and borrowed from
other theories to strengthen its predictive and explanatory potential.
SeeChapter 2for a discussion of the differences between a model and a
theory.
This chapter begins with a description of the historical aspects of the
genesis of the HBM. Next we describe the various constructs that make up
the model. Then we discuss the applications of the HBM in behavioral
research, primary prevention, and secondary prevention. Finally, the
limitations of the model are discussed, and a skill-building application using
the HBM is presented.
The HBM originated from the work of a group of social psychologists in the
U.S. Public Health Service in the 1950s: Godfrey Hochbaum, Stephen Kegels,
and Irwin Rosenstock (Rosenstock, 1974a). These social psychologists were
confronted with the problem that very few people were participating in
preventive and disease detection programs. The Public Health Service sent
out chest x-ray units to neighborhoods to conduct free screening for
tuberculosis, yet few people took advantage of the service. To explain this
phenomenon and to help recruit more participation from people, the group
looked at the existing theories and then developed the HBM.
Development of the HBM was influenced by the theory of Kurt Lewin and
his colleagues (Lewin, 1935;Lewin, Dembo, Festinger, & Sears, 1944) that
behavior depends on two variables: (1) the value placed by an individual on
an outcome (value) and (2) the individual’s estimate of the likelihood that a
given action will result in that outcome (expectancy). It is a goal-setting
theory based on level of aspiration, in which the individual sets the target of
future performance based on past performance (Maiman & Becker, 1974).
Such theories are calledvalue expectancy theories, and the HBM falls into
this category. Maiman and Becker (1974) noted that the HBM was
conceptually similar to five other theories of decision making prominent in
the 1950s: Atkinson’s (1957) risk-taking model, Edwards’s (1954) subjective
expected utility model, Feather’s (1959) decision making under uncertainty
model, Rotter’s (1954) reinforcement model, and Tolman’s (1955)
performance behavior theory.
Atkinson’s (1957) risk-taking model described behavior as a multiplicative
relationship among expectancy, incentive, and motive. Expectancy is the
person’s anticipation of outcomes from an action, which can be positive or
negative. Incentives are rewards that will accrue when the person performs
the behavior. Motives are characteristics that encourage the person to
pursue positive incentives and avoid negative incentives. Edwards’s (1954)
subjective expected utility model purports that action is based on the
subjective value (or utility) of attaining the goal and the subjective
probability (or likelihood) of attaining that goal.
Feather’s (1959) decision making under uncertainty model utilizes three
constructs: (1) attainment attractiveness, which is the individual’s
preference to pursue a goal; (2) success probability, which is the likelihood
that a given goal is attainable; and (3) choice potential, which is the behavior
to be done. Rotter’s (1954) reinforcement model purports that behavior is
based on the expectancy that a certain action will lead to a certain outcome
and on reinforcement from previous learning.
Finally, Tolman’s (1955) theory describes six variables (three positive and
three negative) that influence the performance of any behavior: (1) need-
push for food, (2) positive valence of expected food, (3) expectation of food,
(4) need-push against work, (5) negative valence of expected work, and (6)
expectation of work.
Maiman and Becker (1974) noted that these models all predict behavior
based on two variables: the value the individual placed on a particular goal
(attractiveness of the goal) and the individual’s estimate regarding the
likelihood of attaining that goal (subjective probability). Thus all these
theories are value expectancy theories.
The Health Belief Model relates psychological theories of decision
making (which attempt to explain action in a choice situation) to an
individual’s decision about alternative health behaviors.
—Maiman and Becker (1974, p. 9)
Kasl and Cobb (1966) classified three kinds of behaviors regarding health.
The first arepreventive (or health) behaviors, which consist of actions
taken for the purpose of preventing disease or detecting disease in an
asymptomatic phase by a person who believes him- or herself to be healthy.
Initially, the HBM was developed mainly to address these preventive
behaviors (Rosenstock, 1974b). The second group areillness behaviors,
which consist of actions taken by a person who feels sick and indulges in the
behavior for the purpose of defining the state of his or her health and for
discovering suitable remedies. The third group aresick role behaviors,
which consist of actions taken by people who are sick for the purpose of
getting well. The HBM also has been applied to illness behaviors (Kirscht,
1974), sick role behaviors (Becker, 1974), and behaviors related to chronic
illness (Kasl, 1974).
In the 1970s a review measured the various dimensions of the HBM on
standardized scales (Maiman, Becker, Kirscht, Haefner, & Drachman, 1977),
and in the 1980s the model was strengthened further, mostly by the work of
Marshall Becker and colleagues (Janz & Becker, 1984). In the late 1980s the
model was expanded to include self-efficacy (Rosenstock, Strecher, &
Becker, 1988). Since then the model has been applied to a variety of health
behaviors.
CONSTRUCTS OF THE HEALTH BELIEF MODEL
Theories from behavioral and social sciences have what are known as
“constructs,” and these building blocks can be distinctly identified. The
constructs of HBM are depicted inFigure 3-1. The HBM has six constructs,
the first of which isperceived susceptibility. This refers to the subjective
belief that a person has with regard to acquiring a disease or reaching a
harmful state as a result of indulging in a particular behavior. Individuals
vary considerably with regard to their perception of susceptibility to any
given illness or harmful condition. On one extreme are individuals who
completely deny any possibility of their acquiring the disease. In the middle
are people who may admit to the possibility of acquiring the disease, but
believe it is not likely to happen to them. At the other extreme are people
who are so fearful of acquiring the disease that they believe they will in all
probability acquire it. The more susceptible a person feels, the greater the
likelihood of his or her taking preventive measures.
FIGURE 3-1Constructs of the health belief model.
Perceived susceptibility has a strong cognitive component and is partly
dependent on knowledge (Rosenstock, 1974a). According to the HBM, health
educators need to build perceived susceptibility by elaborating on the
possibility of negative consequences and personalizing those risks for their
participants. For example, in a smoking prevention program, health
educators might mention that smoking causes lung cancer and, based on the
relative risk calculated from epidemio-logical studies, mention that this risk
is 22 times higher for a smoker than for a nonsmoker. A word of caution
needs to be kept in mind: in building perceived susceptibility, one should not
create unrealistic or exaggerated fears about the condition.
The second construct of the HBM isperceived severity, which refers to a
person’s subjective belief in the extent of harm that can result from the
disease or harmful state as a result of a particular behavior. This perception
also varies from person to person. One person might perceive the disease
from a purely medical perspective and thus be concerned with signs,
symptoms, any limitations arising out of the condition, the temporary or
permanent nature of the condition, its potential for causing death, and so on;
whereas another individual might look at the disease from a broader
perspective, such as the adverse effects it might have on his or her family,
job, and relationships.
Perceived severity also has a strong cognitive component, which is
dependent on knowledge (Rosenstock, 1974a). According to the HBM, health
educators need to build perceived severity by describing the serious
negative consequences and personalizing them for participants. For
example, in a nutrition education class, health educators might mention that
consuming large amounts of saturated fats may lead to development of
heart disease and share a story about a member of the community who
suffered a heart attack. In addition to describing the clinical consequences,
the effects on family, job, and relationships would also be shared. The
constructs of perceived severity and perceived susceptibility are often
grouped together and calledperceived threat.
The third construct of the HBM isperceived benefits, which refers to
belief in the advantages of the methods suggested for reducing the risk or
seriousness of the disease or harmful stateresulting from a particular
behavior. The relative effectiveness of known available alternatives plays a
role in shaping actions. An alternative is likely to be seen as beneficial if it
reduces the perceived susceptibility or perceived severity of the disease
(Rosenstock, 1974a). In facilitating the construct of perceived benefits,
health educators need to specify the exact action to be taken and specify the
advantages or benefits that would result from that course of action. For
example, health educators teaching about breast self-examination would
describe the exact technique and the benefits, such as the ability to detect
cancer or other diseases early, feeling good about oneself, feeling in control
of one’s health, and feeling more responsible toward oneself and one’s
family.
The fourth construct, which goes hand-in-hand with the construct of
perceived benefits, isperceived barriers. Perceived barriers refer to beliefs
concerning the actual and imagined costs of following the new behavior. An
individual may believe that a new action is effective in reducing perceived
susceptibility or perceived severity of the disease but may consider the
action to be expensive, inconvenient, unpleasant, painful, or upsetting
(Rosenstock, 1974a). Health educators need to reduce such barriers so the
person will take the recommended actions. They may do so by giving
reassurance, correcting misperceptions, and providing incentives. For
example, in a smoking cessation class, health educators might continually
reassure participants that they can overcome the habit of smoking, correct
the misperception that tobacco addiction is impossible to break by giving
examples of persons who have broken the habit, and provide monetary
incentives for participants to continue in the smoking cessation class.
The fifth construct in the HBM iscues to action, which are the
precipitating forces that make a person feel the need to take action. Such
cues may be internal (e.g., perception of a bodily state) or external (e.g.,
interpersonal interactions, media communication, or receiving a postcard
from the doctor for a follow-up examination) (Rosenstock, 1974a). If the
perceived susceptibility or perceived severity is low, then a very intense
stimulus is needed as a cue to action. When the perceived susceptibility or
perceived severity is high, then even a slight stimulus is adequate.
The final construct,self-efficacy, was added to the model in the 1980s
(Rosenstock et al., 1988). Self-efficacy is the confidence that a person has in
his or her ability to pursue a behavior. It is behavior specific and is in the
present. It is not about the past or future. We will learn more about this
construct inChapter 7in the discussion of social cognitive theory, from
which it was borrowed.
The Health Belief Model (HBM) hypothesizes that health-related
action depends upon the simultaneous occurrences of three classes
of factors:
1. The existence of sufficient motivation (or health concern) to
make health issues salient or relevant.
2. The belief that one is susceptible (vulnerable) to a serious
health problem or to the sequelae of that illness or condition.
This is often termed perceived threat.
3. The belief that following a particular health recommendation
would be beneficial in reducing the perceived threat, and at a
subjectivity-acceptable cost.
—Rosenstock, Strecher, and Becker (1988, p. 177)
Four strategies can be used to build self-efficacy:
1.Breaking down the complex behavior into practical and doable small
steps. For example, instead of telling women to perform breast self-
examination, the women could be taught the entire procedure in small
steps.
2.Using a demonstration from a credible role model. For example, in
facilitating an educational program about quitting alcohol, a popular
movie star (with whom the participants identify) who has successfully
gone through the rehabilitation process could share his or her story to
help enhance the self-efficacy of the participants.
3.Using persuasion and reassurance. If a person has failed in the past to
make a behavior change, those failures can be attributed to external
reasons. For example, in a smoking cessation program, a health
educator could ask participants to identify their past failures with
smoking cessation and then mention that they could have failed
because of bad timing, having too many tasks at hand at that time, the
season in which they were attempting the change, and so on.
4.Reducing stress. Any behavior change is associated with some amount
of stress, which hinders the change process. When this stress is
negative, or distress, it hinders the learning process. Reducing distress is
an effective means of building self-efficacy. For example, if participants
find breast self-examination to be stressful, they can be encouraged to
relax by taking a shower or listening to music or practicing progressive
muscle relaxation before performing the behavior.
Table 3-1summarizes the key constructs of the health belief model.
APPLICATIONS OF THE HEALTH BELIEF MODEL
It is not possible to summarize all the applications of the HBM since the
1950s because so many practitioners and researchers have used it.
However, the applications can be divided into three general categories:
1.Behavioral research model building and instrument development
2.Primary prevention through health education regarding prevention of
diseases or for specific protection against diseases, such as
immunization
3.Screening for diseases, compliance with treatment, and other
secondary prevention tasks
Examples of behavioral research in which the HBM was used include
developing an AIDS health belief scale (Zagumny & Brady, 1998), identifying
factors associated with infant mortality (Eshleman, Poole, & Davidhizar,
2005), refining an instrument for breast cancer screening (Champion,
1993;Medina-Shepherd & Kleier, 2010), involvement of dental practitioners
in the prevention of eating disorders (DiGioacchino, Keenan, & Sargent,
2000), modeling for physical activity behavior (Juniper, Oman, Hamm, &
Kerby, 2004;Rahmati-Najarkolaei, Tavafian, Gholami Fesharaki, & Jafari,
2015), modeling childhood obesity prevention behaviors (Vaitinadin, Rosen,
Ying, Wilson, & Sharma, 2015), predictive modeling to prevent severe acute
respiratory syndrome (SARS) (Wong & Tang, 2005), predictors of health
behaviors in college students (Von Ah, Ebert, Ngamvitroj, Park, & Kang,
2004), modeling of sexual behavior (Lin, Simoni, & Zemon, 2005), modeling
of smoking in college students (Kofahi & Haddad, 2005), sociopsycho-logical
modeling for diabetes (Gillibrand & Stevenson, 2006), and using a sodium
adherence dietary scale (Welch, Bennett, Delp, & Agarwal, 2006).Table 3-
2summarizes these applications.
The Health Belief Model was originally formulated to explain
(preventive) health behavior.
—Rosenstock (1974b, p. 27)
The HBM has been used for primary prevention for promoting bicycle
helmet use (Lajunen & Rasanen, 2004), promoting condom use in female sex
workers (Buckingham, Moraros, Bird, Meister, & Webb, 2005), decreasing
tanning bed use (Greene & Brinn, 2003), promoting healthy dietary behavior
(Chew, Palmer, & Kim, 1998), genetic testing (Raz, Atar, Rodnay,
ShohamVardi, & Carmi, 2003), health coaching (George & Tanner, 2014),
promoting hepatitis B vaccination (Bigham et al., 2006), promoting influenza
vaccination (Lau, Yang, Tsui, & Kim, 2006), promoting measles immunization
(Pielak & Hilton, 2003), osteoporosis prevention (Khani Jeihooni, Hidarnia,
Kaveh, & Hajizadeh, 2015;Nieto-Vázquez, Tejeda, Colin, & Matos, 2009),
pesticide safety (Martinez, Gratton, Coggin, Rene, & Waller, 2004),
prevention of periodontal disease (Ndiokwelu, 2004), solar disinfection of
drinking water (Rainey & Harding, 2005), and tuberculosis prevention
(Rodriguez-Reimann, Nicassio, Reimann, Gallegos, & Olmedo, 2004).Table
3-3summarizes these applications.
Some examples in which the HBM has been used for secondary prevention
are for adherence to malaria chemoprophylaxis (Farquharson, Noble, Barker,
& Behrens, 2004), anxiety reduction in nulliparous pregnant women
(Shahnazi, Sabooteh, Sharifirad, Mirkarimi, & Hassanzadeh, 2015), breast
self-examination and mammography (Dundar et al., 2006;Tavafian, Hasani,
Aghamolaei, Zare, & Gregory, 2009;Torbaghan, Farmanfarma, Moghaddam,
& Zarei, 2014), cervical cancer screening (Ben-Natan & Adir, 2009;Park,
Chang, & Chung, 2005), cognitive status examination for Alzheimer’s disease
(Werner, 2003), colorectal cancer screening (Almadi et al., 2015;Austin et
al., 2009;Greenwald, 2006;Omran & Ismail, 2010;Sohler, Jerant, & Franks,
2015), compliance with anticoagulant warfarin therapy (Orensky & Holdford,
2005), compliance with antiviral therapy in hepatitis B patients (Wai et al.,
2005), HIV testing (de Paoli, Manongi, & Klepp, 2004), medication
compliance in schizophrenia (Seo & Min, 2005), medication adherence in
AIDS (Cox, 2009), medication adherence in hypertension (Yue, Li, Weilin, &
Bin, 2015), medication use in osteoporosis (Unson, Fortinsky, Prestwood, &
Reisine, 2005), patient acceptance of continuous positive airway pressure
(CPAP) therapy in sleep apnea (Tyrrell, Poulet, Pe Pin, & Veale, 2006),
prostate cancer screening (Doukas, Localio, & Li, 2004), recurrent injury
prevention in trauma patients (Van Horn, 2005), screening for bone loss in
epileptic patients (Elliott & Jacobson, 2006), and tuberculosis screening
(Poss, 1999).Table 3-4summarizes these applications.
LIMITATIONS OF THE HEALTH BELIEF MODEL
The HBM is particularly useful for planning programs for disease avoidance
and injury avoidance, but it does not lend itself very well to promotion of
behaviors, particularly long-term behavior change. Harrison, Mullen, and
Green (1992) conducted a meta-analysis of the relationships among four
HBM dimensions (perceived susceptibility, perceived severity, perceived
benefits, and perceived costs) and health behaviors in 16 studies. They
computed mean effect sizes for all studies and found weak effect sizes and
lack of homogeneity in a majority of the studies. They concluded that the
model lacked consistent predictive power mainly because it focuses on a
limited number of factors.Cultural factors, socioeconomic status, and
previous experiences also shape health behaviors, and those factors are not
accounted for in the model. A study by Mullen, Hersey, and Iverson (1987)
found less predictive power for the HBM when compared with the theory of
reasoned action, the theory of planned behavior, and the PRECEDE-PROCEED
model. This conclusion once again underscores the need for the HBM to
expand its predictors. To some extent, that has been done by adding the
construct of self-efficacy.
Another problem with the HBM (which is also true for other models) is that
different questions are used in different studies to determine the same
beliefs, thereby making it difficult to compare studies. Janz, Champion, and
Strecher (2002) noted that the constructs of the HBM do not all carry equal
value. For example, perceived barriers are the single most important
predictors of behaviors in the HBM. Often it is not possible to easily influence
the barriers, and thus the model will not work.
Ogden (2003) noted that the HBM is a pragmatic model but has criticized
its conceptual basis. First, she noted that some studies of the HBM have
found no role of perceived susceptibility, indicating that its constructs are not
specific and cannot be tested. Second, she described two types of truth in
the philosophy of science: synthetic truth, which can be known through
exploration and testing; and analytic truth, which is known by definition. She
contended that the HBM focuses on analytic truth; thus its conclusions are
not supported by observation. Finally, she noted thatcompleting questions
about an individual’s cognition in the operationalization of the HBM may
change that person’s thinking rather than tap into how the individual was
originally thinking. In a rejoinder to Ogden’s article, Ajzen and Fishbein
(2004) refuted all these assertions.
APPLICATION EXERCISE
Applications of the HBM in behavioral research, primary prevention, and
secondary prevention have been cited throughout the chapter. Choose one
study in an area that interests you and obtain the full-text article to see how
this model has been applied.
One example is the development of an instrument for breast cancer
screening behaviors by Champion (1993). She delimited her instrument
development parameters to the constructs of the HBM; namely, perceived
susceptibility, perceived severity, perceived benefits, perceived barriers,
cues to action, and self-efficacy. She developed items for each construct and
used a Likert scale. She established construct validity of the scale through a
panel of national experts and performed a factor analysis. Cronbach’s alpha
reliability coefficients for various construct scales ranged from .80 to .93.
Test-retest correlations ranged from .45 to .70.
Locate the full-text article for this study and prepare a 250-word critique.
In your critique reflect on the validity and reliability of the scale. Is the scale
face valid? Is the scale content valid? Is the scale construct valid? Has
concurrent validity been tested? Is the scale internally consistent? Are test-
retest reliability coefficients adequate? How can this scale be improved
further? If you had to develop a scale using the HBM, what steps would you
undertake?
SKILL-BUILDING ACTIVITY
Let us see how we can apply the HBM to the issue of safer sex practices
among college students.Figure 3-2depicts each of the constructs from the
HBM and links these with the educational processes and behavior objectives
in this example.
FIGURE 3-2How the health belief model can be used to modify sexual
behavior in youth to promote safer sex.
The health education intervention would start with modifying the construct
of perceived susceptibility, which can be done by showing a video about
college students suffering from HIV/AIDS and sexually transmitted diseases
(STDs). The video must show people who are similar to the target audience
in their characteristics. The construct of perceived severity can be built by
making a presentation using statistics and a case study that underscores the
serious negative consequences. These consequences can be medical as well
as involving school, work, family, and relationships. To influence perceived
benefits, make sure students have all the information they need to take the
action: for example, where to get condoms, how to choose them, how to
store them, when to use them, how to put them on, how to remove them,
and how to dispose of them. To modify perceived barriers, have the students
brainstorm all real and imagined barriers. Then discuss in a large group how
each of these barriers can be overcome to abstain from sex, use condoms, or
use alternatives to sex. In addition, as an incentive, the students could be
provided with a small supply of free condoms. To influence cues to action,
visual reminders would be used. Youth would be provided with key chains
with the messages so that they could remember to perform the chosen
healthy behaviors. To build self-efficacy, a video with a credible role model
could be shown that depicts the behaviors in smallsteps; reinforces the
messages about abstinence, condom use, and alternatives to sex; and
provides practical advice to reduce stress and anxiety in times of making
love.
Using this approach, apply the HBM to a health behavior issue for a target
group of your choice.Table 3-5provides a set of questions to assist you in
choosing an appropriate educational method that corresponds to different
constructs of the HBM.
SUMMARY
The health belief model is the first theory that was developed exclusively for
health-related behaviors. It had its start in an exploration of the reasons
people were not accessing free screening for tuberculosis. The HBM predicts
behavior based on the constructs of perceived susceptibility, perceived
severity, perceived benefits, perceived costs, cues to action, and self-
efficacy. Perceived susceptibility refers to the subjective belief a person has
regarding the likelihood of acquiring a disease or harmful state as a result of
indulging in a particular behavior. Perceived severity refers to the subjective
belief in the extent of harm that can result from the acquired disease or
harmful state as a result of a particular behavior. Perceived susceptibility
and perceived severity are together called perceived threat. Perceived
benefits are beliefs in the advantages of the methods suggested for reducing
the risk or seriousness of the disease or harmful state resulting from a
particularbehavior. Perceived barriers are beliefs concerning the actual and
imagined costs of following the new behavior. Cues to action are the
precipitating forces that make a person feel the need to take action. Self-
efficacy is the confidence that a person has in his or her ability to pursue a
behavior. The HBM has been widely used in behavioral research, primary
prevention, and secondary prevention.
Applications
of
the
Health
Belief
Model
in
Secondary
Prevention
Adherence
to
malaria
chemoprophylaxis
Anxiety
reduction
in
nulliparous
pregnant
women
Breast
self-examination
and
mammography
Cervical
cancer
screening
Cognitive
status
examination
for
Alzheimer's
disease
Colorectal
cancer screening
Compliance
with
anticoagulant
warfarin
therapy
Compliance
with
antiviral
therapy
in
hepatitis
B
patients
HIV
testing
Medication
compliance
in
schizophrenia
Medication
adherence
in
AIDS
Medication
adherence
in
hypertension
Medication
use
in
osteoporosis
Patient
acceptance
of
continuous
positive
airway
pressure
(CPAP)
therapy
in
sleep
apnea
Prostate
cancer
screening
Recurrent
injury
prevention
in
trauma
patients
Screening
for
bene
loss
in
epileptic
patients
Tuberculosis
screening
MEL
Ces
Key
Constructs
of
the
Health
Belief
Model
How
to
Modify?
Construct
Perceived
susceptibility
Perceived
severity
Perceived
benefits
Perceived
barriers
Cues
to
action
Self-efficacy
Definition
Subjective
belief
that
a
person
may
acquire
a
disease
or
enter a
harmful
state
as
a
result
of
a
particular
behavior
Belief
in
the
extent
of
harm
that
can
result
from
the
acquired
disease
or harmful
state
asa
result
of
a
particular
behavior
Belief
in
the
advantages
of
the
methods
suggested
for
reducing
the
risk
or
seriousness
of
the
disease
or
harmful
state
resulting
from
a
particular
behavior
Belief
concerning
actual
and
imagined
costs of
performing
the
suggested
behavior
Precipitating
force
that
makes
a
person
feel
the
need
to
take
action
Confidence
in
one's
ability
to
acquire
the
new
behavior
Mention
negative
consequences
{e.g.,
smoking
causes
lung
cancer)
Personalize
the
risks
for
participants
(eg.,
the
chances
of
developing
lung
cancer
if
you
are a
smoker
are
22
times
more
than
a
nonsmoker,
based
on
a
relative
risk
computed
by
epidemiological
studies)
Mention
serious
negative
consequences
(e.g.,
eating
saturated
fats
causes
heart
disease)
Personalize
the
seriousness
for
the
education
participants
(e.g.,
share
a
story
about
a
person
who
died
from
a heart
attack
in
the
community)
Specify
the
exact
action
(e.g,
the
individual
will
carry
out
breast
self-examination
in
every
quadrant
every
month
after
taking a
shower)
Specify
the
positive
benefits
that
will
accrue
from
the
behavior
(eg.,
doing
breast
self-examination
monthly
will
allow
you
to
detect
cancer
or
other
diseases
early,
to
feel
good
about
yourself,
to
feel
in
control
of
your
health,
and
to
feel
more
responsible
toward
yourself
and
your
family)
Reassure
the
education
recipients
that
the
behavior
has
minimal
cost
(eg.,
for
breast
self-
examination,
state
that
it
would
only
mean
spending
another
15
minutes
while
taking
a
shower)
Correct
any
misperceptions
that
education
participants
may
have
(e.g.,
a
person
may
think
a
gall
bladder
ultrasound
is
an
invasive
procedure;
correcting
that
misperception
may
increase
the
likelihood
of
the
person
getting
that
test)
Provide
incentives
for
indulging
in
the
behavior
(eg,,
free
cholesterol
testing
may
be
offered
to
increase
the
chances
that
more
people
will
get
tested)
Implement
a
reminder
system
to
encourage
the
behavior
(e.g.,
post
a
note
or
call
the
person
on
the
phone)
Practice
in
small
steps
(e,g.,
breaking
down
complex
behavior
of
self-examination
into
doable
small
steps)
Have
a
role
model
demonstrate
the
behavior
{eg.,
show
a
video
of
a
well-known
movie
star
with
whom
the
target
audience
can
identify
performing
the same
behavior)
Use
persuasion
and
reinforcement
(eg,,
tell
participants
that
they
have
what
it
takes
to
perform
the
behavior,
and
attribute
failures
to
external
forces)
Reduce
stress
associated
with
implementing
a
new
behavior
(eg,,
have
participants
take
a
relaxing
shower
before
doing
a
breast
self-examination)
