Health Belief Model Discussion Paper

Researchers have always tried to establish the causes and remedy for diseases but there are researchers who chose to come up with something different. This is the health belief model that was designed as a tool for helping health officials study health behavior. The model is based on the assumption that the personal beliefs people have affect their health behaviors. Many people concerned with heath education have adopted this model and this is because it can simply be adapted to suit a health practice. Rosenstock, Strecher and Becker (1994) claim that the last three decades have seen wide use of the health belief model in health related behavior.  The health belief model was a 1950s development of several Public Health Service officials; Hochbaum, Rosenstock, Leventhal and Kegels.

The model was initially created with an aim of analyzing how people tended to use public health services provided by the U. S Public Health Service. This was prompted by tuberculosis service use which according to Hachbaum (1958) were proving to be unsuccessful. Health Belief Model Discussion Paper The model was adopted for the United States Public Health Service prevention programs. It contained four elements or perceptions which the researchers identified as important components that can help one understand health behavior. These perceptions have so far been increased and according to Rosenstock, Strecher and Becker (1994), they are perceived threat (perceived susceptibility and perceived severity), perceived benefits, perceived barriers, cues to action, other variables and self-efficacy. Gatewood et al. (2008) think that the purpose of the health belief model was to explain people’s lack of action in preventing asymptomatic disease. Thus, the health belief model was geared towards health related behavior which Glanz and Maddock (2002) think that the advancements in medicine as well as improvement in sanitation have increased its necessity.

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Perceived Threat

Mackey (2002) asserts that the identification of health risks inherent in a community by its members is a determinant of their health. The threat perception people attach to a health condition in terms of how serious it is and their chances of being affected by it is what constitutes the perceived threat construct. For a health condition, people hold certain beliefs about how and what may happen if they contract it. One person may perceive a health concern as being severe while it may be less severe to another. There are many things that people use to determine the seriousness of a condition and when people know they are more at risk of losing something and would therefore be prompted to take action for their lives. Some people may decide to take action because they are aware of what it might cost them if they were to get sick. When it comes to susceptibility, someone may tend to think that because he/she is of a certain age, then the disease cannot affect him/her. Someone may also have the perception that because they are healthy, they cannot be affected and this is also a belief that affects use of new behaviors.

Perceived Benefits

This refers to the usefulness a behavior will have in helping the individuals reduce their susceptibility and severity of a health condition. When people are introduced to a new behavior that may help to keep them safe, their adoption of the behavior will depend on the benefits they perceive. Hence, people will make use of health services when they know the kind of benefits they can get from them. People will usually assess a disease and the possible outcomes against what they may get from the recommended behavior and when the benefits outweigh the consequences, they are more likely to change behavior. For a health official, there is the need to make people aware of all the benefits associated with a new action.

Perceived Barriers

People also tend to look at the barriers that may prevent them from adopting the new recommended behavior. When someone analyzes his/her condition and determines that there are no perceived barriers, then change of behavior easily occurs. Perceived barriers may include financial constraints in which case a person may lack the money needed for a new behavior. When people are advised to do something, they will have perceptions of things that may prevent them and for a health official, your duty is to help in identifying and getting rid of them.  A new action may come with effects people may not want and this also creates a barrier. Reducing barriers is the best way to get people doing using a new action. Glanz and Maddock (2002) assert that barriers are used in decision making where people consider the advantages and disadvantages of an action.

Cues to Action

Cues to action is a like something that reminds people of the new behavior they need to adopt or something that motivates them towards it. These can be used as a way of making people more aware of the need at the same time letting them know how to go about it. Cues to action strategies can do well in influencing the kind of behavior change required from people. Here, various media can be used and these include posters, radio, TV where you can remind people of the kind of danger they are facing if they will not take up a recommended action. Safety instructions on many products that can easily affect health are a good example of cues to action as it reminds people of what they should be doing or avoiding.

Other Variables

Other variables include characteristics that may be unique to an individual but are also influential in forming perceptions. These include such things as education level which may place one in a position to know everything about a condition as compared to one who knows less. Health Belief Model Discussion Paper  Similarly, cultural and demographic differences may also bring about the difference in perception in which case someone they may have different views about a behavior. The belief that people who live in certain areas are susceptible to some kind of diseases may make other people not to take a disease seriously.  People experiences, especially ones related to a disease will also result in their different perceptions since someone may consider it serious while the other may take it lightly.

Self-Efficacy

Bandura (1977) introduces self-efficacy as one’s own belief to do something. With self-efficacy, people have to believe that they can take the required action so to succeed otherwise, a barrier is created. When people have the fear of not being able to do the new action correctly, it hinders them from getting the intended benefits. Thus, you can only evoke behavior change in your subjects if you make them confident enough to believe they can perform. Rosenstock, Stretcher and Becker (1998) insist that the focus of the health belief model should also be on the individual’s confidence. This is because it was found to have an influence on the kind of choices people make regarding recommended actions. Self-efficacy can be improved through a variety of strategies but it works well of you take time to show people what they ought to be doing to prevent them from shying away.

Implications for Health Behaviors

Many health researchers have applied the health belief model in several studies to determine how people behave towards diseases and practices and these can  portray well the implication of the model to health behavior. Glanz and Maddock (2002) say that there are many factors that might affect health behaviors apart from policies and regulations. Breast-self examination is one of them and for this; early detection is always the best. However not many of the women are keen on conducting breast self examinations and in their study, Norman and Brian (n. d) found that breast self examination performance was affected by several independent predictors which included intention, perceived benefits and self-efficacy.

Hanson and Benedict (2006) use the model in their study to establish food handling behaviors among the older adults. Thus, health belief model is also applicable in nutrition where it can be used to find out how safe people are handling their food. One of the things Hanson and Benedict’s study established is that sanitation was prompted by the perceived severity people had of foodborne illnesses. This is just one of the things that people will use to take action, for instance, when they see on posters or other media of how an illness may affect them, they may have that perception of its severity and would therefore conform to cleanliness.

Radius and Joffe (1988) sought to focus their use of the model on young mothers or adolescents and their perception of breastfeeding.  This is because they may be presented with barriers arising from their own beliefs about activity. These are also benefits and together with the barriers help to influence the young mothers’ decision on whether to breastfeed or not. Radius and Joffe found that many of the adolescent mothers perceived fewer barriers to breastfeeding which shows that many of them found the method to be better than bottle feeding. Many times, people tend to have the wrong information about something which creates the perceived barriers.

While the health belief model can be used on women regarding changing behavior on breast self examination, it can also be used to study the perceptions men have on prostate cancer.  Kleier (2004) conducted such a study on Jamaican and Haitian men where she also sought to find out how much they knew about the illness. In comparing the two Kleier found that Jamaican men seemed to have more information as compared to Haitian men. The study also established that there are other variables affecting perceptions which include language and culture with regard to the subjects of the study. Here, many of the Haitian men have language problems which not made it difficult for them to acquire the relevant knowledge about the disease.

Health belief model does not just have an effect on patient behavior but the staff also has perceptions that can be studied. This is the focus of Agarwal, Sypher and Dutta’s (2009) study where they chose to find the effect of selected constructs of the model on staff behavior. The researchers used knowledge, perceived effectiveness and cues to action and found, among other things, that greater knowledge contributed to a low perception of benefits but did not affect barriers or behaviors. Gatewood et al. (2008) seek to find out how perceived barriers and self-efficacy affect the attendance of a community health program, specifically for cardiovascular risk reduction. They established that participants who had not been exposed to the program tended to have more perceived barriers as compared to those who know about the program.

Roden (2004) used of the model for the promotion of health practices among young families. The researcher used perceived behavioral control and behavioral intention for the study where the model could be modified to suit the selected group. It was established that the two were suited for the modified model. Cerkoney and Hart (1980) used the model to explain behavior of people with diabetes mellitus with regard to how well they complied with their treatment. It was found that there are procedures that they seemed to take seriously with which many of them were complaint while there are those they seemed to ignore.

The use of cues to action is a common practice in health field when there is a need to sensitive people on an issue. Marifran (1999) examines the role HIV test counselors can play in persuading people to play safe sex. The study found that such cues to action improved the condition and many people tended to play safe. Winfield and Whaley (2002) chose to use the model to study the use of condoms where they focused on African American college students. The study found out that condom use was determined by perceived barriers and gender.

Behavior change

Recognition and labeling of one’s behavior

Behavior change is best effected when an individual is able to recognize that he/she exhibits bad behavior which needs to be changed. Here, one would need to know what kind of behavior is questionable and to realize that one can easily be affected by such behavior. In their study Marcus et. al (1992) established that people could adopt more to exercising by understanding the stages of exercise behavior and self-efficacy through the necessary information.

Making a commitment to change behavior

The second step is to make a decision to reduce or do away with the behavior that has been identified as bad. Here, one may have to look at both the advantages and disadvantages as well as how the change may affect you. Since behavior change is to help reduce the risks involved, you may also want to analyze what kind of response you may get once you become the person of desirable qualities. Just like in the health relief model, self-efficacy involves a person determining whether he/she is able to take that action that would lead to behavior change. With this, it may be worthwhile for an individual to consider what will be needed in order to make the process successful. This is in terms of being able to perform the activities chosen and the willingness to keep on trying in case of failure.

Taking action the third action

The third action to behavior change is to take action and this is where an individual may have to consider things such as level of self esteem and communication abilities. This stage may occur in three phases but are not a must and may be skipped. In phases, an individual would be required to seek information first that would be useful to the situation. This is the stage that one needs to have good communication skills as well so you can explain to people that you have changed and the reasons. The individual is exposed to a number of choices with regard to whether formal or informal help is required. There may also be need to have certain resources to help in the adoption of a desired behavior which is also identified at this stage of behavior change model.

Stages of Change

Stages of Change Theory identify some stages which are to be considered during the behavior change cycle. This model is useful in a number of instances where behavior change is necessary and Kern (2008) says that behavior change with this model is a series of steps where individuals will go through different stages before successful change can be realized. Usually, someone will move to the next stage when he/she has established that it is appropriate to proceed and this is only after completing the previous stage.

The developers of this theory advance the four stages which are pre-contemplation, contemplation, action and maintenance and there is also a fifth stage which is the preparation for action.  Prochaska, DiClemente and Norcross (1992) provide a description for each of the stages involved in the cycle. Each of the stages involve an individual doing a different activity, from the initial stages where the person is still considering whether to decide to change or not to the end when he/she either maintains the new behavior or relapses.

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Pre contemplation

This is the initial stage which Kern (2008) says that people here are not serious and may not even be interested in getting help. This is where they are still trying to come to terms with the bad side of their behavior and it may take some time to convince them that they ought to get rid of their current behavior. In this stage, the individual needs to be given a lot of information which will help in understanding their bad habits. There is also need to let the people know what environmental effect their behavior is causing.

Contemplation

At this stage, people have started to take more interest and can therefore accept that they have a behavior problem. This may be prompted by several factors which include experiencing someone suffering as a result of the behavior but this generally involves a self evaluation. Zimmerman, Olsen and Bosworth (2000) say that this is a stage where a patient examines benefits and costs involved and may be helped by incorporating other models such as health belief model.

Preparation for Action

This is where the decision has already been made regarding behavior change and the individual is making plans to take necessary action. When the person understands and can see how serious their bad habits are, he/she would start finding the help needed. This may involve the person finding as much information as possible about the situation and the possible solutions that could be of help.

Action

The action stage is where the person has already selected a course of action such as a behavior change and is not practicing it. This may not be very easy since it may involve a complete change of behavior and since one may have been used to the bad habits very much, there are chances of relapsing. Kern (2008) says that this is people may take different amount of times at this stage but may last up to 6 months.

Maintenance

At the maintenance stage, the person is trying not to relapse and move back to the old habits. When you are in the action stage, it only takes a while before you enter into the maintenance stage provided you are consistent. Those who are able to prevent relapse tend to benefit more from the benefits that change in behavior was meant to bring. The amount of time here is indefinite and will depend on how well a person is able to adapt to new behavior without chances of going back.

Studies that used the Health Belief Model

Attia, A. K., Rahman, D. A., & Kamel, L. I. (1997). Effect of an educational film on the Health

Belief Model and breast self-examination practice. Eastern Mediterranean Health Journal .  Volume 3, Issue 3, 1997, Page 435-443.Page 435-443

Cerkoney, K. A., & Hart, L.K. (1980). The relationship between the health belief model and compliance of persons with diabetes mellitus. Diabetes Care, September 1980 vol. 3 no. 5 594-598 doi: 10.2337/diacare.3.5.594.

Health Belief Model Discussion Paper