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HealthBeliefModel

TheorienoverzichtTCW

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HEALTHBELIEFMODEL
explaininghealthbehaviors
HistoryandOrientation
TheHealthBeliefModel(HBM)isapsychologicalmodelthatattemptstoexplainandpredicthealthbehaviors.Thisisdoneby
focusingontheattitudesandbeliefsofindividuals.TheHBMwasfirstdevelopedinthe1950sbysocialpsychologistsHochbaum,
RosenstockandKegelsworkingintheU.S.PublicHealthServices.Themodelwasdevelopedinresponsetothefailureofafree
tuberculosis(TB)healthscreeningprogram.Sincethen,theHBMhasbeenadaptedtoexploreavarietyoflongandshortterm
healthbehaviors,includingsexualriskbehaviorsandthetransmissionofHIV/AIDS.
CoreAssumptionsandStatements
TheHBMisbasedontheunderstandingthatapersonwilltakeahealthrelatedaction(i.e.,usecondoms)ifthatperson:
1.

feelsthatanegativehealthcondition(i.e.,HIV)canbeavoided,

2.

hasapositiveexpectationthatbytakingarecommendedaction,he/shewillavoidanegativehealthcondition(i.e.,using
condomswillbeeffectiveatpreventingHIV),and

3.

believesthathe/shecansuccessfullytakearecommendedhealthaction(i.e.,he/shecanusecondomscomfortablyandwith
confidence).

TheHBMwasspelledoutintermsoffourconstructsrepresentingtheperceivedthreatandnetbenefits:perceivedsusceptibility,
perceivedseverity,perceivedbenefits,andperceivedbarriers.Theseconceptswereproposedasaccountingforpeople's
"readinesstoact."Anaddedconcept,cuestoaction,wouldactivatethatreadinessandstimulateovertbehavior.Arecent
additiontotheHBMistheconceptofselfefficacy,orone'sconfidenceintheabilitytosuccessfullyperformanaction.This
conceptwasaddedbyRosenstockandothersin1988tohelptheHBMbetterfitthechallengesofchanginghabitualunhealthy
behaviors,suchasbeingsedentary,smoking,orovereating.
TablefromTheoryataGlance:AGuideforHealthPromotionPractice"(1997)
Concept

Definition

Application
Definepopulation(s)atrisk,risk

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levelspersonalizeriskbasedona
person'sfeaturesorbehavior
heightenperceivedsusceptibilityif
toolow.

Perceived
Susceptibility

One'sopinionofchances
ofgettingacondition

Perceived
Severity

One'sopinionofhow
seriousaconditionandits
consequencesare

Specifyconsequencesoftherisk
andthecondition

Perceived
Benefits

One'sbeliefintheefficacy
oftheadvisedactionto
reduceriskorseriousness
ofimpact

Defineactiontotakehow,where,
whenclarifythepositiveeffectsto
beexpected.

Perceived
Barriers

One'sopinionofthe
tangibleandpsychological
costsoftheadvisedaction

Identifyandreducebarriers
throughreassurance,incentives,
assistance.

CuestoAction

Strategiestoactivate
"readiness"

Providehowtoinformation,
promoteawareness,reminders.

SelfEfficacy

Confidenceinone'sability
totakeaction

Providetraining,guidancein
performingaction.

ConceptualModel

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Source:Glanzetal,2002,p.52
FavoriteMethods
Surveys.
ScopeandApplication
TheHealthBeliefModelhasbeenappliedtoabroadrangeofhealthbehaviorsandsubjectpopulations.Threebroadareascan
beidentified(Conner&Norman,1996):1)Preventivehealthbehaviors,whichincludehealthpromoting(e.g.diet,exercise)and
healthrisk(e.g.smoking)behaviorsaswellasvaccinationandcontraceptivepractices.2)Sickrolebehaviors,whichreferto
compliancewithrecommendedmedicalregimens,usuallyfollowingprofessionaldiagnosisofillness.3)Clinicuse,whichincludes
physicianvisitsforavarietyofreasons.
Example
Thisisanexamplefromtwosexualhealthactions.(http://www.etr.org/recapp/theories/hbm/Resources.htm)
Concept

CondomUseEducationExample

1.PerceivedSusceptibility

YouthbelievetheycangetSTIsorHIVor
createapregnancy.

2.PerceivedSeverity

Youthbelievethattheconsequencesof
gettingSTIsorHIVorcreatingapregnancy
aresignificantenoughtotrytoavoid.

STIScreeningorHIVTesting
Youthbelievetheymayhavebeenexposedto
STIsorHIV.
YouthbelievetheconsequencesofhavingSTIs
orHIVwithoutknowledgeortreatmentare
significantenoughtotrytoavoid.

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3.PerceivedBenefits

4.PerceivedBarriers

HealthBeliefModel

Youthbelievethattherecommendedaction
Youthbelievethattherecommendedactionof
ofusingcondomswouldprotectthemfrom
gettingtestedforSTIsandHIVwouldbenefit
gettingSTIsorHIVorcreatingapregnancy.
thempossiblybyallowingthemtogetearly
treatmentorpreventingthemfrominfecting
others.
Youthidentifytheirpersonalbarrierstousing
condoms(i.e.,condomslimitthefeelingor
theyaretooembarrassedtotalktotheir
partneraboutit)andexplorewaysto
eliminateorreducethesebarriers(i.e.,teach
themtoputlubricantinsidethecondomto
increasesensationforthemaleandhave
thempracticecondomcommunicationskills
todecreasetheirembarrassmentlevel).

5.CuestoAction

Youthreceiveremindercuesforactioninthe
formofincentives(suchaspencilswiththe
printedmessage"noglove,nolove")or
remindermessages(suchasmessagesin
theschoolnewsletter).

6.SelfEfficacy

Youthconfidentinusingacondomcorrectly
inallcircumstances.

Youthidentifytheirpersonalbarrierstogetting
tested(i.e.,gettingtotheclinicorbeingseenat
theclinicbysomeonetheyknow)andexplore
waystoeliminateorreducethesebarriers(i.e.,
brainstormtransportationanddisguiseoptions).

Youthreceiveremindercuesforactioninthe
formofincentives(suchasakeychainthatsays,
"Gotsex?Gettested!")orremindermessages
(suchaspostersthatsay,"25%ofsexuallyactive
teenscontractanSTI.Areyouoneofthem?
Findoutnow").
Youthreceiveguidance(suchasinformationon
wheretogettested)ortraining(suchaspractice
inmakinganappointment).

References
Keypublications
Conner,M.&Norman,P.(1996).PredictingHealthBehavior.SearchandPracticewithSocialCognitionModels.OpenUniversity
Press:Ballmore:Buckingham.
Glanz,K.,Rimer,B.K.&Lewis,F.M.(2002).HealthBehaviorandHealthEducation.Theory,ResearchandPractice.San
Fransisco:Wiley&Sons.
Glanz,K.,MarcusLewis,F.&Rimer,B.K.(1997).TheoryataGlance:AGuideforHealthPromotionPractice.NationalInstitute
ofHealth.
Eisen,Met.al.(1992).AHealthBeliefModelSocialLearningTheoryApproachtoAdolescents'FertilityControl:Findingsfrom
aControlledFieldTrial.HealthEducationQuarterly.Vol.19.
Rosenstock,I.(1974).HistoricalOriginsoftheHealthBeliefModel.HealthEducationMonographs.Vol.2No.4.
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Becker,M.H.TheHealthBeliefModelandPersonalHealthBehavior.HealthEducationMonographs.Vol.2No.4.
Champion,V.L.(1984).Instrumentdevelopmentforhealthbeliefmodelconstructs,AdvancesinNursingScience,6,7385.
Becker,M.H.,Radius,S.M.,&Rosenstock,I.M.(1978).Compliancewithamedicalregimenforasthma:atestofthehealthbelief
model,PublicHealthReports,93,26877.
Seealso:http://www.comminit.com/ctheories/sld2929.html
http://www.etr.org/recapp/theories/hbm/
Seealso:TheoryofPlannedBehavior/ReasonedAction,ProtectionMotivationTheory
SeealsoHealthCommunication

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