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Behaviour Change Theory
Admin- Admin
- Number of posts : 182
Location : Lost in the Time Space Curve
Registration date : 2007-02-22
The Saint- Admin
Number of posts : 2444
Age : 51
Location : In the Fifth Dimension
Job : Consultant in Paediatric Emergency Medicine, NHS, Kent, England, UK
Registration date : 2007-02-22
Definition and Rationale for the Health Belief Model
The Health Belief Model (HBM) is one of the most widely used conceptual frameworks for understanding health behavior. Developed in the early 1950s, the model has been used with great success for almost half a century to promote greater condom use, seat belt use, medical compliance, and health screening use, to name a few behaviors.
The HBM is based on the understanding that a person will take a health-related action (i.e., use condoms) if that person:
It's important to note that avoiding a negative health consequence is a key element of the HBM. For example, a person might increase exercise to look good and feel better. That example does not fit the model because the person is not motivated by a negative health outcome — even though the health action of getting more exercise is the same as for the person who wants to avoid a heart attack.
The HBM can be an effective framework to use when developing health education strategies. A large research study reviewed 46 studies of HBM-based prevention programs published between 1974 and 1984. The HBM-based programs focused on a variety of health actions. The results of the meta-analysis provided substantial empirical support for the efficacy of the HBM.
HBM is based on six key concepts. The following table, excerpted with minor modifications from "Theory at a Glance: A Guide for Health Promotion Practice" (1997), presents definitions and applications for each of the six key concepts. Examples of the concepts as they apply to sexuality education are presented after this table.
For examples of what the six key concepts look like when applied to two sexual health actions, review the following table:
The Health Belief Model (HBM) is one of the most widely used conceptual frameworks for understanding health behavior. Developed in the early 1950s, the model has been used with great success for almost half a century to promote greater condom use, seat belt use, medical compliance, and health screening use, to name a few behaviors.
The HBM is based on the understanding that a person will take a health-related action (i.e., use condoms) if that person:
- feels that a negative health condition (i.e., HIV) can be avoided,
- has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., using condoms will be effective at preventing HIV), and
- believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence)
It's important to note that avoiding a negative health consequence is a key element of the HBM. For example, a person might increase exercise to look good and feel better. That example does not fit the model because the person is not motivated by a negative health outcome — even though the health action of getting more exercise is the same as for the person who wants to avoid a heart attack.
The HBM can be an effective framework to use when developing health education strategies. A large research study reviewed 46 studies of HBM-based prevention programs published between 1974 and 1984. The HBM-based programs focused on a variety of health actions. The results of the meta-analysis provided substantial empirical support for the efficacy of the HBM.
| Health Belief Model: Major Concepts |
| Concept | Definition | Application |
| 1. Perceived Susceptibility | One's belief of the chances of getting a condition |
|
| 2. Perceived Severity | One's belief of how serious a condition and its consequences are |
|
| 3. Perceived Benefits | One's belief in the efficacy of the advised action to reduce risk or seriousness of impact |
|
| 4. Perceived Barriers | One's belief in the tangible and psychological costs of the advised behavior |
|
| 5. Cues to Action | Strategies to activate "readiness" |
|
| 6. Self-Efficacy | Confidence in one's ability to take action |
|
| Concept | Condom Use Education Example | STI Screening or HIV Testing |
| 1. Perceived Susceptibility | Youth believe they can get STIs or HIV or create a pregnancy. | Youth believe they may have been exposed to STIs or HIV. |
| 2. Perceived Severity | Youth believe that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid. | Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid. |
| 3. Perceived Benefits | Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy. | Youth believe that the recommended action of getting tested for STIs and HIV would benefit them — possibly by allowing them to get early treatment or preventing them from infecting others. |
| 4. Perceived Barriers | Youth identify their personal barriers to using condoms (i.e., condoms limit the feeling or they are too embarrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e., teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level). | Youth identify their personal barriers to getting tested (i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options). |
| 5. Cues to Action | Youth receive reminder cues for action in the form of incentives (such as pencils with the printed message "no glove, no love") or reminder messages (such as messages in the school newsletter). | Youth receive reminder cues for action in the form of incentives (such as a key chain that says, "Got sex? Get tested!") or reminder messages (such as posters that say, "25% of sexually active teens contract an STI. Are you one of them? Find out now"). |
| 6. Self-Efficacy | Youth receive training in using a condom correctly. | Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment). |
Last edited by The Saint on Fri Jun 06, 2008 7:08 pm; edited 2 times in total
The Saint- Admin
- Number of posts : 2444
Age : 51
Location : In the Fifth Dimension
Job : Consultant in Paediatric Emergency Medicine, NHS, Kent, England, UK
Registration date : 2007-02-22
How Can I Use the Health Belief Model in My Setting?
The Health Belief Model (HBM) can be used alone as the theoretical basis of a health education program, or it can be used in combination with other models, learning theories and approaches. Since no model or learning theory can explain or predict all aspects of health behavior, combining compatible theories and models can create stronger health education programs. The HBM is often combined with Social Learning Theories in health education programs.You can use the HBM in your work with youth by:
Key
Condition = pregnancy, STIs, HIV
Recommended Health Actions = abstaining from sex or using condoms
The Health Belief Model (HBM) can be used alone as the theoretical basis of a health education program, or it can be used in combination with other models, learning theories and approaches. Since no model or learning theory can explain or predict all aspects of health behavior, combining compatible theories and models can create stronger health education programs. The HBM is often combined with Social Learning Theories in health education programs.You can use the HBM in your work with youth by:
- using it as a theoretical framework to better understand the current curricula you are using;
- using it as the theoretical framework for developing new programs and curricula; or
- adapting your current curriculum or program by adding key elements of the HBM.
Key
Condition = pregnancy, STIs, HIV
Recommended Health Actions = abstaining from sex or using condoms
| Checklist for Educators | Implementation Ideas (applicable HBM concepts appear in parentheses) |
| 1. Do you include an activity that increases students' perception of their own vulnerability to the condition? |
(Perceived Susceptibility) |
| 2. Do you assess students' perception of their own vulnerability to the condition? |
(Perceived Susceptibility) |
| 3. Do you include activities that teach the seriousness of the condition and its consequences? |
(Perceived Severity) |
| 4. Do you assess students' perception of the severity of the condition? |
(Perceived Severity) |
| 5. Do you clearly present the desired action to take to avoid the condition? |
(Perceived Benefits) |
| 6. Do you assess whether the youth believe the action will benefit them by preventing the condition? |
(Perceived Benefits) |
| 7. Do you help youth identify their personal barriers to action? |
(Perceived Barriers) |
| 8. Do you support youth in reducing or eliminating barriers (or perception of barriers) to taking action? |
(Perceived Barriers) |
| 9. Do you provide youth with cues to action? |
(Cues to Action) |
| 10. Do you assess whether your students feel confident that they can take the recommended action correctly? | Educators should determine their students’ level of confidence in using a skill or taking an action by:
(Self-efficacy) |
The Saint- Admin
- Number of posts : 2444
Age : 51
Location : In the Fifth Dimension
Job : Consultant in Paediatric Emergency Medicine, NHS, Kent, England, UK
Registration date : 2007-02-22
Challenges and Considerations in Applying the Health Belief Model
Challenges include:
- Needing to be careful not to "blame the victim." The Health Belief Model (HBM) stresses personal responsibility, which may lead people to feel it is their fault if they cannot solve their own health problems.
Unfortunately, a health problem is often more complex or may be caused by factors over which an individual has less personal control (e.g., economic or environmental factors). - Providing meaningful Cues to Action can be challenging, especially as time passes. Make sure you have appropriate permission to use reminder messages outside of class (e.g., posters, newsletter submissions, announcements).
Other special considerations include the following:
- The HBM focuses on beliefs and attitudes and, as such, may be less appropriate for dealing with habitual behaviors like smoking, dieting, or other emotionally motivated health behaviors. These behaviors should be addressed separately. In addition, economic and environmental factors are not addressed with the Health Belief Model since these may be out of an individual's control.
- The HBM is a good fit for prevention-focused programs because these programs generally promote specific actions, and the HBM helps participants to take action. However, HBM is not always a good fit for comprehensive family life education programs which tend to be more information-based and wider in scope of topics.
- To help build self-efficacy, encourage youth to set short-term goals, which are generally easier to achieve and receive reinforcement for than long-term goals, which may not be realized for months or years.
- Grant support for programs which are based on the HBM may be easier to get from funding agencies. Funders generally prefer supporting programs that are carefully crafted and grounded in well-researched approaches and models such as the HBM.
- It is more effective to combine the HBM with other learning theories (e.g., Social Learning Theory) than to offer specific guidelines for teaching skills.
- Be aware that the HBM uses "appropriate fear-based messages" in order to facilitate youths' perceived susceptibility and severity. Be careful not to overdo it. When fear levels are too high, youth may feel helpless.
- The HBM is much more effective for a multiple layer intervention. The combination of multiple interventions (e.g., a school health event, classroom instruction, and an educational ad campaign) is more effective than any single intervention.
- The HBM is best used for a relatively short intervention to achieve a specific change. It may be less effective in achieving long-term change.
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