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Health Belief Theory

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by Monique Gainey (Fall 2016) & Emily Cable (Spring 2015)

DRAFT: This module has unpublished changes.

Definition:

The Health Belief Theory is built on the idea that there are several central concepts that can predict why people will take action to prevent, screen for, or control illness (1). The theory helps explain a worldview behind people’s reasons for making certain health decisions. It can help inform intervention strategies of certain areas that need to be targeted, such as reasons for patient’s non-compliance with medical advice.

 

When the theory was first created, it consisted of four main constructs that consider individual’s perceptions. The constructs are: perceived seriousness of the consequences of the problem, perceived susceptibility to the problem, perceived benefits of specific actions, and perceived barriers to taking action (2).

 

Each of the four constructs of perception are individually defined as the following: perceived seriousness is an individual’s evaluation regarding the severity of the disease (2). Perceived susceptibility is an individual’s assessment of how likely they are to get the disease (2). Perceived benefits is an individual’s judgment on whether or not the new behavior is better than what they are already doing (2). Perceived barriers is an individual’s attitude regarding what will stop him or her from taking up the new behavior (2).

 

In addition to these four constructs, the Health Belief Theory recognizes that these constructs are all influenced by other personal characteristics, known as modifying factors, including but not limited to elements such as culture, education level, past experiences, skills, and motivation (2).

 

Over time, the Health Belief Theory evolved to include two additional constructs identified as cues to action and self-efficacy (2). Cues to action are influences that can start a person on the way to change their behavior (2). Self-efficacy is defined as one’s personal belief in their ability to accomplish something (1). The theory explains that each of these constructs, either alone or combined, can be accounted for as factors that influence health behavior.

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Figure 1. Overview of Health Belief Model. Adapted from Glanz K, Rimer BK, Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass Publishers, 2008.

 

Origin:

The Health Belief Theory was originally developed in the 1950s by social psychologists in response to their failed tuberculosis (TB) screening program, Dr. Godfrey Hochbaum, Dr. Irwin Rosenstock, and Dr.Steven Kegelsd, while they were working in the U.S. Public Health Services (4). In order to determine why there was limited participation in the free TB screening program, the psychologists investigated what factors motivated adults who actually took advantage of the screening services. Overall, they concluded that a patient’s perception of the benefits and risks of getting screened and of the disease greatly impacted their motivation. Consequently the psychologists constructed the four fundamental components of the health behavior theory (4). Throughout the years the model has been further developed to include cues to action and self-efficacy, as defined above. 

 

Application to Global Health:

The Health Belief Theory can be applied to the field of global health in order to explore a variety of long- or short-term health behaviors and, more importantly, to do so in the context of a community’s culture. It can be used to assess sick role behaviors, such as an individual’s compliance with recommended health advice, to prevent health risk behaviors or to promote health behaviors. By analyzing specific situations where the health belief model can be applied, one can therefore develop culturally specific intervention strategies. 

 

For instance, in Canada the Health Belief Theory was applied to explain what factors influenced the low breast and cervical cancer screening behavior among Hispanic women. Using the model as a guideline, the investigators determined that low socioeconomic status, poverty, low levels of education and acculturation are contributing modifying factors.

 

Next, the investigators analyzed the five individual perceptions Hispanic women have about screening for breast and cervical cancer. Researchers found that many Hispanic women believe such screening procedures are unnecessary, especially if they are asymptomatic or do not have a family history of the disease (5). They do not view preventive procedures as a priority, focusing more on curative practices (5). One limitation of the study was that it did not test for the perceived severity of the disease outcome. The study assumed that women consider breast and cervical cancer to be a serious disease (5). The next individual perception as illustrated in Figure 2 below is cues to action. Cues to action, or positive cues to cancer screening, include physician recommendation, community outreach strategies, churches, written materials and media-based public health campaigns (5). All of these cues to action, especially the first three, play an instrumental role in informing Hispanic women of the benefits of screening. These first three individual perceptions contribute to the perceived threat of the disease, as illustrated in Figure 2. So in this case, Hispanic women have a high threat perception of breast and cervical cancer because of the perceived severity of the disease and the number of cues to action to prevent the disease.

 

The next individual perception of the Health Belief Theory is perceived benefits. Investigators found that Hispanic women recognize the success of screening procedures (5). However, this perceived benefit does not outweigh the fact that they also do not believe they are vulnerable to the disease. Some of the perceived barriers the investigators reported include fear of cancer, fatalistic attitudes about breast and cervical cancer, cultural embarrassment and language barriers. These last two individual perceptions (perceived barriers and benefits) contribute to the excepted net gain of getting screened. The expected net gain is low because the perceived barriers outweigh the benefits.

 

All of these individual perceptions contribute to an individual’s self-efficacy. Overall, the study concluded that the self-efficacy of Hispanic women completing breast and cervical cancer screening is low; hence they are less likely to perform this behavior (5). Employing the health belief model provided a guideline to investigators in developing health interventions with the specific aim of changing behaviors. As such, the investigators recommended strengthening programs that focus on community outreach and media-based campaigns (5). 

DRAFT: This module has unpublished changes.
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Figure 2. Application of Health Belief Model to Hispanic women screening for breast and cervical cancer in Canada.

 

Limitations of Health Belief Theory:

One limitation of the Health Belief Theory is that it is based on a psychosocial model, which narrows its scope of application. It primarily focuses on explaining an individual’s health-related behavior with respect to his/her actions or beliefs even though there may be other external factors that impact one’s health actions (6). More specifically, the health belief theory fails to take into consideration the habitual or addictive nature of a behavior, regardless of an individual’s health belief. For instance, smoking, a habitual behavior, can impact their decision-making process to change their behavior. Even though the individual understands their health behavior is negative, they may not be able to stop due to the addictive nature of the chemical or habit. The health belief model also fails to consider health behaviors that are carried out for reasons unrelated to health. This includes but isn’t limited to such behaviors as dieting to improve appearance, or when financial/environmental factors prohibit someone from taking a suggested course of action (6). Further limitations of the Health Belief Theory are based on the core assumptions of the model. The health belief theory assumes that a person thinks a negative health condition can be avoided, that the person believes he/she can successfully follow the advised health action, and that if following the advised action, the negative health outcome will definitely be avoided (7).

 

Additional Useful Resources:

ReCAPP. Theories and Approaches: Health Belief Model [Internet]. Resource Center for  Adolescent Pregnancy Prevention. Available from:

http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.theoriesdetail&pageid=13

 

Health Belief Model [Internet]. Jones and Bartlett Publishers; Available from:

 http://www.jblearning.com/samples/0763743836/chapter 4.pdf

 

UPenn. Main Constructs of Health Belief Model [Internet]. Health Behavior and Health Education. Available from:

http://www.med.upenn.edu/hbhe4/part2-ch3-main-constructs.shtml

 

Sources:

(1) Glanz K, Rimer BK, Viswanath K. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass Publishers, 2008.

 

(2) Hayden, J. Introduction to health behavior theory. 2nd ed. Wayne, New Jersey: Jones and Bartlett Publishers; 2014. p. 30-36.

 

(3) Glanz K, Rimer BK, Lewis, FM (2002). Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons; 2002.

 

(4) Resource Center for Adolescent Pregnancy Prevention [homepage on the Internet]. Theories and Approaches: How the Health Belief Model Was Developed. Available from: http://recapp.etr.org/recapp/index.cfm?fuseaction=pages.theoriesdetail&PageID=13

 

(5) Austin LT, Ahmad F, McNally M-J, Stewart D. Breast and Cervical Cancer Screening in Hispanic Women. Women's Health Issues. 12:122–8.

 

(6) Janz NK, Becker MH. The health belief model: a decade later. Health Education Quarterly [Internet]. 1984 [cited 2015 Feb 28]; 11(1):1-47.

 

(7) University of Twente. Health Belief Model [Internet]. Health Belief Model. [cited 2016Oct23]. Available from: https://www.utwente.nl/cw/theorieenoverzicht/theory clusters/health communication/health_belief_model/  

DRAFT: This module has unpublished changes.