The Health Belief Model (HBM) was originally developed in the 1950s as a way of understanding apparent resistance to seeking preventive treatment in the form of inoculations and screenings for communicable diseases. It can be described as an organizing framework for predicting acceptance of public and individualized health behavior recommendations. Thus, it appears to have applications in the realms of individual intervention, program development, and public policy. The model focuses on health-related motivation, attempting to define what it takes for an individual to engage in health promoting behaviors. This includes not only engaging in preventive actions, but also following interventions prescribed by various health practitioners. As a value-expectancy theory, HBM examines behavior as a function of the subjective value placed on an outcome and the subjective expectation that the action taken will result in the desired outcome. The model also works from the assumption that good health is valued for most people, focusing on the impact of beliefs and values on health-related decision making.
The model includes four primary variables: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. Perceived susceptibility addresses an individual’s belief of vulnerability to the illness or disease when not experiencing symptoms directly. For individuals who have already been diagnosed, this variable has been adjusted to include their acceptance of the diagnosis as well as their perception of resusceptibility to the illness and general susceptibility in regard to overall health. Perceived severity entails the perception of how serious individuals believe the potential effects of the illness will be on their lifestyles, including the potential impact on social factors like their ability to work and their family interactions. Susceptibility and severity can be combined to create the construct of perceived threat, which in turn can be directly compared to the variable of perceived benefits.
The perceived benefits describe an individual’s belief in the effectiveness of preventive or prescribed actions. Perceived barriers range from practical issues of money and healthcare access to more psychologically and fear-based issues (i.e., denial, not wanting to know if he or she has a serious illness). Albert Bandura’s theory of self-efficacy adds the missing piece to explain the power of perceived barriers in an individual’s perception of competence to act in an effective manner to prevent or overcome an illness. In this way, self-efficacy acts as a mediating factor as to whether someone will behave in a health-promoting manner. The model’s focus on health-related motivation seems directly related to theories of change, with the four primary variables (i.e., susceptibility, severity, benefits, and barriers) providing a combined understanding of an individual’s readiness to act in a health-promoting manner. Higher levels of perceived threat (susceptibility plus severity) combined with strong perceptions of the benefit to action and self-efficacy lead to increased motivation to act in health-promoting ways. HBM has been criticized for not directly accounting for non-health-related motivators for various behaviors (i.e., social acceptance) or economic and environmental factors (i.e., hazardous work environment). However, in breaking down and defining the primary variables of the model, it seems that these factors may be barriers to action.
Application of the Health Belief Model
Applications of HBM extend from the individual to the public policy level. In applying the variables of the model to individual therapy, each can provide insight into the development of an effective intervention that a client will be motivated to carry out. It may also be used in identifying various factors that prevent individuals from successfully reaching health-related therapeutic goals. The identification of barriers has been demonstrated by research to be a primary factor in understanding ineffective treatment regimens. From the larger perspective of public policy and the development of intervention programs, HBM provides a flexible, adaptable model that can be applied to multicultural populations, various illness diagnoses, and preventive health-related actions as well as to a wide variety of approaches to intervention and behavioral outcomes. The four primary constructs can be applied to cultural knowledge regarding a specific population or group in the development of interventions such as breast self-examination and AIDS prevention programs, where the model can enhance the effectiveness of the interventions by disentangling differences in age, gender, and culture in regard to the interaction between the constructs for specific groups. Researchers have pointed out the need to pay close attention to how cultural and socioeconomic factors account for differences in measuring the perception of threat, benefits, and barriers.
Implications for Future Research
One aspect of HBM that is still not well understood or researched is the concept of cues that stimulate the link between perceptions and actions. Researchers have struggled to identify the complex nature of environmental, interpersonal, and intrapersonal cues. It seems that health-promoting programs could have increased participation and success if the developers of these programs had a more comprehensive understanding of these cues. It is possible that the cues correlate to the interaction between the perceived severity of and the susceptibility to an illness, implying that different cues are necessary for individuals with differing levels of perceived severity and susceptibility. Cues to action (e.g., emotional or social processes) may be internal (i.e., bodily change or symptom, emotional states, desire to seek approval from a significant other) or external (i.e., media exposure to information, pressure from a loved one to seek treatment). The complexity of measuring the level of influence of these various types of cues continues to challenge researchers in developing studies that would provide information on the impact of such cues on various populations.
The model itself has presented challenges in understanding the specific interactions between the primary variables, self-efficacy, and the predicting behavior. The model suggests that individual perceptions of threat, benefits, and barriers to action may be mediated by self-efficacy beliefs and cues to action that may then predict the likelihood of health-promoting action. Research has demonstrated the individual importance of the primary variables but not necessarily their interaction. Better understanding of the interactions of variables within the model might provide greater power to predict, understand, and enhance participation in preventive health programs as well as in follow-through with respect to prescribed treatment. An example of the dynamic nature of the model is demonstrated by its ability to compare (a) the importance individuals attach to prevention in the context of their own perceived susceptibility to illness versus (b) the importance they attach to benefits of treating an illness they have already contracted.
- Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman/Times Books/Henry Holt.
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