Health Belief Model Theory

The   health   belief   model,   grounded   in   John Atkinson’s  expectancy–value  theory  of  achievement  motivation,  proposes  that  people  are  rational decision makers who, during decision making, take into consideration advantages and disadvantages associated with physical activity. The theory also posits that motivation is unidimensional and that  the  construct  of  intentions,  which  represents motivation,  is  one  of  the  most  immediate  determinants of physical activity. Therefore, the health belief model is a motivational theory that explains intention  formation.  It  does  not  explain  the  processes by which people carry out their previously formed intentions.

The health belief model proposes that an individual’s readiness (intention) to engage in physical activities is a function of the perceived vulnerability to a health condition and the probable severity of that condition. Consistent with the expectancy– value  model,  the  model  posits  that  readiness  is determined  by  a  person’s  beliefs  about  the  benefits  to  be  gained  by  a  particular  behavior  such as  exercise  weighted  by  one’s  perceived  barriers associated with physical activity. Finally, the model predicts  that  readiness  to  action  may  not  result in  physical  activity  unless  some  instigating  event occurred to set the action process in motion. Irwin M.  Rosenstock  termed  such  instigating  events  as cues to action.

Overall,  the  health  belief  model  predicts  that strong intentions emerge when individuals feel vulnerable to an illness, the illness is perceived to be severe, and individuals believe that physical activity will reduce the health threat associated with the illness.  For  example,  individuals  may  feel  susceptible  to  cardiovascular  disease  because  they  have a  poor  diet  and  had  been  told  by  their  physician that they have hypertension. They may also believe that regular exercise may reduce the threat of cardiovascular disease. According to the model, these perceptions are likely to motivate the individual to participate in physical activity.

Thus  far  research  has  shown  that  perceived severity and beliefs about the benefits of physical activity  exert  strong  influences  on  readiness  to engage  in  that  behavior,  while  perceived  severity and  barriers  have  lesser  impact.  In  addition,  evidence suggests that the direct effects of perceived vulnerability,  severity,  susceptibility,  benefits,  and barriers  on  physical  activity  are  small  and  are mediated by readiness. Further, there is evidence to suggest that the health belief model does not sufficiently  capture  all  of  the  psychological  determinants of physical activity and that the model may benefit from considering effects of other constructs such as self-efficacy on intentions and behavior.

One limitation of the health belief model is that it  does  not  define  perceived  vulnerability  clearly, nor does it specify how different variables combine in influencing readiness and physical activity. For example,  it  is  unclear  what  type  of  vulnerability to  disease  should  be  measured.  Shall  we  measure vulnerability  to  cardiovascular  disease  or  vulnerability to back pain? In addition, vulnerability to cardiovascular disease may not predict the physical  activity  behavior  of  young  individuals,  given that  getting  a  heart  attack  is  a  remote  prospect for  youth.  Moreover,  the  model  does  not  explicitly  state  whether  perceived  vulnerability  would facilitate  exercise  or  healthy  dieting  given  that both behaviors would be effective in ameliorating cardiovascular disease risk. Hence, the model does not address behavioral choice. As a result, empirical  evidence  related  to  health  belief  model  varies greatly  across  studies  because  different  studies have used different operational definitions for psychological constructs or populations.

An  important  function  of  research  is  to  provide  information  about  the  content  of  interventions.  Generally  speaking,  the  greater  the  relative importance of a factor in predicting physical activity  intentions,  the  more  likely  it  is  that  changing that factor will influence intentions and ultimately physical  activity  behavior.  Given  that  studies adopting the health belief model have shown that appraisals  related  to  perceived  vulnerability  and perceived  severity,  and  appraisals  related  to  benefits and barriers influence intentions to exercise, it can be suggested that attempts to change exercise behavior  should  try  manipulate  threat  appraisals  alongside  perceived  benefits  and  barriers. An  important  question,  therefore,  is  how  health appraisals can be influenced.

Threat  appraisals  can  be  manipulated  through fear-arousing   communications   that   highlight (a)  the  painful  and  debilitating  effects  of  an  illness  (perceived  severity)  and  (b)  that  people  who do  not  exercise  regularly  are  vulnerable  to  heart disease  (perceived  vulnerability).  Physical  activity benefits can be manipulated by exposing people to information that explains the effectiveness of exercise in preventing disease. The negative impact of perceived barriers on exercise can be circumvented by  asking  people  to  engage  in  types  of  physical activities that are relatively easy to perform or by prompting people to invent coping strategies that help them cope with barriers.

One caveat of interventions based on the health belief  model  is  that  although  they  may  be  successful  in  strengthening  intentions,  they  may  not always bring substantial changes in exercise behavior.  Therefore,  it  cannot  be  expected  verbatim that application of this model will produce strong effects on exercise behavior. Instead, the effectiveness of the health belief model in changing exercise behavior may be enhanced through the implementation of volitional techniques that can help people translate  intentions  into  actions.  Another  limitation  of  the  health  belief  model  is  that  the  threatening  messages  can  sometimes  undermine  rather than   enhance   intentions.   Generally   speaking, people  have  a  desire  to  protect  or  enhance  sense of  self.  As  a  consequence,  they  may  not  easily accept  and  endorse  health-threatening  messages. Therefore,  fear-arousing  communications  should be  designed  and  applied  with  caution.  Health messages  should  not  be  too  threatening  because otherwise  interventions  will  elicit  a  maladaptive coping  response.  For  example,  telling  individuals that exercise reduces the risk of cardiovascular disease may be more easily accepted than telling individuals  that  they  will  have  a  heart  attack  if  they do  not  exercise  on  a  regular  basis.  It  is  therefore always desirable to pilot intervention strategies in a  small  group  of  people  before  conducting  largescale interventions.

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