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The health belief model(HBM) is by far the most commonly used theory in health education, as well ashealth promotion; the most popular conception of the HBM is that healthbehavior is solely determined by a personal belief or perception about adisease and all the strategies available to decrease its occurrence (Jones& Bartlett).  Being one of the firsttheories of health behavior, the HBM was developed in the 1950’s by a team ofsocial psychologists– Irwin M. Rosenstock, Godfrey M. Hochbaum, S. StephenKegeles, and Howard Leventhal at the U.S. Public Health Service, to betterunderstand the widespread failure of screening programs for tuberculosis.  According to one of the developers of theHealth Belief Model, “It is always difficult to trace the historicaldevelopment of a theory that has been the subject of considerable direct studyand has directly or indirectly spawned a good deal of additional research”(Rosenstock, 1974).

 The human healthbehavior is controlled by several different factors, which can and in mostcases, will influence their overall behavior; these include: age, gender,ethnicity, socioeconomic status, cultural values, and religion.  The human health behavior can also beinfluenced by:  pressures presented byfamily and peers, time availability, job demands, and personal or socialcommitments.   The HBM derives from psychological andbehavioral theory with the foundation that the two components of health-relatedbehavior are as follows, according to research conducted by Wayne W. LaMorte,MD, PhD, MPH—the desire to avoid illness, or conversely get well if alreadyill; and the belief that a specific health action will prevent, or cure,illness. Also, after further research, later uses of HBM were forpatients’ responses to symptoms and compliance with medical treatments. Finally,the HBM suggests that a person’s belief in a personal threat of an illness ordisease together with a person’s belief in the effectiveness of the recommendedhealth behavior or action will predict the likelihood the person will adopt thebehavior (LaMorte, 2016).  Throughout myresearch, I plan on discussing in further depths the six constructs of theHealth Behavior Model—perceived susceptibility, perceived severity, perceivedbenefits, perceived barriers, cue to action, and self-efficacy, as well as the limitationsof the HBM.

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  Withinthe HBM, there are a total of six constructs—four of which were developed asthe original, and the last two were developed as more research was conductedand through the evolution of the HBM.  Thefirst construct of discussion within this research will be that of the”Perceived Susceptibility”—or commonly known as Perceived Vulnerability.  This term refers to “a person’s subjectiveperception of the risk of acquiring an illness or disease”; according toresearch, there is a drastically widened variation in a person’s feelings ofvulnerability to a disease or illness (LaMorte, 2016).

  Perceived susceptibility also brings theessential question of “Could this happen to me?”  According to information given by the HBM,perceived susceptibility does also predict that individuals who believe thatthey are more susceptible to particular health problems are more likely toengage in behaviors that allow them to reduce any risk of developing “said”health problems (Wiki pages, 2016).  Amongstthe youth population, a prime example of perceived susceptibility would be theuse of condoms while engaging in sexual intercourse.  Some may say “If I do not use a condom, thenI will most likely, or even most definitely contract an STD or HIV.”—aftercompleting a sex education course. Another example of the use of perceived susceptibility would be ifsomeone chooses to exercise more frequently in order to become more fit, orlook more attractive, all because they have heard that will increase theirchance of a better lifestyle.  Perceivedsusceptibility is also a “central concept in several fear appeals healthinformation processing models, including the Health Belief Model (Becker, 1974;Rosenstock, 1974; Rosenstock, Strecher, & Becker, 1994), parallel responsemodel (Leventhal, 1970), Protection Motivation Theory (Rogers, 1975, 1983) andthe Extended Parallel Process Model (Witte, 1992, 1998)” (Consumer HealthInformatics Research Resource, 2017).   “Perceived Severity”—or commonly known asPerceived Seriousness.

  This term refersto a person’s belief of how severe a condition or disease may be, as well asthe severity of consequences that may arise from them.  When combined, perceived susceptibility,along with perceived severity may form a threat to a person; it can alsodetermine how that person may process certain information about their healthstatus and how motivated they may be to engage in a certain behavior.  Perceived severity has also been linked toother non-health consequences such as how a disease may impact financial,social, or psychological outcomes for a person. A few suggested measures that are included in the concentration of thisconstruct are: “I believe that (the name of the health threat) is severe”, “Ibelieve that (the name of the health threat) is serious”, and finally, “Ibelieve that (the name of the health threat) is significant” (Consumer HealthInformatics Research Resource, 2017).  Perceivedseverity can be linked to several different conditions and illnesses.  The most widespread case involves the use oftobacco products.  For a person whoconsumes these products, without knowing the full knowledge or treatment, mayconsider the risks of consumption, and from that assume that the severity ofsmoking is not worth the risk to their health.

 They also may figure that the disease associated with smoking—asthma,emphysema, or lung cancer, may be enough of a reason to avoid starting thehabit altogether.  Another example wouldbe alcohol consumption; again, not knowing the optimum amount consequences or severityof consumption—cirrhosis of the liver, disorientation, or the risk of afinancial or social fallout may be enough cause for an alcoholic—or even anon-drinker to avoid this habit altogether.  “Perceived Benefits”; this term refers to anindividual’s assessment of the value or efficacy of engaging in ahealth-promoting behavior to decrease risk of disease” (Wiki pages, 2016).  Perceived benefits play such a crucial rolein the adoption of secondary prevention behaviors, making it one of the most importantconstructs of the HBM; in fact, the focus of perceived benefits is that it isthe “why” of the model itself (Jones & Bartlett, 2017).  Through the perceived benefits construct, itis the common belief for an individual that if they were to engage in an action,then they would most likely be able to reduce susceptibility for themselves andparticipate in a more effective action to be relieved from certain health riskand its severity.

   Finally, according toWayne W. LaMorte, MD, PhD, MPH, A perceived benefit is also—in better terms, “The course of action a person takes inpreventing (or curing) illness or disease relies on consideration andevaluation of both perceived susceptibility and perceived benefit, such thatthe person would accept the recommended health action if it was perceived asbeneficial.  Afew example questions that an individual may ask themselves could possibly be,”Would I strive to eat a full five servings of fruits and vegetables, if itwould make me a healthier person?”  If thisindividual really believed and put their full faith into this question, thenthe response would most likely be a “yes.

” Another question into consideration, and a more popular one would be “IfI honestly believe smoking was better for my health than quitting cold turkey,would I continue to smoke?”  Well, we allknow the answer—smoking or using any tobacco product is not essential to aperson’s health; however, if this individual honestly believed that smokingwould be better for them than quitting cold turkey, then they may continue toindulge in the habit.  Finally, the useof sunscreen, according to research has also been in much controversy.  Some believe that if the utilize sunscreen,then they will avoid skin or other cancers altogether, making them more likelyto use sunscreen; for others, they may believe that sunscreen in a gimmick andmay not believe in the prevention in such cancers, so they may avoid italtogether.  Formost, the adaptation and adjustment to change is not much of an easy thing todo; in fact, the HBM construct of “Perceived Barriers”—the last of the fouroriginal constructs of the HBM, discusses such challenge.  Perceived barriers are “an individual’s ownevaluation of the obstacles in the way of him or her adopting a new behavior—ofall of the constructs, perceived barriers have the most impact and the mostinfluence of behavior changes for an individual” (Jones & Bartlett, 2017).  One main explanation of this construct isthat it has the potential to keep people from whatever they “should” do or wantto do, all because of the possible or consequential barriers that individualsface.

   Afew listed examples of potential barriers that people face when seeking careare as follows: financial status, transportation, health care services, oraccess to therapy, screenings, and further treatments (Plowden, 1999).  Modern health care increasingly provides manyinequalities to those in certain socioeconomic living conditions.  A couple major barriers that someunderprivileged populations face is the cost and availability to health careaccess.   When an individual ends upcontracting an illness or develops a certain medical condition, they may feelthat there is no hope—all due to not having coverage nor the financial means tohelp themselves.

  This individual may bemore likely to avoid being seen by a physician, or going to an emergency roomfor treatment because they would not be able to afford said treatment.  Another for instance could be if someonewants to improve themselves by not smoking. Some potential barriers for this individual may be 1) they do not wantto gain unnecessary weight, 2) they may lack will power, 3) they may feel thatthe stress of quitting is not worth the headache, or 4) they feel that withoutthe right treatment or support, they will continually fail.  Thefirst of the two modernly adopted constructs of the HBM is “Cue toAction”.  Cue to Action is defined asfactors in that trigger action—which according to the HBM is necessary toprompt the engagement of health-promoting behavior.

  Cues can be external—events or informationfrom others, the media, or health care providers engaging in health-relatedbehaviors, or cues can also be internal—psychological (pain-related orsymptom-related).  “The intensity of cuesneeded to prompt action varies between individuals by perceived susceptibility,seriousness, benefits, and barriers” (Wiki pages, 2016).  For example, for those who believe that theyare at higher risks for certain diseases or health conditions, if they have aprimary care physician and are close to them, they are more likely to ask aboutcertain screenings or precautionary measures against “said” diseases or healthconditions.  Another example could be ifsomeone receives a reminder in the mail to set a dentist or vision appointment,they may call to set that appointment up to prevent any unnecessary risk totheir health.   Finally, lets revert backto the discussion regarding physical health, say an individual continues togain unhealthy weight, causing them to slow down, lack energy, or libido, thatindividual may consider looking into an exercise and diet program to preventany further damage to their health—with the hopes of changing to a betterlifestyle, and resulting in a more prolonged life.  Finally,the sixth and final construct of the HBM— “Self-Efficacy”, was added in 1988 inorder to better explain “an individual’s perception of his or her competence tosuccessfully perform a behavior” (Wiki pages, 2016).  The truth behind self-efficacy is that peoplegenerally refuse to do something unless they know that they can do itsuccessfully; if they feel that a new behavior is useful (perceived benefit),but does not believe that they can do it (perceived barrier), then they willmost likely avoid trying to change anything pertaining to their currentsituation (Jones & Bartlett, 2017).  Researchhas shown that not only is self-efficacy important for patient education andhealth, but that health care professionals can positively impact patients byenhancing their self-efficacy.

  Some waysin which this is possible are: skill mastery, modeling, and socialpersuasion.  Skillmastery is important for patients because it allows them to see how simple itcan be to master tasks to manage a better lifestyle or change their behaviortowards something.  If a person can seehow successful they can be in something, they are more likely and more willingto adopt a healthier behavior.  A goodexample of skill mastery would be Alcoholics Anonymous.

  These types of programs are very encouragingand do strive to take advantage of self-efficacy by telling a patient that theyare able to overcome something and live to their fullest—taking one baby stepat a time.  Modeling is an importantfactor to self-efficacy, because it allows a person to see and connect withanother person who may have a similar issue. “Support groups and patient groups such as the Arthritis Foundation’sself-help course and the American Cancer Society’s Reach to Recovery Programare based on modeling. When using modeling, try to match patients with modelswho are as much like them as possible in terms of age, sex, ethnic origin, andsocioeconomic status” (Patient Education: Self-Efficacy, 2017).  And finally, social persuasion allows apatient to look at technics and strategies to help reach their health caregoals more realistically versus impossible or too far beyond their reach.  Inconclusion, the HBM has become widespread and most popular in the healthcarefield and has successfully been adopted and implemented by many.

  For one, it allows a person to feel that theycan be successful in the management and prevention of their healthconditions.  When following the HBM, anindividual may begin to feel that they have more control over their own lifeand can make better choices for themselves—relieving them of extra stress, andtherefore, elevating their self-esteem.  However,even though there are benefits to the HBM, there are also many criticisms andlimitations that follow, and as a result can inhibit its effectiveness in theworld of public health.  The biggestissue that I have noticed throughout this research, is that the HBM happens tobe far more descriptive than it is explanatory; it has the habit of describingeach construct and what the HBM stands for, however, it does not go into muchdepth as to how it can be more helpful or useful.  That is, yes, the model does make sense, andis accurate, however, this biggest issue here within the limitation is that itfocuses too much on the “desired behavior” rather than what behavior isnecessary for the individual to become successful.

  Again, as stated by Wayne W. LaMorte, MD,PhD, MPH, “The individual constructs are useful, depending on the healthoutcome of interest, but for the most effective use of the model it should beintegrated with other models that account for the environmental context andsuggest strategies for change.”   


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