Model of health behavior change..

1. Health Belief
Model
Presented by
Kumar Nyaupane
Roselini Shrestha

2. Introduction
• The health belief model is a psychological health behavior
change model developed to explain and predict health related
behaviors. Proposed by Irwin M. Rosenstock and Backer.
• The Health Belief Model (HBM) was developed in the early
1950s by social scientists at the U.S. Public Health Service in
order to understand the failure of people to adopt disease
prevention strategies or screening tests for the early detection
of disease.
• The health belief model proposes that a person's health-
related behavior depends on the person's perception of four
critical areas:
1. The severity of a potential illness
2. The person's susceptibility to that illness
3. The benefits of taking a preventive action
4. The barriers to taking that action

3. Contd….
• Health Belief Model (HBM) is a conceptual formulation for
understanding why individuals did or did not engage in a
wide variety of health related actions.
• Four constructs(perceived susceptibility, perceived severity,
perceived benefits, and perceived barriers) - fairly good
predictor of screening behavior. These concepts were
proposed as accounting for people's "readiness to act."
• Later additional constructs added to better explain changing
habitual behaviors
1.cues to action, would activate that readiness and stimulate
overt behaviour.
2.self-efficacy, or one's confidence in the ability to successfully
perform an action.

4. Model
Demographic variable
[age, sex, race
ethnicity, etc.]
Socio-psychological
variables
Perceived Threat of
Disease “X”
Perceived
Susceptibility to
Disease “X”
Perceived Severity
of Disease “X”
Perceived benefits
of preventive
action
minus
Perceived barriers
to preventive
action
Likelihood of Taking
Recommended
Preventive Health
ActionCues To Action
Mass Media Campaigns
Advice from others
Reminder postcard from physicilan or dentist
Illness of familiy member or friend
Newspaper or magazine article
INDIVIDUAL
PERCEPTIONS
MODIFYING
FACTORS
LIKELIHOOD
OF ACTION

5. Example HIV/AIDS program
Perceived
susceptibility
Young man has
been engaging in
sex with multiple
partners.
Perceived
Severity
Young man
believes that
AIDS is a death
sentence since
there is no cure.
Perceived
Threat
Young man
believes that he
is at risk because
friend is ill.
Cues to Action
Radio messages
explaining the
need for safe sex.
Peer education on
safe sex and HIV.
Benefits/ barriers
 Condoms are
easy to use, one
can feel safe
 Condoms not
readily available,
costly
Desired
Behaviour
Young man buys
and uses condoms
regularly.
Self-efficacy
Young man has
had practice using
condoms and feels
confident to use
them.

6. 1. Perceived susceptibility:
• It refers to subjective assessment of risk of developing a
health problem.
• Individuals with low perceived susceptibility , deny that
they are at risk for contracting a particular illness.
• This model predicts that individuals who perceive that they
are susceptible to a particular health problem will engage in
behaviors to reduce their risk of developing the health
problem.
• Individuals who believe they are at low risk of developing
an illness are more likely to engage in unhealthy, or risky,
behaviors.
• E.g.: a man who, based on family history, believe he is
likely candidate for heart disease is more likely to pay
attention to an advertisement for a program to reduce the
risk of heart disease.
• Perceived severity + perceived susceptibility = perceived
threat.

7. 2.Perceived severity
• Beliefs about the seriousness of a condition and its
consequences
– disability
– death
– pain
• Individuals who perceive a given health problem as serious are
more likely to engage in behaviors to prevent the health
problem from occurring (or reduce its severity).
• Eg: a person newly diagnosed with diabetes may not be likely
to make major life or diet changes if he or she is not
experiencing any symptoms.
• An individual may perceive, Influenza is not medically
serious, but if he or she perceives that there would be serious
financial consequences as a result of being absent from work
for several days, then he or she may perceive influenza to be a
particularly serious condition.

8. •3.Perceived benefits
• It refers to an individual's assessment of the value or
efficacy of engaging in a health-promoting behavior to
decrease risk of disease.
• It is a belief or perception about the benefit of being
engaged in particular health behavior.
• If an individual believes that a particular action will reduce
susceptibility to a health problem or decrease its
seriousness, then he or she is likely to engage in that
behavior regardless of objective facts regarding the
effectiveness of the action.
• For example, individuals who believe that wearing
sunscreen prevents skin cancer are more likely to wear
sunscreen than individuals who believe that wearing
sunscreen will not prevent the occurrence of skin cancer.

9. 4.Perceived barriers
• Beliefs about the material and psychological costs of taking action.
• To what extent does the individual believe there are barriers
preventing him/her from conducting the behavior?
• Even if an individual perceives a health condition as threatening and
believes that a particular action will effectively reduce the threat,
barriers may prevent engagement in the health-promoting behavior.
• Perceived barriers to taking action include the perceived
inconvenience, expense, danger (e.g., side effects of a medical
procedure) and discomfort (e.g., pain, emotional upset) involved in
engaging in the behavior.
• For instance, lack of access to affordable health care and the
perception that a flu vaccine shot will cause significant pain may act
as barriers to receiving the flu vaccine.

10. •Modifying variables
• Individual characteristics,
including demographic, psychosocial, and structural
variables, can affect perceptions (i.e., perceived seriousness,
susceptibility, benefits, and barriers) of health-related
behaviors.
• Demographic variables include age, sex, race, ethnicity, and
education, among others.
• Psychosocial variables include personality, social class, and
peer and reference group pressure, among others.
• Structural variables include knowledge about a given
disease and prior contact with the disease, among other
factors.
• Modifying variables affect health-related behaviors
indirectly by affecting perceived seriousness, susceptibility,
benefits, and barriers.

11. •Cues to action
• Factors that activate ”readiness to change”
• e.g., a television ad or a reminder from one’s physician to
get a mammogram
• This model suggests that a cue, or trigger, is necessary for
prompting engagement in health-promoting behaviors.
• Internal cues -Physiological cues (e.g., pain, symptoms)
• External cues - events or information from closers, the
media, or health care providers.
• The intensity of cues needed to prompt action varies between
individuals by perceived susceptibility, seriousness, benefits,
and barriers.

12. •Self-efficacy
• Confidence in one’s ability to take action
• Are confident in their ability to successfully perform an
action
• Self-efficacy was added to the four components of the
health belief model (i.e., perceived susceptibility,
seriousness, benefits, and barriers) in 1988.
• Self-efficacy was added to better explain individual
differences in health behaviors.
• Developers of the model recognized that confidence in one's
ability to effect change in outcomes (i.e., self-efficacy) was
a key component of health behavior change.

13. Application
Concept Definition Application
Perceived
Susceptibility
One’s opinion of chances of
getting a condition
Define population(s) at risk based
on a person’s features or behaviour.
Heighten perceived susceptibility
if too low
Perceived
Severity
One’s opinion of how serious a
condition and its sequelae are
Specify consequences of risk and
condition
Perceived
Benefits
One’s opinion of the efficacy of
the advised action to reduce risk or
seriousness of impact
Define action to talk: how, where,
when; clarity the positive effects to
be expected
Perceived
Barriers
One’s opinion of the tangible and
psychological costs of the advised
action
Identify and reduce barriers
through reassurance, incentives,
assistance
Cues to Action Strategies to activate “readiness” Provide how-to information,
promote awareness, reminders
Self-Efficacy Confidence on one’s ability to take
action
Provide training, guidance in
performing action

14. Limitations
• It does not account for a person's attitudes,
beliefs, or other individual determinants that
dictate a person's acceptance of a health
behavior.
• It does not take into account behaviors that are
habitual and thus may inform the decision-
making process to accept a recommended
action (e.g., smoking).
• It does not take into account behaviors that are
performed for non-health related reasons such
as social acceptability.

15. • It does not account for environmental or
economic factors that may prohibit or promote
the recommended action.
• It assumes that everyone has access to equal
amounts of information on the illness or
disease.
• It assumes that cues to action are widely
prevalent in encouraging people to act and that
"health" actions are the main goal in the
decision-making process.

16. References
• Wikipedia
• Glanz et al, 2002, p
• www.etr.org/recapp/theories
• Catania, J.A., Kegeles, S.M., and Coates T.J.

18. A
Big
Thank
You