The Health Belief Model

(HBM)

Introduction to HBM
The oldest and one of the most
widely used in public health.
HBM has roots in:
The behaviorist (stimulus and
response) and cognitive psychology,
(the thinking process, the decision
making process). With emphasis on the
latter.
.

How Did HBM Start?

In 1952, Hochbaum et al. conducted
research to find out why turnout
was so low, given the easy and free
access.
In conducting this research, the
larger issue that he investigated was
MOTIVATION. He asked, what
motivated people to come out and
get screened?

Introduction to HBM

Overview

Introduction of HBM
How did HBM start?
Constructs of HBM
Critique of HBM
HBM and Mammography
Class activity: analyzing a research
design using HBM

How Did HBM Start?

Originated in the
1950s from the work of
U.S. Public Health
Service (USPHS)
social Psychologists
Godfrey Hochbaum
and his colleagues.

How Did HBM Start?

Initially the researchers looked at:
Perceived susceptibility beliefs
about:
the possibility of getting TB
the extent to which one could
have TB without symptoms

Type of theory: Individual -Intra personal

Focus

Individuals perception of a threat posed

by a health problem. The benefit of
avoiding the threat. And the factors
influencing the decisions to act.
Constructs:

Perceived susceptibly
Perceived severity
Perceived benefits
Perceived barriers
Cue to action
Self efficacy

How Did HBM Start?

What do we know about
TB?
Free TB screenings was
provided by The USPHS
Mobile clinics were
placed neighborhoods.
Very few people were
being screened..

How Did HBM Start?

Perceived benefit belief
that
x-rays could find TB
without symptoms
Early detection would
improve the prognosis

How Did HBM Start?

Hochbaum showed that perceived
susceptibility and perceived
benefits of a screening behavior
are associated with behavior
performance.

Components of HBM:
Behavior is an Outcome of. . .
Perceived
Susceptibility

The degree to which a person feels at risk for a

health problem.

Perceived severity

The degree to which a person believes the

consequences of the health problem will be
severe.

Perceived benefits

The positive outcomes a person believes will

result from the behavior.

Perceived barriers

Person's own evaluation of the obstacle in

the way of of adopting a new behavior.

Cue to action

Events (external or internal), people or things

that moves people to change their behavior.

Self-efficacy

A persons belief in his or her ability to take

action.

Health Belief Model

Construct

Definition

Example

Jill thinks if she

Perceived Beliefs on
Severity how serious is gets the flu, the

Its early formulation, health behavior

was thought to be motivated by 4 factors:
Perceived susceptibility
Perceived severity
Perceived benefits of an action
Perceived barriers to taking that action.
Added: cues to action and self-efficacy
in 1988

The Health Belief Model

The premise of HBM is that people
are ready to act when they regard
themselves susceptible to a
condition that has serious
consequences.

Health Belief Model

Health Belief Model

Construct Definition

Perceived
Susceptibi
lity

Application
Specify the

Beliefs
about the
persons
likelihood
of having
the
problem.
(risk level)

Perceived Susceptibility AND Perceived Severity

combine to form the construct PERCEIVED THREAT.
Construct Definition

Perceived Overall
Threat
perceptio

n of
threat to
health.

Example
Jill thinks having
the flu is severe
and if she doesnt
get the flu shot, the
consequences can
be SEVERE.
This leads to

PERCEIVED
THREAT

Application
Provide a range of
logical actions.
The action the
individual takes
depends upon the
next two
constructs:
1. Perceived Benefits
2. Perceived Barriers

Example

Application

Jill thinks
she is not
susceptible
to the flu
because she
is a young
college
student.

Define populations(s)
at risk and their risk
levels.
Tailor risk information
based on an individuals
characteristics/ behaviors.
Help the individual
develop an accurate
perception of his own risk.

Health Belief Model

Health Belief Model

consequences
(physical,
the health
consequences
social, and
problem and may be severe: practical) of
its
miss school and risks and
consequences. work, stay in
conditions.
How would it bed, discomfort Recommend
action.
effect my

life?

The Health Belief Model

Construct

Definition

Perceived The positive

Benefits outcomes a
person
believes will
result from the
behavior.

Example

Application

Jill thinks if
she gets the flu
shot, this may
provide her
with some
protection
against the flu.

Explain how,
where, and
when to take
action and what
the potential
positive results
will be.

Health Belief Model

Construct

Definition

Perceived Factors a
Barriers person
perceive
preventing him
or her from
carrying out
the behavior
(cost, time,
access)

Example

Jill doesnt
have medical
insurance.
Jill thinks she
might get
sick from
getting the flu
shot.

Modifying Factors
Application

Offer

reassurance,
incentives, and
assistance.
Correct
misinformatio
n.

Critiques of HBM

Health Belief Model

Construct

SelfEfficacy

Definition

Example

Confidence in Jill believes

ones ability to she has the
take specific ability to go
action or to
to the health
change a
health related center and get
the flu shot.
behavior.

The past four constructs of perceptions

are modified by other variables called
modifying factors; such as:
Culture, education level, skill, Past
experience, motivation
If Jill had the flue once and it was severe,
she will get the vaccine. If she had the flue
once and it was not so bad, she will not get
the vaccine.

Application
Give verbal

reinforceme
nt.
Reduce
anxiety.

Intrapersonal theory: Will not predict

the behavior of groups
Adult based: Not applicable to the
behavior of children. Too Cognitive
Applicable for the most part to one
time actions rather than habitual
behaviors

HBM and Mammography

Break Time

The HBM predicts that women will be more

likely to adhere to screening mammography
recommendations if they:
feel susceptible to breast cancer (BC)
think BC is a severe disease
Their Perceived barriers to screening is
lower than their Self- efficacy for obtaining
mammograms and
received a Cue to Action

Health Belief Model

The model postulates that the person compares benefits and
barriers, and this helps decide the course of action.
Construct

Cues to
Action

Definition
Events (external or

internal), people or
things that moves
people to change
their behavior.
external cues (TV,
friends)
internal cues
(experience)

Example

Application

Jills
friend got
the flu
and Jill
research
es the flu
on the
Internet.

Provide how

to
information.
Promote
awareness.
Employ
reminder
systems.

Critiques of HBM
Doesnt account well for social and
environmental factors.
Assumes that everyone has equal
access to, and an equivalent level of
information from which to make
rational (cost-benefit) calculations
Voluntary health behaviors. It does not
explain compliance with mandated
behaviors

Studies Among
Diverse Populations
Different groups have different beliefs
about the cause of breast cancer.
Perceived susceptibility
Older African Americans:
injury to the breast (no injury =
low susceptibility)
surgery causes cancer to spread
= death

Studies Among
Diverse Populations
Perceived barriers
Asian Americans: Modesty
associated with lack of
adherence.
African Americans:
Fear, embarrassment
cost associated with
adherence.

Mammography-Promotion Interventions
Based on the HBM
Addressed logistical barriers
Placed women in contact with
community resources, such as
mobile mammography units.
Used printed materials
Video clips
Made phone calls

Application of HBM:
Hooking Up

Consequently, those who hook up

might experience:
Unwanted pregnancies
Sexually transmitted infections
(STIs)
Sexual violence

Mammography-Promotion Interventions
Based on the HBM
Learn, Share and Live intervention

(Skinner, et al).
Used HBM to inform community-based
education sessions for older, urban
minority women.
Goal: change perceptions and
practices among the program
participants and enable them to address
mammography-related perceptions.

Mammography-Promotion Interventions
Based on the HBM
Use of lay health advisers
Distributed necklaces of
wooden beads of graduated
sizes;
Used a dandelion analogy
(pulling up dandelions before
their seeds spread)

Application of
Health Belief Model

Application of HBM:
Hooking Up
Sexual risk taking among college
students:

Source:
http://qhr.sagepub.com.mcc1.library.csulb.edu/content/19/9/119
6.full.pdf+html

Unprotected sex
Multiple sex partners
Sex while under the influence of
alcohol or drugs

Application of HBM:
Hooking Up
Hooking up threatens the sexual,
physical, and psychological health of
college-age youth,
Understanding sexual risk taking within
the context of this popular practice is
important.
Explores college students beliefs
regarding sexual risk taking during
hooking up.

Application of HBM:
Hooking Up
Methods
Semistructured interviews with 71 college
students about their hooking-up experiences.

Eligibility: participation in at least

one hookup, namely a sexual activity
(kissing and fondling of the breasts or genitals,
or oral, anal, or vaginal sex) with someone to
whom they had no relational commitments.

Application of HBM:
Hooking Up

Application of HBM:
Hooking Up

Participants filled out a

questionnaire requesting their
general demographics and sexual
orientation.
Then a four-part interview
began.

Methods: Four-Part Interview

Part 1
assessed the students perceptions of
sex and dating norms on campus,
What they thought their peers and
friends believed about the pros, cons,
and acceptability of hooking up.

Application of HBM:
Hooking Up

Application of HBM:
Hooking Up

Part 3 assessed their evaluations

of their hooking-up experiences as
a whole.
Part 4 assessed students
perception of sexual risk taking
during hooking up, with respect to
STIs.

Demographics
Predominately White, Christian,
heterosexual demographics of the
midwestern region of the United
States.
Ages ranged from 18 to 24, with the
average being about 19.5 years.

Application of HBM:
Hooking Up-More Data

Application of HBM:
Hooking Up RESULTS

Of the 69 students who indicated the highest

level of sexual intimacy that occurred during
their last hookup before the interview
53.6% (n = 37) had vaginal intercourse
30.4% (n = 21) had either given or received oral sex
15.9% (n = 11) had experienced either sexual
touching or masturbation.

Of the 69 students who indicated how far they

went during their last hookup, more than
80% experienced a level of sexual intimacy
that required protection against STIs.

Perceived Susceptibility to Adverse

Outcomes
Many of the students were unaware of their own
vulnerability to STIs.
About 50% of the students were concerned about
contracting an STD during a hookup that involved
sexual intercourse.
The majority of students were not concerned about
contracting an STD during a hookup that went only
as far as fellatio or cunnilingus.

Application of HBM:
Hooking Up
Part 2

assessed the events that occurred

during students most recent
hookup.

Application of HBM:
Hooking Up
Six seniors, 9 juniors, 17
sophomores, 39 freshman
One participant self-identified as
gay, 2 identified as bisexual, all of
the others identified as heterosexual.

Application of HBM:
Hooking Up-Results
Common reasons students
underestimated their vulnerability
to STIs:
they placed too much trust in their partners, with
respect to STIs in general.
they placed too much trust in their community,
especially with respect to HIV/AIDS, they believed
that the low prevalence in their midwestern state
warranted their not concerning themselves about it.
they were inadequately informed of the risk of STIs,
especially with respect to oral sex.

Application of HBM:
Hooking Up-Results
Perceptions of the Level of Severity
Many stated that the worst possible outcome of a
hookup would be contracting an STD.

Perceived Benefits and Barriers

Although most believed that protective methods
such as condoms would effectively prevent
STDs, some feared that insistence on using
protection might thwart their chances for having
sex, or compromise their pleasure.

Interference with sexual pleasure.

Application of HBM:
Hooking Up-Results
Knew where they could obtain or
purchase protective barriers, and
understood how to use them;
Unaware of how they could protect
themselves, or that protection was
necessary, during oral sex (not one
student interviewed reported using a
protective barrier during oral sex);

Application of HBM:
Hooking Up-Results
Self-Efficacy

A critical issue among students who failed

to use protection was that although they
expressed high levels of perceived selfefficacy in terms of their knowledge
about and ability to use protection, they
demonstrated a lack of efficacy in terms of
their preparedness for the type of
unexpected sexual intercourse that occurs
during hooking up.

Application of HBM:
Hooking Up-Results
Many students expressed a lack of efficacy
when they assumed or hoped that their
partners would tell them if they had an STI,
and were uncomfortable directly addressing
the issue.
About 81% of those who reported using
alcohol stated that the alcohol played a role
in the occurrence and evolution of the
hookup.

Application of HBM:
Hooking Up-Results

They portrayed themselves as

inefficacious in terms of their
ability to discuss STIs and the use
of protection with their partners.
Knew how to prevent STIs during
sexual intercourse;