Health Belief Model

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 [Page 236]primary variables of the model, it seems that these factors may be barriers to action.

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