The Stephen Kegeles, and Howard Leventhal at

The health belief model
(HBM) is by far the most commonly used theory in health education, as well as
health promotion; the most popular conception of the HBM is that health
behavior is solely determined by a personal belief or perception about a
disease and all the strategies available to decrease its occurrence (Jones
& Bartlett).  Being one of the first
theories of health behavior, the HBM was developed in the 1950’s by a team of
social psychologists– Irwin M. Rosenstock, Godfrey M. Hochbaum, S. Stephen
Kegeles, and Howard Leventhal at the U.S. Public Health Service, to better
understand the widespread failure of screening programs for tuberculosis.  According to one of the developers of the
Health Belief Model, “It is always difficult to trace the historical
development of a theory that has been the subject of considerable direct study
and has directly or indirectly spawned a good deal of additional research”
(Rosenstock, 1974).  The human health
behavior is controlled by several different factors, which can and in most
cases, will influence their overall behavior; these include: age, gender,
ethnicity, socioeconomic status, cultural values, and religion.  The human health behavior can also be
influenced by:  pressures presented by
family and peers, time availability, job demands, and personal or social
commitments. 

 The HBM derives from psychological and
behavioral theory with the foundation that the two components of health-related
behavior are as follows, according to research conducted by Wayne W. LaMorte,
MD, PhD, MPH—the desire to avoid illness, or conversely get well if already
ill; and the belief that a specific health action will prevent, or cure,
illness. Also, after further research, later uses of HBM were for
patients’ responses to symptoms and compliance with medical treatments. Finally,
the HBM suggests that a person’s belief in a personal threat of an illness or
disease together with a person’s belief in the effectiveness of the recommended
health behavior or action will predict the likelihood the person will adopt the
behavior (LaMorte, 2016).  Throughout my
research, I plan on discussing in further depths the six constructs of the
Health Behavior Model—perceived susceptibility, perceived severity, perceived
benefits, perceived barriers, cue to action, and self-efficacy, as well as the limitations
of the HBM. 

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Within
the HBM, there are a total of six constructs—four of which were developed as
the original, and the last two were developed as more research was conducted
and through the evolution of the HBM.  The
first 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 subjective
perception of the risk of acquiring an illness or disease”; according to
research, there is a drastically widened variation in a person’s feelings of
vulnerability to a disease or illness (LaMorte, 2016).  Perceived susceptibility also brings the
essential question of “Could this happen to me?”  According to information given by the HBM,
perceived susceptibility does also predict that individuals who believe that
they are more susceptible to particular health problems are more likely to
engage in behaviors that allow them to reduce any risk of developing “said”
health problems (Wiki pages, 2016).  Amongst
the youth population, a prime example of perceived susceptibility would be the
use of condoms while engaging in sexual intercourse.  Some may say “If I do not use a condom, then
I will most likely, or even most definitely contract an STD or HIV.”—after
completing a sex education course. 
Another example of the use of perceived susceptibility would be if
someone chooses to exercise more frequently in order to become more fit, or
look more attractive, all because they have heard that will increase their
chance of a better lifestyle. 

Perceived
susceptibility is also a “central concept in several fear appeals health
information processing models, including the Health Belief Model (Becker, 1974;
Rosenstock, 1974; Rosenstock, Strecher, & Becker, 1994), parallel response
model (Leventhal, 1970), Protection Motivation Theory (Rogers, 1975, 1983) and
the Extended Parallel Process Model (Witte, 1992, 1998)” (Consumer Health
Informatics Research Resource, 2017). 

 “Perceived Severity”—or commonly known as
Perceived Seriousness.  This term refers
to a person’s belief of how severe a condition or disease may be, as well as
the 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 also
determine how that person may process certain information about their health
status and how motivated they may be to engage in a certain behavior.  Perceived severity has also been linked to
other 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 this
construct are: “I believe that (the name of the health threat) is severe”, “I
believe that (the name of the health threat) is serious”, and finally, “I
believe that (the name of the health threat) is significant” (Consumer Health
Informatics Research Resource, 2017). 

Perceived
severity can be linked to several different conditions and illnesses.  The most widespread case involves the use of
tobacco products.  For a person who
consumes these products, without knowing the full knowledge or treatment, may
consider the risks of consumption, and from that assume that the severity of
smoking 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 the
habit altogether.  Another example would
be alcohol consumption; again, not knowing the optimum amount consequences or severity
of consumption—cirrhosis of the liver, disorientation, or the risk of a
financial or social fallout may be enough cause for an alcoholic—or even a
non-drinker to avoid this habit altogether. 

 “Perceived Benefits”; this term refers to an
individual’s assessment of the value or efficacy of engaging in a
health-promoting behavior to decrease risk of disease” (Wiki pages, 2016).  Perceived benefits play such a crucial role
in the adoption of secondary prevention behaviors, making it one of the most important
constructs of the HBM; in fact, the focus of perceived benefits is that it is
the “why” of the model itself (Jones & Bartlett, 2017).  Through the perceived benefits construct, it
is 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 and
participate in a more effective action to be relieved from certain health risk
and its severity.   Finally, according to
Wayne W. LaMorte, MD, PhD, MPH, A perceived benefit is also—in better terms, “The course of action a person takes in
preventing (or curing) illness or disease relies on consideration and
evaluation of both perceived susceptibility and perceived benefit, such that
the person would accept the recommended health action if it was perceived as
beneficial. 

A
few 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 it
would make me a healthier person?”  If this
individual really believed and put their full faith into this question, then
the response would most likely be a “yes.” 
Another question into consideration, and a more popular one would be “If
I honestly believe smoking was better for my health than quitting cold turkey,
would I continue to smoke?”  Well, we all
know the answer—smoking or using any tobacco product is not essential to a
person’s health; however, if this individual honestly believed that smoking
would be better for them than quitting cold turkey, then they may continue to
indulge in the habit.  Finally, the use
of 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 likely
to use sunscreen; for others, they may believe that sunscreen in a gimmick and
may not believe in the prevention in such cancers, so they may avoid it
altogether. 

For
most, the adaptation and adjustment to change is not much of an easy thing to
do; in fact, the HBM construct of “Perceived Barriers”—the last of the four
original constructs of the HBM, discusses such challenge.  Perceived barriers are “an individual’s own
evaluation of the obstacles in the way of him or her adopting a new behavior—of
all of the constructs, perceived barriers have the most impact and the most
influence of behavior changes for an individual” (Jones & Bartlett, 2017).  One main explanation of this construct is
that it has the potential to keep people from whatever they “should” do or want
to do, all because of the possible or consequential barriers that individuals
face.  

A
few listed examples of potential barriers that people face when seeking care
are as follows: financial status, transportation, health care services, or
access to therapy, screenings, and further treatments (Plowden, 1999).  Modern health care increasingly provides many
inequalities to those in certain socioeconomic living conditions.  A couple major barriers that some
underprivileged populations face is the cost and availability to health care
access.   When an individual ends up
contracting an illness or develops a certain medical condition, they may feel
that there is no hope—all due to not having coverage nor the financial means to
help themselves.  This individual may be
more likely to avoid being seen by a physician, or going to an emergency room
for treatment because they would not be able to afford said treatment.  Another for instance could be if someone
wants to improve themselves by not smoking. 
Some potential barriers for this individual may be 1) they do not want
to gain unnecessary weight, 2) they may lack will power, 3) they may feel that
the stress of quitting is not worth the headache, or 4) they feel that without
the right treatment or support, they will continually fail. 

The
first of the two modernly adopted constructs of the HBM is “Cue to
Action”.  Cue to Action is defined as
factors in that trigger action—which according to the HBM is necessary to
prompt the engagement of health-promoting behavior.  Cues can be external—events or information
from others, the media, or health care providers engaging in health-related
behaviors, or cues can also be internal—psychological (pain-related or
symptom-related).  “The intensity of cues
needed to prompt action varies between individuals by perceived susceptibility,
seriousness, benefits, and barriers” (Wiki pages, 2016).  For example, for those who believe that they
are at higher risks for certain diseases or health conditions, if they have a
primary care physician and are close to them, they are more likely to ask about
certain screenings or precautionary measures against “said” diseases or health
conditions.  Another example could be if
someone 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 to
their health.   Finally, lets revert back
to the discussion regarding physical health, say an individual continues to
gain unhealthy weight, causing them to slow down, lack energy, or libido, that
individual may consider looking into an exercise and diet program to prevent
any further damage to their health—with the hopes of changing to a better
lifestyle, and resulting in a more prolonged life. 

Finally,
the sixth and final construct of the HBM— “Self-Efficacy”, was added in 1988 in
order to better explain “an individual’s perception of his or her competence to
successfully perform a behavior” (Wiki pages, 2016).  The truth behind self-efficacy is that people
generally refuse to do something unless they know that they can do it
successfully; if they feel that a new behavior is useful (perceived benefit),
but does not believe that they can do it (perceived barrier), then they will
most likely avoid trying to change anything pertaining to their current
situation (Jones & Bartlett, 2017).  Research
has shown that not only is self-efficacy important for patient education and
health, but that health care professionals can positively impact patients by
enhancing their self-efficacy.  Some ways
in which this is possible are: skill mastery, modeling, and social
persuasion. 

Skill
mastery is important for patients because it allows them to see how simple it
can be to master tasks to manage a better lifestyle or change their behavior
towards something.  If a person can see
how successful they can be in something, they are more likely and more willing
to adopt a healthier behavior.  A good
example of skill mastery would be Alcoholics Anonymous.  These types of programs are very encouraging
and do strive to take advantage of self-efficacy by telling a patient that they
are able to overcome something and live to their fullest—taking one baby step
at a time.  Modeling is an important
factor to self-efficacy, because it allows a person to see and connect with
another person who may have a similar issue. 
“Support groups and patient groups such as the Arthritis Foundation’s
self-help course and the American Cancer Society’s Reach to Recovery Program
are based on modeling. When using modeling, try to match patients with models
who are as much like them as possible in terms of age, sex, ethnic origin, and
socioeconomic status” (Patient Education: Self-Efficacy, 2017).  And finally, social persuasion allows a
patient to look at technics and strategies to help reach their health care
goals more realistically versus impossible or too far beyond their reach. 

In
conclusion, the HBM has become widespread and most popular in the healthcare
field and has successfully been adopted and implemented by many.  For one, it allows a person to feel that they
can be successful in the management and prevention of their health
conditions.  When following the HBM, an
individual may begin to feel that they have more control over their own life
and can make better choices for themselves—relieving them of extra stress, and
therefore, elevating their self-esteem.  However,
even though there are benefits to the HBM, there are also many criticisms and
limitations that follow, and as a result can inhibit its effectiveness in the
world of public health.  The biggest
issue that I have noticed throughout this research, is that the HBM happens to
be far more descriptive than it is explanatory; it has the habit of describing
each construct and what the HBM stands for, however, it does not go into much
depth as to how it can be more helpful or useful.  That is, yes, the model does make sense, and
is accurate, however, this biggest issue here within the limitation is that it
focuses too much on the “desired behavior” rather than what behavior is
necessary for the individual to become successful.  Again, as stated by Wayne W. LaMorte, MD,
PhD, MPH, “The individual constructs are useful, depending on the health
outcome of interest, but for the most effective use of the model it should be
integrated with other models that account for the environmental context and
suggest strategies for change.”