The Health Belief Model

The Health Belief Model (HBM) is a psychological model that attempts to explain and predict
health behaviors. The major focus is on the attitudes and beliefs of individuals. The model
grew from two major learning theories: stimulus response (S-R) theory and cognitive theory
(C-T). In S-R theory, reasoning and thinking is not required; learning results from events
(reinforcements) that reduce physiological drives that activate behavior. In cognitive theory,
the thought process is essential; reinforcements operate by influencing expectations about the
situation rather than by influencing behavior directly (Champion & Skinner, 2008). The Health
Belief Model was developed in the 1950s by social psychologists Irwin M. Rosenstock,
Godfrey M. Hochbaum, S. Stephen Kegels, and Howard Leventhal at the U.S. Public Health
Service to better understand the widespread failure of screening programs to prevent and
detect disease. The model was developed in response to the failure of a free tuberculosis (TB)
health screening program. Since then, the HBM has been adapted to explore a variety of
long-term and short-term health behaviors, including sexual risk behaviors and the
transmission of HIV/AIDS (Babbie, 2010; Champion & Skinner, 2008). The HBM is one of the
most widely used conceptual frameworks in health behavior research, both to explain change
and maintenance of health-related behavior and as a guiding framework for health behavior
interventions. The HBM has several constructs that explain or predict why people will take
action to prevent, to control, or to screen for a disease.

These constructs include perceived susceptibility, perceived severity, perceived benefits,

perceived barriers, cues to action, and self-efficacy (Champion & Skinner, 2008; University of
Twente, n.d). Along with these constructs, the notion of perceived threat is also mentioned but
not defined individually. It is rather a combination of two of these constructs.

Perceived Susceptibility
Perceived susceptibility refers to the likelihood of getting a disease or condition. Thus, the
HBM predicts that individuals who perceive that they are susceptible to a disease will engage
in behaviors that would help reduce the risk of developing the disease (Champion & Skinner,
2008; University of Twente, n.d). For example, if a man belongs to a family of which several
male members were diagnosed with prostate cancer, he might feel more susceptible to
prostate cancer thereby agreeing to screen for prostate cancer. Perceived Severity Perceived
severity refers to the feeling of seriousness of contracting the disease or leaving it untreated.
The HBM suggests that the more serious that individuals perceive a health problem is, the
more likely they will engage in behaviors to prevent it from occurring or reduce its severity
(Champion & Skinner, 2008). Similarly, if a man is aware of the horrific consequence of
prostate cancer if left untreated, he might be prompted to be screened for early detection. In
contrast, the lack of knowledge regarding the severity of prostate cancer might cause a man
not to seek to be screened for prostate cancer.

Perceived Benefits
Perceived benefits refer to an individual's assessment of the value or efficacy of engaging in
a health-promoting behavior to decrease the risk of a disease. The HBM proposes that the
more benefits that individuals perceive that a particular action will have regarding a perceived
threat, then the more likely they will engage in that behavior regardless of objective facts
regarding the effectiveness of the action (Champion & Skinner, 2008; University of Twente,
n.d). If a man believes that getting screened for prostate cancer can help increase early
detection and consequently reduce morbidity, he will more likely have the intent to screen for
prostate cancer. However, if the man believes that screening for prostate cancer is not so
beneficial, he is less likely to utilize the screening tools.

Perceived Barriers
Perceived barriers refer to potential complications involved with a particular health action.
They are factors that act as impediments to undertaking recommended behaviors. The HBM
suggests that the perceived benefits must outweigh the perceived barriers in order for behavior
change to occur (Champion & Skinner, 2008). The man must believe that it is worthwhile for
him to go through any hurdle in order to seek to be screened for prostate cancer. If the man
believes otherwise, the intent to screen for prostate cancer will simply disappear. Cues to
Action Cues to action refer to the internal or external cues that prompt the action. The HBM
theorizes that a cue, or trigger, is necessary for prompting engagement in health-promoting
behaviors. Internal cues can be physiological such as pain, whereas external cues can be an
event or a billboard sign (Champion & Skinner, 2008; University of Twente, n.d). For example,
if a man’s close relative recently was diagnosed with prostate cancer, this man is more likely
to have the intent to screen soon for prostate cancer. Likewise, if there is no close occurrence,
he is less likely to have the intent to screen for prostate cancer.

Self-Efficacy
Self-efficacy refers to an individual’s perception of his or her competence to successfully
perform a behavior. The HBM recognizes that confidence in the individual’s ability to effect
change in outcomes is crucial to health behavior change (Champion & Skinner, 2008;
University of Twente, n.d). Equally, if a man feels confident that he can go through the process
of getting screened for prostate cancer, then he is more likely to go through with it.

The Notion of Perceived Threat

To address the phenomenon of interest of this study, three of the original four constructs
(perceived susceptibility, perceived benefits, and perceived barriers) were selected.
Perceived severity was omitted because it has been found to have very little variance with
perceived susceptibility (Champion, 1999). It is also important to point out that the
combination of perceived susceptibility and perceived severity is also referred to as perceived
threat (Becker, 1974; Becker & Janz, 1985). Perceived threat is considered the most
predictive construct with regard to health related behavior (Champion & Skinner, 2008). Due
to the slight variance found with perceived severity, perceived threat can be measured by
perceived susceptibility alone without perceived severity (Champion, 1999; Champion et. al.,
2004). For this study, perceived threat was evaluated by utilizing the construct of perceived
susceptibility alone. The HBM maintains that the greater the perceived threat, the greater the
likelihood of engaging in behaviors to decrease the threat. In addition, the perceived benefits
speak directly to the merit of the new behavior. People incline to implement healthier
behaviors when they believe the new behavior will decrease their likelihoods of
developing a disease. 28 However, the perceived benefits may be influenced by the
perceived barriers. The barriers may be so overwhelming, thereby overshadowing the
benefits of the healthier behavior. Hence, the benefits must always outweigh the
barriers.

These three constructs, perceived susceptibility, perceived benefits, and perceived barriers,
were selected because they were better aligned with the purpose of the study, and they
correlated well with the assumptions of the model. Some of the HBM constructs have been
found to have cultural differences. For example, although self-efficacy was found to be a
strong predictor regarding increased condom use, it was found to be significantly lower among
Asian-American than in White, Hispanic, and African-Americans (Hounton, Carabin, &
Henderson, 2005; Lin, Simoni, & Zemon, 2005). Such differences may present among
genders or varies among ethnicity. However, for perceived susceptibility, perceived benefits,
and perceived barriers, the literature supports their consistency in construct validity when
translated into other cultures—Arabic, Turkish, Korean, and Chinese (Champion & Skinner,
2008). For this study, these three constructs were utilized to determine the intent of Haitian
men in Haiti regarding prostate cancer screening.

Health Belief Model in Nursing Care:

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, and

4. The barriers to taking that action.

HBM is a popular model applied in nursing, especially in issues focusing on patient compliance
and preventive health care practices. This model also postulates that health-seeking
behaviour is influenced by a person’s perception of a threat posed by a health problem and
the value associated with actions aimed at reducing the threat.

HBM addresses the relationship between a person’s beliefs and behaviors. It provides a way
to understanding and predicting how clients will behave in relation to their health and how they
will comply with health care therapies.

REFERENCES

1. Marriner TA, Raile AM. Nursing theorists and their work. 5th ed. Sakraida T.Nola J.
Pender. The Health Promotion Model. St Louis: Mosby; 2005

2. Polit DF, Beck CT. Nursing research:Principles and methods. 7th ed. Philadelphia:
Lippincott Williams & Wilkins; 2007

3. Black JM, Hawks JH, Keene AM. Medical surgical nursing. 6th ed. Philadelphia:
Elsevier Mosby; 2006.
4. Potter PA, Perry AG. Fundamentals of nursing. 6th ed. St.Louis: Elsevier Mosby;
2006.

5. Rosenstoch I. Historical origin of Health Belief model. Health Educ Monogr 2:334,
1974.

6. Croyle RT. Theory at a Glance: Application to Health Promotion and Health Behavior
(Second Edition). U.S. Department of Health and Human Services, National Institutes of
Health, 2005. Available at www.thecommunityguide.org.