The Health Belief Model (HBM) is one of the most commonly used theories in the health behavior field. It is used as both an explanatory theory and a change theory. The HBM was first developed in the 1950s to evaluate why people were not using preventive services that were available locally. In the decades since its inception, it has been applied to more modern concerns such as utilization of health screening services, sexual lifestyle risks, and injury prevention.
The HBM explains why people may engage in behaviors that prevent or control health related conditions, making it particularly useful for preventive and early intervention related goals. This model is useful for concerns that are related to preventive behaviors, particularly those which are asymptomatic such as a cancer screening, healthy diet, exercise, and infectious disease prevention.
It is a value-expectancy theory, which refers to the practice of comparing pros and cons or risks and benefits for decision making. What should be noted, however, is that this model relies not on factual comparisons of risks and benefits but rather on perceptions of risks and benefits, as experienced by each unique individual.
For a person to take action, he or she must believe they are susceptible, believe the problem is serious, believe that the advantages outweigh the disadvantages, be capable of making the change, and believe that they are capable of making the change. A trigger may also be necessary for the person to act.
The HBM has six constructs related to how an individual decides whether or not to engage in a particular behavior. A health coach or other health professional can identify which perceptions related to these six constructs should be targeted. By addressing misconceptions in health beliefs, a health professional can help an individual or group of individuals achieve improved health outcomes.
Perceived Susceptibility: Am I legitimately at risk?
Perceived susceptibility asks whether or not this risk is an actual threat to me personally. The general public has a poor history of accurately perceiving susceptibility, particularly in relation to CAM. It is common to over-estimate the risks of conventional drugs while underestimating the risks of natural products.
Interventions for perceived susceptibility include providing accurate, balanced education regarding the known risks and benefits of any CAM practice, including the unknowns. Caution should be exercised here to avoid fear-based approaches, which are ineffective in the long term.
Perceived Severity: Is this outcome really a big deal?
Perceived severity asks whether or not the outcome in question really matters. Is it life-threatening or life-altering? Or is it merely an annoyance? Severity includes an assessment of both physical outcomes (such as death or disability) as well as social consequences. In natural health, social consequences may dramatically shape perceived severity. For example, if vaccines are the health outcome, and vaccinating a child may cause a parent to be shunned from a playgroup, the vaccine may seem to be riskier than it actually is.
Interventions for perceived severity focus on education about consequences of ignoring health risks.
Perceived Benefits: Will this behavior or intervention actually help?
Even if the individual perceives that they are at serious risk of the outcome and that the outcome is harmful, if the intervention or preventive behavior is not believed to be effective, they will not engage in the practice.
Interventions for perceived benefits focus on clarifying the positive effects of a particular health behavior.
Perceived Barriers: What does it cost?
Perceived barriers include hindrances to the activity or intervention that consist of not only financial costs but also time, social costs, physical discomfort, and other social, physical, or emotional costs.
Interventions for perceived barriers include identifying actual barriers and reducing or eliminating them, correcting misinformation, and incentivizing the outcome.
Cues to Action: Am I ready?
Cues to action are triggers that help remind or encourage an individual to engage. Cues to action can be dramatic, such as a health scare that helps someone prioritize preventive behaviors. They can also be simple, such as an alert on a smart phone or a poster in a public place. These remind the person to take action.
Interventions for cues to action focus on how-tos and reminders.
Self Efficacy: Can I do it?
Self efficacy was defined by Bandura and refers to the belief that someone is capable of engaging in a specific behavior.
Interventions for self efficacy are diverse. These include training and guidance, verbal reinforcement, and demonstrating the behavior. The FSIHS Six Pillar Method integrates multiple tools for boosting self efficacy.
Health Belief Model Case Study: Yoga for PTSD in Veterans
The Health Belief Model was used in late 2016 and early 2017 to evaluate the use of a yoga-based intervention for veterans who experience post-traumatic stress disorder (PTSD) (Cushing, Braun, and Alden, 2018). These researchers conducted semi-structured interviews with participants using the HBM with the goal of identifying perceived benefits and barriers to the use of yoga as a component of PTSD treatment.
The researchers identified three leading perceived benefits for the treatment: mental stillness, body awareness, and social connections. The veterans perceived that the yoga therapy was beneficial overall at addressing symptoms they experience as a result of PTSD. Researchers were also able to identify two perceived barriers to yoga for PTSD: lack of social acceptance and lack of physical challenges. The veterans identified social beliefs among their peers that hinder them from participating, as well as a belief that yoga therapy is not a physical activity.
These insights enable the researchers to strengthen the perception of benefits for the use of yoga among veterans who suffer from PTSD. They also inform practice by identifying barriers that can be addressed through programs and materials.
Meet Dr Hawkins
Dr. Hawkins brings 20 years of expertise in the integrative health field to her role as Executive Director of the Franklin School of Integrative Health Sciences and the leader of our clinical research team.
She holds a Bachelor’s Degree in Environmental Health from Union Institute and University, a Master’s Degree in Health Education & Promotion from the University of Alabama, a post-graduate certificate in epidemiology from the London School of Hygiene and Tropical Medicine, a PhD in Health Research from Middle Tennessee State University, and is completing the post-doctoral Global Scholars Research Training Program at Harvard Medical School. She also holds certifications in numerous natural health fields including aromatherapy, aromatic medicine, herbalism, childbirth education, and labor support.