The Health Belief Model is one of the most widespread and successful theories used in the sphere of health education and health promotion. Initially, the researchers created this theory in the sphere of social science in the early 1950s with the primary purpose to understand and assess the failure of people to adopt strategies that may prevent disease. Even nowadays this behavioral change model remains one of the most effective theories applied to predict, evaluate, and change health-related behaviors of individuals in numerous challenging health areas, especially nursing. The health belief model bases on such pillars as perceived seriousness, susceptibility, benefits, and, finally, barriers, and assists healthcare providers in ensuring effective aid and high-quality services to patients.
Keywords: health belief model, perceived seriousness, perceived susceptibility, perceived benefits, perceived limitations, self-efficacy, cues to action
The Health Belief Model
Numerous researchers claim that health promotion programs either lack a theoretical foundation or concentrate on a conceptual model that does not correspond to the priorities and values of health promotion practices. That is why this factor has given rise to the development of health promotion theories to overcome the barriers to progress and success in the arena of health promotion. The given paper aims to shed light on the nature of such middle-range theory as the Health Belief Model. In addition, much attention will be paid to the historical origins of this theory, its development, congruence with a nursing discipline, and researches that prove the efficiency of the health belief model.
Origin and Development of the Health Belief Model
It is always extremely difficult to trace the origin and historical development of every theory because it includes a lot of additional researches. Moreover, it is certainly true about the health belief model, since this theory appeared out of a set of numerous independent research questions. Initially, a group of investigators engaged in the sphere of public health services between the 1950s and 1960s developed the health belief model. Taking into consideration the estimations of the researchers, Rosenstock, an expert in the sphere of social psychology, developed the health belief model that is commonly referred to as the HBM. HBM is recognized as one of the earliest and most successful models in health promotion (Rosenstock, Strecher, & Becker, 1988).
The studies that investigated the reasons why patients refused X-ray examinations for the identification of tuberculosis inspired the creation and development of the health belief model. Initially, this model was based on four major constructs, including perceived susceptibility, severity, barriers, and, finally, perceived costs of adhering to possible interventions (Rosenstock, Strecher, & Becker, 1988). To begin with, perceived susceptibility denotes subjective assessment of possible risks of the condition. Secondly, perceived severity describes the seriousness of the condition and its negative impacts on human health. Thirdly, perceived barriers are constructs that include possible side effects, duration, and various inconveniences. Finally, a direct synonym to the phrase perceived costs is the price of the proposed intervention.
However, during the 1970s and 1980s, Becker and his colleagues modified this theory. The researchers made a decision to respond to symptoms and illnesses as well as to medical directives (Janz & Becker, 1984). Furthermore, in the 1980s this behavioral change theory was extended one more time because the researchers added illness behaviors, preventive health, and finally, health screening to the model. A set of additional constructs, including demographic variables, sociopsychological variables as well as perceived self-efficacy and cues to action modified this behavioral change theory (Janz & Becker, 1984).
Such three features as health motivation, control, and perceived threat contributed to the improvement of the health belief model. At present, the health belief model is extensively applied in the spheres of social psychology, human development, and nursing with the primary purpose to predict and assess general health behaviors as well as positive health behaviors. However, at the initial stages of its creation and development, this behavioral change theory aimed to predict the actions of clients who suffered from acute or chronic diseases (Carpetner, 2010).
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The health belief model is one of the most effective behavior change models created and developed to provide explanations to health-related behaviors of humans, especially in the regard to the uptake of available health services (Carpetner, 2010). Perceived seriousness is the first perception that serves as the main construct of the health belief model. Generally speaking, perceived seriousness expresses the beliefs and expectations of people about the significance or severity of a particular disease. The perception of the seriousness of the disease should be based on medical information and knowledge (Carpetner, 2010). For instance, the majority of people treat flu as a comparatively minor ailment that does not require long-term treatment and hospitalization. However, asthmatics who contact with people who are unwell with flu can end up in a hospital.
Besides, in case a person is self-employed, having flu may mean several days or even a week of lost wages. The second main construct of the health belief model is referred to as perceived susceptibility. According to the estimations of the researchers in the sphere of social psychology, perceived personal risks or, in other words, susceptibility is one of the most influential perceptions motivating people to adopt and follow healthier behaviors. For instance, perceived susceptibility encourages people to get vaccines against such disease as influenza, use a sunscreen with the purpose of preventing skin cancer, and floss teeth in order to prevent tooth loss. The majority of the researchers are the proponents of the idea that if people know they are at high risk to get a disease they will definitely do something to minimize the risks and prevent the disease from happening (Rawlett, 2011).
The construct of perceived benefits may be compared to the person’s opinion concerning the value or usefulness of engaging in a new behavior in order to lessen the risk of developing a particular disease. The results of scientific experiments prove that people usually adopt healthier behaviors when they are sure that their new behavior will minimize their chances of developing a disease. Since the majority of people always resist changes, the HBM includes such constructs as perceived barriers to change. It should be stated that perceived barriers are personal evaluations of people that encompass limitations or obstacles that impede them from adopting a new behavior (Rawlett, 2011).
Having determined and assessed the essence of four major constructs of the health belief model, it is important to note that these four constructs may be modified by many other variables, including culture, educational level, life experience, motivation, and many other characteristics. For example, the HBM suggests that cues to action tremendously influence human behavior. Cues to action may include various events, persons, and even things that motivate people to alter their behavior and style of living in order to minimize the risks of the disease. For instance, hearing TV or radio news about hundreds of fatal crashes as a result of drunk driving is a significant cue to people not to drive un-sober. Finally, self-efficacy is the belief of people in their own abilities to do or change something (Rawlett, 2011).
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Three Published Research Studies that Have Used and Tested the HBM
The researchers have come to the conclusion that the health belief model is extensively applied in the nursing discipline because it has proven its efficiency in the prevention and treatment of various diseases. Numerous research studies that have tested the theory prove that this model brings accurate results. For instance, the research study by Romano and Scott (2014) proves the efficiency of the health belief model for reducing obesity among people (Romano & Scott, 2014). In other words, the researchers have tested the appropriateness of this theory among African Americans and Hispanics with unhealthy lifestyles and proved that the health belief model explains unhealthy behaviors and motivates people to change their life choices. The findings of this research study that included 206 participants prove that the HBM should be integrated into the preventive health programming with the purpose to ensure adherence and increased quality of life of its participants.
According to the statistics, a significantly large percentage of African Americans suffer from high blood pressure, obesity, and even diabetes because of an unhealthy lifestyle (Romano & Scott, 2014). Thus, integrating the health belief model may assist nurses and health care providers in evaluating possible risks and predicting health behaviors. The HBM may serve as a combination of health education and nursing interventions that contribute to healthy lifestyles. Romano and Scott (2014) have made a decision to use this theory because this model remains one of the most recognized and efficient in health promotion (Romano & Scott, 2014). The health belief model has justified its productivity and success because a 16-week program based on this model has drastically decreased unhealthy eating habits and led to considerable weight losses among participants of the experiment who suffered from obesity. In addition, the fat percentage has decreased among people who actively participated in this HBM program (Romano & Scott, 2014).
Therefore, Romano and Scott have successfully estimated that the HBM assists every participant of the experiment in identifying their goals, necessary actions to achieve their goals, possible hindrances or barriers to complete successfully their objectives, and, finally, level of commitment to each goal based on 1-10 scale (Romano & Scott, 2014). The health belief model has incredibly increased the intrinsic motivation of participants in scientific experiments. In the course of the experiment that involved the health belief model, approximately 70 % of adults significantly reduced the intake of food rich in calories with a help of balanced diet (Romano & Scott, 2014). Thus, the researchers summarize that the health belief model has justified its irrefutable efficiency through the treatment of African Americans and Hispanic populations from obesity, hypertension, and many other related diseases (Romano & Scott, 2014).
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Numerous researchers in the sphere of healthcare who examine the effectiveness of the health belief model claim that application of the model may influence the beliefs of many people and convince them that HPV vaccination may drastically decrease the risk to be diagnosed with cervical cancer (Reiter, Brewer, Gottlieb, McRee, & Smith, 2009). Reiter and other researchers have conducted the study concerning recommendations of doctors that insist on the benefits of the HPV vaccine, barriers that prevent people from obtaining this vaccine, and, finally, potential harms and side effects of vaccine (Reiter et al., 2009). Despite the fact that according to the statistical data HPV vaccine may prevent more than 70 % of cancers in the USA, only 5% to less than 30% get it because of negative attitudes and distrust of female individuals to the high quality of the vaccine.
According to this research study, scientists applied the health belief model in order to understand the health behavior of females. In addition, the HBM was used to provide knowledge and additional information to parents that HPV is a dangerous sexually transmitted infection that may lead to the development of numerous diseases, including genital warts as well as cervical cancer, and vaccine is absolutely safe and effective method for preventing numerous health-threatening diseases (Reiter et al., 2009). Extensive application of the health belief model, according to the main idea of the research study, is the most efficient theoretical framework that explains human behavior and motivates them to change their lifestyles.
The researchers have estimated that perceived risk should be understood as the belief that HPV and cervical cancer are likely to occur. Perceived severity is how dangerous and health-threatening effects of HPV infection are. Perceived benefit or, in other words, effectiveness is the assumption that the vaccine will drastically decrease the possible risks and severity of the disease. Perceived barriers include various obstacles that prevent females from taking HPV vaccination. Finally, cues to action encompass a set of situational factors, especially doctor’s recommendations that prompt the effectiveness of the HPV vaccination (Reiter et al., 2009).
Measurement of the Health Belief Model and Nurses Hand Hygiene among the Hospitals is another research study that applies the HBM. Taking into consideration the estimations of the researchers in healthcare, hand hygiene is one of the most vital factors responsible for the control and prevention of hospital infections (Ghanbari, Farazi, Shamsi, Khorsandi, & Esharti, 2014). This research study is based on the health belief model for measuring hand hygiene behavior among nurses. Approximately 130 nurses participated in the experiment aimed at measuring and assessment of health behavior of healthcare personnel. The main HBM constructs, including perceived susceptibility, severity, threat, as well as benefits, cues to action, and self-efficacy scores, revealed that a significant percentage of the nursing staff had poor knowledge about hand hygiene (Ghanbari et al., 2014).
In other words, a set of questions of the HBM that corresponded to the WHO Guidelines on Hand Hygiene and experience of professors and experts’ panel revealed that 40% of nurses care about hand hygiene because of personal commitment and conscience (Ghanbari et al., 2014). Thirty-eight nurses or, in other words, more than 29% of hospital personnel, wash their hands because of the fear of being infected. Twenty-tree people engaged in the sphere of healthcare do not neglect hand hygiene because they want to be rewarded (Ghanbari et al., 2014). Finally, the health belief model provides evidence that 17 individuals practice hand hygiene because they are afraid of infecting their patients with health-threatening diseases. In general, the findings of this research study revealed that practice and compliance of nurses with the norms of hand hygiene are comparatively weak.
Based on the health belief model, the researchers have successfully announced the reasons for the extremely low tendency of nursing staff to care about hand hygiene. The most common reasons for neglecting hand washing are lack of knowledge, insufficient amounts of equipment to observe hygiene rules, the habit of avoiding hand washing, and weak management (Ghanbari et al., 2014). As a result, according to the findings of the research study, the majority of nurses have no practice and knowledge about the significance of hand hygiene, regardless of their positive attitudes as well as perceived benefits. Consequently, application of the health believed model in nurses hand hygiene has justified its efficiency since based on the measurements of the HMB scientists have concluded that authorities should treat the problem of hand washing in hospitals more seriously and promote knowledge about threatening hospital infections (Ghanbari et al., 2014).
Individual-, Family-, and Community-Level Clinical Case that Is Appropriate for the Application of the Health Belief Model
Many researchers in the healthcare field claim that decision-making of parents and influenza vaccination may serve as examples that demonstrate the effectiveness of the health belief model in clinical family cases. The researchers have successfully performed numerous experiments and investigations to prove the benefits of the health belief model in encouraging parents to understand that influenza is a serious respiratory tract infection that may cause other serious diseases (Chen et al., 2011).
The health belief model is used in family-level clinical cases to convince parents that influenza vaccination is one of the most reliable strategies that prevent influenza and minimizes influenza-related complications (Chen et al., 2011). Application of the HBM is extremely important in this clinical case because parental vaccination acceptance or refusal may either benefit or harm the health and well-being of children (Chen et al., 2011). The health belief model is essential because it predicts the final behavior and attitudes of parents towards influenza vaccination, its side effects, and potential benefits. According to the research results, numerous institutional, personal, social, and environmental factors shape the decisions of parents in favor of getting vaccination (Chen et al., 2011).
Taking into account individual-level clinical cases, it should be noted that according to personal beliefs of parents, perceived susceptibility motivates parents to vaccinate their children from influenza because the vaccine will strengthen the immune system of children and make them less vulnerable to other diseases (Chen et al., 2011). Moreover, professionals in the sphere of healthcare claim that the health belief model may be applied to the community-level interventions because the application of the HBM in these cases is primarily targeted to change the behavior of parents and ensure social support. Therefore, community-level cases are the highest and the most influential interventions as they may restrict or support influenza vaccination with the help of laws, regulations, or health campaigns. The health belief model is usually used on community levels to promote behavioral changes in entire communities (Chen et al., 2011).
Appropriateness of Nursing Assessment and Interventions
It is extremely important to stress that nursing assessment and intervention require professional nursing experience, profound knowledge, and health-promotion skills. According to the research data, nurses play a major role in vaccination successes, since the vaccine is the most powerful tool that combats problems of epidemic proportions (Carpetner, 2010).
The researchers provide convincing arguments that nurses should apply the health belief model in order to educate separate individuals, families, and entire communities about vaccination as an effective method of prevention of various diseases, including influenza and HPV infection. According to the estimations of the American Nurses Association, nurses have to ensure that parents are informed about the health risks of the disease, its impacts on the health of children, and reliable methods of disease prevention (Carpetner, 2010).
Moreover, nurses should rely on the quality and effectiveness of the health belief model because it has justified its usefulness in numerous research studies and scientific experiments. Many research studies prove that the health belief model that embraces such components as perceived susceptibility, barriers, severity, and other components positively affects behavioral changes of people, including their attitudes towards vaccination and its impacts on the health of children (Rawlett, 2011).
In addition, nursing interventions based on the health belief model are primarily purposed to educate individuals, families, and communities about the incidence of the disease, individual estimates of possible risks, and profound knowledge about side effects and medical as well as social consequences of the disease (Rawlett, 2011). Nursing interventions may also strive to spread information about methods that reduce risks. Nursing interventions aim to identify and assess commonly perceived barriers and concentrate on social support as an effective method of encouraging behavior that promotes health. Finally, interventions may boost self-efficacy, as individuals, families, and societies engage in health-promoting behaviors (Rawlett, 2011).
As a result, after clarifying the essence of the health belief model, its origin and development, as well as analyzing several research studies that used and tested the effectiveness of the HBM in promoting vaccination and hand hygiene in hospital settings, it is possible to infer that the HBM should be extensively applied in the sphere of health care. It helps explain to patients that healthy behavior, motivation, and decision-making concerning seeking health services positively influence human health. Perceived susceptibility, benefits, severity, and barriers are the four major pillars of the health belief model that help nurses to use appropriate interventions. The health belief model is one of the most successful behavioral theories because it predicts, explains, evaluates, and affects behavioral changes of people.