Health Belief Model
explaining health behaviors
History and Orientation
The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. This is done by focusing on the attitudes and beliefs of individuals. The HBM was first developed in the 1950s by social psychologists Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services. 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- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS.
Core Assumptions and Statements
The HBM is based on the understanding that a person will take a health-related action (i.e., use condoms) if that person:
|1.||feels that a negative health condition (i.e., HIV) can be avoided,|
|2.||has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition (i.e., using condoms will be effective at preventing HIV), and|
|3.||believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence).|
Scope and Application
The Health Belief Model has been applied to a broad range of health behaviors and subject populations. Three broad areas can be identified (Conner & Norman, 1996): 1) Preventive health behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking) behaviors as well as vaccination and contraceptive practices. 2) Sick role behaviors, which refer to compliance with recommended medical regimens, usually following professional diagnosis of illness. 3) Clinic use, which includes physician visits for a variety of reasons.
This is an example from two sexual health actions. (http://www.etr.org/recapp/theories/hbm/Resources.htm)
|Concept||Condom Use Education Example||STI Screening or HIV Testing|
|1. Perceived Susceptibility||Youth believe they can get STIs or HIV or create a pregnancy.||Youth believe they may have been exposed to STIs or HIV.|
|2. Perceived Severity||Youth believe that the consequences of getting STIs or HIV or creating a pregnancy are significant enough to try to avoid.||Youth believe the consequences of having STIs or HIV without knowledge or treatment are significant enough to try to avoid.|
|3. Perceived Benefits||Youth believe that the recommended action of using condoms would protect them from getting STIs or HIV or creating a pregnancy.||Youth believe that the recommended action of getting tested for STIs and HIV would benefit them — possibly by allowing them to get early treatment or preventing them from infecting others.|
|4. Perceived Barriers||Youth identify their personal barriers to using condoms (i.e., condoms limit the feeling or they are too embarrassed to talk to their partner about it) and explore ways to eliminate or reduce these barriers (i.e., teach them to put lubricant inside the condom to increase sensation for the male and have them practice condom communication skills to decrease their embarrassment level).||Youth identify their personal barriers to getting tested (i.e., getting to the clinic or being seen at the clinic by someone they know) and explore ways to eliminate or reduce these barriers (i.e., brainstorm transportation and disguise options).|
|5. Cues to Action||Youth receive reminder cues for action in the form of incentives (such as pencils with the printed message “no glove, no love”) or reminder messages (such as messages in the school newsletter).||Youth receive reminder cues for action in the form of incentives (such as a key chain that says, “Got sex? Get tested!”) or reminder messages (such as posters that say, “25% of sexually active teens contract an STI. Are you one of them? Find out now”).|
|6. Self-Efficacy||Youth confident in using a condom correctly in all circumstances.||Youth receive guidance (such as information on where to get tested) or training (such as practice in making an appointment).|
Health Promotion and Prevention Theories and Models
This section provides a brief overview of key theories and strategies that we can use to encourage healthy sexual practices. Each concept is one part of the overall, comprehensive approach for prevention. Some models may already be in use on your campus, and others may be worth exploring and discussing with your peer education group. By reviewing these strategies along with those already in place on your campus, you will have the opportunity to build and strengthen your prevention work.
Harm reduction is one strategy campuses may use to encourage safer sex. In this model of prevention, campuses encourage students to lower the risks associated with sexual activity including intercourse, oral sex and anal sex. For some students this means choosing to abstain; for others, it means employing the following lower risk guidelines:
• Using a condom during vaginal, oral and anal sex
• Using a dental dam during oral sex
• Using a water-based lubricant to reduce chances of a condom tear
• Not engaging in sexual activity while intoxicated
Social Norms is a strategy that campuses may use to encourage healthy sexual behaviors. This marketing strategy highlights healthy student choices instead of highlighting a problem behavior. In a non-judgmental way, campaign materials speak about behavior of the majority of students.
For those of you who have not used a Social Norms approach before, it does not have to be complicated or intimidating. Here are some very simple steps that will help you understand how you can develop a Social Norms campaign:
Baseline: Collect baseline data that will show you actual and perceived norms. For example, when working on Sexual Responsibility Week you might want to collect actual percentage of students always using a condom. You will also want to collect what percentage the general student body thinks that students always use a condom. You can collect data on several health behaviors, so this is a good time to learn about which behaviors have large discrepancies between perceived behavior and actual behavior.
Intervention: Expose the student body to data about actual behaviors, not the perceived behaviors. This is when you would develop and distribute marketing materials (posters, websites, postcards, palm cards, incentives) with the information collected from the baseline data. For example you might want to use this Social Norms message, “XX% of ABC University students always use a condom during sexual activity.”
Results: After you have exposed the student body to the Social Norms message you measure results. Generally speaking, there are two different ways to measure the effectiveness of your message. You may either measure a reduction in the health behavior or whether students have an accurate perception of the health behavior.
When utilizing the Social Norms model, consider the following:
• Will you use campus data or other data?
• Is the data you are using in line with the behavior you want to encourage?
• Stay in the positive. For example, “Most students….”
Perkins, H.W. (2003). The Social norms approach to preventing school and college age substance abuse. San Francisco, CA: Jossey-Bass.