Summary
The basic idea of the original version of this model was that, if people know about a serious health threat, feel at risk of it personally, and think that the benefits of taking an action to avoid the threat outweigh the costs of the action, they will do what it takes to reduce their risk. Two additional predictors of the behavior were added later:
- a person’s confidence in his or her ability to take the action, given the barriers to the action
- and reminders to act.
Authors
Houghbaum, G.M., Becker, M.H., Rosenstock, I.M., Stretcher, V.J.
Seminal references
Rosenstock, I.M. The health belief model and preventive health behavior. Health education monographs, 1974, 2(4), 324-473.
Becker MH. Social learning theory and the health belief model. Health Education Quarterly, 1988, 15(2), 175-183.
Major constructs
(Original) Perceived Threat Severity, Perceived Threat Susceptibility, Perceived Benefits
(Added) Cue to Action, Perceived Barriers
(Subsequently added) Self-efficacy
Examples
Scarinci IC, Bandura L, Hidalgo B, Cherrington A. Development of a theory-based (PEN-3 and Health Belief Model), culturally relevant intervention on cervical cancer prevention among Latina immigrants using intervention mapping. Health Promot Pract. 2012 Jan;13(1):29-40. Epub 2011 Mar 21. PubMed PMID:21422254.
Lombard DN, Lombard TN, Winett RA. Walking to meet health guidelines: the effect of prompting frequency and prompt structure. Health Psychol. 1995 Mar;14(2):164-70. PubMed PMID: 7789352.
Chen AH, Sallis JF, Castro CM, Lee RE, Hickmann SA, William C, Martin JE. A home-based behavioral intervention to promote walking in sedentary ethnic minority women: project WALK. Womens Health. 1998 Spring;4(1):19-39. PubMed PMID: 9520605.
Major advantages
- This theory is straightforward and intuitively appealing to health service providers.
- There is a substantial amount of research literature on the HBM.
Major Criticisms
- The HBM is “reductionistic” in that it leaves out emotion1 as well as social and other environmental influences such as culture.10
- It is a “rational exchange” model in that it argues that individuals systematically list and weigh the barriers and benefits of a behavior. This ignores evidence from behavioral economics2 that people often don’t do the mental work necessary to list and weigh all the possible outcomes of a decision. Instead, they make decisions based on mental rules of thumb and short cuts most of the time.
- The HBM is silent on “if/then” situations (technically referred to as interactions between or among variables).1 According to HBM, for example, the perception of personal risk is necessary to motivate a protective behavior. But what about Mary? She perceives influenza to be a serious illness for someone her age. She doesn’t think a flu shot would be painful, and she believes that the vaccine is fairly effective. Even though she thinks of herself as the kind of person who never gets sick, she might agree to be immunized if her pharmacist told her that the injection would be free of charge and offered to immunize her on the spot.
- Individual differences such as sensation-seeking or major personality type11 are not accounted for (in this theory, or any of the others in TheoryPicker). Individual differences could affect attention to health messages and/or their processing and motivational value. They might also cluster in ways that could be useful in audience segmentation.
- HBM grew out of prevention and is based on beliefs about only undiagnosed conditions.1
- Finally, risk perceptions do correlate with behavior, but interventions aiming to increase perceived risk have not been markedly effective at changing behavior.3
Resources
National Cancer Institute, Theory at a Glance (see pages 13-14)
University of Twente, Health Belief Model