Health Belief Model

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             The health belief model, developed by researchers at the U.S. Public Health Service in the 1950s, was inspired by a study of why people sought X-ray examinations for tuberculosis. It attempted to explain and predict a given health-related behavior from certain patterns of belief about the recommended health behavior and the health problems that the behavior was intended to prevent or control. The model postulates that the following four conditions both explain and predict a health-related behavior:

1.     A person believes that his or her health is in jeopardy. For the behavior of seeking a screening test or examination for an asymptomatic disease such as tuberculosis, hypertension, or early cancer, the person must believe that he or she can have the disease yet not feel symptoms. This constellation of beliefs was later referred to generally as "belief in susceptibility."

2.    The person perceives the "potential seriousness" of the condition in terms of pain or discomfort, time lost from work, economic difficulties, or other outcomes.

3.    On assessing the circumstances, the person believes that benefits stemming from the recommended behavior outweigh the costs and inconvenience and that they are indeed possible and within his or her grasp. Note that this set of beliefs is not equivalent to actual rewards and barriers (reinforcing factors). In the health belief model, these are "perceived" or "anticipated" benefits and costs (predisposing factors).

4.    The person receives a "cue to action" or a precipitating force that makes the person feel the need to take action.

The model soon changed shape when applied to another set of problems concerning immunization and more broadly to (the variety of) people's different responses to public health measures and their uses of health services. In these wider applications, the model substituted a belief in susceptibility to a disease or health problem for the more specific belief that one could have a disease and not know it, which had been featured in Godfrey Hochbaum's original study as the most important belief accounting for seeking screening examinations.

In the mid-1970s, a monograph devoted to the wide-ranging applications of the model described its history and experience (Becker, 1974). This was soon followed by a review of the standardized scales for measuring its several dimensions (Maiman et al., 1977). The model continued to evolve into the 1980s, largely at the hands of Marshall Becker at Johns Hopkins University and later at the University of Michigan School.

The Health Belief Model relates largely to the cognitive factors predisposing a person to a health behavior, concluding with a belief in one's self-efficacy for the behavior. The model leaves much still to be explained by factors enabling and reinforcing one's behavior, and these factors become increasingly important when the model is used to explain and predict more complex lifestyle behaviors that needs to be maintained over a lifetime.

A systematic, quantitative review of studies that had applied the Health Belief Model among adults into the late 1980s found it lacking in consistent predictive power for many behaviors, probably because its scope is limited to predisposing factors (Harrison, Mullen, and Green, 1992). One study that specifically compared its predictive power with other models found that it accounted for a smaller proportion of the variance in diet, exercise, and smoking behaviors than did the theory of reasoned action, theory of planned behavior, and the PRECEDE-PROCEED model (Mullen, Hersey, and Iverson, 1987).

Nevertheless, the health belief model continued to be the most frequently applied model in published descriptions of programs and studies in health education and health behavior in the early 1990s. It has since been displaced in frequency of application by the transtheoretical model of stages of change. It remains, however, a valuable guide to practitioners in planning the communication component of health education programs.

LAWRENCE W. GREEN