HEALTH BELIEF MODEL (HBM)
INTRODUCTION
HBM is a popular model in nursing, especially in issues focusing on patient
compliance and preventive health care practices.
The model postulates that health-seeking behavior is influenced by a person’s
perception of a threat posed by a health problem and the value associated with
actions aimed at reducing the threat.
HBM addresses the relationship between a person’s beliefs and behaviors. It
provides a way to understanding and predicting how clients will behave in relation to
their health and how they will comply with health care therapies.
THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL
There are six major concepts in HBM:
1. Perceived Susceptibility
2. Perceived severity
3. Perceived benefits
4. Perceived costs
5. Motivation
6. Enabling or modifying factors
1. Perceived Susceptibility: refers to a person’s perception that a health
problem is personally relevant or that a diagnosis of illness is accurate.
2. Perceived severity: even when one recognizes personal susceptibility,
action will not occur unless the individual perceives the severity to be high
enough to have serious organic or social complications.
3. Perceived benefits: refers to the patient’s belief that a given treatment will
cure the illness or help to prevent it.
4. Perceived Costs: refers to the complexity, duration, and accessibility and
accessibility of the treatment
5. Motivation: includes the desire to comply with a treatment and the belief
that people should do what
6. Modifying factors: include personality variables, patient satisfaction, and
socio-demographic factors.
HEALTH PROMOTION MODEL
INTRODUCTION
The health promotion model (HPM) proposed by Nola J Pender (1982; revised,
1996) was designed to be a “complementary counterpart to models of health
protection.” It defines health as a positive dynamic state not merely the absence
of disease. Health promotion is directed at increasing a client’s level of
wellbeing. The health promotion model describes the multi dimensional nature of
persons as they interact within their environment to pursue health. The model
focuses on following three areas:
· Individual characteristics and experiences
· Behavior-specific cognitions and affect
· Behavioral outcomes
The health promotion model notes that each person has unique personal
characteristics and experiences that affect subsequent actions. The set of
variables for behavioral specific knowledge and affect have important
motivational significance. These variables can be modified through nursing
actions. Health promoting behavior is the desired behavioral outcome and is the
end point in the HPM. Health promoting behaviors should result in improved
health, enhanced functional ability and better quality of life at all stages of
development. The final behavioral demand is also influenced by the immediate
competing demand and preferences, which can derail an intended health
promoting actions.
ASSUMPTIONS OF THE HEALTH PROMOTION MODEL
The HPM is based on the following assumptions, which reflect both nursing and
behavioral science perspectives:
1. Persons seek to create conditions of living through which they can
express their unique human health potential.
2. Persons have the capacity for reflective self-awareness, including
assessment of their own competencies.
3. Persons value growth in directions viewed as positive and attempts to
achieve a personally acceptable balance between change and stability.
4. Individuals seek to actively regulate their own behavior.
5. Individuals in all their biopsychosocial complexity interact with the
environment, progressively transforming the environment and being
transformed over time.
6. Health professionals constitute a part of the interpersonal environment,
which exerts influence on persons throughout their lifespan.
7. Self-initiated reconfiguration of person-environment interactive patterns is
essential to behavior change.
THEORETICAL PROPOSITIONS OF THE HEALTH PROMOTION MODEL
Theoretical statements derived from the model provide a basis for investigative
work on health behaviors. The HPM is based on the following theoretical
propositions:
1. Prior behavior and inherited and acquired characteristics influence beliefs,
affect, and enactment of health-promoting behavior.
2. Persons commit to engaging in behaviors from which they anticipate
deriving personally valued benefits.
3. Perceived barriers can constrain commitment to action, a mediator of
behavior as well as actual behavior.
4. Perceived competence or self-efficacy to execute a given behavior
increases the likelihood of commitment to action and actual performance
of the behavior.
5. Greater perceived self-efficacy results in fewer perceived barriers to a
specific health behavior.
6. Positive affect toward a behavior results in greater perceived self-
efficacy, which can in turn, result in increased positive affect.
7. When positive emotions or affect are associated with a behavior, the
probability of commitment and action is increased.
8. Persons are more likely to commit to and engage in health-promoting
behaviors when significant others model the behavior, expect the
behavior to occur, and provide assistance and support to enable the
behavior.
9. Families, peers, and health care providers are important sources of
interpersonal influence that can increase or decrease commitment to and
engagement in health-promoting behavior.
10. Situational influences in the external environment can increase or
decrease commitment to or participation in health-promoting behavior.
11. The greater the commitments to a specific plan of action, the more likely
health-promoting behaviors are to be maintained over time.
12. Commitment to a plan of action is less likely to result in the desired
behavior when competing demands over which persons have little control
require immediate attention.
13. Commitment to a plan of action is less likely to result in the desired
behavior when other actions are more attractive and thus preferred over
the target behavior.
13. Persons can modify cognitions, affect, and the interpersonal and
physical environment to create incentives for health actions.
THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION
MODEL
Individual Characteristics and Experience
PRIOR RELATED BEHAVIOR
Frequency of the similar behavior in the past.
Direct and indirect effects on the likelihood of engaging in health promoting
behaviors.
PERSONAL FACTORS
Personal factors categorized as biological, psychological and socio-cultural.
These factors are predictive of a given behavior and shaped by the nature of the
target behavior being considered.
Personal biological factors
Include variable such as age gender body mass index pubertal status,
aerobic capacity, strength, agility, or balance.
Personal psychological factors
Include variables such as self esteem self motivation personal
competence perceived health status and definition of health.
Personal socio-cultural factors
Include variables such as race ethnicity, acculturation, education and
socioeconomic status.
Behavioral Specific Cognition and Affect
PERCEIVED BENEFITS OF ACTION
Anticipated positive out comes that will occur from health behavior.
PERCEIVED BARRIERS TO ACTION
Anticipated, imagined or real blocks and personal costs of understanding a
given behavior
PERCEIVED SELF EFFICACY
Judgment of personal capability to organize and execute a health-promoting
behavior. Perceived self efficacy influences perceived barriers to action so
higher efficacy result in lowered perceptions of barriers to the performance of the
behavior.
ACTIVITY RELATED AFFECT
Subjective positive or negative feeling that occur before, during and following
behavior based on the stimulus properties of the behavior itself. Activity-related
affect influences perceived self-efficacy, which means the more positive the
subjective feeling, the greater the feeling of efficacy. In turn, increased feelings
of efficacy can generate further positive affect.
INTERPERSONAL INFLUENCES
Cognition concerning behaviors, beliefs, or attitudes of the others. Interpersonal
influences include: norms (expectations of significant others), social support
(instrumental and emotional encouragement) and modeling (vicarious learning
through observing others engaged in a particular behavior). Primary sources of
interpersonal influences are families, peers, and healthcare providers.
SITUATIONAL INFLUENCES
Personal perceptions and cognitions of any given situation or context that can
facilitate or impede behavior. Include perceptions of options available, demand
characteristics and aesthetic features of the environment in which given health
promoting is proposed to take place. Situational influences may have direct or
indirect influences on health behavior.
Behavioral Outcome
COMMITMENT TO PLAN OF ACTION
The concept of intention and identification of a planned strategy leads to
implementation of health behavior.
IMMEDIATE COMPETING DEMANDS AND PREFERENCES
Competing demands are those alternative behaviors over which individuals have
low control because there are environmental contingencies such as work or
family care responsibilities. Competing preferences are alternative behavior over
which individuals exert relatively high control, such as choice of ice cream or
apple for a snack
HEALTH PROMOTING BEHAVIOUR
Endpoint or action outcome directed toward attaining positive health outcome
such as optimal well-being, personal fulfillment, and productive living.
