The Health Belief Model – A Useful Tool in Understanding Patient Behaviour

The Health Belief Model helps predict public attitudes and actions around health issues. It is used implicitly or explicitly in many areas of medicine. The Health Belief Model assumes that people are largely rational in their thoughts and actions, and will take the best health-supporting action if they:

• Feel that it is possible to address a negative health issue.
• Have a positive expectation that taking the proposed action will be effective in addressing the issue.
• Believe they are able to take the proposed action.

There are a number of sub-variables in the belief that a health-related action is valuable. These provide both factors to enable measurement of attitudes and also routes to persuading people to act in healthy ways.

Perceived susceptibility: This is the person’s assessment of the likelihood of them getting the given condition. If, for example, they are younger and believe that the condition afflicts mainly older people, then they will be less likely to act to protect themselves. Education may correct misunderstandings about susceptibility, which is often grossly incorrect, typically due either to social folklore or individual denial.

Perceived severity: This is the person’s view of how severely they would be impacted if they were affected by the condition. The most severe health impact is death, followed by disablement and pain. Duration is also important: a short, sharp pain may be preferable to a long ache. As with susceptibility, education can be specific about severity, including probabilities of survival and disablement.

Perceived benefits: This is the belief in how effective the advised medicine or action will be in mitigating the problems of the condition considered in severity. You can give a positive message about the benefits of taking specific actions, including accurate information about how effective medicines are at reducing susceptibility and severity. The message may also subtly include instructions in taking the recommended actions and indicate the timescales involved before benefits appear.

Perceived barriers: This is the person’s perceptions of the difficulties they would encounter in taking the proposed actions, including both physical and psychological barriers. These may be addressed through various means of support, from financial through reassurance and assistance.

Cues to action: These are the prompts that are needed to move the person into the state where they are ready to take the prescribed action. These can include practical ways of nudging them, such as marked calendars, email reminders, how-to charts and so on.

Self-efficacy: This is the person’s confidence and belief in their own ability to take the given action. If they think ‘I cannot do this’ or even ‘I would find it difficult’ then they may well shy away from action, even if they believe the action is essential or otherwise worthwhile. This self-belief can be bolstered with encouragement, hand-holding, training and other support.

THE MODEL

The model assumes the following causal linkages between constructs and other factors.

• Likelihood of behaviour change is affected solely by the perceived threat from the disease.
• Perceived threat is impacted by:
  • Perceived susceptibility and seriousness
  • Cues to action, including information and symptoms
• General factors such as age, sex, race, personality and intelligence affect all of:
  • Perceived threat
  • Perceived susceptibility and seriousness
  • Perception of benefits vs. barriers

This model simply describes a combination of a personal risk analysis, followed by an evaluation of the proposed solution and its use. As a general method of addressing beliefs it offers a useful structure for a wider range of belief-change situations.

When seeking to change a person’s belief, we first need to understand the model beneath the belief and then address the sub-elements. The Health Belief Model provides a useful framework that may either provide direct help or may inspire similar thinking.

Want to know more how this model can be used effectively in your daily dealings with patients and colleagues?