You want to change your health behaviour? You better believe it to see it
For anyone who has tried, it’s no secret that trying to change behaviour can be challenging. Theoretical models and frameworks help to explain or predict why a certain behaviour may be difficult to start or stick to. This in turn helps us to inform interventions to promote behaviour change.
Understanding Health Choices and the Health Belief Model
For close to 75 years, the Health Belief Model (HBM) has been one of the most widely used frameworks to understand, predict and explain health-behaviour change.1 HBM helps to explain why we make decisions about our health. While it focuses on the individual, the model recognizes and addresses the social context in which health behaviors take place.2 It was first developed as a public health model to explain the widespread failure of people to participate in programs to detect and prevent disease.3 It can be a helpful framework to predict why people take action to prevent, screen or control for illness.
A person’s willingness to change their health behaviours primarily comes from their health perceptions.
Understanding the Six Core Concepts
The HBM is made up of six concepts that explain how people make health decisions:1
- Perceived severity – the likelihood that someone will change their behaviour depends on how serious they believe the consequences are. This includes both physical and social consequences.
- For example, you may not cancel dinner plans with a friend who has the sniffles, but during the COVID pandemic the risk of contracting COVID from your sniffly friend may have resulted in you cancelling that dinner date.
- Perceived susceptibility – people are less likely to change their behaviour if they don’t believe they are at risk. This concept is a strong predictor of whether people will engage in preventive health behaviours.2
- For example, you are less likely to wear sunscreen if you think you are unlikely to get skin cancer.
- Perceived benefits –someone is unlikely to implement a recommended health change if they don’t perceive it to be beneficial.
- For example, someone with diabetes may not take their medication if they don’t believe it will help to control their blood sugar.
- Perceived barriers – the obstacles or negative consequences that might happen when you take action will influence whether you actually do it.
- For example, someone who perceives breast mammograms to be painful may not adhere to regular screening.
- Cues to action – internal (experiencing symptoms) or external (public health messaging) prompts can cue action to change behaviour. This concept is difficult to study however, and therefore address.
- For example, a cue to get the annual flu shot can be as unconscious as walking past a promotional poster.
- Self-efficacy – self-efficacy is your belief that you can execute a behaviour.4 This concept was the most recent to be added to the model. For someone to successfully change their behaviour, they must feel competent to overcome perceived barriers to take action.
- For example, having self-efficacy means you are confident that you can remember to take your medication as prescribed each day.
Using HBM to Design Successful Health Promotion Messaging and Interventions
In summary, a person is more likely to change their behaviour if they believe:
- they are susceptible to a condition,
- that the condition would have serious consequences,
- that a course of action available to them would be beneficial in reducing either their susceptibility to or severity of the condition, and
- that the anticipated benefits of taking action outweigh the barriers to action.
Threat of an illness/disease (e.g., diabetes) + belief in the effectiveness of a behaviour (e.g., daily exercise) = level of engagement in the behaviour
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Champion, V. L & Skinner, C.S (2015). The Health Belief Model. In Glanz, K., Rimer, B.K., Viswanath, K.() Health Behaviour and Health Education: theory, research, and practice (pp. 75–94). Jossey-Bass.
Jones, C.L., Jensen, J.D., Scherr, C.L., Brown, N.R., Christy,K. & Weaver, J. (2015) The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation, Health Communication, 30:6, 566-576, DOI: 1080/10410236.2013.873363
Rosenstock, I.M. What research in motivation suggests for public health. Am J Public Health Nations Health. 1960 Mar;50(3 Pt 1):295-302. doi: 10.2105/ajph.50.3_pt_1.295. PMID: 14439041; PMCID: PMC1373163
Bandura, A. (1997). Self-efficacy: The exercise of control. W H Freeman/Times Books/ Henry Holt & Co.