Health Belief Model – III: 60 years later

In my previous two posts on the Health Belief Model, I discussed its origin and a review of the model conducted a decade later. 

In 1974, Rosenstock found that perceived susceptibility to a problem and perceived benefits were the most powerful components of the model. However, he pointed out that the published studies by that time did not address cues to action and perceived accessibility (in other words perceived barriers). Then, Janz and Becker, a decade later found that perceived barriers as the most powerful variable.

Health Belief Model -III: 60 years later

In 2010, more than 60 years after the introduction of the Health Belief Model (HBM), Christoper J. Carpenter evaluated its effectiveness using meta-analysis which more advanced and powerful method for analyzing results because unlike in Janz and Becker’s method, in which they counted number of statistically significant results in studies whilst Carpenter calculated mean effect sizes considering whole suitable samples as one sample. However, his review involved only 18 studies that assessed the model’s components (constructs) at two time periods – at the beginning and then sometime later. This is unique since the review included longitudinal studies only.

A summary of the Carpenter review:

His chosen studies covered mammogram screening, quitting smoking, drug-taking, dental care, condom use, cervical smear testing, and program attendance. As we can see, these studies have focused on our responses to screening services, medication compliance and repetitive behavior such as condom use.

The following were his findings: 

  • Overall, perceived barriers found to have the strongest correlation with the whole sample. (This is consistent with previous two reviews).
  • Perceived benefits had the second-strongest correlation with the whole sample.
  • Perceived severity and perceived susceptibility had the weakest correlation with the whole sample.
  • Perceived benefits found to have the strongest correlation with preventive behaviors.

The updated Health Belief Model

The updated model consists of six constructs. It is as follows;

constructThe belief of,
perceived susceptibilitythe chance of affecting
perceived severitythe belief of the seriousness of the problem
perceived benefitsthe effectiveness of the recommended action
perceived barriersthe perceived physical as well as psychological barriers
cues to action triggers to take action
self-efficacythe ability to take action

What are the practical applications of these findings?

Whenever we design a promotional material or a program, we need to highlight on HBM constructs in the following order in priority order.

  1. How to overcome barriers that the target population would perceive in engaging in the recommended behavior
  2. How to highlight benefits in ways that the target population would perceive
  3. How to inform about susceptibility and severity in ways that the target audience would perceive
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Author: Prasantha De Silva

A specialist in Community Medicine board-certified in Sri Lanka and a research analyst in Canada

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