Affiliate University
Theories in Nursing
Abstract
Health Belief Model has played a key role in predicting and understanding health behaviour. This paper studies the history and evaluation of the model, its description, applicability and a review of three articles on the appropriateness of the model. The paper cites one case of Osteoporosis healthpromotionprogramswhere the model was put into use in developing and implementing the program. Finally, the recommendation and conclusion of the model’s applicability and its relevance in nursing is provided.
Key words: Health Belief Model, nursing, intervention, behaviour change
Introduction According to Painter et al, (2008), theleadingcause of illnessanddeath globally are closelylinked to behaviour. Interventionsfocusing on behavior and its role in healthpromotionandprevention of illness may holdgreat potential of improvingthehealthstandards in global population (Glanz et al., 2008). Theories can be utilized to explainvarious behavioural aspects which may guide in thedevelopmentandenhancement of health promotional andeducationalefforts (Painter et al., 2008). Thesetheoriesfocus on a number of behavioural determinants at theindividual level, group level, societal level andmanyother levels (Roy & Jones, 2007). Among thesehealth behaviour theories is the Health Belief Model (Peterson &Bredow, 2009). Health Belief Model may guidethemedicsunderstandsome of the underlying reasons that lead an individualpatient to embraceorreject a givenpreventivehealthserviceorleadhealthpromoting behaviour (Green, 2002; Rosenstock et al.,1994).Historicalbackground Amongthevariousreviewedmodels of health behaviour, the Health Belief Model (HBM) has had a longerhistory as compared to many others. Initialthesocialpsychologistsformulatedthe Health Belief Model in an attempt to predictthenumber of people, who would usevaccinationsandthe screening tests (Kearney-Nunnery, 2012). Themodelstipulatesthatthechancesthat an individualtakes a preventiveaction to avoidgettingill, highlydepends on variousfactors of his/her perception. Theseincludethe following:• Whether a patientthinksheorshe is personallysusceptible to thecondition• Whether theconsequencesresulting from theconditionsare considered to be serious•Whethertheprecautionaryactionresults in preventivemeasures to thecondition• Whether benefits of mitigatingthedanger of theailmentsupersededthecost of theproposedintervention. (Kearney-Nunnery, 2012). Thetheorywasdeveloped by Irwin M. Rosenstock in theyear 1966, with an aim of understandingandpromotingtheconsumption of healthservices. Thefailure of thefreetuberculosis (TB) screening programcontributed to thedevelopmentandadoption of thetheory. In theearly 1970s and 1980s, Becker and his colleaguesdevelopedthetheoryfurther by addingsomechanges. Theseamendedtheknowledgereceived by a personand their responsibilities. Themodelhas beenadapted to help in establishing a variedvariety of shortandthelongtermhealth behaviours (Roy & Jones, 2007). Themodelwasoriginallydevelopedforthepurpose of predictingtheexpectedresultsforpatients, whoare treatedforeither chronic oracuteillnesses. However, currently ithas beenused to predictthebroadform of health behaviours (Roy & Jones, 2007). Forexample, the Health Belief Model typically positions a person’s opinionand his way of seeingthings in relation to thediseaseandhowitis perceived. Thispointemphasizestheindividualopinions on certaindiseases in terms of howtheyare transmitted to otherpeople. This is evidentwhensomeindividualsregardparticulardiseases as cursesandfail to acknowledgethefactthatsuchillnessesexist (Becker, 2010).Thiscase is not new in thesociety since somesaythat HIV is witchcraft. As a result of this, rate of infectionincreasesbecause of thepeople’s opinion, which is not supported by facts. It is alsoevident in thecase of commoncold, whensomeindividualsbelievethatthosewhogetinfectedhave a weakimmunesystemandignorethequestfortheagents of transmission. Forcommoncoldexample, the Health Belief Model demonstratesthatindividuals are likely to be infected by thevirus since they are surethat not everyone is prone to it. Thisfallacyleads them to not beingcautious with howtheydress during coldseasons (Becker, 2010).Thedescription of Health Belief Model Inusingthemodel to examinethereasonsforpatients’ non-compliance to a healthbehavior, the underlying constructs includestheperceivedsusceptibility which embroils a biasednotion of thevariousrisks that theperson may incur from a conditionorstate. Thesecondoneis perceivedseverity, which entailsthesubjective evaluation of the criticality of theconsequencesrelated to theconditionorstate. Itshowsthedegree of negativeeffect that arises from contracting an illness. According to Abraham andSheeran (2005) theseeffectsvary from one individual to theother since peoplehavedifferentroutines; hencetheimpact is not similar. Under thiscomponent, theconcernalsoarises based on contracting a diseaseorleavingit untreated, andthedegree of worryalsovaries from one individual to theother. Thus, severalfactors may be thereasonfor one to be concerned.Thesefactorsincludefamilylife, effects on one’s career, andsocialrelations as well as responsibilities of a person (Becker, 2010). Under the perceived benefits, Abraham andSheeran (2005) arguedthattheperceivedbenefits depends on an individualassessment of howwell a guidedaction will minimizetheriskormoderatetheeffects of thestateorcondition. In thiscomponent, theindividualis mostlyconcerned with thegains to be acquired from a condition, which is believed to be serious. In thissituation, itwassupposedthat an individual would not acceptrecommendedhealthpractice unless ithadbeenperceived as efficaciousandfeasible through time (Bandura, 2004). According to Kearney-Nunnery (2012), hearguesthat an individualwhohappens to be in self-employment, he is morelikely to be concerned about his healthcondition than thosepeoplewhoare employed at full-time job. Thishappensbecause self-employed personshave to workextrahard as heis clouded by lot of uncertainty in their business, unlike theemployedpeople. Also, in thiscomponent, a personis concerned with theseverity of gettingillnessdue to medical/clinical consequences, which haveseverebearings, such as intensepain, permanentdisabilitiesordeath. Anotherkeycomponent of themodel is thecues to action which are factors that usuallyenhance a person’s motivation. In thisfactor, thepersontends to focusmore on therestrictions that may prevent him or her from gettingtreatment. There are severalbarriersthatindividualsface, andtheydiffer from one person to another. Examples of suchbarriers are thecost of treatment. Forexample, in manydevelopingcountriesthecost of receivinghealthcare is unreasonablyhigh; henceit is an impediment to qualityhealth. In order to alleviatetheimpediment, their cost-effective measuresare introduced to helpindividuals. Self-efficacy involves one’s assurancethat he/she is capable of undertakingtheproposedaction (Poss, 2001).Assumptions of Health Belief Model The Health Belief Model is takethefollowingassumption in its applicability: Thefirstone is thatpeople are primarilyrational in their engagementsandviews, and will opt forthemostappropriatehealthmechanismaction in variouscases. Thesecond is whentheyrecognizethesignificance of payingattention to a troubling healthmatter,theyanticipatethatthesuggestedaction will have a positiveimpact by addressingtheissue. Thethirdone is thebeliefthatthey are in a position to take up theproposedaction (Kearney-Nunnery, 2012).Appropriatenessand Evaluation of Research Studies Since 1974, when Health Belief Model (HBM) had a comprehensivereview, it has continued to receivesubstantialtheoreticalandresearchattention from severalscientistsandmedics as a model that can helpunearthedsome of thebehaviouralconditions that lead to complianceor non-compliance to a medicalintervention (Glantz, 2002). Despite of thetheory’s wideapplicationthemajorquestionmost researchers are asking is theappropriateness of themodel as a toolforpredictingthe uptake of a givenmedicalintervention. Aresearchcarried out by Loghman-Adham (2003) on patients with end-stage renal disease regimen heavily relied on the Health Belief Model.Thisstudywascarried out to testthecapability of Health Belief Model to forecastthe dialysis patients’ compliance to theinstructionregarding minimization of dietary potassium, phosphorus-binding interventionandalsolimitedconsumption of fluid. Thisstudy in relation to Health Belief Model variables was in line with theanticipateddirections. Anotherstudy by Becker et al (2007) which utilizedthe Health Belief Model in their research, “Mother’s Compliance with Regimen for Child’s Condition”.It is one of theearlieststudies to use HBM to sick-role behavior. Itcomprised a review of thetreatment of children with a middleearinfection with a sample of 116 mothers. Themodelpredictedresultscorrectly since most of its variables worked to provethehypothesis (Becker et al., 2007). On his article titled, “Prediction of Coronary Heart Disease Preventive Behaviors in Women: A Test of the Health Belief Mode”, Ali (2002) supporttheability of Health Belief Model to predict an individual’s chances of compliance to a medicalintervention. In his experimentaldesign, hetook a psychologicalapproach to evaluatetheappropriateness of Health Belief Model in explainingthemother’s compliance to dietary prescriptionfor their obesechild. By designing three interventioncontrols: highfear, lowfearcontrol, theresultsobtainedcorresponded with themodels On the other hand, Harrison et al (1992) in their review of themodelacknowledgesthat in its initialform, the Health Belief Model would yieldtheexpectedresults.Daddario (2007) supportstheargumentadvanced by Harrison et al (1992) thattheincorporation of social, economic and/or environmental factors as predictors and determinants of health behaviour. According to Daddario (2007)the Health Belief Model componentsandpsychological constructs are related to cognizance, andperceptions rely on thepatient’s responses to their environments. Butthisalone cannot be relied upon to allowsocialandeconomicrealities to be adequatelyappreciated. Abraham andsheeran (2005) furtherarguethatthevalue of the ‘perceived threat’ factorsserving as a key behavioural motivation in the Health Belief Model is questionable. Assumingthatpeoplemakedecisions based on theperceivedbarricades, demographic and socio-economic factors as utilized in themodelmay be taken to indicatethathumans are rationalactorsmotivated by theconsciousunderstanding of theenvironment. This may be misleading to thinkthatpeoplereact based on the environmental factorsrather than combinatorial factorscomprising oftheunconscious, emotionalandother non-rational reactor to theexternalenvironment.
With the inclusion of the demographic and socioeconomic variables, thesystem can prove to be effective as evidenceavailableindicatesthatthe HBM has beenwidelybeenapplied in thecontext of healthserviceacceptancematterssuch as immunization reception, andcompliance with medicaltreatment (Conner & Norman, 2005).
A Clinical Case wherethe Health Belief Model Has Been applied Theresearchcase by Turner et al (2004) which designedandimplemented an Osteoporosis healthpromotionprograms based on the Health Belief Model. Turner et al (2004) describes Osteoporosis as, “a crippling condition that frequentlyend in earlydeathandsubstantial morbidity that is exhibited in theform of fractures, bonemalformation, andpain”. The statistics contained in the Turner et al (2004) articleshowsthat 25 million peoplewereaffectedand of the 25 million peopleaffect in America, 80% werewomen.Applying the Theory
The model is used to predict an individual compliance level to a clinical intervention with a view to modifying the clinical intervention in a way that appeal to the individual so as to increase the compliance level(Sheeran, 2005). The Model according to Becker (2010), rely on a number of construct in determining the compliance level to a clinical intervention.
For a person to adhere to a medical intervention he/she must understand the benefits they are going to accrue by taking up the intervention(King, 2007). The nurses will have to explain and demonstrate the benefits the participant will get by actively taking part in the intervention program. The program would be designed in a way that the health benefits are highlighted in the course of the implementation or administration of the intervention (Becker, 2010).
Furthermore, the theory statesthat person’s decision to comply to an intervention also depend on his/her perception of the severity of the condition. Nurses would have to demonstrate the statistics and show pictures of past cases for severity implications to sink deeper into the person’s mind and draw him/her to seek or stick to the intervention (Becker, 2010)..
Some individual may think that the condition cannot affect them due to their belief, but Conner and Norman (2005)research shows that Osteoporosis is a health condition that can affect anybody especially women are more vulnerable. The nurse should modify the education program to address the issue of susceptibility for the participants to understand and help them stick to throughout the program (Painter et al., 2008).
The perceived barrier is another major factor that the theory cites as the influencing factor in decision-making process(Peterson &Bredow, 2009). Some of the barriers the nurses need to address may include the cost barriers, lack of baby caretakers, locational inconveniences, and schedule (Glanz et al., 2002).
Modifyingfactorsandself-efficacy to action are further determinants of the decision to comply with a clinical intervention(Becker, 2010)..
Nursing Assessments and Interventions to Apply the Health Belief Model
In preparingthe implementation of theprogramtheplannerstookconsideration of the four Health Belief Model constructs: perceivedbarriers, perceivedbenefits, perceivedsusceptibility, andperceivedseverity. Theplannersalsotook into consideration of the modifying factorsandself-efficacy to action in their implementation plan(Roy & Jones, 2007). The perceivedbarriers, which were identified by the nurses,werelack of time, inaccessiblelocation, lack of childcareandcostissues. In addressing the challenges, theprogramdesignersmadetheprogram to be free, dividedtheprogram to eight sessions, whichwerespread over a givenperiod of time that wasconvenient to accommodatetheschedule of all thepotentialparticipants, theclasseswerealsoheld in a centrallylocated ultra-moderncommunitycentre with free childcare services.To bring out theissues of severity of thediseasetheparticipantswerepresented with thevariouseffect of thedisease, whichincludeddeath, crippling among otherpsychologicaleffect of thedisease. Theprogramrecruited 392 womenand 342 completedtheprogram. Health Belief Model was not onlyapplied at theplanningstagebutextended to the implementation stage. Theprogramwasarrange in a mannerthatthe four Health belief Model constructs werepresented, with materials that demonstratedhowseverity of thediseaseforexample. To deal with theissue of self-efficacytheinstructorperformedsome of thepracticalsession, whichtheparticipantrealizedtheycouldalsodothesame(Brewer & Fazekas, 2007).Havingconsideredallaspects of themodeltheprogramwasverysuccessful as theybypassedthetarget 300 participants. Followupdone a yearlatershowed a considerablecompliance to thepositivebehaviour thatreducedthechances of contractingthedisease.Conclusion The Health Belief Model (HBM) as described attempts to shade light and forecast a person’s behaviours, special focus is attitudes and beliefs. Educational programs encourage people voluntarily adjust their health behaviours. The success of these educational programs would majorly rely on the an individual’s view of the circumstances and the responsiveness to the educational programs. The nurses’ responsibility is to guide an individual in the process of self-realization and self-direction and spark an inner urge and motivation to behaviour change. Health Believe Model played, and will continue playing a key role in the medical field for nurses and community health interventions.
Health Belief Model according to Conner and Norman (2005) can significantly helpnursesandothercommunityworks to predictthe behaviour andtherefore re-evaluate betterways of delivering oradministering a medicalintervention to patients in a manner that increasecompliance. In thecase above the Health Belief Modelresultshelpedthenurses to identify behaviours that werelikely to causenoncompliance to theOsteoporosis intervention program. In thepreparation of theeducationalprogram of theparticipants,thenursestookconsideration of the four majorconstruct of Health Belief Model by identifyingandeliminatingtheperceivedbarriers, presenting to theperceivedbenefits of vaccines anddemonstratingthesusceptibility of thedisease of themedicalinterventionwas not adhered to.
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