5/14/2007
Health Belief Model (HBM)
Dr. McKinley Thomas
Associate Professor
Department of Community Medicine
Mercer University
Accomplishments
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Examine the details of the health belief model (HBM)
Offer an example of HBM in practice
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Compare international immunization rates
In Essence
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Centered on the ideas that individuals take specific health‐related actions toward positive change if he/she…
„ …feels that a negative health condition can be avoided
„ …has a positive expectation that by taking a recommended action, he/she will avoid a negative health condition „ …believes that he/she can successfully take a recommended health action
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Origins
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Developed in the 1950s
Social Psychologists
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Hochbaum, Rosenstock and Kegels ,
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USPHS
Free TB screening programs
Expanded to explore both long‐term and short‐
term health outcomes
Based Upon Four Constructs
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Perceived
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Susceptibility
Severity
Benefits
B
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Barriers
Stimulated by “cues to action”
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Recent component
Added by Rosenstock (1988)
Construct
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Abstract or general idea inferred or derived from specific instances „
Synonyms
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Concept
Conception
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Limitations
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Attitudes / beliefs rather than behaviors / reality
Abs become surrogate measures for actual threat perceived
How one “feels” varies over time
Model doesn’t deal well with addictive or repetitive behaviors, which are nonlinear
Neglects non‐health‐specific motives
Assumes that health is highly valued
Assumes cues to action are prevalent Example
Hay, J. L., Ford, J. S., Klein, D., Primavera, L. H., Buckley, T. R., Stein, T. R., Shike, M., & Ostroff, J. S. (2003). Adherence to colorectal cancer screening in mammography‐adherent older colorectal cancer screening in mammography adherent older
women. Journal of Behavioral Medicine, 26 (6), 553‐576.
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Research Questions
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Are the various elements of the updated HBM useful in explaining adherence?
Are there any interactions among perceived susceptibility, severity, self‐efficacy, and physician recommendation and perceived benefits of and barriers to CRC?
Are higher perceived benefits and lower perceived barriers the mechanisms by which perceived susceptibility, severity, self‐efficacy, and physician recommendation related to CRC?
Colorectal Cancer
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3rd leading cause of cancer mortality among females
Available screenings are underutilized
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50% of subjects were adherent to CRC screening guidelines
Regression Analysis
Screening Recommendations
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Fecal occult blood test (FOBT), which checks for hidden blood in three consecutive stool samples, should be administered every year. Flexible sigmoidoscopy should be administered every 5 years. Double­contrast barium enema should be administered every 5 years. years
Colonoscopy, 10 years. 4
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Participants
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N = 280
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Females, 50+
December 98 – June 00
Urban breast diagnostic facility
Health‐belief survey (multiple screenings)
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Knowledge
Attitudes
Adherence
Methodology
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Written Consent
Assessment battery
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Phone calls to those unreturned within two weeks
83% Rate of Return
Findings
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40% of explained by
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Self‐efficacy
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Physician Recommendation
Perceived barriers to screening
Perceived benefits to screening
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Another Example
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Parental Views of Immunization
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Believes that infectious diseases are dangerous
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Susceptibility
Believes that immunization is effective in eliminating the danger
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Severity
Believes there is a danger of the child contracting an infectious disease i f i
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Benefits
Has the means to access the vaccination service „
Barriers
Immunization
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Limited Coverage
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Nigeria (25%)
United States (96%)
Viet Nam (98%)
Vaccinations
Disease
Smallpox Diphtheria Pertussis P
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Tetanus Poliomyelitis Measles Mumps Rubella Haemophilus 20th C
48,164
175,885 147,271 147 271
1,314
16,316 503,282 152,209 47,745 20,000 1998
0 1 6,279 6 279
34 0
89 606 345 54 Decrease
100% 100%
95.7% 95 7%
97.4% 100% 100%
99.6% 99.3% 99.7% 6
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Biomedical Advanced Research and Development Agency
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S. 1873
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Biodefense and Pandemic Vaccine and Drug Development Act of 2005, „
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Sen. Richard Burr (R‐NC) Sen
Richard Burr (R NC)
Senate Majority Leader Bill Frist (R‐TENN)
Designed to assigned to assist /encourage private industry in developing medical countermeasures for bioterrorism agents and natural outbreaks such as a possible avian flu pandemic
A Problem?
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1873 grants BARDA total categorical exemption from the requirements of FOIA.
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Placed on Calendar as No. 257
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BTW
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International Immunization Rates
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http://www.unicef.org/publications/index_28135.html
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