Assignment 4
1. The HBM (Health Belief Model) was created sometime in the late 1950s by several
researchers named Hochbaum, Kegels, and Rosenstock and expanded upon in the 1980s by
Becker (Largo-Wight, 2010). This model is based off of cognitive theory and is considered a
"value-expectancy" model. Value-expectancy means a person believes they will get the desired
outcome if they alter their actions specifically those involving their health (Largo-Wight, 2010).
Originally, there were 4 primary constructs: "perceived susceptibility, severity, benefits of
action, and barriers to taking that action" (Egbert, 2014). Additionally, "cues to action" and "selfefficacy" were included after more research was completed (Egbert, 2014). Further, the
constructs are arranged into 3 sub-groupings: threats, pros-cons, and success tools. The first two
constructs are threats, the next two pros-cons, and the final two success tools (Largo-Wight,
2010). Some constructs are more effective than others. For example, perceived severity is
considered the least effective while perceived barriers is considered the most effective. The
model can be used for a variety of purposes. According to the lecture video slides, the most
common uses are to alter behavior in: screenings, prevention, health promotion, and treatment
compliance (Largo-Wight, 2010). While I am sure other applications exist, the UNF library
website definitely confirms that these areas consistently utilize HBM.
Resources:
Edberg, M. (2014). Essentials of Health Behavior: Social and Behavioral Theory in Public
Health (2nd ed.). Burlington: Jones & Bartlett Learning.
Largo-Wight, E. (2010, January 1). HBM video lecture. Retrieved September 28, 2014.
2.
Descriptive Study
a. Rollins et al. (2014, August 13). Direct-to-Consumer Advertising of Predictive Genetic Tests:
A Health Belief Model Based Examination of Consumer Response. Retrieved September 29,
2014, from http://www.tandfonline.com.dax.lib.unf.edu/doi/pdf/10.1080/07359683.2014.936295
b. In this article, the researchers attempt to discover how viewing an advertisement for a PGT
(predictive genetic test) affect the viewer based on several factors. Specifically, the researchers
wanted to know whether or not increasing the perceived threat or other demographics played a
role in seeking out further information about these tests.
c. The researchers utilized Qualtrics software to perform a survey on participants all of which
were 18 years or older. The participants were asked questions about an advertisement that
promoted a fake PGT. The questions mainly dealt with the following: how at risk the participant
felt, participants intention to learn more about the test, and likelihood of participant was to take
the test.
d. The primary result was that people who viewed the advertisement were more likely to find out
more information about the test. Few people actually indicated a desire to take the test just
because of the advertisement.
e.
The authors do an excellent job with the threat portion of the HBM. The authors clearly
demonstrate throughout the article the ways in which they went about measuring perceived
susceptibility. The authors also mention benefit of action though it is not a focus of their
research. For example, they show how people with a family history of genetic disease were more
likely to view the ad more seriously than people without a family history of genetic disease. This
leads me to believe that the authors conclude that perceived threat and benefit of action are the
most important constructs with dealing with this topic.
However, the authors do leave out some of the most important constructs altogether.
According to Dr. Largo-Wight's lecture on HBM, the most important construct is perceived
barriers. The authors choose to leave out this construct completely throughout the course of the
paper. Though the ad itself can be considered a cue to action, the authors do not specifically
mention this construct by name either. Lastly, the authors fail to include any primary research
dealing with self-efficacy. Because the authors leave out three of the six main constructs, I am
forced to consider their research as incomplete. They may have chosen to leave out the
constructs intentionally, but they never mention why which is a cause for concern. If they
conducted further research, they should consider perceived barriers because research shows it to
be the most important construct.
Applied Studies
1.
a. Naghashpour et al. (2014, September 1). Nutrition Education Based on Health Belief Model
Improves Dietary Calcium Intake among Female Students of Junior High Schools. Retrieved
September 29, 2014, from
http://eds.a.ebscohost.com.dax.lib.unf.edu/eds/pdfviewer/pdfviewer?sid=aed01b85-5088-444bbaf9-3152adf3091b@sessionmgr4004&vid=21&hid=4213
b. The purpose of the study was to determine how an education program on nutrition may affect
overall attitudes and behavior in female students in middle school in Iran. Calcium intake was
the main focus of the article.
c.
The students involved in the "intervention" group were given two questionnaires (one
prior and one after). The questionnaire consisted of 20 questions and were created using HBM
constructs. The Likert scale was used to measure the results. Students had five questions a piece
dealing with: perceived susceptibility, severity, benefits, and barriers. A second survey was used
to measure the amount of calcium intake each student had.
The intervention was eight 30-60 minute lectures that primarily dealt with nutrition
education. For example, the lessons showed the probability of a teenage girl not having proper
calcium intake to display perceived risk. The lessons also showed how important calcium was to
a person's diet. It was demonstrated how calcium affects many processes in the body and how
not having enough calcium could severely affect the body (perceived severity). To explain selfefficacy, the lessons showed students how to calculate their daily calcium intake. This
corresponds to perceived barriers because it showed how minimal the costs were of ingesting
more calcium. The students saw that increasing their calcium intake was little more than eating
one or two items and taking a few minutes to write it down.
d. The intervention group had significantly higher knowledge about calcium intake than the
control group.
e.
This article clearly indicates how they incorporated the first four constructs of HBM.
They even give a chart to relate how perceived susceptibility, severity, benefits, and costs were
relayed to the students. The questionnaire was a proper length and included each of these four
constructs in an equitable manner. By utilizing each of these constructs sufficiently, the students
received a thorough lesson plan, and it is obvious, based on the results, that that the lessons were
somewhat effective.
Similar to the first article I reviewed, this article fails to mention anything about the other
two constructs. Cue to action and self-efficacy were explicitly excluded from the analysis.
Though this intervention did not involve a behavior reversal (ie smoking cessation), it would
have been nice to see what kind of support system these students had for keeping up with their
daily intake logs. Secondly, there were almost no cues to action. The researchers could have
presented the students with examples of people that increased their calcium intake. By doing this,
the students could have seen a real life example of a person doing better by ingesting more
calcium. Better yet, the researchers could have brought in a respected older individual suffering
the consequences of poor calcium intake to demonstrate just how serious calcium intake truly is.
Overall, the program was successful, but it could have been even more successful with the
addition of further constructs.
2.
a. Ahmad et al. (2014, April 8). A pilot study: The development of a culturally tailored
Malaysian Diabetes Education Module (MY-DEMO) based on the Health Belief Model.
Retrieved September 29, 2014, from
http://eds.a.ebscohost.com.dax.lib.unf.edu/eds/pdfviewer/pdfviewer?vid=2&sid=4fe200d5-70944e3b-9707-2078b1cc22fb@sessionmgr4002&hid=4111
b. The purpose of this study was to determine whether or not a suitable diabetes education
program based on HBM had been created.
c.
A questionnaire was given before and after the educational program (an hour long video)
to determine whether or not a shift from baseline in diabetes education had occurred. The survey
contained 18 "items" and 37 "sub-items." The questions asked about general information
regarding diabetes as well as specific health behaviors that the participants had. Again, these
questions delved into the constructs of the HBM and used a Likert scale so that results could
easily be measured.
Because the target population used a specific language, the questions were worded in a
way so that the perceived susceptibility and severity could be easily understood. The real
challenge of this study was not to come up with questions. Rather, it was to translate the
questions in a way that this group of people could easily understand. For example, the authors
had to use certain diction choices like "sweet blood" to ensure that the population truly
understood the disease properly. The educational video also included the complications to
illustrate how severe the disease could be. Also, analogies were created to ensure everyone could
understand. Self-efficacy was demonstrated by explaining how exercise and a controlled diet
could alter the course of diabetes.
d. There was an increase is knowledge regarding perceived benefits and cues to action. However,
there was a decrease in knowledge about severity somehow.
e.
The article does incorporate all of the constructs. However, it does not precisely explain
how all of the constructs were utilized. It says that they included information about perceived
barriers but fail to give examples of how they did so. Considering perceived barriers is the most
important construct in most cases, this is once again an alarming thing to consider while
examining this research. However, I feel the pain of these researchers. They most likely know
how to present the constructs in an effective way, but the language barrier is preventing them
from doing so effectively.
Overall, I would like to see more of how the video showed people how to actually change
their lifestyle. Though the participants had an increase in knowledge about cues to action, were
these cues to action causing them to actually alter behavior. Secondly, I want to know what
support system was in place for people that were interested in change. Were their doctors or
clinics the participants could consult? Did they have charts or brochures about specific foods to
stay away from? Were there nutritionists available or physical trainers? It is one thing to know
whether or not a person knows more about diabetes. It is a completely different thing to see an
actual change in behavior. The purpose of any program should be to change behavior. Without
more thoroughly incorporating self-efficacy and cues to action, behavior will not probably
change. But, the authors did seem to breakthrough in perceived susceptibility. Obviously, their
video was at least informing this population that diabetes could happen to them.