Health Behavior Models

Discuss the rationale for using multiple theories in behavior change to structure interventions.
Describe the Health Belief Model (HBM).
Identify behavior-change interventions/strategies and their theoretical basis.
Discuss the concept of tailoring behavior changes to meet individual differences.
Application of these concepts.

Theories and models of health behavior were developed at a time when public health officials specified that:
- The concepts that influence the desired health behavior and the relationships among these concepts provide direction for how to intervene, promote change, and predict the expected outcomes of behavior change.
Theories and models of health behavior specify:
- Concepts that influence the desired health behavior.
- Relationship among these concepts.
- How to intervene to promote change.
- Predict expected outcomes of behavior change.
Most theories and models of health behavior attempt to explain:
- Why individuals do or do not engage in health behaviors.
- How individuals change negative behaviors.

Self-change is defined as new behaviors that clients willingly do to achieve self-selected goals or desired outcomes.
Question: As healthcare professionals, do you have a role in assisting clients to make self-changes?
Healthcare professionals:
- Promote a positive climate for change.
- Serve as a catalyst for change, assist the client with various steps of the change process.
- Develop the client’s capacity to maintain change.

Developed in the 1950s when public health officials were concerned about widespread reluctance to accept screening for tuberculosis, Pap smears for the detection of cervical cancer, and immunizations, even when these services were free or at minimal charge.
- Many people did not undergo these screening tests.
HBM was viewed as useful to predict those who would or would not use preventive measures and to suggest interventions.
HBM explains why some people who are illness-free take actions to avoid illness, whereas others fail to do so.

Evidence has shown that individuals will take action if two conditions are present:
- There is a perceived threat to personal health (illness susceptibility and severity).
- Belief that the benefits of taking action to protect health outweigh the barriers that will be encountered.

Perceived seriousness: Based on medical information or knowledge; beliefs about difficulties a disease may create, including medical, clinical, or social difficulties a health condition can create.
Perceived susceptibility: Personal risk; greater perceived risk for a health problem leads to a greater likelihood of engaging in behaviors to decrease risk (e.g., using sunscreen for skin cancer, using dental floss to prevent gum disease).

Life space in which an individual exists is composed of regions, some regions have negative valence, others positive, and others neutral.
Illnesses are considered to be regions of negative valence, exerting a force that moves the person away from regions of positive valence.
Preventive behaviors are strategies for avoiding the negatively valenced regions of illness.

When the perception of susceptibility is combined with seriousness, it results in the perceived threat or negative valence of that illness.
If the perception of threat is to a serious disease, behavior often changes.
Among people whose parents have the disease, the perceived threat makes these people take more health-enhancing, risk-reducing behaviors.

Perceived benefits: A person’s opinion of the usefulness of a new behavior in decreasing the risk of developing a disease (e.g., more energy, save money).
A study showed that African American women who perceived benefit of Breast Self Examination (BSE) for early detection of breast cancer, did BSE more frequently (Graham, 2002).

Perceived Barriers: A person’s own evaluation of the obstacles to adopt a new behavior, including perception about negative aspects of taking action (e.g., unpleasantness like craving cigarettes, inconvenience, time required, etc.).
Some of the barriers to performing BSE include: difficulty starting new behavior, not sure if doing behavior correctly, and embarrassment (Umeh & Rogan-Gibson, 2001).

Cues to action: Events, external (anti-smoking campaign, provider advice) or internal (shortness of breath) that trigger action (media, advice from others, illness of family member).
Modifying factors: Variables such as demographic (age, sex, race), socio-psychologic (social class, personality), or structural (knowledge or prior contact with the disease) indirectly affect action tendencies.
Both cues to action & modifying factors affect an individual's tendency to take action indirectly through their relationship with perceived threat.

Diagrams illustrating the Health Belief Model, showing the interplay between individual perceptions, modifying factors, and the likelihood of action are presented.
Individual Perceptions
- Perceived susceptibility.
- Perceived seriousness of disease.
Modifying Factors
- Age, sex, ethnicity.
- Personality.
- Socio-economics.
- Knowledge.
Likelihood of Action
- Perceived benefits versus barriers to behavioral change.
- Cues to action (education, symptoms, media information).
- Perceived threat of disease.
- Likelihood of behavioral change.

Scenario 1: Jassim is a 55-year-old male who presented to the urology clinic complaining of difficulty in urination, hesitancy, and pain in the lower abdomen. He did not think much of that until he read an article in the Khaleej Times about prostate cancer, and this reminded him of his father and brother who died of prostate cancer. Even though he is a devoted Muslim, he still worries about the destiny of his five children if he has prostate cancer. The urologist told him that he needs to introduce a needle through the urethra and take a biopsy from the prostate and look at it to make sure that he does not have prostate cancer. The urologist told him that the procedure is expensive and not very comfortable.
- Apply the HBM to this scenario.