2. Health Belief Model History
• Initial Development in the 1950’s by social
psychologist Hochbaum, Rosenstock and
Kegels in the U.S. Public Health Service
• One of the earliest health behavior theories
• It was later expanded to study peoples
response to symptoms and diagnosed illness
3. Health Belief Model History
• Stimulus Response Theory (Waston, 1925)
• learn new behaviors and/or change old
behaviors because of consequences
• Skinner, 1938
• Cognitive Theory (Lewin, 1951)
4. Health Belief Model History
• Has been one of the most widely used
theoretical frameworks in research on health
behavior since the 1950’s
• HBM has been expanded and used to
support interventions
8. Concept Definition Application
Perceived
Susceptibility
One's opinion of chances
of getting a condition
Define population(s) at risk, risk
levels; personalize risk based on a
person's features or behavior;
heighten perceived susceptibility if
too low
Perceived
Severity
One's opinion of how
serious a condition and its
consequences are
Specify consequences of the risk and
the condition
Perceived
Benefits
One's belief in the efficacy
of the advised action to
reduce risk or seriousness of
impact
Define action to take; how, where,
when; clarify the positive effects to be
expected
Perceived
Barriers
One's opinion of the
tangible and psychological
costs of the advised action
Identify and reduce barriers through
reassurance, incentives, assistance
Cues to Action
Strategies to activate
"readiness"
Provide how-to information,
promote awareness, reminders.
Self-Efficacy
Confidence in one's ability
to take action
Provide training, guidance in
performing action
9. Osteoporosis
• Osteoporosis, or "porous bones," causes
bones to become weak and brittle — so
brittle that a fall or even mild stresses like
bending over or coughing can cause a
fracture. In many cases, bones weaken when
you have low levels of calcium and other
minerals in your bones.
10.
11. Early Prevention
• In order to prevent and delay the onset of
osteoporosis in the later part of life,
prevention methods need to begin many
decades before menopause
• Education on prevention methods is a major
component
12. Kasper, M.J., Peterson, M.G.,Allergrante, J.P., Galsworthy,
T.D., & Gutin, B. (1994) Knowledge, beliefs, and behaviors
among college women concerning the prevention of
osteoporosis.Arch Farm Med, 3, 696-702.
• Objective - To access college age women's
knowledge on osteoporosis risk factors and their
beliefs about the disease.
• They also looked how they practiced
preventative behaviors already.
• Completed questionnaire with a 100% response
rate
13. Kasper, M.J., Peterson, M.G.,Allergrante, J.P., Galsworthy,
T.D., & Gutin, B. (1994) Knowledge, beliefs, and behaviors
among college women concerning the prevention of
osteoporosis.Arch Farm Med, 3, 696-702
• Results - 114 heard about osteoporosis
• Only 49 of that 114 had received information from school or
a health care provider
• There was a significant relationship between receiving
osteoporosis information and being able to identify risk factors
• Only 6.7% of the women reported getting the appropriate
exercise requirement to protect against osteoporosis and getting
the recommended 1200mg of calcium per day
14.
15.
16. Comments
• The study found that educational institutions
and health care providers are not providing
information about osteoporosis to young
women or the information has not been
received and retained by the women
Limitations
• Small sample size
• Self reporting data
17. Sedlak, C.A., Doheny, M.O., Jones, S.L. (2000).
Osteoporosis education programs: Changing
knowledge and behaviors. Public Health Nursing,
17(5), 398-402.
• Goal - to describe the type of program that would
change knowledge, health beliefs, and behaviors for
women with different needs and backgrounds about
osteoporosis risk factors
• 3 educational programs
• Varied in length and method of presenting content
• Completed survey before and 3 weeks after program
• Each program had a different “intensity” level
18. Conclusion
• Survey completed 3 weeks after program
• Results
• Impact of program on health beliefs
• Only difference was the participants in the intermediate
group increased their beliefs that calcium intake was
beneficial for prevention of osteoporosis
• Impact of osteoporosis preventing behaviors
• Participants in the intense group reported that they
significantly decreased their intake of caffeine
• Impact of program on knowledge
• Participants of all programs had significantly higher levels of
knowledge posttest
19. Discussion
• All programs increased knowledge about
osteoporosis prevention, regardless of program
design
• Overall, all programs did not change the
participant’s health beliefs about osteoporosis or
increase their prevention behaviors
• Further programs are needed to access how
women's health beliefs help them engage in long-
term osteoprevention behaviors.
20. Osteoporosis knowledge and educational
program in the Greek community at
University of Alamabama
• Purpose of the study would be to test the
women’s knowledge on osteoporosis and
provide information on what they can start
doing during their college years to prevent
or delay the onset of osteoporosis when
they get in their 50’s 60’s and 70’s
21. Osteoporosis knowledge and prevention
program in the Greek community
• Recruit 30 women from 18 sororities Panhellenic
and Pan-Hellenic
• Women will take an initial survey
• Questions will cover the 6 constructs
• Complete 5 group sessions that will directly follow
their chapter meetings
• There will also be a make-up meeting on another
night during the week if girls are not able to make
the original
• During the final class the girls will take the original
survey to test what they have learned
22. Sample Survey Questions
• Do you believe you are at risk for getting osteoporosis in
the future? Yes No Don’t know
• Does osteoporosis run in your family? Yes No Don’t
know
• Do you engage in 30 minutes of weight-bearing exercise 3
days a week? Yes No Don’t know
• Do you believe calcium consumption is beneficial to
prevent the onset or delay osteoporosis? Yes No Don’t
know
• Does consuming excess amounts of caffeine increase the
onset of osteoporosis? Yes No Don’t know
• Do you believe you are susceptible to getting osteoporosis
in your postmenopausal years? Yes No Don’t know
• Do you believe you are knowledgeable on ways to prevent
osteoporosis later in life? Yes No Don’t know
23. Discussion
• Limitations
• The program only includes Greek affiliate women
• The surveys are self reported
• Possibility of women missing sessions because of
conflict
• Even though the program only reaches a small amount
of the entire sorority population, the women will be
knowledgeable about osteoporosis and be able to take
the information they learn in the program and,
hopefully, share it with other members of their chapter
24. Discussion
• The severity of osteoporosis needs to be taught
to women before they are diagnosed with this
deadly disease
• The Health Belief Model is ideal for this
program because college age women are not
statistically shown to perceive osteoporosis as a
threat
• Our main goal is to increase perceived
susceptibility and the severity of osteoporosis
to the women since they are at such a crucial
age where it is most important for them to
know all the facts about osteoporosis
25. References
• Glanz, K., Rimer, B.K., Viswanath, K. (2008) Health Behavior and
Health Education: Theory, research, and practice. San Fransisco: Jossey-
Bass.
• Kasper, M.J., Peterson, M.G., Allergrante, J.P., Galsworthy, T.D.,
& Gutin, B. (1994) Knowledge, beliefs, and behaviors among
college women concerning the prevention of osteoporosis. Arch
Farm Med, 3, 696-702.
• Sedlak, C.A., Doheny, M.O., Jones, S.L. (2000). Osteoporosis
education programs: Changing knowledge and behaviors. Public
Health Nursing, 17(5), 398-402.
• Turner, L.W., Hunt, S., Dibrezzo, R., & Jones, C. (2004). Design
and implementation of an osteoporosis prevention program
using the Health Belief Model. American Journal of Health Studies
26. References
• Noar, S.M. (2005) Ahealth educator’s guide to theories of health
behavior. Int’l Quarterly of Community Health Education, 24(1), 75-
92.
Editor's Notes
developed in response to the failure of a free tuberculosis (TB) health screening program. Since then, the HBM has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS.
SR theorist believed learning results from events(reinforcements) that reduce psychological drives that activate behavior.
Skinner- frequency of behavior is determined by its consequences or reinforcements. Response immediately following the behavior, whether it be negative or positive is what is going to determine if the behavior will be repeated OR NOT.
reinforces, punishments, rewards
Cognitive th- Emphasize the role of subjective hypotheses and expectations held by the individual.
Beliefs, attitudes, desires, expectations, etc.
Influencing beliefs and expectations about the situation can drive behavior change, rather than trying to influence the behavior directly.
Ie weight loss, rewarding yourself with new clothes
Both to explain change and maintenance of health-related behaviors and as a guiding framework for health behavior interventions
Interventions to change health behaviors
P. Suce- A person’s belief about their chances of getting a disease or health condition
***One of the more powerful perceptions
People who are not at risk for a certain condition have low perceived susceptibility
****osteoporosis
P. Severity- A person’s belief about the seriousness or severity of the disease or health condition
p. benefits- A person’s belief of the value or usefulness of a new behavior in decreasing the risk of developing a disease or health condition
People tend to adopt healthier behaviors when they believe the new behavior will decrease their chances of developing a disease.
p. barriers- A person’s belief about the obstacles in the way of him or her adopting a new behavior.
***most significant construct in determining behavior change
Cues- Events, people, or things that move people to change their behavior.
Self-eff- The belief in one’s own ability to do something. I KNOW Y’ALL Haven't HEARD OF THIS ONE
People generally do not try to do something new unless they think they can do it.
These can effect behavior compliance
Age Sex Culture Education level Past experiences Skill Motivation SES Personality Demographics
Can result in premature mortality and significant morbidity from fractures, bone deformity and pain
Osteoporosis Affects over 25 million people, 80% women
Responsible for more than 1.5 million fractures annually
17 billion dollars is spent, nationally, each year on this disease
Up to 50% of women will be affects
Most people think osteoporosis (loss of bone mass) is a disease of the elderly. However, although people normally lose bone mass as they age, the amount of bone growth that occurs during childhood and adolescence is just as important a factor in developing osteoporosis. That's what experts at the National Institutes of Health (NIH) said at a conference on Osteoporosis Prevention, Diagnosis and Therapy in March 2000
Cross sectional study
127 women, roughly 20 years old 92% white
They were enrolled in a required undergraduate health course
To test reliability, 30 participants were randomly requested during the second class to complete questionnaire a second time, 24 completed it. 6 were absent
Respondents believed they were not at risk for developing osteoporosis
They felt osteo was not as sever in women when it came to morbidity and mortality as hear disease and breast cancer
Limitations
Other possibilities could be that even when information is disseminated, because the women do not think or believe they are at risk, they do not remember the information.
In general the women in the study were not practicing osteoprotective behaviors (exercise 3x a week for 30 min, 1200mg calcium dailey)
The more info the women received, the more they reported knowing about risk factors for osteoporosis
The women in the study believed that one is as responsible for getting oeteo as one is for getting the common cold (flu).
There was no significant relationship between the concerns, seriousness, or likeliness of getting osteo and calcium intake, osteoprotective exercise or risk factor identification
82% reported consuming less than the recommended 1200mg of calcium a day
The article made the assumption that the vast majority of young women in the US may have lower peak bone mass and have a greater risk of having osteoporotic fractures in their later years
They believe this is the first study done that documents that young women believe that it is unlikely that osteo will develop in them
Majority of women DO engage in exercise and calcium intake behaviors but that are inadequate for building healthy, strong bones
Perceived susceptibility to osteoporosis, perceived seriousness of the disease, perceived benefits to osteoporosis prevention activities (that is, increased dietary calcium, increased weight bearing exercise), perceived
barriers to action (that is, cost of interventions), and motivation to engage in osteoporosis prevention activities are
factors that may be related to the extent to which individuals engage in health promoting behaviors.
Each program was conducted differently depending on what they wanted to learn( how much detail) and their time commitment
The intense group met with the program developers for three sessions over a 3 week prd and were given assignments to complete during the program sessions. 31 young college women. Most were under 25 and had completed some form of college education. Women voiced praticipating in this study after completing a previous study on osteo risk factors and did not engage in preventative behaviors
The intermediate group consisted of 3- 1 hour sessions. 35 women 22-83. this program was designed the way it was because of the heterogeneity of age and knowledge of osteop. Physicians, nutritionist, exercise physiologist, and two nurses presented the info as it pertained to their field.
The brief program was one 45 minute session. 18 nurses, 35-59. breief b/c they have previous knowledge.
conclusion
With adults they have a showed reediness to learn through voluntary participation and self direction
Knowledge does not equal change
“What they did learned” rather then “what they were going to do”
The survey contains questions from each construct of the HBM
In the meetings they will learn all about osteoporosis and why it is important for them to be preparing their bodies know.
My program models parts of the the program Dr. Lori Turner’s and colleges OPP program from 2003. The first session will be an orientation, welcoming the women to the study and giving them an overview of how the program will go. 3 out of the 5 group sessions, the women will complete educational classes. The topics covered will be general nutrition that will cover importance of calcium and the best ways to get the adequate amounts. In the nutrition they will also discuss genetics and the importance of talking with their mothers and grandparents about their health history. There will be an osteoproducative exercise class and then finally a bone density testing class. In the bone density testing class the women will receive dexa scans on their hips and spine that will provide their bone density. The reading will be explained to the girls in a way they can easily understand.
During each educational class they will be provided pamphlets and educational material that will correspond with the material they are being taught.
Sharing will be encourage. We will also provide extra handouts and pamphlets for the women to handout at their chapter houses.
Baby boomers getting to the age where they are dealing with osteoporosis
