The document discusses the Health Belief Model (HBM), which is designed to explain health-related behaviors and originated to address why individuals do not engage in preventive health measures. It outlines the model's key components: perceived susceptibility, severity, benefits, and barriers, along with its strengths, limitations, and extensions, including cues to action and self-efficacy. Additionally, it highlights the application of HBM in research, particularly in understanding oral health behaviors among people living with HIV.

1. Ms. Jyoti Chand
M.Sc. Nursing

2. Objectives :
At the end of seminar ,audience will be able to:
➢ define health belief model(HBM)
➢ define goal of health belief model
➢ list postulates of HBM
➢ enumerate extensions to original HBM
➢ infer strengths and limitations of HBM
➢ interpret extended HBM

3. Introduction
❖ The growing increase in lifestyle-related health problems has motivated a shift
from treatment-and-prescription centric (reactive) healthcare system to a
patient-centric (proactive) system that is based on prevention and promotion
of healthy behavior around the world.
❖ Several health behavior theories have been used to inform health intervention
designs, such as the Theory of Planned Behavior, the Transtheoretical Model,
and the Health Belief Model .

4. ………contd
❖ The Health Belief Model (HBM), was developed in the 1950s to investigate
why people fail to undertake preventive health measures, remains one of the
most widely employed theories in the design and evaluation of health
behavior interventions.

5. History of HBM
❏ The HBM is the first theory that was developed exclusively to explain health-
related behaviors.
❏ The model was developed in response to the failure of a free tuberculosis
(TB) health screening program.The TB screening program provided adults
with free TB screening x-rays from mobile units conveniently located in
various neighborhoods. When few adults came out for the free services,
program organizers began investigating why more adults did not come out.
Hochbaum, however, began to study what motivated the few who did come
out.

6. Goal of HBM
The original goal of the developers of the HBM was to focus the effort of
researchers who aim to improve public health by understanding why people do not
take preventive measures to promote health promotion.

7. Postulates
Health-related behavior is determined by his/her perception of the four variables:
1. Perceived Susceptibility
2. Perceived Severity
3. Perceived Benefit
4. Perceived Barrier
These four variables have been broadly categorized into two main aspects of
individuals’ representations of health and health behaviors: Perceived Threat and
Behavioral Evaluation

8. Perceived Threat
The HBM posits that an individual is likely to perform a behavior if he/she
perceives a threat from a disease or health condition.
The threat perception is based on two beliefs:
1. The perceived susceptibility of the individual to the disease
2. The perceived severity of the consequences of the disease for the individual.

9. Behavioral evaluation
HBM proposes that an individual is likely to perform a behavior if s/he perceives
that performing the behavior will supposedly reduce the negative health outcome.
The behavioral evaluation is based on two beliefs:
1. The perceived benefit or efficacy of the target health behavior
2. The perceived costs or barrier to performing the target behavior.

10. Extensions to original HBM
1. Cue to Action
2. Self-Efficacy

11. Strengths of HBM
● The main strength of the HBM is its use of simplified health-related constructs
that make it easy to implement, apply, and test .
● The HBM has provided a useful theoretical framework for investigating the
cognitive determinants of a wide range of behaviors for over three decades.
● It has focused researchers’ and health care professionals’ attention on
variables that are prerequisites for health behavior.

12. Limitations of HBM
● The model did not explicitly spell out the relationships between the variables
and no clear rules for combining the formulated variables.
● A major weakness of HBM is its predictive capability.The primary variables
account for less than 21% (R2 < 0.21) of variance in healthy behavior change
and the effect sizes of the individual variables are very small

13. Extended HBM
Researchers have identified some other important variables that affect the
tendency of performing a behavior. Most of these variables have not been
examined in the context of any existing theoretical framework and therefore, have
not been widely employed by health behavior intervention designers

14. Cont…
Newly added variables are
1. Consideration of future consequences
2. Self identity
3. Concern for appearance
4. Perceived importance

15. Strength of Extended HBM
Including these four variables significantly increased the predictive capacity of the
model by approximately 78 %

16. Limitation of Extended HBM
Variables (consideration of future consequences, self-identity, concern for
appearance, and perceived importance) have been validated as independent
predictors of various behaviors. However, they have not been examined in context
of any known health theories to know their relationships with other variables.

17. Application of HBM(HIV prevention )

18. Smoking cessation

19. Application of Research
An exploration of the oral health beliefs and behaviors of people living with HIV in
Mangalore, India: a qualitative study
Anisha Rodrigues et al. ,BMC Oral Health. 2021.Apr 30;21(1):222.
PMID: 33931053 PMCID: PMC8086078 DOI: 10.1186/s12903-021-01549-5

20. Contd….
Health Belief Model (HBM) and qualitative methods using in-depth interviews with 16
PLHIV was used,Content analysis of the transcribed data was done. The data was
grouped under the constructs of the HBM.The perceived susceptibility to oral diseases
and awareness on the importance of good oral health was low. Regular tooth brushing
and traditional methods for oral hygiene maintenance were considered beneficial.
Regular dental visits were not considered important. Psychosocial issues, time and
financial constraints were the barriers. Participants believed that information on oral
health should be provided by the health providers in hospitals and dental clinics.The
findings on the oral health beliefs and behaviors support the need for education on oral
health and preventive health care practices among PLHIV. Oral health promotion
should include behavioral change as one of its components.

21. Conclusion
HBM is a psychological model that attempts to explain and predict health behaviours.this is done
by focusing on the attitude and beliefs of individuals. The Health Belief Model (HBM) was
developed in the early 1950s by social scientists in the U.S. Public Health Service in order to
understand the failure of people to adopt disease prevention strategies or screening tests for the
early detection of disease.The model was first presented with only four key concepts: Perceived
Susceptibility, Perceived Severity, Perceived Benefits, and Perceived Barriers. The concept of
Cues for Action was added later to "stimulate behavior." Finally, in 1988, the concept of Self-
Efficacy was added to address the challenges of habitual unhealthy behaviors such as smoking
and overeating.The HBM is based on the understanding that a person will take a health-related
action,if that person 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 and
believes that he/she can successfully take a recommended health action.

22. References
1. Janz NK, Becker MH. The Health Belief Model: a decade later. Health Educ Q. 1984 Spring;11(1):1-47. doi:
10.1177/109019818401100101. PMID: 6392204.
2. Abraham C, Sheeran P. The health belief model. In: Conner M, Norman P, editors. Predicting Health Behaviour:
Research and Practice with Social Cognition Models. 2nd Ed. Maidenhead: Open University Press; 2005. pp. 28–80.
3. Becker MH, Maiman LA, Kirscht JP, Haefner DP, Drachman RH, Taylor DW. Patient perceptions and compliance:
Recent studies of the Health Belief Model. In: Haynes RB, Taylor DW, editors. Compliance in Health Care. 1979.
4. National Cancer Institute . Theory at a Glance: A Guide for Health Promotion Practice. Washington, DC: U.S.
Department of Health and Human Services; 2003.
5. Orji R, Vassileva J, Mandryk R. Towards an effective health interventions design: an extension of the health belief
model. Online J Public Health Inform. 2012;4(3):ojphi.v4i3.4321. doi: 10.5210/ojphi.v4i3.4321. Epub 2012 Dec 19.
PMID: 23569653; PMCID: PMC3615835.
6. Rodrigues A, Hegde V, Hegde AV, Shastri SG, Ravikumar DN, Rodrigues R. An exploration of the oral health beliefs
and behaviors of people living with HIV in Mangalore, India: a qualitative study. BMC Oral Health. 2021 Apr
30;21(1):222. doi: 10.1186/s12903-021-01549-5. PMID: 33931053; PMCID: PMC8086078.