The health belief model was one of the first theories of health behavior and remains one of the most widely recognized in its field (National Cancer Institute [NCI], 2005). It was developed in the 1950’s to describe why some people who are free of illness will take actions to prevent illness where as others fail to do so (Pender, Murdaugh, & Parsons, 2011, p. 38). According to Aboyoun Hayden the health belief model is by far the most commonly used theories in health education and health promotion (Aboyoun Hayden, 2009, p. 31). The health belief model is comprised of six main constructs that influence a person’s decisions about whether to take action to prevent, screen for, and control illness. The six main constructs include: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue to action, and self-efficacy (National Cancer Institute [NCI], 2005). Each of these constructs will now be examined individually and discussed further.
The first construct of the health belief model is perceived susceptibility. Perceived susceptibility means a person believes they are susceptible to a condition (National Cancer Institute [NCI], 2005). According to Aboyoun Hayden “susceptibility is one of the more powerful perceptions in promoting people to adopt healthier behaviors, the greater the perceived risk, the greater the likelihood of engaging in behaviors to decrease the risk. It is only logical to conclude that when people believe they are at risk for a disease they will be more likely to do something to prevent it from happening. Unfortunately, the opposite also occurs. When people believe they are not at risk or have a low risk or susceptibility, unhealthy behavior results” (Aboyoun Hayden, 2009, p. 32). When the perception of susceptibility is combined with seriousness, it results in perceived threat, if the perceived threat is to a serious disease for which there is a real risk, behavior often changes. According to Pender, “perceived susceptibility reflects an individuals feelings of personal vulnerability or risk for a specific health problem” (Pender et al., 2011, p. 38).
The second construct of the health belief model is perceived severity. Perceived severity means there is a belief that the condition has serious consequences (NCI, 2005). Aboyoun Hayden refers to this construct as perceived seriousness. She says “that while the perception of the seriousness or severity of the disease is often based on medical information or knowledge, it may also come from beliefs a person has about the difficulties a disease would create or the effects it would have on him or her in general” (Aboyoun Hayden, 2009, p. 32). Pender states “perceived seriousness of a given health problem may be judged either by the degree of emotional arousal created by the thought of having the disease, or by the medical, clinical, or social difficulties (family and work life) that individuals believe a given health condition would create for them” (Pender et al., 2011, p. 38). Also according to Pender “the belief about personal susceptibility and the seriousness of the illness combine to produce the degree of threat or negative valence of the illness” (Pender et al., 2011, p. 38).
The third construct of the health belief model is perceived benefits. Perceived benefits are an individual’s belief that taking an action would reduce the susceptibility of the condition or its severity (NCI, 2005). According to Aboyoun Hayden “the perceived benefit is a person’s opinion of the value or usefulness of a new behavior in decreasing the risk of developing a disease. People tend to adopt healthier behaviors when they believe the new behavior will decrease their chances of developing a disease. Perceived benefits play an important role in the adoption of secondary prevention behaviors such as screenings” (Aboyoun Hayden, 2009, p. 32). Pender says “perceived benefits are beliefs about the effectiveness of recommended actions in preventing the health threat” (Pender et al., 2011, p. 38).
The fourth construct of the health belief model is perceived barriers. According to the National Cancer Institute, perceived barriers are a belief that costs of taking action are out weighed by the benefit (NCI, 2005). Aboyoun Hayden states that “this is an individuals own evaluation of obstacles in a way of him or her adopting a new behavior. Of all the constructs, perceived barriers are the most significant in determining change. In order for new behaviors to be adopted, a person needs to believe the benefits of the new behavior outweigh the consequences of continuing the old behaviors. This enables barriers to be overcome and the new behaviors to be adopted” (Aboyoun Hayden, 2009, p. 33). According to Pender “perceived barriers are perceptions regarding the potential negative aspects of taking actions such as expense, danger, unpleasantness, inconvenience and time required” (Pender et al., 2011, p. 38).
The fifth construct of the health belief model is cues to action. Cues to action means exposure to factors that prompt action (NCI, 2005). “Cues to action are events, people, or things that move people to change their behavior. Some examples include illness of a family member, medical reports, mass media campaigns, advise from others, reminder post cards from a health care provider, or health warning labels on products” (Aboyoun Hayden, 2009, p. 33). Pender states that “cues to action are events, internal or external, that trigger actions such as bodily or environmental events” (Pender et al., 2011, p. 38).
The sixth and final construct of the health belief model is self-efficacy. Self-efficacy means people are confident in their ability to successfully perform an action (NCI, 2005). According to Aboyoun Hayden “self-efficacy was added to the health belief model in 1988. She states that self-efficacy is the belief in one’s own ability to do something. People generally do not try to do something new unless they think they can do it. If someone believes a new behavior is useful, but does not think he or she is capable of doing it, chances are it will not be tried” (Aboyoun Hayden, 2009, p. 33). According to Pender “a study was conducted using the extended health belief model, which contains self-efficacy. The study found that women who performed self breast examinations infrequently reported perceived lower self-efficacy, greater emotional barriers, and fewer health benefits. In another study using the extended health belief model, perceived benefits to undertaking exercise and self-efficacy were the two most important determents of exercise for stroke prevention. Willingness to select healthy bread was studies across four countries with the extended health promotion model. The perceive benefit was the major significant prediction in three countries, although not significant in two. Results of these studies substantiate the addition of self-efficacy to the health belief model” (Pender et al., 2011, p. 40).
“Since health motivation is its central focus, the health belief model is a good fit for addressing problems behaviors that evoke health concerns. Together the six constructs provide a useful framework for designing both short-term and long-term behavior strategies. When applying the health belief model to planning health programs, practitioners should ground their efforts in understanding of how susceptible the target population feels to the health problem, whether they believe it is serious, and whether they believe action can reduce the threat at an acceptable cost. Attempting to effect changes in these factors is rarely as simple as it may appear” (NCI, 2005, p. 13). According to Aboyoun Hayden “according to the health belief model, modifying variables, cues to action, and self-efficacy affect our perception of susceptibility, seriousness, benefits and barriers, and therefore, our behaviors” (Aboyoun Hayden, 2009, p. 35).
In order to determine which population of people needs to be screened for prostate cancer, some statistical information about prostate cancer needs to be discussed.
According to the Center for Disease Control and Prevention (CDC) prostate cancer is the most common cancer in men. In the United States in 2007, 223,307 men were diagnosed with prostate cancer, and 29,093 men died from it. Prostate cancer is the second most common cause of death from cancer among white, African American, American Indian/Alaska Native, and Hispanic men. It is the fourth most common cause of death from cancer among Asian/Pacific Islander man. Prostate cancer is more common in African-American man compared to white men. It is less common in American Indian/Alaska Native and Asian/Pacific Islander men compared to white men. It is also more common in Hispanic men compared to non-Hispanic men. Kentucky is one of the 15 states with the lowest rates of prostate cancer. The rates for these states are 120.0 to 148.1 per 100,000 people (Center for Disease Control and Prevention [CDC], 2011). According to the Journal of the American Medical Association only 75 percent of men age 50 and older have had a prostate specific antigen test (Sirovich, Schwarz, & Woloshin, 2003). Not that the statistical information has been presented, a creative program has been designed to target African American men between 50 -75 years of age. Since African American men have almost double the prevalence and morbidity from prostate cancer, it would appear that the program would need to target this population.
To develop the creative program, an attempt would be made to find prominent African American men between the ages of 50-75 who have been diagnosed with prostate cancer. Once several men have been found, interviews would be conducted and taped. The interview questions would cover a wide range of topics about prostate cancer, but the most important questions for the program would include that following: how did you feel when you got the diagnosis of prostate cancer, why did you get tested, if the person was older when they got their first test a what was/were the reason(s) they waited to get tested, what have they done since getting tested, as well as what information they were given when they received their diagnosis. Once all the interviews have been conducted and transcripts typed out, Morgan Freeman would be contacted to see if he had any interest in being the performer for “The Prostate Monologues.” Morgan Freeman was chosen to be the performer because of his amazing acting ability as well as his ability to adapt to any situation. He is within the same age range and ethnicity of the target population of the program. He comes across in a non-threatening way and is well known. The program would be similar to The Vagina Monologues. Morgan Freeman would be on a stage recounting other’s stories about how they are dealing with prostate cancer. The program would be presented in places that would be easily accessible to anyone with venues ranging from public parks, churches, community centers, and retirement homes. The program would be free and would include several intermissions. There would also be information posted about possible signs and symptoms of prostate cancer, and if anyone in attendance was experiencing any of the symptoms, testing would be available. During the intermissions a team of healthcare professions would have several booths set up so that if the people in attendance wanted to get their prostate specific antigen drawn, it would be readily accessible and free. If anyone in the audience decided to get tested, they would be asked to fill out an information card so they could be contacted. If anyone had a PSA result that indicated possible cancer, follow ups and referrals would be made by the medical staff that conducted the testing. The program would be advertised on the radio, television, and fliers would be posted.
The goal of this program would be for African American men in attendance to get tested for prostate cancer. With presenting stories about prominent African American men with prostate cancer, it would help open the eye of the public that maybe they do need to get tested. A lot of people have the attitude “it won’t happen to me.” This program attempts to speak to the perceived seriousness of prostate cancer. With the information being presented about the signs and symptoms of prostate cancer, it allows the individuals in attendance to determine if they might be at risk. The goal of this program is to get African American men to realize they are at increased risk of not only developing prostate cancer, but they are almost twice as likely to die from prostate cancer. Hopefully this will be enough information to allow a person to make the decision get tested. This decision not only speaks to the construct of perceived benefits but it also speaks to the construct of cues to action. If somebody watching the program was adamant about not getting a PSA before, but the information presented was so powerful they got one, their belief about the usefulness of the test would have been changed. Having the ability to readily perform the test as well as having the test be free speaks to the perceived barriers. Also with having the testing readily available and free it speaks to self-efficacy because if they thought they couldn’t get the test for what ever reason, it is again readily available.
As you can see, the Health Belief Model is an excellent fit when developing this particular program about prostate cancer or any other program for that matter. As long as all six constructs are present when developing a program as well as picking the appropriate targeted population, a program developed using the Health Belief Model will be successful.
Author: Jason Hawkins RN, BSN, MSN
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Aboyoun Hayden, J. (2009). Introduction to Health Behavior Theory. Sudbury, MA: Jones and Bartlett Publishers, LLC.
Center for Disease Control and Prevention. (2011). Prostate Cancer. Retrieved from Center for Disease Control and Prevention: http://www.cdc.gov/
National Cancer Institute. (2005). Theory at a Glance A Guide for Health Promotion Practice. (2nd ed.). Bethesda, MD: National Cancer Institute.
Pender, N., Murdaugh, C., & Parsons, M. A. (2011). Health Promotion in Nursing Practice (6th ed.). Upper Saddle Ridge, NJ: Pearson Education, INC.
Sirovich, B. E., Schwarz, L. M., & Woloshin, S. (2003, March 19). Screening men for prostate and colorectal cancer in the United States: does practice reflect the evidence? . JAMA, 289 (11), 1414-1420. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12636464