1. Chapter 13: Health Belief Model, Protection Motivation Theory, and Physical Activity

2. Health Belief Model (HBM)
One of the first models that adapted theory from the behavioral sciences to health problems
Most widely recognized conceptual framework for health behavior
Developed to ________________ that prevent unwanted adverse conditions
First formulated around 1950 in an attempt to explain why only a proportion of the asymptomatic US population agreed to undergo screening tests for conditions such as lung cancer.
Since, it has been applied to other preventative health behaviors, such as getting a flu vaccine.
HBM most commonly used theory or model tested to explain health behaviors.
Encourage behaviors to prevent getting influenza, tuberculosis, high blood pressure, coronary artery disease

3. Assumptions of the HBM
For an individual to take action to avoid an unwanted health outcome, he/she must feel …
Personally susceptible
Disease will have at least moderate severity on some component of life
By taking action, severity or susceptibility will be reduced
Perceived benefits of doing the behavior will outweigh the perceived barriers
HBM postulates that the likelihood of adopting a behavior appropriate to the prevention or control of some disease depends upon:
Individual’s perception of a threat to personal health
Individual’s conviction that the recommended action will reduce this threat.

4. Constructs of Health Belief Model
Perceived ____________
Perceived _____________
Cues to Action
Self-Efficacy
Cues to action that may awaken and strengthen an individual’s perceptions of the threat of a condition and efficacy of the recommended behavior could include:
A friend having a heart attack.
Or, having chest pains and dizziness.
Self-Efficacy was added later to the model by Rosenstock et al. in 1988.
Confidence in ability to successfully perform a behavior for a specific outcome.

5. Likelihood of Action Individual Modifying Factors Perceptions
Benefits of Action
Minus
Barriers to Action
Demographic
Factors
Perceived Susceptibility
Likelihood of
Action
Perceived Threat
Perceived Severity
This is the health belief model.
We will go through the HBM and look at the how the constructs interact to explain, predict and understand the likelihood of undertaking the health behavior.
The HBM postulates that the likelihood of adopting a an appropriate health behavior to prevent or control the spread of some disease is based upon:
the individual’s perception of a threat to personal health
And an individual’s conviction that the recommended action will reduce this threat.
Self-Efficacy
Cues to Action

6. Individual Perceptions
Perceived ______________ _______________ the disease
Perceived Susceptibility
Perceived Threat
Likelihood of
Action?
Perceived Severity
Perceived susceptibility:
Person must believe that it is a possibility that he/she will contract a disease or adverse health condition (Coronary Hearth Disease), in order to engage in a health behavior.
People vary in their perceived susceptibility.
According to model, if a person believes they are highly susceptible to contracting CAD, they my begin an exercise program to reduce their perceived susceptibility
Perceived Severity:
Person’s feelings of the seriousness of a disease, In terms of:
Difficulties an illness would create
Pain, discomfort, death
Social consequences
Occupational consequences—lost time, financial burdens.
Perceived _____________ of disease in terms of contraction or non-treatment

7. Benefits of Action Barriers to Action Likelihood of Action
Individual
Perceptions
Likelihood of Action
Modifying Factors
Benefits of Action
Minus
Barriers to Action
Demographic
Factors
Perceived Susceptibility
Likelihood of
Action
Perceived Threat
Perceived Severity
The other two mediating constructs that influence adoption of the health behavior involve perceptions of the recommended action.
Benefits of Taking Action:
How efficacious is the advised action for reducing the risk or impact of a disease?
For a sedentary individual at high risk of CAD, is PA a feasible and efficacious way to prevent the disease?
Barriers to Action:
Even if perceived efficacy of action and self-efficacy is high, individual may still not engage in the recommended health behavior
This may be due to Common barriers to the action, such as:
Low motivation
Lack of time
Physical discomfort, such as muscle soreness
Expense
Lack of or inconvenience of facilities
Self-Efficacy
Self-Efficacy
Cues to Action

8. Demographic Factors Individual Modifying Factors Perceptions
Likelihood of Action
Modifying Factors
Demographic
Factors
Benefits of Action
Minus
Barriers to Action
Perceived Susceptibility
Perceived Threat
Likelihood of
Action
Perceived Severity
Other variables important for predicting health behavior:
Demographic factors such as age, sex, and race
PA decreases with age
Males engage in more vigorous and moderate intensity PA than females
African Americans and Hispanic Americans have higher rates of inactivity that White Americans
Another modifying factor is psychosocial variables such as personality and social support.
Self-Efficacy
Cues to Action

9. Cues to Action Self-Efficacy Individual Modifying Factors Perceptions
Likelihood of Action
Modifying Factors
Demographic
Factors
Benefits of Action
Minus
Barriers to Action
Perceived Susceptibility
Perceived Threat
Likelihood of
Action
Perceived Severity
Perceived susceptibility and Perceived Severity (perceived threat) may be awakened or strengthened by certain events or cues.
These cues may trigger the decision making process and motivate the individual’s readiness to take action.
Cues may be internal:
Bodily states/sensations such as dizziness, elevated heart rate (I am out of shape!)
Cues may be external:
Such as Mass Media: Poster or video promoting PA to reduce health risk
Advice from doctor
A close friend having a heart attack
Illustration of how components of HBM are hypothesized to predict behavior
Sedentary person believes he could have a Heart Attack (Susceptibility) after doing person risk factor assessment with Health Pro
He believes inactivity could lead to a debilitating heart attack (Severity)
He believes that becoming Physical Activity will reduce his risk of heart attack (Benefits)
And there will not be many negative side effects, such as chronic muscle soreness (Barriers)
Health professional sends him a reminder to be Physical Active (Cues to action)
Person creates a behavior change program with Health Professional to increase PA gradually (Self-efficacy)
Mass media
Advice from others Family illness
Cues to Action
Self-Efficacy

10. HBM and Physical Activity
Slenker and her colleagues (1984) examined the utility of the HBM for distinguishing joggers from non-exercisers
Joggers = 3 times/wk for twenty minutes
Non-exerciser = had not exercised regularly for the past six months
Joggers=greater perception of severity, more benefits of and cues to jogging, and less barriers to jog
Perceived __________________ did not distinguish joggers and non-exercisers.
Cross sectional study of 124 joggers and 96 nonexercisers
Looked at five HBM constructs (Susceptibility, Severity, Benefits, Barriers and Cues to action)
Point out operational definition of variables:
Joggers definition probably influenced by old ACSM recommendations (3-5 x week at 60-80% HRmax for at least 20 min)
Results:
Mixed support of HBM
Greater perception of Severity, Benefits, Cues to jog, and less barriers to job predicted Jogging behavior
Contrary to model: Perceived Susceptibility did not predict jogging behavior
Perceived Barriers was the most important factor is distinguishing joggers and nonexercisers.
So researchers suggested that Health Educators may more effectively change behavior if they target barriers to jogging

11. HBM and Physical Activity
Desmond et al. (1990) assessed …
Exercise knowledge
Cues to action
Perceived severity of health risks
Perceived susceptibility to health risks
Benefits of exercise
Barriers to exercise
154 Black and 93 White fit and unfit adolescents.
Study not in text book:
Desmond and colleagues examined whether the HBM constructs assessed in a questionnaire could distinguish between black and white high school students who were in either poor or good physical condition.
Looked at ethnicity variable because There is data showing that morbidity and mortality rates from CVD are higher in blacks than in whites
And Blacks are less likely than whites to believe that inactivity is a contributor to CVD.
Questionnaire items reflected the HBM constructs:
Such as
Severity: Not exercising makes me feel lazy.
Susceptibility: I am more likely to exercise than others my age and sex.
Benefits: People who exercise are healthier than people who do not exercise
Barriers: One reason why I would not want to exercise is because I just ate too much.

12. HBM and Physical Activity
Unfit (vs. fit) black students ….
Rated health problems from no exercise as more severe
Unfit (vs. fit) white students ….
Rated susceptibility to health problems as greater
Both contrary to health belief model
Some of the results did not support the HBM, in fact they were contrary to what the HBM would predict.
Unfit black students perceived greater severity of health problems from no exercise than fit black students.
Unfit white students perceived greater susceptibility to health problems than fit white students.
Opposite of what is expected with HBM

13. Is Health Belief Model Valid for Prediction of Exercise Behavior?
Godin & Shephard (1990) carried out a narrative review
Found no clear support for model in physical activity
Why Not?
Godin and Shephard (1990) Use of Attitude-Behavior Models in Exercise Promotion. Sports Medicine, 10(2),
Narrative review of health behavior models.
Found mixed results in studies using the HBM to predict PA behavior.
Some support
Other studies showed contradictory results to what HBM hypothesized.

14. Limitations of the Health Belief Model…
_________________ as the primary driving force behind exercise behavior.
Developed to predict a single instance of a specific behavior acute (not chronic)
Health Belief Model relies on health as the primary driving force.
People engage in PA for a variety of reasons.
One could be to reduce change of getting CVD
But other reasons include
To be involved in social activities
To lose weight to enhance physical appearance
Makes you feel better both physically and mentally
Factors other than health believes such as Cultural factors, socioeconomic factors, previous PA history also influence health behaviors.
Developed to predict acute behaviors,
Such as getting a chest x-ray or a flu vaccination
Not developed to explain complex, chronic health behaviors such as participating in an exercise program
Studies have used it to predict health behaviors, but it is a better model to explain the process of behavior change, particularly in regards to cognitive factors.

15. Protection Motivation Theory
Developed to explain inconsistencies in research on fear appeals and attitude change
Concerned with the decision to protect oneself from harmful or stressful life events
May also be viewed as a theory of coping
Many health behavior change advertisements try to instill fear in the viewer in order to change the viewers attitudes and behavior.

18. Protection Motivation Theory
Decisions to engage (or not engage) in health-related behaviors based on:
__________ appraisal
___________appraisal
Common index of protection motivation is a measure of ______________

19. Threat Appraisals:
Vulnerability
Severity
Intentions
Behavior
Coping Appraisals:
Self-Efficacy
Response efficacy

20. Protection Motivation Theory
Threat appraisal:
An evaluation of the factors that influence the likelihood of engaging in a potentially unhealthy behavior
__________________________--estimate of the degree of personal risk for a specific health hazard if a current unhealthy behaviors is continued
_________________________--estimate of the threat of the disease
Continuation of unhealthy behavior is increased by the perceived intrinsic and extrinsic rewards of the unhealthy behavior

21. Protection Motivation Theory
Coping appraisal:
______________________--expectancy that complying with recommendations will remove the threat
______________________--belief in one’s ability to implement the recommended coping behavior or strategy
The likelihood of carrying out the preventive coping response is decreased by the perceived costs of completing the health behavior

22. Protection Motivation Theory Assumptions
Motivation to implement the coping response is at its maximum when the individual perceives :
The threat is ___________
He or she is personally ____________ to the threat
The _________________ is effective to avert the threat
He or she has the _________________ the coping response

23. Protection Motivation Theory Research
Meta-analysis carried out by Floyd and her colleagues (2000)
65 studies with 29,650 participants
Adaptive intentions and behaviors were moderately facilitated by:
increases in threat severity
threat vulnerability
response efficacy
self-efficacy

24. Protection Motivation and Physical Activity
Plotnikoff and Higginbotham (1998) examined the prediction of diet and physical activity to prevent further cardiovascular heart disease in 151 recent heart attack patients
Completed baseline measures of threat appraisal following a heart attack
Six months later completed measures of threat appraisal and coping appraisal
Self-efficacy was the strongest predictor of exercise and diet intentions and behaviors
Concluded that health education for this population should promote self-efficacy enhancing activities for such behaviors

25. Protection Motivation and Physical Activity
Courneya (1995) compared perceptions of the severity of a sedentary lifestyle among 270 senior citizens who were classified within one of the five stages of the Transtheoretical Model.
Precontemplation
Contemplation
Preparation
Action
Maintenance

26. Protection Motivation and Physical Activity
Found:
Precontemplation stage reported the least perceived severity of the consequences of an inactive lifestyle
Concluded that the main function of perceived severity of physical inactivity is to motivate people to seriously consider becoming physically active

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