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

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

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.

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.

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

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

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

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

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

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

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.

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

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), 103-121. 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.

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.

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.

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 ______________

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

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

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

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

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

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

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

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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