1. The Health Belief Model
Dr. Mahmoud Alhussami

2. Illness: what the patient feels when he goes to see the doctors
ILLNESS & DISEASE
Illness: what the patient feels when he goes to see the doctors
Disease: what he has on the way home from the doctor’s office.
Illness: is what the man has, disease is what the organ has illness is subjective, disease is objective.

3. Health according to the WHO 1946, “complete physical, mental, and social well being and not merely the absence of disease or infirmity”
In many culture health is conceived as “balanced relationship” between man and man, man and nature, man and supreme power, man and supernatural world.
One can define him self being ill based on his perception, other perception, or both.

4. Defining one self being ill follow number of subjective experiences:
perceived changes in body appearance
changes in regular body function
unusual body emission
changes in the functional limbs
changes in the five major ‘senses
unpleasant physical symptoms
excessive or unusual emotional state
behavioral changes in relation to others

5. Etiology of health-ill
Four major worlds the (lay person theory):
1. the patient:
responsibilities
sick role
sick behaviors
physical vulnerability
social vulnerability
psychological and emotional vulnerability
heredity proneness (genetics)
degeneration

6. 2. The natural world: heat, cold, win, snow and dampness.
3. the social world:
Blaming others for one's health-ill.
Witchcraft: a mystical; power to harm others and it is intrinsic
Evil eye: …
Sorcery, sorcerer ((العرّاف: the power to manipulate and alter natural and supernatural events with the proper magical knowledge and performance of rituals.
4. The supernatural world: Gods, spirit, ancestral shades.

7. Psychosocial Health
Figure 2.1

8. Elements Shared by Psychosocially Healthy People
They feel good about themselves
They feel comfortable with other people
They control tension and anxiety
They are able to meet the demands of life

9. They curb hate and guilt
They maintain a positive outlook
They enrich the lives of others
They cherish the things that make them smile
They value diversity
They appreciate and respect nature How do you view psychosocially healthy people?

10. Defining Psychosocial Health
Mental Health: The Thinking You
The “thinking” part of psychosocial health
Mentally healthy people tend to respond in positive ways
Irrational thinking may indicate poor mental health

11. Defining Psychosocial Health
Emotional Health: The Feeling You
The “feeling you”
Emotions are complex feelings
Examples include: love, hate, frustration

12. Defining Psychosocial Health
Emotional Health: The Feeling You (Continued)
Richard Lazarus notes 4 types:
1) Emotions from harm, loss, threat
2) Emotions from benefits
3) Borderline emotions (hope/compassion)
4) Complex emotion (grief/disappointment)
Can you think of some examples of emotional health?

13. Defining Psychosocial Health
Importance of social interactions
Social bonds
Social supports
Prejudices may indicate poor social health

14. Defining Psychosocial Health
Spiritual Health: An Inner Quest for Well-Being
A belief in a unifying force that gives purpose or meaning to life
Four main themes of spirituality:
1) A feeling of interconnectedness
2) Mindfulness
3) Spirituality as a part of daily life
4) Living in harmony with the community

15. The Health Belief Model
The health belief model (HBM) was initially developed in the 1950s by a group of social psychologists at the U.S. Public Health Service in an effort to explain the widespread failure of people to participate in programs to prevent or to detect disease.
Later, the model was extended to apply to people’s responses to symptoms and to their behavior in response to diagnosed illness, particularly compliance with medical regimens.

16. For more than four decades, the model has been one of the most influential and widely used psychosocial approaches to explaining health-related behavior.
During the early 1950s academic social psychology was engaged in developing an approach to understanding behavior that grew out of a confluence of learning theories derived from two major sources:
Stimulus Response (S-R) Theory.
Cognitive Theory.

17. S-R Theorists believe that learning results from events (Termed Reinforcements) that reduce physiological drives that activate behavior.
In case of punishment, behavior that avoids punishment is learned because it reduces the tension set up by the punishment.

18. Cognitive theorists emphasize the role of subjective hypotheses expectations held by the subject. In this perspective, behavior is a function of the subjective value of an outcome and of the subjective probability or expectation that a particular action will achieve that outcome.
Such formulations are generally termed value expectancy theories. Mental processes, such as thinking, reasoning, hypothesizing, or expecting, are critical components of all cognitive theories.

19. Components of the Health Belief Model
Perceived susceptibility. The dimension of perceived susceptibility refers to one’s subjective perception of the risk of contracting a health condition.
In the case of medically established illness, the dimension has been reformulated to include acceptance of the diagnosis, personal estimates of resusceptibility, and susceptibility to illness in general.

20. Perceived severity. Feelings concerning the seriousness of contracting an illness or of leaving it untreated include evaluations of both medical and clinical consequences (e.g. death, disability, and pain) and possible social consequences (such as effects of the conditions on work, family life, and social relations).
Note: many investigators have found it useful to label the combination of susceptibility and severity as perceived threat.

21. Perceived benefits. While acceptance of personal susceptibility to a condition also believed to be serious (perceived threat) is held to produce a force leading to behavior, it does not define the particular course of action that is likely to be taken. This is hypothesized to depend upon beliefs regarding the effectiveness of the various available actions in reducing the disease threat, or the perceived benefits of taking health action.

22. Perceived barriers. The potential negative aspects of a particular health action, or perceived barriers, may act as impediments to undertaking the recommended behavior. A king of nonconscious, cost benefit analysis is thought to occur wherein the individual weighs an action’s effectives against perceptions that it may be expensive, dangerous, unpleasant, inconvenient, time-consuming, and so forth.

23. Other variables. It is believed that diverse demographic sociopsychological, and structural variables may, in any given instance, affect the individual perception and thus indirectly influence health-related behavior. Specifically, sociodemographic factors, particularly educational attainment, are believed to have an indirect effect on behavior by influencing the perception of susceptibility, severity, benefits, and barriers.

24. Key components of the HBM
Threat.
Perceived susceptibility to an ill-health condition (or acceptance of a diagnosis).
Perceived seriousness of the condition.
Outcome expectations.
Perceived benefits of specified action.
Perceived barriers to taking that action.
Efficacy expectations. Conviction about one’s ability to carry out the recommended action (self-efficacy).

25. Health Promotion Model Of Nola J. Pender
A competence or approach oriented model that depicts the multidimensional natures of persons interacting with their interpersonal and physical environments as they follow health.

26. The major motivational variables that can be modified through nursing intervention include

27. 1-Individual characteristics and experiences:
Prior related behavior = previous experience.
Personal factors( biological, psychological and sociocultural)
Ex: - Lung Cancer in close relative may motivate the pt. to stop smoking .
- Weaker personality need more encouragement from the nurse.
- Exact information about dangers of smoking may motivate the pt. to stop smoking.

28. 2- Behavior-specific Cognition and affect:
Perceived benefits of action.. (for the patient it's very motivating to discuss about positive outcomes expected after changing behavior )
Ex. The nurse can discuss with the pt. on many benefits of non-smoking, not only the physical.
Perceived barriers to action.. (it's important to discuss beforehand because otherwise these difficulties could destroy the new behavior )
Ex. Pt. has used to smoke after drinking coffee, nurse help the pt. plan substitutive behavior for these situations

29. Perceived self-efficacy
Perceived self-efficacy.. (this concept refers to the conviction that a person can successfully carry out the behavior necessary to achieve a desired outcome.)
Ex. Maintaining an exercise program to decrease weight.
Activity-related affect.. Includes the feeling before, during and after the new behavior. To succeed the patient should associate positive feeling with the new lifestyle )
Ex. The smoker should see non-smoking worthwhile and beneficial enough in spite of problems and find nice experiences without smoking.

30. Interpersonal Influence
Interpersonal Influence.. (its coming from people living around the patient; family, friends, colleagues …etc. their beliefs, attitude, advice and support have a great effect on patient lifestyle)
Ex. Emotional support
Situational Influence.. (means that the nurse help the patient to think how his life situation and environment influence his attempt to change lifestyle )
Ex. Is it easier for the pt. to stop smoking in hospital than at home…??
Is his life usual or full of stress which may make it more difficult to live without relief from cigarettes..??

31. 3- Commitment to a plan action:
The greater the commitment to the health-promoting lifestyle, the more likely the patient will continue the new behavior

32. 4- Immediate competing demands & preferences:
Competing demands: are those behaviors over which an individual has low level of control.
Ex. Unexpected loss of work may destroy the pt decision to live without smoking.
Competing preference: are those behaviors over which an individual has a high level of control, this control depends on the individual's ability to be self-regulation or not.
Ex. The non-smoker pt. begin to smoke again to get back his old friends.

33. 5- Behavioral Outcome:
Health promoting behavior, the outcome of health promotion model, is directed toward attaining positive health outcomes for the client.
Health promoting behaviors should result in improved health, enhanced functional ability, and better quality of life at all stages of development.

34. Implementation Of Health Promotion Model
Perceived Susceptibility:
Women belief that they can get reproductive infections
have more children, having more problems related to their health and health of their children
choosing the wrong contraceptive methods, feeling powerless and have less quality of health and wellbeing

35. Perceived Severity: Are significant reasons for:
Women believe that the consequences for get reproductive infections
have more children, having more problems related to their health and health of their children
choosing the wrong contraceptive methods, feeling powerless and have less quality of health and wellbeing
Are significant reasons for:
Taking the educational course
choosing the appropriate family planning methods,
consider post-natal care,
learn about the reproductive infections
practice effectively in the decisions and selection of contraceptive methods
making appropriate decision related to their health and wellbeing.

36. Perceived Benefits:
Women believes that taking all recommended health practices and interventions related to their reproductive health…etc
would protect her from:
have more children,
having more problems related to their health and health of their children,
choosing the wrong contraceptive methods,
feeling powerless
have less quality of health and wellbeing.

37. Perceived Barriers:
Women identify barriers for adherence to reproductive health practices, family planning methods, empowering self and decision making abilities as:
feeling embarrassed to talk about family planning and reproductive infections husband and HCP
cultural and social perception toward using contraceptive methods and reproductive health planning.
They also will explore ways to overcome these barriers through learning, practicing and seeking support from their intimate partners.
Also through enhancing self expression and communication skills with intimate partners and HCP related to practices,

38. Self-Efficacy:
Women will have the confident is selection the appropriate contraceptive method, define health needs, define indication for seeking medical advice for reproductive infection, making the right decisions, participating in all decision related to her health, participating and making appropriate decision related to her child’s health.

39. THANK YOU