Irwin M. Rosenstock

Historical Origins of the Health Belief Model

I t is always difficult to trace the historical development of a theory that has been the subject of considerable direct study and has directly or indirectly spawned a good deal of additional research. This is certainly true of the Health Belief Model, perhaps even more than usual because the Model grew out of a set of independent, applied research problems with which a group of investigators in the Public Health Service were confronted between 1950 and 1960. Thus, the theory and development of the Model grew simultaneously with the solution of practical problems. Two classes of circumstances should be described which were largely responsible for the type of model that ultimately emerged. These concern the settings in which research was required and the training and background experiences of those who participated in the development of the Model.

The Health Belief Model and Preventive Health Behavior

The Health Belief Model was originally formulated to explain (preventive) health behavior. As defined by Kasl and Cobb,’ health behavior is “any activity undertaken by a person who believes himself to be healthy for the purpose of preventing disease or detecting disease in a n asymptomatic stage.” This is in contrast with illness behavior, defined as “any activity undertaken by a person who feels ill, for the purpose of defining the state of his health and of discovering suitable remedy,” and sick-role behavior, “the activity undertaken by those who consider themselves ill for the purpose of getting well.” The present paper is confined to the first of these areas health behavior. I t should first be noted that the three modes of behavior are not discontinuous. Hardly anyone can be found who, upon intensive questioning, would report himself free of all symptoms. Similarly, the edges between illness behavior and sick-role behavior are blurred. Nevertheless, the distinctions are valuable because they refer to modal mental states which help to account for behavior.

The Role of Self-Efficacy in Achieving Health Behavior Change

The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.

The Health Belief Model and HIV Risk Behavior Change

The Health Belief Model (HBM) was initially developed in the 1950s by a group of social psychologists in 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 (Hochbaum, 1958; Rosenstock, 1960, 1966, 1974). Later, the model was extended to apply to people’s responses to symptoms (Kirscht, 1974) and to their behavior in response to diagnosed illness, particularly compliance with medical regimens (Becker, 1974). Over three decades, the model has been one of the most widely used psychosocial approaches to explaining health-related behavior.

Selected Psychosocial Models and Correlates of Individual Health-Related Behaviors

RELATIVELY LOW LEVELS of public participation in screening, immunization, and other preventive health programs have been extensively documented,21 50 55, 91 as have the generally poor rates of individual compliance with prescribed medical therapies.42, 52, 81, 86 Over the past two decades, hundreds of research reports and review articles have been published reflecting the desire to both discover and better under-

Some influences on public participation in a genetic screening program

To identify the psychosocial factors associated with voluntary cooperation in mass genetic testing, stratified random samples of 500 participants and 500 nonparticipants were drawn from an identified at-risk population for Tay-Sachs disease. Participants were relatively younger and better educated, reported higher levels of perceived susceptibility to being a carrier, and also stated more often that the impact of learning of being a carrier would be low. Participants were also more likely to indicate they would not alter plans for future progeny. Recommendations are made for enhancing participation in future genetic screening programs of this type.

The effect of health beliefs and feelings of self efficacy on self management behavior of children with a chronic disease

Abstract This study is among the first to examine the value of chronically ill childrens health beliefs, self-efficacy beliefs, experiences of hospitalization, and participation in a health education program in predicting self-management behavior. Data were collected from a random sample of 214 children with asthma being served by any of four NYC hospitals. As measured, perceived self-efficacy, prior hospitalization and participation in a health education program had modest predictive value for self-management while measures of perceived severity of asthma attacks and beliefs in the benefits of self-management techniques in controlling the disease failed to predict subsequent use of self-management techniques. We conclude that (1) the Health Belief Model may not be useful in predicting the behavior of children because of their developmental status, or (2) the measures used in the present study did not adequately tap the health belief constructs.

Parental and Child Health Beliefs and Behavior

Personal interviews concerning health beliefs and behav iors were conducted with a parent and child in each of 250 households. Index scores were constructed for parental and child health beliefs, and these scores were entered, along with demographic variables, in a series of multiple regression analyses predicting child health beliefs and behaviors. The age of the child was the variable most highly associated with three of four child health behaviors and four of six child health beliefs. The childrens snacking between meals and cigarette smoking were related to several parental behaviors and, to a lesser extent, parental health beliefs. The childrens health beliefs were less predictable than were their health behaviors, and the observed significant relationships were with parental health beliefs and demographics. The implications for the design of health education programs are discussed.

Public response to cancer screening and detection programs: Determinants of health behavior

As A BACKDROP against which to illuminate the kinds of educational problems that will be encountered in stimulating public acceptance of cancer screening and detection programs, an analysis should be presented of the conditions under which people take action leading to the detection or prevention of diseases. Unfortunately, very little pertinent research has been done with respect to cancer screening or detection programs. The bulk of the findings that will be reported has emerged from a series of investigations on public response to tuberculosis detection programs [I] as well as public response to preventive programs in the areas of dental diseases [2], rheumatic fever [3], influenza [4], and polio [5]. One specific study of women’s response to screening for cervical cancer has been made, but it is of unknown generality since the population studied was a group of female employees of the Chronic Disease Division of the Public Health Service [6]. The findings from these studies have led to the formulation of a model for explaining behavior in response to disease threat. Since the model has been spelled out in some detail in the published documents cited, its major pertinent elements will be given only briefly here. The principal components of the model that are relevant to this discussion include (1) the health motive or health threat, (2) beliefs about the utility of various courses of action in reducing the health threat and (3) conflicts among motives and potential courses of action, Other elements of the model that are less relevant here will not be discussed. 1. The health motive or threat

Gaps and Potentials in Health Education Research

It is all too easy to deplore the gap between theory and practice in public health education and thereby avoid taking effective action to reduce it. That such a gap exists is not to be denied, but it will be more helpful in the long run to try to analyze its reasons than to decry its existence. To give us some perspective in this task it is first desirable to consider, if only briefly, a number of areas in which the gap is minimal. Behavioral science has provided a number of principles and findings which have long since been taken up by practitioners and are part and parcel of their armamentarium, so much so in fact that the contributions are no longer recognized as such which is all to the good. Consider the area of motivation. It is today commonplace to accept the facts that all behavior is motivated, that motives distribute themselves in a hierarchy some being more important than others, that much of the individuals behavior is determined by forces of which he is unaware, that behavior IS determined not so much by objective factors in the environment as it is by the individuals beliefs about the environment which may or may not mirror reality. Some of our basic principles of modern education based on behavioral science findings and theory are equally well integrated into health education practice. Consider the principle of participation by the learner in the educational process the principle that learning takes place only in a motivated individual, the principles of retroactive inhibition and proactive inhibition, and the laws of memory. All these and many others, whatever language is used to describe them, are regarded as facts about people which health educators and other health practitioners uniformly accept without question.