DISCUSSION

Abstract

This study examined the benefits of using relevant components of The Belief Model as an intervention to prevent obesity, due to over intake of sugar-sweetened beverage among adolescents attending Middle Schools in West Virginia, USA. It also, considers any additional theory that might supplement the shortcomings of The Health Belief Model in order to formulate a more rounded theory that can prove to be more effective. Finally, it highlights the limitations of the proposed intervention in addressing the health issue at hand. 

The Belief Model: A proposition for its use in preventing obesity, 

due to over intake of sugar-sweetened beverage among adolescents

 attending Middle Schools in West Virginia, USA

Obesity among adolescents is a perplexing public health issue. The main causes of excess weight in youth are like those in adults, including someone’s behavior and genetics (CDC, 2015). Additional causal factors in our society such as the food and environment drivers, education and skills, and food marketing and promotion can make a difference in any public health issue (NHANES, 2015). 

To put it in context, an increase in obesity prevalence has been observed in West Virginia from pre-school children to adolescence with the obesity rate among middle school (male and female) ages currently being 20.3% (West Virginia Obesity Statistics, 2017). This increased figure calls to attention the need for intervention in order to curb the spiraling rate of obesity amongst the adolescents attending middle schools in West Virginia. In answering that call, I herein propose using relevant components of The Belief Model as part of the intervention to prevent obesity. This will be coupled with the trans-theoretical model to improve the impact of my proposed intervention

The Health Belief Model aims to both explain why people engage in health behaviors to prevent and control disease conditions. It consists of six constructs, namely Constructs include: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Each of these constructs can effectively be applied in the intervention.

The first construct, perceived susceptibility fused with perceived susceptibility, are also referred to as perceived threat, one’s perception of individual susceptibility to a serious illness. However, individuals with low perceived susceptibility are likely to have low motivation to adopt the healthy behavior and prevent the condition (Dziedzic and Hammond,2014). Therefore, Educating the students on how excessive intake of sugar-sweetened beverage places them at a higher risk of being overweight or obese, and the resultant diseases and conditions that one is prone to, they are able understand the importance of living an active lifestyle and the role such a lifestyle plays in disease prevention. 

The third construct, perceived benefits, touches on the adolescent’s belief in the recommended action to help them reduce their intake of sugar-sweetened beverage and the health benefits such reduction will have on their short-term and long-term health. The fourth construct, perceived barriers, will be used to evaluate an individual’s probability to engage in behavior change by considering what might hold them back from reducing their intake of sugar-sweetened beverages. In considering the barrier one is able find a solution to overcoming the barrier. Consequently, the fifth construct, cues to action, which the strategies for activating “readiness” to act are important in setting out an individual specific set of actions to be followed in the quest to reduce intake of sugar-sweetened beverage. Finally, The Fifth Construct, self-efficacy, which refers to the confidence one has in his or her ability to take action to change behavior is important as it gives the adolescent the required self esteem to see through their effort.

Despite the strengths of the Health Belief Model, there are limitations present in the model. However, by incorporating the trans-theoretical model, I seek to improve the intervention. Ideally, the theory is a successful framework used to influence behavioral change by evaluating the readiness of the individual to initiate new behavior and provides strategies/ processes to guide the individual. The model posits that changing behavior is a process that involves first recognizing that different people are in different stages of change and readiness (Hashemzadeh, Rahimi, Zare-Farashbandi, Alavi-Naeini, & Daei, 2019). The process uses five stages that include pre-contemplation, contemplation, preparation, action, and maintenance followed by ten processes of change. The ten processes of change are what complement the health belief model. In particular, the environment re-evaluation process considers the problem in the context of the individual and the social liberation recognizes the support that can be derived from society and help the individual in behavior change (Taylor, 2007). The helping relationships process involves finding the right people who can support the individual in their change process while stimulus helps encourage healthy behavior by using cues and reminders to encourage healthy behavior.

Drawing upon the limitations associated with the health belief model, some of the limitations associated with the intervention/program in preventing obesity in middle schools in West Virginia is that, it fails to consider the skills needed to change behavior and ignores the social factors likely to influence health behavior. More specifically, the intervention fails to consider social and environmental factors that may influence the target population to go back to unhealthy behavior. For instance, social pressure may influence the target population to engage in unhealthy eating habits and engage in physical exercise. On skills needed to influence change in behavior, the model fails to consider that although it informs the parents about perceived susceptibility, perceived severity, and perceived benefits, it fails to provide them with the skills to initiate behavior change. For example, when it comes to physical activity, the model fails to teach the parents about the right physical exercises the children should engage in to prevent obesity. 

Conclusion

Despite the limitations associated with the health belief model, the model also has some strengths that make it appropriate for the intervention. Ideally, the HBM applies well to the reasons and ways in which parents and children can be influenced to observe healthy diets and engage in physical exercise. The health belief model helps parents discover their child is susceptible to obesity or other complications associated with obesity and may agree to adopt healthy behavior to prevent the condition from occurring. When the parent perceives the severity of their child’s condition, he/she may consider influencing the children to adopt healthy diets and encourage their children to engage in physical activities to prevent the condition from escalating. However, if parents do not believe that the behavior change can improve their children condition, they may see this as a barrier. Consequently, the parents and children attitude towards behavior change can be evaluated by the HBM, as parents agree to take action and change behavior to prevent obesity. This will be done using the self-efficacy variable that will evaluate the confidence level of the parents to execute the behavior change. Many cues to action will be used such as knowledge acquired to initiate behavior change. On limitations associated with the health belief model, skills will be compensated by physical education programs incorporated in the intervention. On social factors, the model will rely on the perceived severity to help parents and children overcome these barriers.

References

(n.d.). Behavior, environment, and genetic factors all have a role in causing people to be overweight and obese | CDC. Retrieved from https://www.cdc.gov/genomics/resources/diseases/obesity/index.htm

The State of Obesity. (2019). State Briefs. [online] Available at: https://www.stateofobesity.org/states/wv/ [Accessed 1 Sep. 2019].

Dziedzic, K., & Hammond, A. (2014). Rheumatology: Evidence-Based Practice for Physiotherapists and Occupational Therapists. London: Elsevier Health Sciences UK.

Hashemzadeh, M., Rahimi, A., Zare-Farashbandi, F., Alavi-Naeini, A. M., & Daei, A. (2019). Transtheoretical Model of Health Behavioral Change: A Systematic Review. Iranian Journal of Nursing and Midwifery Research, 24(2), 83-90.

Orji, R., Vassileva, J., & Mandryk, R. (2012). Towards an effective health interventions design: an extension of the health belief model. Online Journal of Public Health Informatics, 4(3), 1-33.Taylor, D. (2007). A Review of the use of the Health Belief Model (HBM), the Theory of Reasoned Action (TRA), the Theory of Planned Behaviour (TPB) and the Trans-Theoretical Model (TTM) to study and predict health related behaviour change. National Institute for Health and Clinical Excellence. Retrieved from https://warwick.ac.uk/fac/sci/med/study/ugr/mbchb/phase1_08/semester2/healthpsychology/nice-doh_draft_review_of_health_behaviour_theories.pdf