introduction to Theory
Identified as one of the earliest and most influential models in health promotion, the Health Belief Model was developed in the 1950s by three social psychologists – Godfrey Hochbaum, Irwin Rosenstock, and Stephen Kegels (Onoruoiza, Musa, Umar, and Kunle, 2015). The Health Belief Model posits that a combination of several factors is needed to influence optimal health-related behavior. According to Jones, Jensen, Scherr, Brown, Christy, and Weaver (2015), these factors include perceived benefits, perceived severity, perceived susceptibility, cues to action, and self-efficacy. In health care, the HBM is used to promote prevention programs and to educate people on preventive health behavior to prevent a disease or detect it during the early stages. The model seeks to predict and explain health behavior by analyzing and understanding the beliefs and attitudes behind health behaviors and the probability of an individual to participate in preventive health behavior.
Perceived risk of diseases; the variable encompasses the perceived susceptibility of contracting the condition (Dziedzic and Hammond, 2014). It involves asking questions such as does the person perceive the vulnerability to the disease? For instance, in this case, the variable seeks to understand if the individual perceives the risk of contracting obesity with the lack of a healthy diet and physical exercise. The variable will be used to educate adolescents and their parents on the importance of eating a healthy diet (avoiding sugar-sweetened beverages) and physical exercise. The parents and children will also be educated on the perceived susceptibility of becoming obese if they do not engage in physical exercise and eating a healthy diet. Perceived severity refers to the opinion an individual has regarding the seriousness of the condition or its consequences (Dziedzic and Hammond, 2014). Applying this variable in the intervention will highlight whether the parents understand the severity of the condition and its consequences in leading to other conditions such as cardiovascular diseases or diabetes among others. Perceived benefits refer to the individual’s belief of the benefits associated with the recommended health behavior (Dziedzic and Hammond, 2014). In this case, perceived benefits involve the perceived benefits of adhering to a healthy diet or physical exercise. The other benefit is the perceived effectiveness of adhering to dietary strategies to help reduce the threat of the development of obesity. Perceived barriers refer to the perception of elements that prevent an individual from adhering to the recommended health behavior with the potential of reducing the perceived threat or eliminating it (Dziedzic and Hammond, 2014). In this case, perceived barriers include the perceived issues that may prevent the child to engage in physical exercise or adhere to a healthy diet. The barriers range from financial demands such cost of new foods, lack of nutrition knowledge, or disability prohibiting one to the physically active. Ideally, cues to action encompass the events that motivate people to engage in healthy behavior. For instance, in this case, cues to action involve events that are likely to motivate people to take action to change their dietary habits and physical exercise habits. Some of these events may include educating the target group on the risk of the disease as a way of triggering or a change.
Self-efficacy refers to the confidence level that an individual has on their ability to adhere to the healthy behavior to reduce the risk of the condition (Dziedzic and Hammond, 2014). People with low self-efficacy are likely to have low levels of confidence in their ability to influence a change of behavior. In this intervention, self-efficacy is an important variable in that it helps identify if an individual believes that he/she can successfully execute the healthy diet behavior and physical exercises needed to prevent obesity.
The health belief model as a psychological model was used to explain and predict health behaviors of the target group and parents by focusing on their attitudes of the individuals. The key variables of the health belief model that will used in this intervention include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The program incorporates all the variables of the health belief model because they all play an important part in ensuring the intervention is successful. For example, according to Dziedzic and Hammond (2014), individuals with low perceived susceptibility are likely to have low motivation to adopt the healthy behavior and prevent the condition. In such a case, the sharing of information intensively can help change health behavior. The use of perceived susceptibility and severity can influence behavior change due to the consequences associated with failure to change behavior. Consequently, the variable of perceived benefits will be used to increase the probability of the parents and children in engaging in healthy behavior. For parents and children who are convinced by perceived risks and severity, they will adopt a healthy diet and engage in physical exercise. The perceived barriers will be used to evaluate an individual’s ability to engage in behavior change. Issues such as financial constraints, lack of knowledge in nutrition and elements of a healthy diet, or disability such as a child who is physically challenged may arise and addressed accordingly. The cues to action will be used as motivators to make parents and children take action.
Obesity is a major health concern in West Virginia and there is a need for efficacious interventions to reduce its prevalence. The intervention targeting middle schools in West Virginia will apply the health belief model to children who have obesity and those who do not have along with their parents. During the recruitment process, the participants will be informed that participation is voluntary and they can withdraw from the program at any time. However, collaboration with school heads will be necessary. The intervention will be implemented in four sessions. The intervention will use the HBM to first assess the barriers preventing them from practicing healthy behavior to prevent obesity. In this case, the perceived susceptibility, perceived severity, and perceived barriers will be applied to evaluate what prevents the parents from changing behavior. Using perceived susceptibility, the variable will be used to evaluate if parents understand the risk of not observing a healthy diet and physical exercise during the first session. During the second session, the use of perceived severity will be used to understand if children and parents perceive the risk and consequences of their children being obese. The variable of perceived barriers will be used on the third session to evaluate why parents were or would be reluctant to change behavior. Apart from parents, children will also be asked why they are reluctant to adopt a healthy diet and engage in physical activities.
After this, the program will outline the perceived benefits of changing behavior and use the cue to action to analyze whether the parents would be motivated to initiate healthy behavior for their children. Along with that, the intervention will use the self-efficacy to analyze the belief on their ability to adhere to the behavior change. It is expected that some parents may exhibit low confidence, which may prompt the program organizers to highlight the risks and consequences associated with not initiating behavior change. At the end of the program, it is expected that all parents will agree that they need to initiate behavior change for their children.
Recognizing that childhood obesity is a serious health problem in the U.S., various intervention programs have been implemented to prevent obesity. For instance, according to Weihrauch-Blüher et al. (2018), programs such as evidence-based recommendations, programs focusing on behavior-oriented prevention, and community/environment-based prevention have been widely used in schools in an attempt to prevent childhood obesity. However, the effect of these programs has been limited. For example, as Weihrauch-Blüher et al. highlight, the behavior-based prevention has a more positive effect if the children are younger. The use of school-based prevention programs involving general recommendations were successful only if they were offered for more than 1 year and involved a combination of multiple efforts.
Compared to these programs, the application of the health belief model is innovative and better/different from other programs in that it engages the target groups in a way to influence change in health behavior. A strategy that is particular with the program is the use of the health belief model to change the perception about initiating health behavior. More specifically, using the health belief model, the intervention engages the participants by first seeking to know if they understand the risk of not initiating behavior change. Further, the program seeks to understand the barriers that prevent the participants from initiating health behavior change. This way it is easy to come up with approaches to ensure positive effect of the initiative by addressing the barriers.
Centers for Disease Control and Prevention. (2013). Community profile: Mid-Ohio Valley, West Virginia. Retrieved from https://www.cdc.gov/nccdphp/dch/programs/communitiesputtingpreventiontowork/communities/profiles/obesity-wv_midohiovalley.htm
Centers for Disease Control and Prevention. (2019). Childhood obesity facts. Retrieved from https://www.cdc.gov/obesity/data/childhood.html
Dziedzic, K., & Hammond, A. (2014). Rheumatology: Evidence-Based Practice for Physiotherapists and Occupational Therapists.
Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2015). The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation. Health Communication, 30(6), 566-576.
Onoruoiza, S. I., Musa, A., Umar, B. D., & Kunle, Y. S. (2015). Using Health Beliefs Model as an intervention to non-compliance with hypertension information among hypertensive patient. IOSR Journal of Humanities and Social Science, 20(9), 11-16.Weihrauch-Blüher, S., Kromeyer-Hauschild, K., Graf, C., Widhalm, K., Korsten-Reck, U., Jödicke, B., Markert, J., … Wiegand, S. (2018). Current Guidelines for Obesity Prevention in Childhood and Adolescence. Obesity Facts, 11(3), 263-276.
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